Place Matters:Building a Culture of Health

Donald F. Schwarz, MD, MPH, MBA

Vice President, Program

Robert Wood Johnson Foundation

Housing Alliance of Pennsylvania

Homes Within Reach Conference

U.S. Largest Private Foundations

Rank Name/(state) Assets

1. Bill & Melinda Gates Foundation (WA) $41,310,207,525

2. Ford Foundation (NY) 12,259,961,589

3. J. Paul Getty Trust (CA) 11,110,918,337

4. The Robert Wood Johnson Foundation (NJ) 10,173,403,442

5. The William and Flora Hewlett Foundation (CA) 9,042,503,000

6. W. K. Kellogg Foundation (MI) 8,621,183,526

7. Lilly Endowment Inc. (IN) 7,699,211,116

8. The David and Lucile Packard Foundation (CA) 6,902,501,278

What shapes culture?

How do we build a Culture of Health?

70%of 17- to 24-year-olds are

ineligible to serve

in the military.

More than

1/3of kids are

overweight or obese

Health Care SpendingPercentage of GDP, 1980–2013

0

2

4

6

8

10

12

14

16

18

1980 1983 1986 1989 1992 1995 1998 2001 2004 2007 2010 2013

US (17.1%)

FR (11.6%)

SWE (11.5%)

GER (11.2%)

NETH (11.1%)

SWIZ (11.1%)

DEN (11.1%)

NZ (11.0%)

CAN (10.7%)

JAP (10.2%)

NOR (9.4%)

AUS (9.4%)*

UK (8.8%)

Notes: GDP refers to gross domestic product. Dutch and Swiss data are for current spending

only, and exclude spending on capital formation of health care providers.

Source: OECD Health Data 2015.

Percent

* 2012.

Life Expectancy by AgeInternational Comparison

Before age 75, the US never ranks above 15 out of 17 countries

Men

Women

Source: OECD Health Data 2015

68% of seniors

have at least 2

chronic illnesses

Source: OECD Health Data 2015

Culture change:Stop defining health as not being sick.

What really shapes health?

Source: VCU and RWJF, 2016.

In Philadelphia, 5 miles changes

your life expectancy by 20 years!

5 miles

What really shapes health?

Genes and Biology, 10%

Clinical Care, 10%

Social, Economic, and Physical

Environments, 50%

Behavioral Factors, 30%

Source: CountyHealthRankings.org

Nearlyone-fifth of all

Americans live in neighborhoods that make it hard to be healthy.

Moving to Opportunity Demonstration

HUD Moving to OpportunityExperiment

• From 1994-1998

• 4,600 families

• Five sites: Baltimore, Boston, Chicago, LA, and NYC

• Families randomly assigned to one of three groups:

• Control: Project-based public housing in high poverty

areas (>50% at baseline)

• Section 8: Conventional housing vouchers, no

restrictions

• Experimental: Housing vouchers restricted to low

poverty (< 10%) census tracts

Moving to Opportunity

After 3 years, mental health of both parents and

sons who moved to the low-poverty

neighborhoods improved.

After 10 to 15 years, movers had lower levels of

obesity, severe obesity & diabetes risk (HbA1c)

Source: Leventhal and Brooks-Gunn, 2003; Ludwig et al. NEJM, 2011

Children who moved at age 10 ended up with

incomes that were about halfway between the

average incomes of kids who spent their

entire childhoods in one of the two places

The later families moved, the less their

children were affected

Moved when

children were 9 Age at move

Source: Leonhardt, D. NYTimes, Upshot. May 4, 2015 (adapted from Chetty and Hendren)..

Impact of County on Income

Source: NYT after Raj Chetty and Nathaniel Hendren, “The Impacts of Neighborhoods

on Intergenerational Mobility.”

Impact of County on Income, SEPA

http://www.nytimes.com/interactive/2015/05/03/upshot/the-best-and-worst-places-to-grow-up-how-your-area-compares.html?_r=0

Boys Exposed to County EnvironmentsEarnings Per Year of Exposure

Source: Heckman, J. Science. 2006

We need to recognize that intervening early is better than intervening later

Source: Heckman, J. Science. 2006

Impact of County on Income

Source: NYT after Raj Chetty and Nathaniel Hendren, “The Impacts of Neighborhoods

on Intergenerational Mobility.”

Life Expectancy at Birth, 2012

Source: County Health Rankings and Roadmaps.

Heart Disease Death Rates, 2008-2010Adults, Ages 35+ by County

2016 STATE OF OBESITY REPORT

Source: Trust for America’s Health, 2016.

How does place impact health?

Spending per Student by School District

Current Status of State Medicaid

Expansion Decisions

Adopted (32 states + DC)

Not Adopting Yet (19 states)

What Works For Health?

• Healthy, affordable housing

• Healthy air

• Proximity to employment opportunities

• Access to transit

• Available healthy food/local food production

• Safe places for recreation

• Using health information in design and planning

East Lake Meadows Public HousingAtlanta, GA

Villages of East LakeAtlanta, GA

Crime

Violent crime

Employment

Student performance

> $200 M private investment

Private

Investors,

including

Philanthropy

GovernmentCommunity

Development,

including Community

Members

Community Development Partners Building Equitable Communities

More

CDFI

HUD Supports

Medicaid

Program funds

Paying for SuccessGreen and Healthy Homes Initiative

ExpansionGHHI Program

Health Care

Private

Investors

Health

Insurer

Government

Financing for HealthLIIF Social Impact Calculator

http://www.liifund.org/calculator-tool/

Housing Alliance of Pennsylvania + CSHMedicaid Crosswalk

Healthy PracticeBuild Healthy Places Network

http://www.buildhealthyplaces.org/

US Green Building Council Partnership