Economic Opportunity + a National Culture of Health: Did You Miss a Game-changer?

Originally published by the Build Healthy Places Network on February 17, 2016

Douglas Jutte, MD, MPH and Colby Dailey, MPP
Directors, Build Healthy Places Network

If you missed the speeches by Williams and Lavizzo-Mourey that closed out the National Interagency Community Reinvestment Conference (NICRC) in Los Angeles, you missed a game changer.

Really?  Yes.

John C. Williams, President and CEO of the Federal Reserve Bank of San Francisco, talked about health.

Risa Lavizzo-Mourey, President and CEO of the Robert Wood Johnson Foundation (RWJF), talked about finance (and walked us through a New Markets Tax Credit deal in Philly!).

In a unique role reversal, a leading macro economist and banker, whose jurisdiction includes one-fifth of our country’s population, and the physician-CEO of our largest domestic health foundation nailed it: you can’t expect to succeed if you separate poverty, economic prosperity and health. This, in front of a full room of 1200 bankers. In the words of Lavizzo-Mourey, talk does nothing, “investment makes changes.”

All across America, financiers, community development, philanthropy, public health and health systems are choosing to make progress together. It was not always this way.

Less than six years ago there was a landmark meeting at the Federal Reserve Board of Governors in Washington DC, co-sponsored by RWJF. A leadership audience — half from the Fed’s constituency and half from RWJF’s world — were introduced to each other. Like a high school prom, they clustered with their own, but left intrigued: at this low-point for American prosperity, was there a better way forward? The painful Great Recession had highlighted that America’s economic stability rests on the shoulders of its people, and America needed every resource, every new strategy and every opportunity to complete a turnaround. It all begins with everyone having a pathway to opportunity. And with nearly one-in-five people living in low-income neighborhoods where those pathways were scarce, the bad times triggered a call for fundamental change. Exposure to each other’s work and the potential for collaboration has led leaders across sectors to evolve rapidly.

For community development and health, the message is clear: stable families support a stable economy, which supports our nation’s stability, prosperity and health. Or, as Williams put it, “physical and economic health are inextricably linked. Prosperity is like a Jenga tower: take out one piece and the whole thing can fall.”

Six ways economic opportunity and the Culture of Health are moving forward together

Here is what we are seeing now:

  1. Initial curiosity has progressed to enthusiasm and to real innovation; as Lavizzo-Mourey said, “we are standing on the threshold of a new era.”

    The Low Income Investment Fund (LIIF) jumped ahead of the pack, creating a Social Impact Calculator to help community developers demonstrate the monetary value of social returns as well as financial ROI.

    Stewards for Affordable Housing for the Future (SAHF) also took an early stand and developed a set of outcome measures to track not just medical needs of their residents but also important social determinants of health like community engagement and child educational success.

  2. In communities, partnerships are demonstrating how to improve economic opportunity, opportunity for better health and better lives.

    Purpose Built’s Villages of East Lake in Atlanta developed a vibrant, new, mixed-income community where there had been a public housing project. One outcome: where previously 5% of low-income children were reading at grade level, now 98% do, surpassing children from the wealthiest suburbs—an example of how a strong community can begin to break the cycle of poverty.

  3. There are increasingly more funders interested in cross-sector projects, more CDFIs as well as new players including Federal programs like Medicaid, health systems like Kaiser Permanente, anchor institutions like hospitals, and more.

    The Children’s Hospital of Philadelphia (CHOP), the city government, and a cluster of other investors have pieced together $42.5 million to build the Community Health & Literacy Center, bringing together better access to health care, a new library and a beautiful recreational center, all in a neighborhood where the poverty rate is 24 percent.

    Meanwhile, in New York, Medicaid allocated $47 million for supportive housing units for high-cost Medicaid recipients. (Read more here)

  4. Philanthropy is engaging in new ways to support cross-sector initiatives.

    At the NICRC plenary, Lavizzo-Mourey announced a new $30 million program funded by RWJF and other national foundations, in collaboration with LIIF, Enterprise Community Partners, the National Resources Defense Council and the Federal Reserve Bank of San Francisco, to transform the social determinants of health in up to 10 metropolitan regions.

    And, the Healthy Futures Fund, a joint effort of the Kresge Foundation, Local Initiatives Support Corporation (LISC) and Morgan Stanley bank, provided financial support to So Others Might Eat (SOME), a faith-based community organization focused on poverty, for the $90 million Conway Center in Washington, D.C. Sited in a high-poverty neighborhood, it will include more than 200 affordable apartments, a health center, job-training center, shops, offices and green space – all across from a Metro station.

  5. Increasingly, the market is valuing health.

    It takes investment to create real change, and capital is flowing. If we add it all up, the examples noted here plus many others, we’re talking about more than a billion dollars in current investments that address social determinants of health.

  6. With the ACA requiring nonprofit hospitals to conduct a community health needs assessment, and the CRA requiring banks to conduct a community needs assessment, there is an opportunity for new alignment at the local level.

    By working together to assess a community’s needs, both investors in economic growth and the payers who foot the bill for poor health can craft a more holistic and promising pathway forward. A brief by St. Luke’s Health Initiative in Arizona outlines concrete, discrete ways community developers can be part of the needs assessment process.

Where we are headed; are you going with us?

For too long our country has tried to fix intractable problems in isolation: an economic fix or a health improvement fix or an educational fix or a jobs fix. We’re now seeing the Jenga tower. As Williams said, “we have a broad definition of health that encompasses jobs, education and safety.” And from Lavizzo-Mourey’s perspective, “health is the bedrock of personal fulfillment, the backbone of prosperity and the core of a strong competitive nation.” We applaud Williams and Lavizzo-Mourey for standing together across sectors, linking America’s problems and opportunities, and, in the words of Lavizzo-Mourey, embracing new allies.

At the Build Healthy Places Network, we represent cross-sector perspectives, expertise and advocacy. We are energized by the rapid, exciting changes we see – and share. As a “connector” among leaders, practitioners, investors and policymakers, across sectors, we strive to advance progress by synthesizing research, identifying best practices, encouraging measurement and providing capacity-building tools and resources.

Williams and Lavizzo-Mourey epitomized leadership at the conference, but we are also seeing leadership and best practices explode in neighborhoods around the country.

Challenges we all face

We commend everyone—across finance, community development, health and health care—who has taken the plunge, working in tandem to improve opportunities in our poorest neighborhoods.

Our challenge now is to spread and sustain cross-sector, systemic changes in policies, financing, and long-held practices that compartmentalize problems and solutions. So what do we need to do to keep the momentum?

  • Ensure that enthusiasm does not outpace strategies that will work;
  • Grow the evidence showing that cross-sector projects, programs and policies produce success—economically for our nation and personally for our families—and that we can achieve both;
  • Open even more channels between sectors and keep them open—share the challenges, share new approaches, share what works.

That’s where the Network comes in.  We hope that you will share with us what you have learned and what you see coming down the pike. Send us examples of success, and your ideas for effective cross sector collaboration.

A new era

In Investing in What Works for America’s Communities, published by the Federal Reserve Bank of San Francisco and LIIF in 2012, Lavizzo-Mourey wrote:

“I envision a time in the near future when our fields and the people who work in them…will be working side by side in communities, in states, and nationally, with common aims, combining our best assets and skills to improve the lives of all Americans.”

Last week we heard it loud and clear–the dawn of that future is here! We’re excited to usher it in.

The views expressed here do not necessarily reflect the views of the management of the Federal Reserve Bank of San Francisco or of the Board of Governors of the Federal Reserve System.