Monthly Archives: April 2011

A Financial Case for Public Health

Pay now or pay later. States face this choice every day, particularly with how and when they invest in clinical preventive health services leading to prevention and reduced economic burden in terms of length of hospital stay and general health care costs.

The rewards of paying now are better known than ever before. Research has demonstrated that supporting healthy early childhood development–from before through age 5–generates substantial educational, social and financial benefits for individuals, families and communities.

A major study, The High Costs of Failing to Invest in Young Children produced by Partnership for America’s Economic Successhighlighted that the price society pays when a single person experiences child abuse, drops out of high school, or abuses alcohol can range up to tens to thousand dollars over that person’s lifetime. The study’s purpose was to help policy makers and the public fully evaluate the consequences of their present funding decisions.

The latest RWJ/University of Wisconsin County Health Ranking (CHR) revealed that morbidity numbers are rather low in Lehigh County (37 out of 67 counties) and Northampton County (a shocking 60 out of 67). Morbidity is a term that refers how healthy people feel in the community while alive and it captures the Birth Outcomes along with Health-related quality of life (HRQoL) within the community. Birth Outcomes are measured using low birth weight (LBW) that represents child’s current and future morbidity. Low birth weight is reported to be higher in both Lehigh Valley (8.3%) and Northampton County (8.7%) as compared to the State average of 8.2% and way higher than the national average of 6.0%, according to CHR report.

It was mentioned in the blog on County Health Ranking Across Pennsylvania that the public health spending in Pennsylvania is extremely low as compared to other states in U.S. In this context of scarce resources, the advantage of economic analysis is that helps substantiate present action in terms of investing in prevention and public health. Such an analysis helps providers in managing an individual’s health and administrators in appropriately focusing resources, and — moreover — illustrates the return on investment (ROI) for public health initiatives. According to a study in Western New York, a positive ROI was demonstrated for a prenatal program developed at the Managed Care Organization using a model of economic analysis.

In general clinical preventive services are cost-effective; some are cost-saving. Some clinical preventive services prevent disease or injury (e.g. cervical cancer screening); some preventive services catch disease in early stages when treatment is most effective and least expensive (e.g. STI screening). Because clinical preventive services can prevent or reduce the need for treatment, they provide a cost-offset. Lehigh County has the highest number of sexually transmitted infection rates as compared to state or national average, according to CHR report. Key studies have been done that support the cost-offset value of prevention.

Below are the examples of cost-offset of clinical preventive services recommended in the Plan Benefit Model conducted as part of study that provides rationale to our current work on establishing a regional health department for Lehigh Valley. Of particular note is the cost offset by screening for Chlamydia and Sexually Transmitted Diseases (STDs). Screening for gonorrhea and Chlamydia allows for early recognition of diseases that could prevent the costly implications of late stage complication such as Pelvic Inflammatory Disease (PID). The average life-time cost of PID and its major complications for women have been estimated to be in the range of 1,060-6,840 US dollars. Check out the image below for details on how investment in prevention saves financial resources over the long term.

Biking Towards Social Integration

The essential elements of livable cities can be boiled down into just three central characteristics, according to ThisBigCity:

1) Resilience is about the ability of a city to ‘invent’ or ‘re-invent’ itself through shocks and stresses, to harmoniously accommodate old a new values, and to adapt the functions and requirements of the city.
2) Inclusiveness is about creating social integration and cohesion.
3) Authenticity is the ability to maintain the local character of the city, the local heritage, culture and environment.

Want a visual for this? This creative infographic from Phillips Livable Cities illustrates these concepts well.

Enhancing Inclusiveness in Bogota, Colombia

If you haven’t seen it already, check out these three elements in action in this amazing Streetfilms video that focuses on innovative ciclovías (bike paths) that have been instrumental in making Bogota, Colombia a more livable — and integrated — city. One of the interviewers, Karla Quintero, sums up well the role of these bike lanes in improving social integration:

Every time we referred to it as a large scale street closure event, they would always correct me and say that, no, it’s totally more than that. It’s about social integration. It’s about giving people an opportunity to see their city, to know their city, and to connect with parts of their city that they would otherwise be isolated from because of the streets.

Connecting the Allentown Community Through Bike and Pedestrian Paths

Adopted by the Allentown City Council, the Connecting Our Community plan will connect Allentown’s parks and people through a network of bicycle and pedestrian trails, both on and off street. From

The first phase of implementation will include improvements along Linden and Turner streets – a priority corridor linking Center City and Cedar Creek Parkway with the neighborhoods, schools, parks, businesses, and cultural institutions in between. All other on-street projects will stem from this important corridor.

Want to make Allentown a safer place to for pedestrians and bicyclists? Share your opinion at the Connecting Our Community meeting on April 27th. It will be held at Central Elementary School on 829 Turner St (in the Cafeteria) from 7pm-8:30pm.

Public Infrastructure “Privatization” Pitfalls: Penn State Law Prof.’s Article Worth Reading . . . and Passing Along to Your Favorite Elected Official

If I were to choose a single sentence encapsulating why Professor Ellen Dannin’s recent article on public infrastructure privatization is important and worthwhile reading for our elected officials and taxpayers alike, this would be it:

“Nothing at the [Federal Highway Administration] website, however, warns that language commonly found in infrastructure privatization contracts shifts substantial risk–and costs–to the public while also limiting the state and local government’s ability to make policy decisions.” (p. 76)

Prof. Dannin discusses a number of recent public infrastructure privatization deals/proposals (including long-term leases for Chicago’s parking meters and for the PA Turnpike) that essentially created–or very nearly created–classic “heads-I-win, tails-you-lose” deals that provide cash-strapped government entities with up-front revenue that is then–in large measure–subject to recapture based on contractual provisions that essentially seek to guarantee a the private partner’s return on investment in previously-public infrastructure.

Beyond the questionable fiscal sense that such contracts make for state and local governments, Dannin argues that common infrastructure contract provisions–euphemistically termed “compensation events”–actually “create conditions [or incentives] that pit profits against public safety.”  (pp.58-59)  For example, the proposed terms of the long-term lease contract for the PA Turnpike would have required the Commonwealth to compensate the private counter-party for performing maintenance and ensuring compliance with safety regulations.  (p. 59)  Here’s another paragraph that highlights the issue starkly:

Clashes between the private sector and public welfare are not hypothetical concerns.  For example, in 2006, the Indiana Toll Road contractor installed sand-filled barrels in Toll Road turn-arounds to prevent drivers from using them.  However, those turn-arounds were created to get emergency crews to accidents as quickly as possible.  State officials and emergency services were not consulted or even informed of the decision to block the turn-arounds, and it was months before the contractor agreed to remove the barrels. These problems could have been avoided had the contractor met its contractual obligation to prepare an emergency response plan for the Toll Road.  Thus, privatizing the road left the public with less protection and with its needs for safety not being taken into consideration, despite the requirements of the Toll Road lease.

The article is titled, Crumbling Infrastructure, Crumbling Democracy:  Infrastructure Privatization Contracts and their Effects on State and Local Governance:  Here’s the abstract:

Key arguments for privatizing public infrastructure range from providing money so cash-strapped governments can fix crumbling infrastructure and build much needed new infrastructure to shifting future financial risk from the public to a private contractor.  The reality, though, is far different.  Provisions commonly found in infrastructure privatization contracts make the public the guarantor of private contractors’ expected revenues.  Indeed, were it not for provisions that protect contractors from diminution of their expected returns, the contracts would be far shorter and much less complex.  An effect of those contract provisions is to give private contractors a quasi-governmental status with power over new laws, judicial decisions, propositions voted on by the public, and other government actions that a contractor claims will affect toll roads and revenues.  Giving private contractors such a role may well violate the non-delegation doctrine that bars private entities from exercising power that is inherently governmental.   

This Article examines the operation and effects of three provisions that are commonly found in infrastructure contracts: (1) compensation events; (2) noncompetition provisions; and (3) the contractor’s right to object to and receive compensation for legislative, administrative, and judicial decisions.  The operation of these provisions gives private contractors power over decisions that affect the public interest and are normally made by public officials and subject to oversight, disclosure, and accountability—none of which apply to private contractors.  The existence and operation of these provisions have gone virtually unexamined and undiscussed.  Rather, discussions about infrastructure privatization have been narrowly focused on tolls, reflexive pro- or anti- private or public provisions, and spending or investment decisions on up-front payments. 

 Finally, this Article places infrastructure privatization in the larger context of funding and building infrastructure for the future.  It identifies and critiques substantive and procedural issues that must be resolved if we are to have the high quality infrastructure necessary to meet this nation’s needs and further its goals and if we are to achieve those goals by an open and democratic process

Water News

MCall article on a deal in the works for the City of Bethlehem to take over the East Allen Township municipal water system.

The Cost of Compromise – Federal Budget Roundup

Last week, Americans had the privilege of enjoying a live broadcast as the 112th Congress presented its latest round of political theater. As the clock ticked closer to a government shutdown, it started to feel as if the split-party Congress had zero chance of reaching a budget agreement. For the entire long and painful first act, we watched, read, and listened as politicians from both sides of the aisle threw blame at each other harder than any pitcher hurled a fastball on opening weekend. Neither side could agree on terms: House Majority Leader John Boehner struggled to balance the demands of the Tea Party and the less-rabid members of his party, while the Democrats fought to use their remaining powers of control to counter attacks on social policies wholly unrelated to fiscal conservation. Meanwhile, President Obama was left sounding like the disappointed father of two bickering children, pleading with them to just share the crummy plastic toys.

But late Friday night, with less than two hours left before the shutdown, the curtain closed for intermission when a deal was finally reached (although according to today’s NY Times, the agreement may be at risk). This news was certainly welcome to government workers, families of soldiers, homebuyers, visitors to national parks, and countless others. However, the details of the deal were not immediately known. All that was announced was that cuts to federal spending for the rest of fiscal year 2011 (through this September) will total around $39 billion — more than the $33 billion the Democrats proposed in their original compromise, but less than the $61 billion called for by the GOP-controlled House, or the staggering $100 billion screamed for by the most vocal of the Tea Party. The suspense was palpable, a perfect cliff hanger for the second act.

On Monday, Act II began as the specifics of the compromise bill started to trickle out. The entire bill is far too lengthy to discuss on Crossroads, but here are the areas of the most importance to RenewLV and the smart growth community.

Please note: information is still a tad bit sketchy, and specifics may change by the time the bill is fully passed. Every effort has been made to check all information against the House’s and Senate’s Appropriation Committee’s multiple press releases, all dated Monday, 4/11 and Tuesday, 4/12.

Housing and Urban Development

This one hurts, folks. The  Department of HUD suffered a host of brutal cuts, including a $942 million cut to HUD’s community development fund. Additionally, there is a 16% ($650 million) cut to the Community Development Block Grant, a 33% ($50 million) reduction to the Sustainable Communities Initiative, and a 19% ($456 million) cut to the public housing capital fund. Fortunately, there is a piece of great news to take the edge off: the Community Services Block Grant (CSBG; see below for more information), which stood to lose almost one-third of its funding ($285 million), will only be cut by $20 million. Even that (relatively) small amount can do harm, but we certainly can be thankful that the originally proposed cut did not come to fruition.


The Environmental Protection Agency: Although the EPA’s total budget is decreased by a painful $1.6 billion (16%) from last year, it could be worse. Last week’s GOP attempts to reverse various climate regulations and block the EPA’s ability to create rules on global warming were successfully defeated.

Conservation: The budget deal represents a 12% cut to the National Resources Conservation Service, including a tough 55% cut to the Watershed Rehabilitation program. Land and Water Conservation Fund (land acquisition) programs are cut by 33% ($149 million).


Public Health: Thankfully, good news on this front. While there are various cuts to health care programs, reductions to many public and community health initiatives have been avoided. The Prevention and Public Health Fund (discussed in this Crossroads post) was untouched, despite a $750 million cut proposed by the GOP. However, the CDC’s budget was cut by 9%.

Food and Drug Administration: Although the Food Safety and Inspection Service’s funding decreases by 1%, The FDA’s FY 2011 budget actually sees a 4% increase over last year. As the Senate press release points out, “this funding level will allow the FDA to begin implementation of the recently passed Food Safety Modernization Act.”


Compared with 2010, there is a $900 million cut to transit spending. Additionally, President Obama’s proposed high-speed rail system faces a $1.5 billion cut for FY 2011, while about $400 million in last year’s funds were rescinded. This leaves $1 billion for this year.


The President’s “Race to the Top” program escaped cuts, but the Pell Grant program has been trimmed – grants can no longer be used for summer school.

While I am grateful that the draconian $61 billion in spending cuts from H.R. 1 did not pass, the cuts in this budget compromise are still, in simple terms, brutal. In fact, the cuts are the largest in U.S. history. I am particularly happy about the survival of the Community Service Block Grant, but even that relatively small reduction, combined with the other cuts to HUD, have the potential to do great harm.

I wrote about potential reductions to the CSBG and CDBG back in February, after President Obama announced his original budget proposal. The community service grants represent a significant source of funding to organizations such as the Community Action Committee of the Lehigh Valley (CACLV), which are crucial to job creation and economic development. I don’t think that anyone, left or right, would disagree with me in saying that unnecessary spending must be reduced in order to close the federal deficit. However, cuts that come at the expense of vulnerable citizens and actually hurt the economy, such as those to community development and transportation programs (which have the potential to create a multitude of jobs and stimulate the economy), are just plain foolish.

County Health Rankings Across Pennsylvania

When the annual County Health Rankings were released late last month, the Morning Call, Express Times and Patch reported on the very high morbidity numbers in Northampton County and Lehigh County. Meanwhile, these county rankings received coverage that looked at how other parts of the state were faring as well. Union County was ranked the highest [Check out WNEP news for more info] and Philadelphia was ranked the least in regards to health outcomes and health factors [Here’s the link]. Closer to home, both Montgomery and Bucks Counties ranked in the top 10 of Pennsylvania counties in terms of overall health [Here’s the link here for article].

Generally, the rankings showed that counties located in south and central Pennsylvania performed better than did counties in the northeast and northwest. Also, more of the urban counties are ranked in top half than the rural counties — this using the definitions of “urban” and “rural” developed by the Center for Rural Pennsylvania (The Center defines rural vs. urban Pennsylvania based on population density).

Amid these overall regional trends, in some cases the rankings show significant differences even among neighboring counties. Consider the area to the north of Harrisburg, where Union and Snyder Counties both are amongst the top five counties statewide in overall health, while adjacent Northumberland County is ranked in lower one-third. The factors that contribute to such great disparities among neighboring counties would lend itself to further analysis that could shed light on the local conditions that contribute to – or stand in the way of – good health. (As a side note: For an interesting resource on county-level conditions across economics, demographics, and other areas, check out Patchwork Nation – an interactive data site.)

While considering how Pennsylvania counties fare among themselves, it is important to look at where Pennsylvania stands nationally on support for public health. Public health infrastructure in Pennsylvania clearly lags that in others. For its population size, Pennsylvania has the lowest number of public health professionals. Also, according to a study released last month, public health spending in Pennsylvania is very low itself. Here’s the link.

Ultimately, failing to adequate support public health is a short-sighted policy and an unwise investment of public dollars. As noted in the local coverage of the county health rankings [Patch article], we either invest upfront in public health and prevention or we spend far more on what it takes to address illness and injury after they occur.

What is impressive and valuable about the County Health Rankings is not only the numbers themselves, but the huge potential to use these data to improve the health of our communities. Look here to see how people can take action. Patrick Remington, who is the University of Wisconsin Professor and has lead the County Health Rankings report, remarks that the County Health Rankings report is a teaser to catch interest. The point is get people to take some action towards the health of their community.

The current work on establishing a regional health department for the Lehigh Valley represents an important step toward building a strong system of prevention and health promotion for our region. For more information on this effort, visit RenewLV’s Regional Health Initiative page.

Study: Consumers Want Smart Growth

Some good news for smart growth advocates: a new report released by the National Association of Realtors indicates that Americans favor mixed-use walkable neighborhoods over those that necessitate more driving. More than three-quarters of those surveyed for the report said they would look for neighborhoods with pedestrian-friendly infrastructure, and half of the respondents stated that they would prefer to see improvements to existing public transportation over new road construction.

Furthermore, the survey indicates that while most Americans would prefer to live in detached single-family homes (generally for privacy reasons), they would “choose a smaller home and smaller lot if it would keep their commute time to 20 minutes or less.” This result is highly significant: Americans place such a high value on walkable neighborhoods with shops, restaurants, and local businesses that they would be willing to sacrifice home size.

Smart Growth America’s discussion on the report quotes Chris Leinberger, President of LOCUS: Responsible Real Estate Developers and Investors, as saying “NAR’s survey reveals what many real estate developers are seeing across the country: smart growth strategies are the best way to meet market demand for walkable neighborhoods with shorter commutes, diverse housing options and transportation choices. Demographic shifts in the United States along with the changing consumer preferences highlighted in NAR’s survey illustrate that consumers want neighborhoods with more walkable housing and transportation choices.”

This study is a reminder of a major economic benefit of smart growth. Americans’ desire for mixed use walkable communities can contribute to a rise in property values in neighborhoods that meet this demand. This, of course, is in addition to the many other advantages of smart growth practices, including benefits to the environment, public health, and local businesses.

County Health Ranking And What It Means For Us

A new report released by County Health Ranking (CHR) reveals that morbidity numbers are shockingly low in Lehigh County (37 out of 67) and Northampton County (60 out of 67).

Morbidity is a term that refers how healthy people feel in the community while alive. Morbidity numbers capture the Health-related quality of life (HRQoL) and Birth Outcomes within the community. The measures used to assess the HRQoL of the population were self-reported health and number of physically and mentally unhealthy days per month. Birth Outcome was measured using low birth weight (LBW) that represents child’s current and future morbidity.

Lehigh County of Pennsylvania has slipped in overall county health rankings from a ranking of 19 in 2010 to 27 rank in 2011. In regards to morbidity numbers, age-adjusted numbers of poor physically unhealthy days reported in past 30 days have gone up as compared to 2010 numbers and 2 points higher than the average state numbers (3.7 in 2011; 3.5 in 2010; PA rates of 3.5 in 2011). There were no changes in the reported low-birth weight percentages as compared to last year percentages (8.3%); however state percentages were still better at 8.2%. Northampton county, too, has slipped from last year overall ranking of 26 to current ranking of 27 primarily due to increase in morbidity rates. Even though there were no changes in age-adjusted numbers of adults reporting poor health and low-birth weight percent this year from last year numbers (Poor or fair health at 16% in 2010 and 2011; Low birth weight at 8.7% in 2010 and 2011), average number of physically unhealthy days and mentally unhealthy days reported have increased (poor physical health days 3.7 in 2011 and 3.6 in 2010, and poor mental health days 3.8 in 2011 and 3.6 in 2010). Poor mental health days were comparable to state last year; however, this year the numbers are more than the state average.

The above rankings, based on model of population health, clearly depict the need of public health prevention efforts in order to make the community a healthier place to live, work, and play. Apart from morbidity numbers, the report ranks mortality and health factors including healthy behaviors, clinical care, socio-economic factors, & physical environment. Crossroads will be reporting more on CHR in the coming weeks as it has implications on improvement of public health infrastructure in Lehigh and Northampton County.