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2015 Population HealthCommunity Forum

March 2, 2015

Kate Kohn‐ParrottPresident and CEO

The Greater Detroit Area Health Council

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Average spending on healthper capita ($US PPP)

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USNETHFRGERCANSWIZUKJPNAUS

Total health expenditures aspercent of GDP

Notes: PPP = purchasing power parity; GDP = gross domestic product. International Comparison of Spending on Health 1980-2010Source: Commonwealth Fund, based on OECD Health Data 2012.

The U.S. pays far more for health care than any other country

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BETTERBETTER

Yet the U.S. lags all other high‐income countries in terms of health outcomes

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The Commonwealth Fund ranks the U.S. last in terms of health outcomes and cost

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Clinical/medical care influences 20% of health outcomes; 80% driven by social determinants

Source: RWJF

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Yet, in the U.S., clinical care is seldom integrated with social determinants 

SOCIAL DETERMINANTSHEALTHCARE

Mental/ Beh Health

Health Behaviors Environment

Economics /Poverty

Housing, Transportation, 

Etc.Education

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The U.S. spends more on health care than on social determinants

020406080

Health Care = 64%Social Determinants =

36%

Spending on Health and Wellbeing—U.S.

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Europe spends $2 on social determinants to every $1 on medical/clinical care

020406080

Health Care = 34%Social Determinants =

66%

Spending on Health and Wellbeing‐‐Europe

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Michigan is 34th in America’s Health Rankings (UnitedHealth Foundation)

Challenges

• High prevalence of obesity • High prevalence of binge drinking • Low rate of high school graduation

‐ See more at: http://www.americashealthrankings.org/MI#sthash.Sh2W3fuM.dpuf

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Michigan was just ranked 42nd in overall wellbeing (Gallup‐Healthway Rankings)

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Wayne County ranks last in the “County Health Rankings”

Great Disparities in Care

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Detroit statistics . . .

• Most polluted zip code (48217) in State• More fast food restaurants than sit‐down• Food deserts• Deadliest city for children

Compared to national averages• Rate of heart disease is twice as high• Rate of HIV/AID is nearly three times as high• Cancer rate is 20 percent higher• Diabetes rates is 35 percent higher• Infant mortality is more than double

But we are making great improvements!

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How do we fix this? Start by breaking down these silos

SOCIAL DETERMINANTSHEALTHCARE

Mental/ Beh Health

Health Behaviors Environment

Economics /Poverty

Housing, Transportation, 

Etc.Education

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Agreed‐Upon, Unified 

Community Health and 

Economic Goals

Health Care Delivery

Behavioral Health

Education

Transportation

Environment and Safety

Economics (Poverty)Literary

Housing

Healthy Food Safety

City Planning

Policy Development

Coordinate efforts and endorse common goals supported by “Health in All Policies”

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Thanks for being here today and helping develop solutions

Healthy people.Healthy economy.

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Creating Health:

Redefining the Roles of Health Professionals

Detroit Wayne County Health Authority

March 2, 2015

Jonathan Heller

Co-Director and Co-Founder

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Human Impact Partners

HIP is a national non-profit working to transform the

policies and places people need to live healthy

lives by increasing the consideration of health and

equity in decision making.

Core strategies:

Conduct research

Advocate

Build capacity

Bringing the power of public health science to

campaigns and movements for a just society

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The Problem

Health Stats – Wayne County

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Health Inequities

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Why?

Health status is determined by:

Health care 20%

Behaviors 30%

Social circumstances 40%

Environment 10%Booske et. al. 2010. Different Perspectives for Assigning Weights to Determinants of Health

Reducing Children’s Death Rate

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Zoning

Sanitation

Child labor laws

Worker safety

Penicillin

Immunizations

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Social and Economic Stats – Detroit

Poverty level 38%

Unemployment rate 23%; ~4X national

High school graduation rate 65%

Pop with bachelor's degree 13%

Vacant properties ~60K (out of 380K parcels)

Homes at risk of foreclosure ~35,000

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Worldview Spectrum

IndividualStructural

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Resources for Improving Health

Bradley et al. (2011)

Total Healthcare and Social Service Expenditures, 2005

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Why Solve These Problems?

Health Impact Assessment

Democracy

Equity

Sustainable Development

Ethical Use of Evidence

Comprehensive Approach to Health

1) To improve people’s health and lives

1) To reduce health inequities

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Solutions

Health in All Policies

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Health in All Policies is the concept of incorporating

health considerations into the policies and

programs of sectors that are the root causes of

health.

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Health Impact Assessment

How does a proposed

project, plan, policy affect

Determinants of Health

and lead to

health outcomes?What recommendations can be

made to improve health outcomes?

Example 1: Regional Planning

lorem ipsum dolor issue, date

1

!

!

SB375!Health!&!Equity!Metrics!

SB375:!Sustainable!Communities!Strategies!for!

Regional!Transportation!Planning!With%the%goal%of%reducing%greenhouse%gas%emissions,%SB375%requires%that%California’s%Metropolitan%Planning%Organizations%(MPOs)%prepare%a%Sustainable%Communities%Strategy%(SCS)%as%part%of%their%Regional%Transportation%Plan%(RTP).%The%SCS%process%is%an%opportunity%to%improve%the%health%of%all%communities%in%the%state,%truly%ensuring%our%sustainability.%

SB375!&!Health!As%California%continues%to%grow%over%the%coming%years,%we%will%need%to%accommodate%millions!of!new!households%and%jobs.%%%Currently,%the%cars!and!trucks%we%drive%account%for%almost%40%!of!our!greenhouse!gas!emissions.%How%will%further!growth%impact%our%climate?%%%%Transportation%and%land%use%decisions%impact%our%health%by%changing%air%quality,%noise%levels,%physical%activity%rates,%pedestrian%and%bicycle%injury%rates,%and%access%to%the%goods%and%services%we%need%to%live%healthy%lives.%%%%Children%born%today%are%expected%to%have%a%shorter%life%span%than%their%parents%due%to%obesity%and%respiratory%illnesses.%How%will%further!growth%impact%our%health?%!

· American%Lung%Association%in%California%

· Bay%Area%Regional%Health%Inequities%Initiative%

· Climate%Plan%· Fehr%&%Peers%· Healthy%Places%Coalition%· Move%LA%· Nelson%&%Nygaard%

%

· PolicyLink%· Public%Health%Institute%· Prevention%Institute%· Public%Advocates%· Public%Health%Departments%

in%Shasta,%Marin,%San%Mateo,%&%%Los%%Angeles%

· Public%Health%Law%&%Policy%%%

· Public%Law%Center%· Public%Policy%Institute%of%

California%· Raimi%&%Associates%· Reconnecting%America%· Safe%Routes%to%Schools%· TransForm%

!

Starting%with%metrics%proposed%by%many%organizations%and%agencies,%we%developed%a%final%list%of%13%metrics.%For%each%proposed%metric,%we%also%provide%a%review%of%its%links%to%health%and%a%description%of%how%it%can%be%measured.%!

Performance!Metrics!and!Planning!MPOs%use%a%variety%of%performance%measures%to%assess%different%scenarios%for%land%use%and%transportation%changes.%%As%we%have%seen%in%the%past,%if%those%metrics%don’t%include%health%and%equity%measures,%it%is%unlikely%that%the%final%selected%plan%will%lead%to%healthy%and%equitable%outcomes.%For%example,%if%MPOs%use%the%indicator%“Automobile%Level%of%Service%(LOS)%on%Roadways,”%their%decisions%will%focus%on%making%driving%easier,%which%might%not%be%the%best%for%health%given%the%many%ways%driving%can%harm%health.%If%instead%they%use%“Premature%Death%due%to%TrafficYRelated%Pollution,”%then%their%plans%are%more%likely%to%decrease%trafficYrelated%pollution%by%promoting%alternate%forms%of%transportation.%Our%goal%is%to%provide%MPOs%a%set%of%metrics%that%will%promote%health%and%equity%as%well%as%sustainability.%

Developing!the!Health!and!Equity!Performance!Metrics!To%develop%a%list%of%health%and%equity%metrics,%Human%Impact%Partners,%an%OaklandYbased%nonYprofit%that%strives%to%transform%the%policies%and%places%people%need%to%live%healthy%lives,%received%funding%from%the%Resources%Legacy%Fund%and%worked%in%collaboration%with:%%

!

A statewide coalition in CA developed 13 health and equity

metrics for inclusion in Regional Transportation Plans

Topics included: safety; access to goods,

jobs, services; transportation; future

growth; economy; pollution; equity

Sample metrics:

Daily amount (in minutes) of work-trip and non-

work trip related physical activity

Estimate premature mortality attributed to

traffic related ambient PM 2.5 and estimate

asthma incidence and exacerbation

attributed to traffic-related NO2

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Result: Metropolitan Planning Organizations are now

incorporating some of these metrics in their plans

Example 2: Foreclosures

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Alameda County Public Health and Causa Justa::Just Cause

Primary data collection, stories from community members

Wins:

Local and state legislation that

stopped water shutoffs when

landlords don’t pay bills

Local legislation that mandates

banks maintain foreclosed

properties

Built community capacity and

trust and transparency in

government

Example 3: Public Transit

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https://www.youtube.com/watch?v=z_Tc3kYXBXI

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Example 4: Minimum Wage

Income is a strong and consistent predictor of health

Mechanisms: ability to meet material needs, access to health

care, quality of neighborhoods in which people can afford to

live, child health and development, chronic stress, interpersonal

relationships

Outcomes: premature mortality, chronic disease, hunger, mental

health, ...

MN Health Commissioner Tweet: “Governor

Dayton signing the minimum wage bill into

law. A great public health achievement.”

Analyses completed in MN (2014), CA (2014), SF

(1999); public health became advocate and new

voice for raising the minimum wage

Many states and cities recently passed or are

considering minimum wage increases

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Example 5: Incarceration

1 in 3 blacks, 1 in 6 Latinos, and 1 in 17 whites will be

incarcerated in their lifetime

“Tough on crime” policies have not improved public safety;

recidivism rates are over 50%

Those incarcerated are 6X more likely to be

mentally ill; 20X more likely to have a substance

abuse problem

Mental health and substance abuse programs

reduce recidivism

Criminal justice reforms being investigated across

the country

Public health lens has been used in WI (2012)

and CA (2014) to help win reforms

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Example 6: Education Funding

Promising Practices

School-based mental health

programs

School-based health centers

Nutrition programs

Physical activity programs

Asthma programs

Dental care services

Parent engagement

Safe and supportive learning

environments (e.g.,

Restorative Justice)

Teacher training on social-

emotional needs

Additional HiAP/HIA Project Topics

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Health Determinant Policy Issue

Education Discipline; Funding; Integration; Siting

Jobs Wages; Pay equity; Paid sick days; Wage

theft; Hiring practices

Housing Mixed-use housing development; Public

housing redevelopment

Transportation Freeway expansion; Public transit funding

Land use Planning and zoning; Waste facility siting;

Transit oriented development

Incarceration Diversion; Sentencing reform; Ban the box

Agriculture SNAP; Farm to school; Ag plans

Energy Natural resource extraction; Wind farms;

Cap and trade

Outcomes

Local and statewide wins to improve neighborhood, housing,

transit, criminal justice, education, and employment conditions

and policies for low-income communities and communities of

color

Increased participation in decision-making by community

residents and empowerment of community organizations

Explicit consideration of health inequities in decision making

Changes in how policies are framed and debated

Increased media coverage of the health and equity implications

of decisions

New collaborations between health professionals, public

agencies, community organizations, and other stakeholders

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Elements of Success

Moving upstream: focusing on social inequities (causes)

rather than the health disparities (outcomes)

Process: building relationships and collaborations across

agencies, with communities, and with other

stakeholders

Community engagement: strengthening the ability of

communities facing inequities to change the conditions

that lead to poor health outcomes

Solution oriented: creating viable alternatives and

recommendations that provide an achievable vision

Changing worldview: use the work to raise awareness of

structural causes of health outcomes

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So What Can Health Professionals Do? (I)

Research

Communications

Capacity Building

Relationship Building

Funding

…to help communities facing poor health

outcomes build their power to make change

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What can Health Professionals Do? (II)

Who What

Public health

professionals

Provide data and research connecting public policy

and health

Non-profit

hospitals

Analyze SDOH in CHNA; use community benefit

spending on SDOH

Medical

professionals

Support community organizers and policy advocates

fighting for policy change by using their individual

and collective voices

Public health

nurses

Build social cohesion and strengthen social networks

when providing services in the community

All of us Build capacity of low income people and people of

color to advocate on their own behalf for policies

that improve living conditions

All of us Use the power of our positions to build relationships

between those facing the greatest inequities and

those who can change policy

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Community Organization

An organization that:

• Helps a community identify common problems,

mobilize resources, and develop and implement

strategies to reach their collective goals;

• Brings people who identify as being part of the

community together to solve problems that they

themselves identify;

• Works to develop civic agency among

individuals and communities to take control over

their lives and environments.

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Detroit Public Transit

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Detroit Foreclosures

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Detroit Future City

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Michigan Sales and Gas Tax Ballot Initiative

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Michigan Criminal Justice Reform

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Michigan Prevailing Wage

Jonathan Heller

510-452-9442 x100

jch@humanimpact.org

Thank you!!!

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Community Benefits Presentation EQUITABLE DETROIT COALITION, PEOPLE’S PLATFORM & THE SUGAR LAW CENTER FOR ECONOMIC & SOCIAL JUSTICE

The mission of the Equitable Detroit Coalition is to foster beneficial relationships between developers and the Detroit community

Open, transparent dialogue between Community & Developer

Residents are stake holders because their money subsidizes the projects and they must live with the projects.

Membership list in your folders

Support for CBA Ordinance growingu City-wide movement

u The People's Platform in alliance with Equitable Detroit and the Economic Justice Alliance of Michigan door knocked more than 3000 doors across the city of Detroit educating residents about the proposed CBA ordinance.

u Collected more than 2000 signatures of Detroit voters in support of the CBA ordinance

u Built strong alliance with the Black Chamber of Commerce who are growing small businesses support.

u CBAs not new to Detroitu Parkside Residents Council (PRC) worked with Detroit Housing Commission’s (DHC)

contractor on a $90 million housing project. They successfully negotiated a legal binding agreement for $350,000, sign off on all architectural designs, first right to move into the new development, and a United Way for $1,000,000 to provide funding for on-site service providers at Parkside. Residents would evaluate service providers and determine funding levels

Post-bankruptcy, the city of Detroit’s biggest asset is land. In the next few years, Detroit will be at the epicenter of urban land development. Projects without a CBA:

Bridge to Canadau $2 billion project

u 165 acres of Detroit land

u Close to 200 homes displaced, including churches and 43 businesses

u Received 301 properties for $1.4 million

u No legally binding agreement regarding jobs, air quality, housing, etc.

Henry Ford Medical Warehouseu Henry Ford Health Systems’ $500

million expansion

u Involves 300 acres in the West Grand Blvd neighborhood

u Agreed ONLY to a letter of understanding that is NOT binding

Without a CBA process, cont.

Marathon Oil Refinery Expansion

Largest refinery expansions in the U.S., $2.2 billionReceived $175 million tax breakPromised to hire 51% of Detroiters for the over 200 jobs createdONLY hired 15 DetroitersProcessing of the dirtiest crude oil, tar sands

Michigan State FairgroundsDevelopment of 157-acre Michigan State Fairgrounds Community proposals and ideas were ignored

Meijer’s in Brightmoor

Grand Rapids-based retailer Meijer is breaking ground on a second Detroit location at the corner of Grand River and McNichols roads on May 15. $3 million Brownfield Credit Hiring 500 peopleSmall business impact?

Events Arena & Hockey StadiumNew Arena/Hockey Stadium

u New $650 million entertainment and hockey stadium

u Received $284 million tax break & land transfer of 39 publicly owned parcels along the Cass Corridor for $1.00

u Olympia refuses to enter into a CBAu Received $284 million in tax

subsidiesu Does not include the deals on land

transfersu No legally binding agreement to

hire local residents or improve quality of life of host community.

Joe Louis Arena u In 1980, the Red Wings, then owned by

Bruce Norris, signed an agreement with the city to pay it 25 percent of any gross profits over $750,000 from any television rights revenue for events broadcast live at Joe Louis or adjacent Cobo Center.

u With the new arena, we get no shared revenue.

In your district, do you have a neighborhood that looks like this?

At the foot of the Ambassador bridge, no CBA

The neighborhood post-refinery expansion, no-CBA

CBA policies well-established in other cities

u Expansion of Columbia University in New York Cityu Casino & hockey arena in Pittsburghu Several mixed-use developments: the Staples Center expansion in

Los Angeles, the Cherokee-Gates development in Denveru Beltline development projects in Atlantau Milwaukee Park East Redevelopment Compactu San Diego BallPark Village mixed-used projectu Oakland’s Oak to Ninth housing projectu Municipalities such as St. Louis, Atlanta, Cleveland and Milwaukee

have adopted broad community benefits policies during public works projects.

Examples of CBAs in other cities

Penguins Pittsburgh Hockey Stadiumu $1 million for a Hill District grocery store. u Creation of a First Source Employment

Center that will give neighborhood residents the first chance to apply for jobs created at the arena.

u The creation of a master planning committee that has until Feb. 19, 2010, to come up with guidelines for development of the Hill District and Uptown.

u The city, county and URA agreed to work with Pittsburgh YMCA to build a community center in the neighborhood.

u The Penguins agreed to pay $500,000 a year for six to 12 years for a Neighborhood Partnership Program focused on development and social services such as treatment for drug and alcohol addiction.

Twitter in San Francisco

u Twitter obtained a tax exemption worth about $70 million in payroll & stock option taxes for six years.

u Required Twitter to purchase $500,000/per year worth of goods & services from small businesses

u $3 million each year for a neighborhood learning center

u $3 million per year to nonprofit organizations in the neighborhood

u 4,000 volunteer hours (Friday for Good program) by Twitter employees

u $50,000 (min.) a year donation of IT equipment to local schools

u $60,000 per year in free advertisement for nonprofit organizations on Twitter

Detroit Community Benefits Ordinanceu The latest version under discussion:uOnly applies to developments requesting public

subsidiesu Triggers involved: $300,000 tax break and $15-million

project then they are required to seat down with the community (Tier 1)

uNot one-size-fits-all: Specific agreements developedu Exemptions allowed – equivalent agreements or

impasse

QuestionsNext Steps:

Anti-CBA House Bill 4052

Detroit Ordinance Support

Contact:Rashida TlaibSugar Law Center for Economic & Social JusticeRashida@sugarlaw.org313-993-4505

220 Bagley Ste. 212, Detroit MI 48226

313.962.5290www.mosesmi.org

Population Health ForumMarch 2, 2015

Why Congregation BasedCommunity Organizing?

“The center of our values in Congregation-

Based Organizing is belief that our values

SHOULD determine the policies and practices

of our government and our society.

We know with intentional intervention that

policies and practices will change when

people of FAITH put their VALUES into

ACTION”

“A true revolution of values will soon cause us to question the fairness and justice of many of our past and present policies. ... A true revolution of values will soon look uneasily on the glaring contrast of poverty and wealth”

Dr. Martin Luther King Jr.Riverside Church in NY April 4, 1967

Social Inequities

Health Inequities

Segregation Income & Employment Education

Housing Transportation Air Quality Food Access & Liquor Stores

Physical Activity & Neighborhood Conditions Criminal Justice

Access to Healthcare Social Relationships & Community Capacity

Social Inequities

Powerlessness is making People sick!

Kalamazoo Co. H.D.

ISAAC

Kent Co. H.D.

Various Partners

Ingham Co. H.D.

ACTION of G. Lansing

Saginaw Co. H.D.

Ezekiel Genesee Co. H.D.

Various Partners

Detroit/Wayne Co. H.A .Wayne County Health Dept

Institute for Pop HealthDetroit Health Depart

MOSES

Washtenaw Co. P.H.

WeROC

BerrienCalhoun

Eaton

Housing

Immigration

School closings

Transportation

Ban-the-box

Minimum Wage

Infant Mortality

Health in All Policies

Mass Incarceration

Building Networks of Power to impact Health Inequities