Healthy Cities ‘Take an Entire Community’
To make a population healthier, “it takes an entire community across the various sectors, because health is beyond just health care,” said Sue Siegel, chief executive officer of GE Ventures and healthymagination, at the Dean’s Symposium “Building Healthy Cities: Boston and Beyond,” held at the School of Public Health on March 5.
The event was co-hosted by GE healthymagination, the company’s initiative to support health innovations around the world. Coming a year after GE moved its headquarters to Boston, the discussion brought together leaders in health across private and public sectors to explore new, collaborative ways to make cities healthier.
The day’s discussions focused on cities as concentrated centers of both inequity and opportunity—leading the way in healthcare innovations even as they struggle to break down silos in order to provide health access to all.
“We’re not data historians,” said Monica Valdes Lupi (’99), executive director of the Boston Public Health Commission. “We should use the data that we have for action—liberate that data and share it with our community members.”
Boston is one of the country’s most walkable and active cities, Valdes Lupi said, with an uninsured rate less than half the national average, and a massive network of world-class hospitals and health centers. Still, “there are also things that we’re not very proud of,” she said. “We are ranked first in income inequality according to the Brookings Institute—we beat out Atlanta, New York City, and San Francisco. About one-third of our residents live in poverty, and one in five of our kids live in poverty.”
Inequality, Valdes Lupi said, also means health disparity, with rates of diseases from diabetes to asthma to depression markedly higher in neighborhoods with lower incomes and education levels. “So much of what influences a community’s health happens outside of the clinic walls,” she said.
The city is already doing a great deal of work to level the playing field, she said, from making neighborhoods safer and more walkable to making healthy food more available. That work takes data to pinpoint issues and solutions, “and unfortunately some of our surveillance systems at the public health level are not as nimble and agile as those in the private sector. Events like today and the work that we’ll be doing in partnership with GE provide a tremendous amount of opportunity for us as a city to advance our work,” she said. “We’re all in this battle together.”
To reshape cities as environments that promote better health, the speakers all stressed the need to engage across sectors, applying the resources and creativity of businesses to the problems cities face.
Siegel described how GE began to take interest in improving health on the scale of cities. In 2009, GE’s spending as a self-insuring company was unsustainable. Rather than waiting for state or federal government to come up with a solution, however, GE decided to see if it, as a large, self-insured employer, could work with cities to drive changes that would make the population healthier. “We started with Cincinnati, where we are one of the biggest employers because of our aviation unit there,” she said. The program soon expanded to other cities where GE employees make up a large segment of the population: Erie, Pennsylvania; Louisville, Kentucky; and, most recently, Houston, Texas.
As part of moving its headquarters to Boston, Siegel said, “one of the things GE committed to was investing about $50 million in the city of Boston for education and health.” The city told GE a major area to direct efforts should be opioid addiction, she said, “so the GE Foundation has been working with the city of Boston to address this, in what hopefully will be an experiment for the country.”
Siegel urged using cities as laboratories, to test innovations in miniature, “but also effectively show success, and then scale it up” to national or even international levels, she said.
Flexibility has to be central to any collaboration in this area, said Jennifer Edwards, director of Developing Health US at the GE Foundation. When it moved to Boston last year, GE was “the new kid on the block,” she said, “but we had experience working in community health and underrepresented populations, so we came in with an idea.” After meeting with stakeholders throughout the city, from health care to academia to other funders, she said it was clear behavioral health and addiction were major areas to address. “It wasn’t what we had had in mind,” she said. “We had to change direction, and we had to have the courage to go back to our board and say that this is what we are doing. What we are doing needs to be meaningful to the city of Boston and the Commonwealth of Massachusetts, so we pivoted.”
When it comes to working with communities, whether from the public or private sector, “the motto is, ‘We don’t care what you know until we know you care,’” said James S. Marks, executive vice president of the Robert Wood Johnson Foundation. The key to making any collaboration work, he said, is to make sure parties can develop enough of a relationship to feel like they are truly working together, instead of competing. “That trust is best built before a crisis,” he said.
Maureen Disognano, professor emerita and senior fellow at the Institute for Healthcare Improvement and the afternoon’s keynote speaker, also urged focusing on the strengths of a patient or population instead of just the areas of concern. “Healthcare workers need to move from ‘What’s the matter?’ to ‘What matters to you?’” she said.
Other speakers were: Jascha Franklin-Hodge, CIO of the City of Boston; Karen DeSalvo, former acting assistant secretary for health at the US Department of Health and Human Services; Jonathan Levy, professor of environmental health at SPH; Tom Grilk, CEO of Boston Athletic Association/Boston Marathon; Bechara Choucair, senior vice president and chief community health officer at Kaiser Permanente; Karen Hein, former president of the William T. Grant Foundation and adjunct professor of community and family medicine at the Dartmouth College Geisel School of Medicine; George J. Isham, senior advisor at HealthPartners and senior fellow HealthPartners Institute; Dariush Mozaffarian, dean and Jean Mayer professor of nutrition and medicine at Tufts Friedman School of Nutrition Science and Policy; Elizabeth Mitchell, president and CEO of Network for Regional Healthcare Improvement; Lisa Berkman, director of the Harvard Center for Population and Development Studies and Thomas D. Cabot professor of public policy, epidemiology, and global health and population at the Harvard T.H. Chan School of Public Health; Lonny Reisman, founder and CEO of HealthReveal; Steven H. Woolf, director of the Center on Society and Health and professor of family medicine and population health at Virginia Commonwealth University; Susan Dentzer, president and CEO of Network for Excellence in Health Innovation; Sanji Fernando, vice president of Optum Labs Center for Applied Data Science; Peter Marx, vice president of advanced projects at GE Digital and adjunct professor at the University of Southern California; Rick Brush, CEO of Wellville; Rain Henderson, founder of Elemental Advisors and advisor at the Clinton Foundation; and Harold Cox, associate dean for public health practice and associate professor of community health sciences at SPH.
“One of the questions on which this School has rested since its inception is, ‘How can we be part of our urban environment towards creating a healthier city, to create healthier populations within this city?’” Dean Sandro Galea said. “That very much animates the work we do as a school, and it animates the questions our faculty ask. It is a large part of the reason our students come to us, and a large part of our practice engagements.
“What’s exciting about cities is the potential to do things that were not previously thought possible. One day it’s impossible, the next day it’s bold, and the next day it’s been done all over the country.”
Find video of the full day’s proceedings here.