The current economic recovery effort presents an opportunity to build stronger, healthier communities. That’s a central goal for the Create Jobs for USA Fund that Opportunity Finance Network (OFN) and Starbucks launched late last year to support job creation and retention.
Economic growth and job creation provide more than income and the ability to afford health insurance and medical care. They also enable us to live in safer homes and neighborhoods, buy healthier food, have more leisure time for physical activity, and experience less health-harming stress. The research clearly shows that health starts in our homes and communities and not in the doctor’s office.
In that way, economic policy is, in fact, health policy.
Since 1985, OFN’s national network of community development financial institutions (CDFIs) has loaned more than $23 billion to benefit low-income, low-wealth, and other disadvantaged communities. The Robert Wood Johnson Foundation (RWJF), with an endowment of around $8.5 billion, is the nation’s largest philanthropy focused solely on improving health and health care for all Americans. Marrying the business acumen of CDFIs and others to health philanthropy’s ability to supply the research, analysis, and expertise to make sure community development activities improve residents’ health is a powerful union.
Working together, we can leverage our individual strengths and have a greater impact on improving the health of communities and the people who live in them.
Across the nation, similar cross-sector collaborations are forming around this sort of community health innovation among groups as diverse as the Federal Reserve System, the John D. and Catherine T. MacArthur Foundation, the Kresge Foundation, Bank of America, the U.S. Department of Housing and Urban Development, and Living Cities. While these alliances may seem unlikely, the vibrant U.S. network of real estate developers, banks, philanthropies, public entities, and nonprofit groups focused on community development have worked for many years on parallel but separate tracks to improve the lives of low-income people.
These sectors have been working side by side – in Los Angeles, for example, public health has focused on childhood obesity in the same neighborhoods where the community development sector has been working to reduce economic hardship. Until recently, we have not been working together.
But this is changing.
The Healthy Food Financing Initiative, a partnership between the Community Development Financial Institutions Fund in the U.S. Treasury Department and the U.S. Departments of Agriculture and Health and Human Services, is investing $500 million annually to subsidize grocery stores in low-income neighborhoods. This increases access to healthier foods, creates jobs and these stores are profitable. Win-win-win.
Additionally – and perhaps as a surprise to the health sector – a growing focus of CDFI financing is community-based health care, including both physical and mental health. Primary Care Development Corporation, based in New York City, has pioneered a model combining finance and technical assistance to improve access to care and quality of care in low-wealth communities. IFF, a nonprofit lender and consultant headquartered in Chicago and working across the Midwest, has helped nonprofit health care providers increase capacity by more than 160,000 patient visits.
The goal for both the health sector and for CDFIs is to make the healthy choice the easy choice. CDFIs have a long history of collaboration with local residents, which increases their input into decisions about which projects happen and boosts community support for local development projects.
One example is Market Creek Plaza, a $23.5 million real estate development project in what was once one of the most distressed and dangerous communities in San Diego. Developed by the Jacobs Foundation and Clearinghouse CDFI, Market Creek Plaza was designed, built – 70 percent of the construction was conducted by local minority-owned businesses – and is now owned by community residents. It has brought together affordable housing, healthy food, a community center and jobs for community residents that include living wages, health insurance and pension plans. This is just one instance of CDFIs working to improve neighborhood conditions, create jobs and increase opportunities to be healthy.
These collaborations also make fiscal sense since improving low-income communities yields both health and economic benefits. An unhealthy workforce adds to health care costs and also is less productive. The work so far is encouraging, but we need to do more. We need to recognize that income security and economic opportunities lead to a healthier, more productive workforce and reduced health care costs, which in turn, leads to a stronger economy.
The end goal? Create and sustain job growth across the country. Improve communities. Improve health. Give people the opportunities to make smart, healthy decisions so that they can act in the best interests of their communities, themselves, and future generations.
Mark Pinsky is president and CEO of Opportunity Finance Network, and Risa Lavizzo-Mourey, M.D., M.B.A., president and CEO of the Robert Wood Johnson Foundation.
Oh, I think it was clear enough. Yes, there are a lot of costs that come about as a result of allopathic care and iatrogenic health problems – but the far greater danger, economically, environmentally and socially is a large increase in population brought about by precisely the wellness approach you describe.
Worse still, as well as increasing the population dramatically, increasing the dependency ratio, and using up resources even faster, all these “well” people are still going to age. We don’t have a way of eliminating the problems associated with old age and worn out body parts. At best you can push these back in time and defer costs, but eventually even the weight-lifters, bike-riders,, organic food eaters will reach the limits of the benefits of such lifestyle modifications.
Instead of being 70-80 and having to replace heart valves they may be 80-90. Maybe they will buy another 5-10 years before starting on anti-hypertensives. But there is nothing that points to people living an extra 10-12 years of perfect health and then simply dying.
It isn’t that I don’t like the concept. Far from it. I just don’t think we ought to be selling wellness as a solution to health care cost problems because over the last 50 years this has certainly not been true and it is unlikely to be true during the next 50 years.
Advocate it because people may feel better, live longer, enjoy good health longer – anything but that it will save money.
Sorry for the long delayed response.
I think you may have missed the point of my comment as you are really suggesting that we do more of the same.
The core of any country’s economic activity must be the creation of material wealth. The more wealth produced the more benefits can ultimately be provided to the population. Spending on health rarely increases material wealth. It may be desirable – but one ought not confuse desirability with utility.
As to holistic health care – There are some opportunities in holistic health but they tend to be drowned out by the tsunami of useless holistic health services. Truth is there is little more than anecdotal successes for most holistic health approaches. Crystal therapists think they are bestowing health on their clients. Reiki providers feel the same. But there is little definitive evidence that either of these approaches results in any improvement in the health or well being of clients.
Mr. Cox is correct that more people are living longer and dying with more complex conditions, that this is an expensive scenario for the future, and that our current system of healthcare, especially its prevention, plays a significant role in what is happening.
My earlier post was not clear enough. What we need is a fundamental change in the medical system itself, in its technologies and allopathic approach to disease, including its prevention programs.
Treatment of symptoms with diagnostics and therapies that override or damage the body’s innate healing response can only lead to side-effects that require more and more care, which leads to managing disease rather than healing it. In my view this is the core of rising costs.
Without a shift away from allopathic care and toward wellness, a shift that is interconnected with why the body becomes sick, nothing can change this path we are on: not the restructuring of insurance programs, not new symptom-focused treatments, and not even commendable collaborations for healthier communities and more jobs as Dr. Lavizzo-Mourey and Mark Pinsky pointed to in their initial article.
We must refocus our system on healing rather than managing chronic disease, and this requires a fundamentally different approach to both prevention and care.
For example, both Functional and Bioenergetic Medicine practitioners honor and work with the body’s self-healing properties. Their technologies are capable of identifying root causes, of helping patients understand how they became sick, and of creating both treatment protocols and action plans for lifestyle change.
As informed patients, who are also consumers, take their health needs into the marketplace, everything changes: business must consider the health impacts of its goods and services; rural economies revive as food becomes fresh and local again; city neighborhoods respond to urban agriculture and the sense of community it grows; healthcare contributes to the economy as the green industry it can be when therapists and patients are focused on healing.
This scenario is not theory, nor is it anecdotal. It is extrapolation from what has been a steadily increasing market for sustainably grown foods, natural lifestyle products and holistic healthcare for decades.
Wellness already generates economic wealth, spread at the state and community levels among entrepreneurs like practitioners, makers of medicinals, farmers, artisan food producers, crafters of healthy goods of all kinds, and others. This is not massive globalized wealth of pharmaceuticals or agribusiness, but neither is it taking us down the path of unsustainable healthcare costs. In this scenario, played out into the future, death comes with more dignity and less a high price tag.
Healthcare is a growing segment of our economy and is even being viewed as an economic development strategy, but is it sustainable to base growth on poor health?
Wellness can be a development strategy too, and the more capable our health practitioners become at telling us why we are sick and what to do to heal, the more successful “wellness as development” will be. Conventional healthcare, even with its prevention programs, cannot do this.
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I find some measure of agreement with Mr. Cox’s argument. My suggestions are two and simple: 1) consider placing health at the center of economic development policy and use it to guide the type of development/business activity that is sought, perhaps doing HIAs (Health Impact Assessments) as part of the process. Too often we have sacrificed health for job creation in accepting whatever industry wanted to produce and however they chose to produce it leading to environmental and worker health consequences; 2) our current model of health care (and what insurance pays for) is often suppressive in its effects on the body and thus contributes to chronic disease over time. A great wealth of information and therapies are now available in holistic health care which are, unfortunately, not being put to the good use in reducing health care costs in the short or long term.
The achievement of laudable goals is often the parent of despicable consequences.
In the 1960s we had few preventive health programs, the social security trust funds were solvent, the contributions relatively low, health insurance premiums were also relatively low, few high tech medical interventions were available, most of thes small number of people who lived long enough to collect social security, medicare, and other retirement benefits died with 2-5 years.
Since the 1960s we have expanded our health prevention programs, producing an arguably healthier, but most certainly older and more chronically ill population. Many retirees live for decades, not years, drawing pensions for far longer than anticipated in the best actuarial forecasts of 20-30 years ago.
We have more high tech, more expensive, and more protracted demands for health care services by people who live long enough to survive multiple bouts with cancer, heart disease, bone and tissue damage, and we still have the deferred costs of dying that will eventually be borne in the last months of life.
The success and most certainly the cumulative long term costs of preventive health care which we/are supposed to reduce overall costs have been and will continue to be abject failures from a population perspective despite the delight we take in extolling the benefits for selected individuals and communities.
Our increasingly elderly and costlier success stories raise the dependency ratio, leading to higher costs for labor, higher production costs for goods and services, as smaller numbers of workers struggle to support themselves, their families, their parents and in some cases their grandparents.
As a result, we become less and less competitive vis-a-vis other countries which are not investing in preventive health and not incurring costs as high as ours.
If we continue to succeed at the pace we have in the last 50 years during the next 1-2 decades we will, as a country, be poorer, weaker, and unhealthier than we were in the 1960s.
Prevention does not reduce the interest and mortality discounted future costs – it merely pushes back the time at which we pay.
To fully evaluate the benefits of prevention programs we need to understand and account for all the consequences, not just the desirable short term gains of cheating death and debility for specific individuals and targeted sub-populations, but the total costs for our prevention activities, the costs for the services that these individuals and targeted sub-populations would never have incurred except for our intervention, and how these costs are going to be managed by parents, children, extended families, communities, and our country.
Preventing further misjudgments and miscalculations might be a good first step toward a long term program of financial solvency and sustainable operations for our failing health care (finance) systems.