Health Policy

Healthcare’s Million Dollar Blocks

By KIM BELLARD

Since I first heard about them, I have been fascinated, and dismayed, by the concept of “million dollar blocks.”  For those of you unfamiliar with the term, it doesn’t refer to, say, Beverly Hills,  Chicago’s Gold Coast, or Manhattan’s Hudson Yards — areas where the wealthy congregate.  No, it refers to city blocks for which society spends over a million dollars annually to incarcerate residents of that block.

I, of course, have to think about the healthcare parallels.

The concept dates back many years, credited to Eric Cadora, now at Justice Mapping, and Laura Kurgan, a professor of architecture at Columbia University, where she is the Director of the Center for Spatial Research (CSR).  The power of the concept is to use data visualization to illustrate the problem. 

Here, for example, is CSR’s map of Brooklyn for prison spending:

CSR describes the findings as follows:

The maps suggest that the criminal justice system has become the predominant government institution in these communities and that public investment in this system has resulted in significant costs to other elements of our civic infrastructure — education, housing, health, and family. Prisons and jails form the distant exostructure of many American cities today.

Think about that: “criminal justice is the predominant government institution in these communities.”  Something is wrong with that picture – not theirs, but, rather, the picture of our society that it presents.

Mr. Cadora told NPR in 2012:

No one had ever actually sat down and gotten the home street address of everyone going into prison and jail, as well as all the background information about their age and their employment status, etc. And when you have all that data, it tells you a lot about what’s going on on the block.

In all honesty, what we mapped was not a big surprise to people. But when you actually gather the real data … on maps, [it becomes] immediately understandable to people who didn’t see it — like legislators, city council people, researchers.

No, not a big surprise, not to most people.  We know we spend lots of money on criminal justice; we just don’t always realize how we spend it.  We’ve long had the dubious distinction of locking up more people – in total and per capita – than any other country. 

But if, as they say, a picture is worth a thousand words, then perhaps data visualization is worth a million dollars.  Even hardened criminal justice advocates have to blanche at how spending is so often concentrated in certain blocks, and should wonder if perhaps there are better ways to use that money for them.

CSR has a variety of projects in addition to their criminal justice work, including some focused on healthcare.  Earlier this year, for example, they created an interactive vaccine allocation map to help guide decisions about allocating then-scarce COVID-19 vaccines, and late last year their New Politics of Care project used an interactive map to highlight existing areas of health care needs.  They proposed a New Deal for Public Health, with a million new community health workers deployed around the country based on the identified needs.  

Kim is a former emarketing exec at a major Blues plan, editor of the late & lamented Tincture.io, and now regular THCB contributor.

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  1. We normally think of collective action as a cluster of social interactions that exists to produce a positive common good. Unfortunately, there is nothing inherently guaranteed that the human social interactions associated with a collective action strategy will necessarily achieve a decrease in human suffering. I offer my own definition of collective action as an example.

    COLLECTIVE ACTION may be defined as “a social interaction involving a cluster of three or more persons who collaborate with variably sufficient social capital and congruent ethnography to change the beneficence and autonomy of their cluster or another cluster by
    *) establishing a visioning statement that defines the short-term and long-term measurable goals of the cluster’s collaboration;
    *) preparing an action plan to achieve the cluster’s visioning statement including, if applicable, the special provisions for managing a common-pool resource; and
    *) delegating the specific responsibilities for implementing the visioning statement to either one or more-than-one of the following options: a) the cluster itself, b) another cluster of persons, or c) an institution chosen by the cluster.

    Within neighborhoods, the generational destruction of family units by the collective action of meso social networks then inexorably destroys a person’s family-originating maturation from a dependent person to an independent person. Meanwhile, the affected neighborhoods are left to become increasingly dysfunctional by their community’s decline in social cohesion. The result, yes, has become measurable most clearly by incarceration and our nation’s worsening health spending.

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