Motivating Collaborations: The Convergence of Public Health and Community Development
"Because good health does not [just] happen in a doctor's office"
-Elissa J. Bassler, Chief Executive Officer, Illinois Public Health Institute
The Community Development and Policy Studies (CDPS) division of the Federal Reserve Bank of Chicago, in partnership with the Build Healthy Places Network (BHPN), Illinois Public Health Institute (IPHI) and County Health Rankings and Roadmaps, hosted an event titled Building Healthy and Prosperous Neighborhoods in Cook County on November 15, 2018, to motivate collaborations between healthcare and community development in Cook County, Illinois.
The purpose of the meeting was to understand where and how the public health and community development sectors were collaborating to improve health outcomes in Cook County. More specifically, according to Jeremiah Boyle, assistant vice president and managing director of Community and Economic Development at the Chicago Fed, organizers sought "to mitigate inefficiencies that were resulting from working in the same communities, often having noted the same challenges, but without effective collaborations." The call to action was for public health officials, healthcare professionals, and community development corporations (CDCs) to join forces to increase cross-sector investments and collaboration in low-income neighborhoods.
Chronic diseases such as heart disease, cancer, asthma, and diabetes are the leading drivers of cost on the nation’s $3.3 trillion spent on medical care each year.1 Most of these persistent conditions – Cook County’s leading cause of death is heart disease2 – are preventable and most occur in low-income communities.3 Being low-income is not only a socio-economic characteristic of a community, it is a major factor in the health outcomes of residents.4
Community-based interventions that address the social determinants of health – such as race/ethnicity, income, access to credit, housing quality, crime and safety, and pollution – may help translate collaboration into action as outlined by multiple speakers at the meeting.
The goals of the meeting were:
- Build knowledge and enhance relationships among Cook County healthcare and community development leaders;
- Identify opportunities to address social determinants of health in Chicago and suburban Cook County through cross-sector collaboration and investment; and
- Develop a more strategic and accelerated approach to launching initiatives between healthcare and community development in Cook County.
The day's discussions were framed in a context of racial equity by Julie Willems Van Dijk, senior scientist and director of County Health Rankings & Roadmaps. She challenged attendees to ask, "How can we describe health in a way that improves people’s lives in their communities? If we are not also focused on issues of inequities, we will not arrive at the healthiest communities. We have to close the gaps, and narrow (racial, ethnic, and economic) disparities."
Panelists, including Joanna Trotter, senior program officer in the Economic and Community Development for The Chicago Community Trust, Mary Sajdak, chief operating officer of Integrated Care Services at Cook County Health, and Julie Morita, commissioner of the Chicago Department of Public Health, stressed the need to advance evidence-based initiatives, to inform policy with data, to find opportunities to collaborate, recognizing that it would take “patience, commitment, and creativity.” Panelists counselled that the process would likely “get uncomfortable,” but that the two sectors needed to “learn each other’s language.”
A panel of national community development-public health partnership examples, including LISC Chicago, Build Healthy Places Network: Community Development and Health, Cinnaire, Trinity Health, Nationwide Children's Hospital, illustrated the complexity and the opportunity of collaborating across sectors to address housing, infrastructure, financial literacy, and other issues in order to advance towards health equity in targeted communities. Meghan Harte, executive director, Local Initiatives Support Corporation (LISC) Chicago, moderated the panel and opened by suggesting that “if people can be informed, they can make really good decisions.”
Colby Dailey, managing director, Build Healthy Places Network, provided the example of Central City Concern, a coalition of five hospitals addressing homeless and housing issues in Portland, Oregon, to align social services and healthcare. “Hospitals make direct investments in housing and the capital can be used to mitigate barriers” to healthcare and social services. Susan Frank, executive vice president, Cinnaire, speaking about its partnership with Trinity Health in Detroit, reflected on the importance of leadership for collaboration success: “Commitment at the highest level is really important; having that first commitment or being the first mover makes everything else happen.” Tonya Wells, vice president, Social Impact Investing and Community Development, Trinity Health, Detroit, Michigan, concurred with Ms. Frank, but also added that there is no roadmap for these partnerships: “We are learning as we go.” Gretchen West, executive director, Healthy Homes, Nationwide Children's Hospital, Columbus, Ohio, raised $15 million, in partnership with a local Community Development Financial Institution (CDFI), including $5 million in equity and grants, to "improve economic outcomes for residents who don't have good jobs."
However, an essential component of any collaboration is the alignment of financial resources to support and sustain the collaboration. Steve Kuehl, economic development director for the Community Development and Policy Studies Division at the Federal Reserve Bank of Chicago, explained the unique synergies that exist between the Community Reinvestment Act and the Affordable Care Act, both of which mandate that banks and hospitals, respectively, work to address the needs of the communities they serve.5
Four afternoon breakout sessions featured local collaborations between health partners and their communities to address specific social determinants of health.
- Flexible Housing Pool is an innovative source of public-private investments to offer supportive housing to people most at need. A county-wide public-private partnership, Flexible Housing Pool (FHP) works with community partners such as Cook County Health, UI Health, Chicago Department of Family & Support Services, Chicago Department of Public Health, Housing Authority of Cook County, and Illinois Public Health Institute. FHP seeks to stabilize housing for individuals who have been homeless with high behavioral health and physical health needs who are most at risk of using high-cost emergency services. The city of Chicago has committed $1.8 million to the program.
- The Focal Point Community Campus
Saint Anthony Hospital is partnering with the Chicago Southwest Development Corporation (CSDC), residents and over 100 community groups to serve individuals and families who are impacted by poverty, trauma, violence, discrimination, language barriers, and limited health access in the neighborhoods that surround the hospital on the West and Southwest sides of Chicago. Saint Anthony will build its new hospital on a 32-acre campus at 31st Street and Kedzie Avenue, and will offer a range of retail, wellness, education, arts and recreation, and affordable housing services to improve the health and well-being of the community and its residents. The total project cost is $500 million.
Serving the communities of Maywood, Bellwood, Broadview, and Melrose Park, Proviso Partners for Health (PP4H) is funded through a five-year seed grant from Trinity Health and is focused on economic mobility for youth, improving food systems, and access to healthcare. In partnership with Loyola University Health System and Loyola University Chicago Stritch School of Medicine, PP4H is addressing racial, health, and economic inequities in the Proviso communities.
By addressing disparities in health equity, West Side United (WSU) intends to coordinate investments and share outcomes to "build healthy, vibrant neighborhoods." In partnership with healthcare providers such as Ann and Robert H. Lurie Children's Hospital of Chicago and Rush University Medical Center, as well as education providers and community based organizations, WSU seeks to invest $2.5 million in initiatives from housing to youth services and $100,000 in small business grants.
Metrics and data to document inequities can drive targeted, strategic approaches to areas with significant needs. Multi- and cross-sector investment initiatives highlight the consequences of poor health and poverty on community residents, but also the opportunity for effective collaboration. These collaborations demonstrate the potential of cross-sector investments to help low-income communities address their needs. National and local examples of public health-community development collaboration are relatively new, are beginning to bear fruit, but remain areas of innovation. Convenings such as Building Healthy and Prosperous Neighborhoods in Cook County provide unique opportunities to convene a broad spectrum of actors around this developing topic.