The Federal Reserve Wants to Rebuild Main Street

We all have a vision of the “Main Street” we would like to live near – tree-lined, friendly and safe. But our “Main Streets” are in disrepair. Across the country, they lack sidewalks, parks, well-stocked grocery stores with fresh food, healthy homes and apartments, and convenient public transportation. And it turns out, these things add up to a lot more than just an unpleasant place to live – they can have a major impact on our health.

There has been much in the news about the costs of medical care and our current and future economic competitiveness because of those costs. But little has been done as a nation to see if we can reduce the amount of disease we have to treat.

On Main Street in America, a woman with diabetes – perhaps one who is newly insured under health reform – will see her doctor, who after telling her what medications and tests she needs, will tell her to improve her diet and be more physically active. But what if she returns home, to a neighborhood that makes following the doctor’s advice nearly impossible because there is no supermarket with fresh food like in Detroit, where there are only 5 grocery stores for a city of 139 sq. miles?

Or, what if her neighborhood is unsafe, rundown and a bad place to walk? Her diabetes will be less well controlled, complications will occur earlier, hospitalizations be more frequent. Her care will become more costly, all from factors outside the capability of medical care.

To show how important things like this can be, you only have to look at two communities a few miles apart. In Washington, D.C., residents of one inner-city neighborhood die nearly a decade younger than people who live just a few miles and 17 stops away at the end of the Metro line.

On the D.C. Metro’s Red Line, there’s a 9-year difference in life span between Union Station and Shady Grove in Montgomery County, Md. View full map.

Last month, our organizations, the Community Affairs Function at the Federal Reserve and the Robert Wood Johnson Foundation, formed a unique partnership with a common goal: to make the places we live healthier.

Together, we convened leaders in public health, finance, housing and community development to meet, share what’s working, learn from each other, and collaborate on the issues facing our neighborhoods and communities.

For many who walked into the room, it was the first conference where they did not know everyone already.

The Federal Reserve, which works to strengthen communities with better housing and increased economic opportunity, heard how its investments have important health effects that could increase with careful planning. The public health community gained a better understanding of how investments from outside the health sector can significantly contribute to better health. Real progress was made in connecting groups from across sectors, and having many diverse perspectives in the room was essential.

As U.S. Health and Human Services Assistant Secretary Howard Koh so aptly put it, “Health is too important to be left to the health sector alone.”

For banks and community developers, whose capital finances everything from small businesses and apartments to charter schools and day-care centers, this means thinking about themselves as long-term equity investors in both the human and physical capital of communities, not just as short-term lenders in a series of one-off projects. Community development finance is adept at taking innovative local ideas – like affordable housing with wrap-around health services for formerly homeless residents and mobile fresh produce carts – and finding ways to grow those efforts into full-scale solutions for improving our nation’s health. As the Berkeley epidemiologist Len Syme said, “those who design our living environments are some of the most important public health workers of our time.”

For foundations, this means scouting for innovations like the Fresh Food Financing Initiative to eliminate food deserts, testing and evaluating, and developing tools like Health Impact Assessments to help community developers make their targeted investments have the highest probability for success.

For the federal government, this means collaborating across agencies – HUD, HHS, EPA, Transportation, Energy, Labor – and using their power as a convener, funder and evaluator to find what’s working and bring it to scale.

The Federal Reserve will broaden its discussions on these topics and will hold its first regional health and community development conference at its branch in Los Angeles in September.

Beyond Health Care:New Directions to a Healthier America: Recommendations From the Robert Wood Johnson Foundation Commission to Build a Healthier America.

For all of us gathered last month, including leaders from public health, community development and finance, the energy and sense of common purpose was exciting. And, it put in perspective what could happen with initiatives like Promise Neighborhoods, the First Lady’s Let’s Move campaign to combat obesity and the EPA/DOT/HUD partnership to promote livable communities.

Many described this meeting as “The Moment” – when community development, philanthropy, public health, and federal government are all understood that they had to work together to achieve their goals improve the livability, economic vigor and physical and fiscal health of our communities. For the Robert Wood Johnson Foundation, it was an inspiring outcome of our work on the Commission to Build a Healthier America, which called for exactly this type of collaboration in it its recommendations last year.

So what’s next?

Those with the dollars – banks, government, philanthropy and other investors – most often ask in their own lingo, “Is this program proven to work based on evidence and data?” or “What’s the return on investment?” We have spent years asking these questions, and both the Robert Wood Johnson Foundation and the Federal Reserve have rigorous evaluation mechanisms in place.

But imperfect science should not be a barrier to action. There’s too much need right now to wait for the perfect evidence. As Ron Sims, deputy secretary of the U.S. Department of Housing and Urban Development, put it, “Good works if it saves lives; good works if it saves futures. Is it an experiment? It’s a wonderful experiment!”

With so much at stake, we need to learn along the way and measure and evaluate everything we can to strengthen our efforts and invest wisely.

But now is time to act, and what we’ve seen and heard tells us that we’re ready to move beyond talk to change. The way forward includes more intentional collaboration between community development, finance and public health to improve the places we live, learn, work and play. We can no longer allow some neighborhoods to win and some to lose.

It’s time to rebuild Main Street as a healthier place for us all to live.

For more on the event, read the recently published journal from the Federal Reserve Bank of San Francisco that was the impetus for this conference, visit the conference website, and follow the discussion on Twitter at #FedHealth.

David J. Erickson, Ph.D., is Director of the Center for Community Development Investments at the Federal Reserve Bank of San Francisco and edits the Federal Reserve journal "Community Development Investment Review." Dr. Erickson recently published a book on the history of community development–Housing Policy Revolution: Networks and Neighborhoods. The views represented here are his own and do not represent the views of the Federal Reserve.

Dr. James S. Marks, M.D., M.P.H., is Senior Vice-President at the Robert Wood Johnson Foundation and Director of the Foundation’s Health Group. Dr. Marks oversees all of the Foundation’s work in childhood obesity, public health and vulnerable populations. Prior to RWJF, Dr. Marks was Assistant Surgeon General and Director of CDC’s National Center for Chronic Disease Prevention and Health Promotion.

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MGreen, BSNAlethia CarrDavid R WilliamsTom LeithGary Lampman Recent comment authors
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MGreen, BSN
MGreen, BSN

This is a travesty. Any of the central banks’ personnel should be ON THEIR KNEES working in these cities. It is the fault of the central banks that our economy is, as it is. They are desperate and this is a PR stunt. The (NOT) Federal (NO) Reserve bank STINKS to high heaven. People are poor/bankrupt because of them, and people like Rothschild are stinkin’ rich. Go figure. This is horrifying.

Alethia Carr
Alethia Carr

This initiative is a good first step. Now let’s look at how to transform the funding streams so they weave across the many areas that work together to improve health. The way the money flows will guide the conversations as well. While doing that, let’s be sure to include the diverse populations that are often most adversely affected by our current system. A glance at the disparate health outcomes of African Americans and often Native Americans shouts who else should be at the table as we determine the changes needed to improve neighborhoods to help improve health for all.

David R Williams
David R Williams

The kind of innovative thinking reflected by this initiative of the Fed and RWJ is essential to the future economic prosperity of our nation. The scientific evidence is clear that where we live, learn, work, play and worship can have a greater impact on how long and how well we live than medical care. And a healthy workforce is a productive workforce! Se we do need a new national conversation that includes groups that have not worked together in the past to see how we can ensure that all Americans have the opportunity to make the choices that will allow… Read more »

Tom Leith
Tom Leith

When the Central Bank (or Congress) begins to create debt-free money and make sure it is widely distributed, I might be more inclined to believe the it wants to build anything.


“How about eliminating Fast Food and require restruants to provide safe ballanced foods.”
Gary, I do think that gets way too close to John’s “central planning”. We still have a somewhat free market (less the bailouts) so I think the best way would be to recognize what corporate practices contribute to society’s costs then tax those harmful things to pay for it. Junk food, even though a pollutant and contaminate, shouldn’t be banned. We can also stop giving subsidies to corn and transfer them to fresh fruit and vegetables.

Gary Lampman
Gary Lampman

How about eliminating Fast Food and require restruants to provide safe ballanced foods.Let make Corporate America accountable for putting people at High Risk from poor judgement,loose policies and corrupted ethics. Much of what happens to the Health of Individuals is not only the responsibility of Individuals Only! Contrary to narrow minded popular beliefs. Corporations who willfully put profits over Health are to blame as well.For decades ,Corporations have bought their way and lobbied to be insulated from all accountability. Our food supply ,process plants,beverage companies and Farms are knowingly and wellfully putting the Public at risk.FDA is turning a blind… Read more »

Doug Loescher

The National Trust Main Street Center applauds this type of out-of-agency thinking and commends you for investigating ways to close the gap among community development, finance, and public health. For 30 years, we have been working to promote smart growth, spur small business development, and create more livable communities through community revitalization. Today, we have more than 1200 downtown revitalization organizations using our Main Street Four-Point Approach(r) in the US. These volunteer-driven organizations are rebuilding their hometowns by making them pedestrian friendly, revinvesting in existing buildings and infrastructure, boosting tax revenue for the local economy. If you want to know… Read more »


“But what if she returns home, to a neighborhood that makes following the doctor’s advice nearly impossible because there is no supermarket with fresh food like in Detroit, where there are only 5 grocery stores for a city of 139 sq. miles?” “To show how important things like this can be, you only have to look at two communities a few miles apart. In Washington, D.C., residents of one inner-city neighborhood die nearly a decade younger than people who live just a few miles and 17 stops away at the end of the Metro line.” “On the D.C. Metro’s Red… Read more »

John R. Graham

Please Dr. Erickson and Dr. Marks! I have seldom seen the fatal conceit of central planning expressed with such cold abandon by professional men.
Through ObamaCare, the federal government will control my access to medical services. Now you want the Fed (which is the world’s largest and most reckless hedge fund, choking on junk mortgages) to control the levers as well!