LV and Beyond: Regionalizing Public Health in Other States

Just last month, the Robert Wood Johnson Foundation released this short report summarizing the overall challenges to improving public health capacity through cross-jurisdictional relationships, conditions for successful relationships, and moving forward with regionalization.

Information was gathered through in-person interviews and site visits with executive leadership and important staff at organizations such as CDC, NACCHO, PHAB, and HRSA.  Researchers interviewed various local public health leaders and policymakers either interested or currently involved in regionalization in Colorado, Wyoming, South Carolina, Connecticut, New Hampshire, Nebraska, and Illinois.

Although these efforts are specific to location, the report provides insightful generalizations about regionalizing public health. Here’s a short outline of its key points:

Key barriers to improving cross-jurisdictional relationships:

• A gap exists between elected officials and public health leaders in understanding population health.
• There are differences in understanding, appreciating, and operationalizing cross-jurisdictional relationships within the public health practice community.
• No common language or frame of reference exists for discussing cross-jurisdictional sharing.
• Cross-jurisdictional sharing and regionalization are occurring in a range of ways.
• Regionalization does not necessarily result in improved public health capacity or performance, but cross-jurisdictional sharing often does.

Conditions for successful cross-jurisdictional relationships:

• Clarity of purpose (Policy makers and public health leaders must be clear about their purpose)
• Incentives, especially financial, are helpful
• Willingness on both sides—public health leaders and elected policymakers
• Attention to environment, culture, and history (interplay of history, culture, and relationships must be addressed)
• Role in governance (all parties should feel that they have sufficient voice and control)

So, how should we move forward with collaboration?

• Elected state and local policymakers need to be involved in national public health systems development work.
• Understanding of the local environment is essential to successful public health endeavors.
• Cross-jurisdictional relationships vary greatly in their details and address a wide variety of needs, but they do not have to develop further beyond their original purpose.

The conclusion?:

Public health leaders and policymakers found that cross-jurisdictional relationships improve local public health. Although accreditation was not a central focus of the report, the public health leaders acknowledged that cross-jurisdictional sharing will likely be necessary for health departments applying for national accreditation.

Visit RenewLV’s Regional Health Department page for information about local efforts in the Lehigh Valley.

Would You Rather Pay Less Now, or Pay More Later?

There’s an interesting issue brief online from the Partnership for America’s Success, a coalition managed by the Pew Center on the States. The brief, citing an analysis by several economists and criminologists, makes the case that we should invest in healthy child development now as a way to avoid the significantly higher costs of societal problems later.

The researchers identify several negative outcomes of failure to invest early, and note the potential price tags:

• Child Abuse: Societal costs for medical and mental health care and services such as foster care total more than $30,000 for a child who is abused.
• Teen Parenthood: When a teenager has a child, the nation pays $120,000 for expenses including medical care, social assistance programs and efforts to deal with higher rates of abuse and neglect among these young parents.
• High School Dropout: A dropout costs society $250,000 through lower earnings and benefits.
• Illegal Drug Abuse: Treatment, medical care and other societal costs caused by a drug abuser amount to $250,000.
• Alcohol abuse: Societal costs for an alcoholic, such as medical problems, car crashes and lost productivity at work, add up to $230,000.

The brief goes on to compare some of the costs of early investment against the price tag of later problems. For example, the cost of “quality pre-kindergarten programs” which reduce the frequency of high-school dropouts, is around $10,000. On the other hand “a high school dropout’s lower earnings create costs for public assistance programs and efforts to offset the dropout’s reduced contribution to society.” These costs can total $250,000.

The issue brief focuses on the long-term savings of prevention; in this case, prevention of the effects of poor childhood development. Public health programs have the same goal — to prevent diseases and other health problems as a way to save money on treatment. As the saying goes, “an ounce of prevention is worth a pound of cure.”

So what would you prefer? To invest now and gain a higher return in the form of significant savings, or to wait until a problem comes up, and find yourself shouldering higher costs?

Yet Another Reminder of Why We Need a Regional Health Department

An announcement this month from the U.S. Department of Health and Human Services (HHS) serves to reinforce one of the key reasons that RenewLV supports the establishment of a regional health department, which would encompass all of Lehigh and Northampton counties.

On February 9, HHS announced a $750 million investment in prevention and public health for 2011. Building on a similar $500 million investment last year, the program is funded through the Prevention and Public Health Fund, an important component of the Affordable Care Act. According to the HHS press release, the $750 million, which will be distributed mainly through grants, is broken down into four categories:

• Community Prevention ($298 million): These funds will be used to help promote health and wellness in local communities, including efforts to prevent and reduce tobacco use; improve nutrition and increase physical activity to prevent obesity; and coordinate and focus efforts to prevent chronic diseases like diabetes, heart disease, and cancer.
• Clinical Prevention ($182 million): These funds will help improve access to preventive care, including increasing awareness of the new prevention benefits provided under the new health care law.  They will also help increase availability and use of immunizations, and help integrate behavioral health services into primary care settings.
• Public Health Infrastructure ($137 million): These funds will help state and local health departments meet 21^st century challenges, including investments in information technology and training for the public health workforce to enable detection and response to infectious disease outbreaks and other health threats.
• Research and Tracking ($133 million): These funds will help collect data to monitor the impact of the Affordable Care Act on the health of Americans and identify and disseminate evidence-based recommendations on important public health challenges. 

There are two things worth noting from the press release. First, a grant within the “Public Health Infrastructure” category could be used to help offset the initial investment required to create a regional health department. While this is just speculation for now (specific details regarding the grants are not easily accessible), it seems likely that such a project to improve local public health infrastructure would be able to find support.

Second, a regional health department would have more success when applying for grants under all four categories. A larger health department presents a more competitive application than two smaller ones. The Allentown and Bethlehem Health Bureaus have a very poor chance of winning grants if larger municipalities such as Philadelphia choose to apply to the same programs. The proposed regional health department, however, covering over 600,000 people, would have much improved chances, and would be more likely to net the federal money.

This competitive advantage would combine with an increase in state funding. We know that a regional health department would receive $3 million from the state that the two current independent health bureaus are missing out on. State public health funding is allocated on a per capita basis under Act 315 and Act 12. Therefore, a larger population serviced by a regional department would be eligible for greater funding. 

Keep in mind that the Affordable Health Act’s Prevention and Public Health Fund represents a $15 billion investment over 10 years. So, a regional health department would be competitively applying for these specific funds for at least the next 8 years, in addition to countless other federal grants.

For more information, take a look at the following resources:

• RenewLV Regional Health Department Fact Sheet
• HHS 2011 Prevention and Public Health Fund Fact Sheet
• HHS 2010 Prevention and Public Health Fund – PA Funds Fact Sheet

Lower Saucon Planners’ Decision on Pheobe Ministries’ Proposal

Today’s MCall Online features an article entitled “To cheers, Lower Saucon planners reject Phoebe plans: But council will have final say on whether to allow housing for as many as 500 seniors.”

The Lower Saucon Twp. Planning Commission rejected the proposed rezoning of a 65 acre lot at the intersection of Meadows Rd. and Friedensville Rd.–just southeast of Lehigh’s South Mountain atheletics facilities.  

According to the article, the 65 acre parcel is currently zoned to permit single-family residences on roughly 1/2 acre lots.  Apparently, the planning commission meeting was well attended, with crowd sentiment decidedly opposed to the proposed rezone.  The rezoning would permit Phoebe Ministries to build a continuing-care (55+?) community that could accommodate “as many as 500 residents.”  That number–I’d wager–was the primary attendance driver for the meeting, where 200 residents showed up (to a planning commission meeting).

“We hope Phoebe Ministries understands this isn’t about them,” Dugan said.

The tract is zoned suburban residential, which allows for single family homes on roughly half-acre lots.

Jason s. Engelhardt, a planning engineer from Bethlehem representing Phoebe Ministries, said roughly 84 single-family homes could be built on the site.

At previous meetings, residents opposed the heights on some of the buildings, the density proposed-as many as 500 residents — and the strain on public water and sewer systems, alteration of the geology in the carbonate rich region and the impact on neighboring properties.

My questions relate to the concerns expressed by residents about the proposed rezoning.  If the tract were currently zoned as green space or some type of preservation purpose, I’d be considerably less likely to support the rezone, but the proposed change should be assessed in light of the current zoning of the tract and the development likely to take place there in the future absent the proposed change.

First, residents expressed concerns about the density of Phoebe’s proposed development.  Density, in and of itself, does not provide a sound reason for opposing the proposed change.   It is difficult to imagine that aesthetic concerns of township residents could not be addressed through the design of the development.  Moreover, the property on the north side of Friedensville Road across from the 65 acre site contains Lehigh University graduate student housing, and there is at least one apartment complex further east on Friedensville Road.  While Phoebe’s proposed development would increase density in the area, it would not appear to be wildly out of place by any means.   

Second, while 500 seniors sound like–and I suppose, is–a sizeable figure, the shock factor this likely created with residents will be reduced by considering the residential alternative for the site.  Specifically, Phoebe’s engineer estimated that 84 single family homes could be constructed on the 65 acre lot as currently zoned.  Of course, 84 single family homes do not mean only 84 residents: assuming a household size of 3, that’s 252 people; assuming household of 4, that 336 people.  Therefore, rather a marginal increase in the number of township residents of 500, the marginal increase in residents is more likely to be on the order of 175 to 250.

Now, I’m not suggesting that 175 to 250 new township residents would not have a noticeable impact on municipal service demand; however, it seems important to acknowledge who those new residents are likely to be and what services they are likely to demand.  Most notably, the single family residential development likely to occur absent the proposed zoning change is sure to bring in a significant number of school children–a particularly pricey proposition.  School children are an additional cost/demand that the Phoebe development would not create.

As the Lower Saucon Township Council and residents considers whether or not to ultimately approve the proposed rezoning and Phoebe’s proposed development, it would appear the better part of reason to compare the proposed continuing-care community with 65 acres of green space, but with single-family subdivision that will likely, eventually replace that presently-green space if the rezoning is rejected by the council.

Here’s the link to the multi-municipal comprehensive plan developed by Lower Saucon Township,  the Borough of  Hellertown, and the Saucon Valley School District.

Infrastructure Investments – A Silver Lining in a Dark Cloud: Obama’s 2012 Budget

By now, you have probably seen President Obama’s proposed 2012 budget. If you are reading this blog, it’s likely that you are a smart growth advocate. If that’s the case, chances are that you are as torn and surprised as I am at how the President has managed to both promote a key principle of smart growth, while critically wounding another.

I’ll start with the bad news. Obama’s budget reflects a proposal he alluded to in his State of the Union address: cutting in half the Community Service Block Grant (CSBG). The CSBG is a main source of funding for community action groups (including the Community Action Committee of the Lehigh Valley, a major partner of RenewLV). These groups provide a multitude of services, with the overall goal of helping people achieve economic security. They directly and indirectly promote job creation, small business ownership, and other programs to help those in need get back on their feet. The effects of this cut in funding, if it is passes in the final budget, may prove devastating. Take a look at the National Association for State Community Service Programs’ (NASCSP) press release regarding the cut.

The good news is that the budget proposal contains a few significant measures to invest in smart growth programs. Smart Growth America‘s CEO and President Geoffrey Anderson posted a statement on the organization’s blog applauding the President. He notes the particular provisions endorsed by Smart Growth America, including those which (quote):

• Support an interagency effort led by HUD and the Department of Commerce’s Economic Development Administration to help distressed cities and regions utilize public resources more strategically and to form partnerships to support job creation and economic development.
• Stimulate economic growth in areas stymied by brownfields by providing technical assistance towns and cities and maintaining an area-wide planning program to integrate sustainable community development with environmental remediation activities.
• Invest in sustainable, innovative communities by providing $150 million to create incentives for more communities to develop comprehensive housing and transportation plans that result in sustainable development, reduced greenhouse gas emissions, and increased transit-accessible housing.
• Preserve the Community Development Block Grant (CDBG) Program. This will continue to enable State and local governments to address infrastructure, affordable housing, and economic development needs in their communities. [Note that the CDBG is different from the CSBG. The CDBG also faces proposed cuts.]
• Include a six-year framework for funding surface transportation programs to modernize the country’s transportation infrastructure, create jobs, and create sustainable investments for long-term economic growth. The President plans to work with the Congress to ensure that the plan will not increase the deficit. This type of reform are precisely in line with recent polls, including one released today by the Rockefeller Foundation which shows that voters believe strongly that providing a modern, safe infrastructure is a primary role of our government.
• Promote infrastructure repair policies that will ensure that transportation agencies stop siphoning off money intended to rehabilitate bridges and highways.

It is great to see that the President has produced a fiscally responsible budget that promotes aspects of smart growth. However, the vision shared by organizations like RenewLV are not limited to a few specific programs and resources. Smart growth encourages those initiatives as a means to achieving a viable urban reality, in which American cities live up to their promised potential. Cutting the CSBG has the potential to destroy programs that fight poverty, aid small businesses, help children receive an education, and promote safe, diverse, healthy neighborhoods. In other words, community action groups support economic growth and directly work towards smart cities.

Fortunately, the budget proposal is just that: a proposal. In the coming months, the President will have to negotiate with advocates from around the nation and with Congress in order to draft a finalized budget. Please, consider lending support to the effort to save the CSBG. Sign this online petition to remind the President of the importance of community action groups, and stay tuned to RenewLV and CACLV for updates.

The proposed federal support for transportation and infrastructure initiatives are fantastic. It’s just a shame that these provisions come alongside such damaging cuts to our communities.

OpenCities: Culturally Diverse Cities Are at a Competitive Advantage

Today’s post draws on the work of Nina Izábal over at ThisBigCity. OpenCities, an innovative project presented at the UNESCO/UN-HABITAT seminar focused on enhancing inclusiveness for international migrants in cities, acts on the idea that migrants are important contributors to city development and enrichment. After analyzing various indicators (such as perception and inflow of international population), areas, and policy ideologies in 26 different cities, OpenCities reached the conclusion that cities that attract new populations are more competitive than those that do not.

Thus, the project revealed an important implication: migrants enhance cities by adding cultural enrichment, which in turn puts these cities at a competitive advantage. Not only do migrants bring cultural diversity, but they also make necessary contributions to business and innovation that encourage city growth and progress.  “Cities are dynamic by definition and new residents change the urban landscape,” Ismael Fernandez Mejía from ISOCARP points out in the seminar.

How is this relevant to the Lehigh Valley? You may have found 2010’s State of the Lehigh Valley report particularly revealing in terms of the trends in population demographics. While in 2009 and 2010 the Lehigh Valley had a lower percentage of Black residents than in the rest of Pennsylvania, the US Census Bureau data in the report indicates a greater percentage of the Lehigh Valley reported being Hispanic than in the rest of the state.

The Lehigh Valley has steadily attracted more residents; from 2000-2009, the population in both Northampton and Lehigh Counties grew significantly. According to this report, recent population growth in the Lehigh Valley has been primarily due to the influx of foreign immigrants:  “The principal component of population change in the last decade has been in-migration from other countries, not other states.”

Given the population trends in Lehigh Valley, the OpenCities’ approach will help to identify ways to make our cities more open and integrated.  What exactly does “open” mean in this context? As defined on their website, openness is “the capacity of a city to attract international populations and to enable them to contribute to the future success of the city.”

What are organizations in the Lehigh Valley already doing to allow for more “openness”? To name a few, AEDC has a strong focus on fostering urban manufacturing and entrepreneurship, and is working to engage the diverse communities of Allentown. In addition, LVEDC provides business assistance for minority-owned businesses. Among other initiatives, CACLV provides individualized assistance and entrepreneurial training to new and existing business owners through their Start Your Business course.

I’ll leave you with some food for thought: What can we do to make cities in the Lehigh Valley more “open”? And what are some practical ways we can better foster inclusiveness to encourage smart growth?

Public Health

The past several weeks have seen a few interesting tidbits emerge on public health both within the Valley and without:

The Lehigh Valley Board of Health met last Monday to discuss its next course of action. The Board is continuing to try and raise support for a regional (bi-county) health department covering Lehigh and Northampton counties (you can read more about the benefits of a regional health department at RenewLV’s website). The Emmaus Patch reports that the Board is planning on a fresh campaign to try and building support within the general public and elected officials. Health Board Chairwoman Ilene Prokup is quoted saying “I think probably our major effort over the next couple of months has to be education, education of the public and education of the county commissioners and council people as to what is the difference between public health and why its important and the private health or medical system.” (For a short, simple explanation of the difference between public health and private healthcare, take a look at this Crossroads post from last year).

NRDC’s Switchboard has a post about the consequences that global climate change will have for public health in the U.S. Kim Knowlton discusses new estimations from the insurance industry and the national security community about the health threats posed by storms, floods, and other disasters caused by climate change. “Besides the initial mortality rates, people in impacted U.S. regions could suffer from waterborne illnesses and see an increase in infectious diseases.” Knowlton presents a call to action:

It’s my duty as a health scientist to help people reduce their exposure to harm from public health threats, yet climate change – called “the biggest global threat of the 21st century” by one of the world’s premier medical journals – presents a daunting array of risks that too few Americans know about.

Let’s shine a light on this issue and look at what’s being done across the U.S. to prepare for life under a changing climate, applaud the champions who are already taking action to protect the nation’s health, and defend our right to a climate-secure, healthier future.

Finally, StreetsBlog discusses a new review by the World Health Organization of 300 studies in an effort to demonstrate the link between transportation policies and public health. While the link is seemingly obvious, research attempting to provide quantifiable evidence for the link tends to be incomplete or lacking. Hopefully, the WHO review will fill the current void. Take a look at the post, it’s worth a read.

Sprawl Begets More Sprawl

Happy Monday, Lehigh Valley! Hope everyone enjoyed the Superbowl and had a relaxing, (relatively) snow free weekend.

Kaid Benfield over at NRDC’s Switchboard posted a great piece today about an article in the new edition of the Journal of the American Planning Association. The article, titled “Do Large Subdivisions Induce Further Development? A Spatially Explicit Hazard Analysis of Land Use Change in Charlotte,” provides proof for what we’ve already thought: sprawl leads to sprawl. The authors, Bev Wilson and Yan Song, examined the suburbs of Mecklenburg County, North Carolina, to test their hypothesis that “large-scale residential subdivisions represent an intense, localized change in land use that exerts priming effects on subsequent land use decisions.”

To put it simply (and to paraphrase Benfield), the authors found that it is much more likely for a new subdivision to appear near a recently built one than in a place with no previous development. The most important implication of the study for those advocating smart growth is that review of a proposed project’s environmental and economic impacts should focus not just on the specific site of the proposal, but also on the effects of potential development of nearby sites. While this is something that smart growth advocates have said before, the study provides measurable data to back up these claims.