Author Archives: ramonpllamas

Affordable Housing’s Ripple Effect

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Affordable Housing’s Ripple Effect

The availability of affordable housing is a growing problem across the country. A consequence of economic growth in many cities across the country, lack of affordable housing options have forced many residents to move to more rural areas. But as the move to rural areas may offer a short-term solution for housing, other issues from living in a rural area may become problematic, outlined below.

  • Lack of employment opportunities in rural areas leads to longer commutes
  • Access to appropriate healthcare services – e.g. specialty care or mental health counselors
  • Social networks and community ties
  • Spaces for leisure and recreation

When these factors are combined with a longer commute, a sedentary lifestyle becomes status quo. Therefore, affordable housing, should be viewed as a public health issue.

So, how are we tackling this issue?

At this point, it seems like most cities are still in planning mode. “Best practices” to solve affordable housing are few, if any. Most of the solutions require policy (zoning) and/or money (appropriation funds) – two things that don’t necessarily lead to quick action. One solution that comes up in the discussion most often is a public-private partnership with the city and for-profit developers. The catch, however, is appropriated funding in the form of tax credits for developers to build new affordable housing complexes, which could take months to years to come to fruition. But while we wait, many more residents are displaced.

Are these the only solutions?

Problem-solvers unite

Earlier this year, the Impact Hub in Austin hosted a showcase to a diverse group of stakeholders – affordable housing advocates, legislative staff, investors, mortgage brokers, and other community members – for their issue-specific Affordable Housing Accelerator. In the course of three months, 9 ventures focused their attention on directing innovative problem-solving and entrepreneurship toward the city’s affordable housing problem. The 2017 cohort included startup companies focused on 3D-printed structures, Accessory Dwelling Units (ADUs), and tiny homes, while other solutions offered innovative financing models or analytical tools to support data-driven decisions. Each of the 9 teams plan to continue building their companies at their respective stages, according to the Hub’s managing director. One company, Sprout Tiny Homes, exceeded expectations for the accelerator program and secured a $26m contract to provide 275 tiny homes in South Austin.

To recap, in a span of three months, 9 distinct solutions to Austin’s affordable housing problem were prototyped, tested, and refined during this issue-specific accelerator program.

Complex social issues like this one can’t be solved with a narrow perspective. City and state governments need to empower entrepreneurs to tackle social challenges and provide them with the resources to do what they do best – solve problems. And when synced with the work of public health and healthcare professionals, we have an opportunity to impact communities, and quality of life, in holistic and sustainable ways.

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Public Health in Action – Health, Wealth, and UBI

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Albert Einstein defined insanity as doing the same thing over and over and expecting different results.

As you may know, our country spends a lot of money on healthcare annually – over $3T, to be exact. You may also know that what we spend our healthcare dollars on isn’t exactly improving health outcomes. So, our hypothesis – spend more = better health – doesn’t hold up. So, what’s wrong?

First thing’s first: health and healthcare are not one in the same and should not be used interchangeably. Healthcare is a social determinant of health, which defined by Kaiser Family Foundation is a “structural determinant and condition in which people are born, grow, live, work and age.” Examples of social determinants of health include education, socioeconomic status, physical environment, employment, social support networks, and healthcare – seen in the first figure below.

SDOH2

Social determinants of health essentially contribute to an individual’s overall health in complex ways. And research provides their respective impact on health outcomes, specifically risk of premature death, in the following figure.

SDOH

But why do we spend so much annually on healthcare if research shows it’s only impacting up to 10% of health outcomes? Why aren’t we reallocating some of that toward addressing social and environmental factors like employment and housing?

Ask Einstein.

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Earlier this year, I came across a concept called Universal Basic Income (UBI) and followed up with more reading and research. I continue to wonder and speculate about its potential impact on individual and population health. Financial matters are an integral part of our daily lives – whether it’s paying bills, purchasing food, or filling a prescription, money is on our mind. It’s no wonder that income and wealth are linked to health and longevity, according to this brief from the Urban Institute

I’m excited to share a recent interview I had with Conrad Shaw, a former engineer, turned actor and co-founder of Bootstraps, a documentary series on a UBI trial they’ve developed.

Check it out!

Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as co-founder of Bootstraps.

Conrad Shaw: It was a long and winding road. I studied mechanical engineering in college, because I was pretty good at it and it represents a fairly safe career and a good education to head out into the world with. I liked it fine, and some of the work was rewarding, but I knew deep down that I was never passionate about it. The one class I really loved in college was Acting 101 in my senior year. I had always been a movie nerd, but this was my first experience with performing, and it brought me to life. I figured I should finish up my degree and get some experience on the resume in engineering, though, as a smart fallback plan and a way to keep my parents from panicking. A year and a half into working on missile systems and satellites for Lockheed Martin in Silicon Valley, I had had enough. Cubicle life was not for me, at least not yet. I gave my notice and moved to New York City to give acting a real go. I came in knowing nobody and struggled quite a lot to find flexible restaurant work, some engineering work, even a little day trading of stocks, and paid my way through acting school. Then I graduated and did all of the struggling that comes with building an acting career. I also wrote a couple of screenplays I’m still working to get developed, but I haven’t yet done anything you would have heard of, in case you were thinking of asking. Needless to say, starting an acting career is not a journey for the faint of heart.

It was meeting and falling in love with Deia Schlosberg – we’re now engaged – that sucked me into the world of documentary film-making. She had already established herself in the field, a supremely lucky break for me, and we were looking to work on a project together. I had just recently read an article that introduced me to the concept of universal basic income (UBI) and had become utterly fascinated. All my life, especially since being in New York, the issue of homelessness and poverty just didn’t quite make sense to me. There just had to be a smart way to handle it with a large governmental program, I always believed, and I’d be happy to pay extra in taxes for it to be so – assuming some day I was making an income that would even be worth taxing. But I never put too much thought into it, distracted by my own struggles, assuming somebody must be working on it. And if it hadn’t been done already or wasn’t in the works, it must be too large of a problem to solve – or so I assumed. We must not have enough resources for everyone to live well. But then along comes this idea of UBI. Well, holy crap, the issue wasn’t scarcity of resources after all; it was inefficiency, corruption, lazy thinking, and bad policy. Suddenly, I could no longer ignore the needless suffering going on around me; I couldn’t walk past a homeless person without a burning rage welling up inside me. How could I? I am part of this system, and so I am responsible for this human being’s suffering. What’s more, I’m especially culpable, because I now have an understanding of how we could fix it! But how could I help, I wondered, other than by sort of screaming into the wind on social media? It’s so hard to know what to do to actually make a difference, and so apathy threatens to numb out the rage.

In terms of the logistics, the simple mathematical elegance of the concept and implications of universality spoke to the engineer in me. I did some research and ran some back-of-the-napkin calculations on the realities of what our economy could handle, and really learned for the first time just how extreme our problem of economic inequality is in this country. Suffice to say we could fund a UBI multiple times over and still have bajillionaires roaming around. And the idea of having basic security while pursuing one’s ambitions spoke volumes to the struggling actor side of me. The kicker came when I was discussing it with a friend from the other side the political aisle, with whom I always disagree on everything, and we quickly were finding a lot of agreement on this radical new policy. I was hooked on the concept after about two weeks, and that’s around when Deia casually mentioned that it could be the subject of our next project together. The lightbulb went off at that moment, and we started working at it with all of our energy and haven’t stopped sprinting since.

Me: What inspires you on a daily basis, especially when things get hard?

CS: There are the little things in life, like acts of kindness, good art, cute kids, that are always sure bets for daily inspiration. Then there’s Deia of course. She’s a total badass – she’s all heart and kindness – and we certainly lean on each other and become better than the sum of our parts. I also read a lot about the problems we face and the solutions coming down the pipeline through the eyes of economists, futurists, thinkers, and policy makers who regularly blow my mind. But lately, too, there’s our project, Bootstraps, and what we’ve managed to cobble together so far. We’re running our own basic income trial in order to document and share the stories of regular Americans receiving basic incomes. It was and still is incredibly difficult to raise the funds both for a production and for a separate UBI trial, but we’ve had enough success at it that our trial now has 17 participants (soon to be 20) across 10 states. Letting them know they would be getting $1000/month in unconditional support for the next two years was the most rewarding and joyous thing I’ve ever experienced. And now, every day, we’re getting to see these beautiful people face life’s struggles with a little more confidence in their step and a bit more security in their hearts. We’ve seen a 56-year-old homeless man open his first checking account and save up for his first apartment. We’ve seen a prison inmate make the leap to push for his parole after delaying for 3 years out of fear that he’d fail on the outside. We’ve seen a family able to spend an entire year caring for their newborn in the hospital, able to take time from work to ensure that he continues to develop and have as normal a life as possible despite suffering a genetic condition. The list goes on. These people inspire Deia and I on a daily basis.

Me: Illustrate what problem this film series and UBI is attempting to fix.

CS: I could go deep into the weeds here, but the essence of basic income, as I see it, is shifting power to the people. It is the most efficient and elegant way to guarantee that everyone has a voice and can impact the way the world operates around them. It is a floor not only below which nobody can fall, but also one upon which everybody can stand and build. If everyone can vote with their wallets on what they care about, and if everyone can spare their time and attention on what is important to them without sacrificing their most basic security, then democracy, morality, and community flourish. We take a society preoccupied with accumulating as much as possible to hedge against catastrophe and protect themselves first and  foremost – a society designed to be selfish out of necessity – and evolve it into a society of interdependence and common strength in which every citizen feels part of the whole and cared for. Suddenly people can instead focus on what they can give back to society, how they want to contribute and to matter. Despite all the fearful rhetoric about looming job loss due to automation – which I do believe is a serious concern – UBI at its root is more importantly an issue of human rights, and of humanism itself. It’s a respect for the inherent value in every individual and a societal decision to include and invest in each person’s potential.

The goal of our film series, Bootstraps, is more specific within the UBI movement. We see a gaping hole in the conversation. To date, it is very technocratic and academic. We read daily about the threat of automation and growing support from Silicon Valley billionaires. We learn about ambitious UBI experiments happening in Canada, Oakland, Kenya, Finland, and more. However, political change doesn’t only happen because billionaires and professors, or even politicians, speak out for it, even if they do so beautifully. Things shift when the public rises up and demands that change. Not many people know that we almost had a basic income under Nixon in the 70s. We even had significant experiments of the concept back then, too. The parties in Congress were split on what level we should implement, though, and the people weren’t really kept in the loop so well, and the idea fizzled. We ended up with the crappy welfare system as we know it today. We won’t get the basic income we deserve and need unless it’s fully supported by a people’s movement, and the UBI movement is not yet bringing the people along. Most Americans don’t read thought pieces on economic policy, and certainly won’t read the white papers coming out of these current experiments. Nobody has time to research; we’re all trying to survive.

So, our aim with Bootstraps is to mainline the idea of UBI straight into people’s hearts and minds and create a major catalyst for a grassroots movement. We don’t want to do this with an advocacy piece, mind you. We’re not here to push UBI, but to spark awareness about, and discussion of, UBI. I happen to be an advocate on the side, because I’m pretty sold on the idea so far, as you may have noticed, but we’ve designed Bootstraps to be an honest experiment. And while the other experiments occurring are more quantitative, with large sample sizes and measuring for all kinds of statistical results, Bootstraps is meant to be more qualitative. Essentially, our goal is to show every American stories of fellow Americans who they would relate to, as well as some who they might judge negatively or suspiciously, and introduce a lens of UBI into those stories. Each of our 20 or so participants will receive their basic income for two years, and we will show what they do with it – the good and the bad. We don’t wish to teach people what we believe they should think, but rather to kickstart serious and widespread discussion on the potential merits and flaws of guaranteeing everyone a basic income. And we hope to stream these stories to millions of living rooms in every part of the country.

Me: What’s your vision for the film or movement in the next year, 5 years and 10 years? What do you need to get there? How can we help you?

CS: If the movement can keep growing at the pace it has been for the past few years, it would be incredible. The number one thing people can do to help is to get interested and to learn more. And don’t just listen to your news source of choice. Do some digging. The thing that’s special about UBI is it has serious support from all ideologies, and detractors. Find the different points of view and read them carefully. Let them land on you, and then sit with them. Discuss them with your friends and family, those with whom you agree and disagree. Try to imagine what kind of a system you would want to create to address the issues that UBI seeks to. This idea, I believe, might just prove to be a defining moment in history, a major legacy of our generation, so get engaged!

We will release the film in early 2020 in order to have maximum impact on the national discussion leading up to the presidential primaries. There is already one candidate, Andrew Yang, running with UBI explicitly as his main platform, and many other politicians toying with the idea of endorsing, so we need to do all we can in the meantime to apply pressure to them. My hope is that UBI will be a major issue discussed in earnest on stage in the 2020 presidential debates. I’ve talked to many who don’t anticipate it growing that fast, but these people haven’t been following UBI and interviewing people on the streets about it for the last year and a half as I have. This movement has legs, and the public is poised for a major change in the way we operate. Hell, we voted in Trump, didn’t we? If that’s not a giant red flag that revolution is nigh and possible, then I don’t know what is.

I don’t really have much of a 5 or 10 year plan on UBI. My thinking right now is generally grounded in that 2020 timeframe, because that’s when our project will release. We’ll just have to keep adapting to what circumstance brings moving forward. I’m sure there will be no lack of work to do.

In terms of how people can help with the film, they can get engaged with us, too! Go to our website and get on the newsletter; follow us on social media (@bootstrapsfilm); donate to the production or introduce us to major funders if they have that ability or those connections. They can share about us with their friends. We’ll be working between now and 2020 not only to create this film, but to bring the latest and best information on UBI to our followers, primarily through Facebook and the newsletter. We’ll also be sharing other ways people can help the movement as they come up.

Me: What are the current needs in NYC (or focus in on the city you live in) as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

CS: In general, my overarching philosophy revolves around opening up access and security to everyone, efficiently and universally, such that each can most easily contribute to their maximum potential. In New York City, same as everywhere else, there are several basics in life people need to be able to operate effectively. I think this applies to rural America and NYC similarly, the only difference being that NYC just has a bigger logistical scope to contend with. Along these lines, I would promote universal access to: 1) food and shelter, 2) healthcare, 3) transportation, 4) information, and 5) education, in that order of urgency, but there’s no reason I wouldn’t support doing them all at once.

Food and shelter would best be secured with UBI. In terms of providing affordable housing, I would love to see our awful system of shelters and soup kitchens perhaps replaced by something more along the lines of dormitory style living. What people need at minimum is the safety of a locking door, a place to keep their belongings and sleep at night every night. I would design buildings that provide these rooms, plus things like common areas, restrooms, cafeterias, electricity, wi-fi (this takes care of the information issue), and security staff with the goal of keeping costs below the level of UBI. The formerly homeless, the 20-somethings still working on finding their purpose, the bootstrapping artists and entrepreneurs, the natural disaster survivors, etc. could sustain themselves in dignity while pursuing their own roads to recovery, growth, prosperity, whatever, all the while fostering community and resilience among the residents.

Healthcare, I believe, would best be secured with single payer universal.

For public transportation, I imagine we should be able to find a way to subsidize completely through taxes. In NYC, anyone should be able to take a bus or a subway ride without first swiping. I don’t know the numbers behind this, but I imagine it would benefit society in general not to have people choosing between a trip to the doctor or the grocery store, or parents walking for miles to pick their kids up from school.

The costs of education would be mitigated to some degree by UBI already, but I’m certainly open to learning more about subsidized or free tuition for public school. I’m a strong proponent of fostering as educated and skilled a populace as possible.

Some people and pundits would put work opportunities at the top of that list. Many have started promoting things like a “Job Guarantee” program as an alternative to UBI and other tactics. I’m in support for work opportunity programs, sort of like a new ‘New Deal’ approach, as a method of helping people find purpose and ways to contribute in society. However, without a UBI floor first in place to guarantee basic security, a jobs program is not truly optional to the participants and therefore amounts to forced labor. Also, a UBI will allow many to find their own solutions to prosperity, by starting businesses, going back to school, etc. Without it, an attempt at a catch-all jobs program will end up another hopelessly overwhelmed bureaucratic quagmire. With a UBI in place, then sure, let’s invest in giving people more job opportunities doing important society-building work like infrastructure, home care, and more.

Lastly, in NYC politics as well as in all other localities and nationally, I think it’s essential that the voice of the people be empowered above that of any special interest. I would support not only overturning Citizen’s United, but restricting all campaigns to equal public funding only. Plus, I would support automatically registering every adult citizen to vote, making voting day a national holiday, and putting a serious effort into figuring out how to allow people to vote online. The debacle of 2016’s primaries left me among the millions who were thoroughly disillusioned with the idea that this country is actually a democracy we can still shape with our voices and votes. That needs to change once and for all.

If we invest in providing these sorts of universal access, the people of New York City will no longer sleep in shelters and on streets, will not wait endlessly for government to help them in their personal situations, will be empowered to take action in their communities, will be freed up to pay attention to and participate in politics, will be more resilient in the face of misfortune, and will no longer need to wonder how they’ll pay for their next meals. These are simple abilities that are currently not accessible to a large number of New Yorkers, and Americans in general, as I’ve witnessed over recent years.

A Clean Slate, Or Is It?

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I’m always fascinated about trends, especially in the health and wellness industry. Coming from a background in public health and working in various sectors, including managing an employee wellness program, there were always conversations about the new “it” thing that’s “life changing.” But, at its core, most things are just that, trends. The underlying motivations to improve or change one’s life is what’s really important to understand. Brands such as hims and Russell Wilson’s Good Man Brand provide a platforms for education and engagement on relevant health issues. The search for understanding human behaviors is what ultimately piques my interest.

A few of Well + Good’s top 18 of 2018 fitness and wellness trends that caught my eye:

Self-care is not an indulgence

High-tech sleep science in the bedroom

Analog destinations to unplug are the new “it” spots

The examples above fall under lifestyle changes, specifically on the ever elusive work-life balance sweet spot working professionals are always striving to achieve. While work-life balance is highly personalized, the fundamental question is true for everyone: how should I prioritize my time to maximize my productivity in professional and personal fulfillment? And what better time to ask this fundamental question than on the first few days of the new year.

Lindsay Jean Thomson, a regular contributor on Medium, offered an alternative to the annual resolution-setting ritual. In her piece, she encourages her readers to set a theme for the year rather than a goal-oriented resolution. This strategy empowers readers to focus on an improvement in lifestyle over singular goals.

New year’s resolutions such as losing weight or training for a marathon are admirable. Ms. Thomson also points out that only 8% of people actually keep them. By focusing on a theme or vision of how each of us wants to live in 2018 (and beyond), it provides a road map that can be a source of constant feedback and adjustment. It forces us to pay more attention to our behaviors, and maybe, just maybe, it forces us to examine the underlying motivations for said behaviors.

Unfortunately, no one really has a silver bullet answer or life hack that translates to conquering work-life balance. That answer lies within each of us and is a moving target. It is an evolving process of self-awareness, reflection, and readjustment. For that reason, the best advice I can pass on is from Ms. Thomson:

“Whether you choose a resolution, a vision, a theme, or something else, be kind to yourself — because it’s not just about what you do, but how you do it.”

Here’s wishing each of you an introspective, intentional, and personally fulfilling 2018. And remember, nothing worth doing is ever easy.

Reflections of 2017 – We’re Only A Millimeter Away from Success in Public Health

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2017 was an interesting, and remarkable year, to say the least. I have no doubt each of you will read your share of best and worst stories of 2017. Before writing this, I did a quick Google search of top stories in healthcare, health, and public health, and as expected, my recollection of this year’s top news stories were completely different, which I’ve listed below.

One of the best decisions I made this year was to incorporate Medium into my daily routine. Every morning, I read a handful of thought-provoking articles to jump start my brain. If you haven’t read any articles on Medium, please do. It’s a curated source of original content from our country’s thought leaders on various topics such as entrepreneurship, healthcare, technology, culture, media, productivity, and design, among others. Learning from thought leaders in sectors outside of public health and healthcare continually challenges me to view the world from an unfamiliar lens – and it’s made all the difference in my personal and professional growth.

Tim Denning is a regular contributor to Entrepreneur.com and several publications on Medium. A recent article he wrote, “11 Ideas that will Rewire your Brain,” caused me to stop, reflect, and later inspired this year end post. His first idea was quite impactful:

You’re only a millimeter away from success

While attending a seminar, I heard a fascinating idea; according to a well-known cosmetic surgeon, the difference between you being butt ugly and a super model is a millimeter in a few spots of your face. That’s it!

Tiger Woods also explains that the difference between getting the ball close to the hole on the first shot, and hitting the ball in the water, is a millimeter either side of your swing.

There are times when you might think you are a million miles away from your desired goal. Remember next time that this is false, and you are only a millimeter away from success.

While I could spend thousands of words describing how frustrated, angry, and drained I was throughout the year, my optimism remains unshaken for what we can still achieve. And my optimism, inspiration, and motivation comes from thought leaders like Tim, Steve Downs, Naveen Rao, and Jordan Shlain, among so many others. It comes from social entrepreneurs and nonprofit leaders in North Carolina, Washington, D.C. and all the various places I visited this past year. Lastly, my optimism is fueled by the passionate, compassionate, and proud residents of communities across the country who volunteer their time to make their communities a better place. Their empathy and altruism is why I love this country so much – and it’s the very reason I won’t waste my time complaining about our country’s struggles. For those aforementioned reasons,  I’m excited about 2018 and beyond because we have a lot of work to do. But remember, nothing ever worth doing comes easy.

 

My Top 17 of ‘17

 

Innovation

Lyft and Uber step in to assist healthcare

Dear Silicon Valley, It Pays to Care About Public Health

Food as Medicine – 5 Good Ideas

Prescriptions for Fresh Produce

 

Application (Best Practices)

Kansas City Physician Takes on Community Health at the YMCA

Stamford, Connecticut Health and Wellness District

New Type of Food Pantry is Sprouting in Yards Across America

Hope – and Healing – Go into Massive Redevelopment Effort

 

Sustainability (Financial Sustainability)

Military Investing for a Less Costly, Fit & Healthy Force

Dreaming Big on Sustainable Financing

Health Insurers Try Paying More Upfront to Pay Less Later

 

Research

Outcomes of Digital Health Program to Reduce Risk of Diabetes

Leveraging Behavioral Economics to Address Health Behaviors

Amazon’s Latest Grocery Experiment Involves Accepting Food Stamps

 

Policy

Berkeley Approves Tiny Houses for the Homeless

Bike Lanes May Be the Most Cost-Effective Way to Improve Public Health

L.A. County’s Latest Solution is a Test of Compassion

Public Health in Action – Predictably Irrational

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Richard H. Thaler is a kind of a big deal, and if you don’t know, now you know.

Professor Thaler, who teaches at the University of Chicago Booth School of Business, was awarded the Nobel Memorial Prize in Economic Sciences last month for his contributions to the field, specifically in understanding human behaviors. His life’s work illustrated that humans act irrationally in consistent ways that can be predicted and modeled. The implications of his work transcend all sectors. In 2008, Thaler co-authored “Nudge” and encouraged governments to use their insights for public good. Enrollment in retirement savings accounts significantly increased with a slight change: enrollment was the default option, which forced people to “opt out” if they weren’t interested. Observing and prioritizing human behavior, such as what behavioral economists describe above as “inertia”, over standard economic theories of rational actors, has made all the difference and has created myriad pathways into practical application.

Take the Center for Advanced Hindsight (CAH) at Duke, founded by Ted rockstar Dan Ariely. It houses decades worth of social and behavioral science knowledge, researchers AND entrepreneurs all under the same roof. CAH’s current focus has been working with startups that address financial security or health behaviors.

Public health, like economics, was built on the assumption that people behave rationally at all times. Thaler and Ariely have challenged those assumptions time and time again. We, as public health professionals, need to lean into uncertainty, especially when in matters of health behaviors. The populations that are most at-risk and need public health folks the most don’t live in ideal conditions. They may or may not have stable income, housing, transportation or have access to their next meal. If we can’t assume that people will behave rationally in a “normal” situation, we can’t assume they would behave rationally in a “distressed” situation.

Those are exactly the questions that crossed Allison Sosna’s mind at various points in her life and she shares her experience with us, below.

 

Allison Sosna, aka Chef Alli, is the founder of the MicroGreens Project

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Me: How did you end up doing the work that you’re currently doing?  Describe your journey to your current role as founder of MicroGreens.

Allison Sosna: I was in college and on the rowing team. Food, at that time, was synonymous for fuel that my body needed to perform. Sure, I ate healthily – lots of veggies, carbs, and protein (mostly chicken and eggs) but I did not give it any further thought. In my junior year, I lived in Italy. It was there that I was enlightened by the power of food on a community and would therein change the course of my life. I lived in a small neighborhood outside of Rome where residents all knew one another. They knew the barista and asked him how school was going. They wanted to know if the butcher’s cold had gone away. Everyone cared about one another and food was clearly the denominator of affection. In Rome, I realized that I wanted to do something with food and people. I did not come back wanting to be a chef, but, I saw that as a way for me to create food and community. So, I volunteered as a prep cook down the street when I got back to DC. I loved it. I loved the physical exertion that went into working on the line during dinner service. I loved wearing a uniform and feeling part of a community; a diverse community of women, men, people of different races, and different backgrounds with different stories. The sociologist in me was in love.

Shortly after, I went to culinary school, had a jaunt in fine dining, and then got a full time job at Dean and Deluca. While I learned a lot there, I realized I wanted to do more with my community; I didn’t want to feed rich people anymore. I had veered off course from the initial eureka moment. Leaving that job, I landed a job at a non-profit called DC Central Kitchen overseeing Fresh Start Catering, the social enterprise of the non-profit. When I started, we were providing the food services for a private school for at-risk boys, but it was generic and too similar to the lackluster school food that America is known for. Seeing such, I brought in healthier options, started making food like meatballs in-house, a salad bar, and marketed our vegetables to be more “fun” by using them as anecdotes. For example, I would say that foods like roasted carrots was a veggie that basketball players ate to perform better on the court (It’s true!). We had a lot of success there and that led us to win a food service bid for 8 DC Public Schools. We served thousands of meals a day to low-income kids who didn’t have easy access to fruits and vegetables (in 2010). Kids, of course, were coming to school with chips and soda, but I wanted to do something about it. I thought about the parents or guardians that were at home with the kids. How did they eat? Was it influencing their kids’ eating behaviors? How could I shift behavior? What I drew from all these questions was the question of their budget. How does a low-income family eat healthily? If I was a parent on SNAP, how did I use my money? Did I know how to cook? Did I know what to buy? The majority did not. As a result, I started MicroGreens and the Allison Sosna Group (ASG). ASG is my consulting “firm” for menu development, food service consulting, and private chef services. I had left my job to start MicroGreens, but also needed an income! I continue to consult today.

MicroGreens teaches kids to cook on a budget of $3.50 per meal, per family of four. The program has graduated over 150 kids across the country, with the help of community leaders that want to make their neighborhoods healthier. MicroGreens can be implemented anywhere, for any income level, for any length of time, and with any age group.

I moved to New York City in 2013 and while I was still working on MicroGreens and taking chef jobs, I needed an income and a job I truly cared about. So, I applied to jobs in public health nutrition with a focus on project coordination. After a year and a half of coming close to many jobs (NYC is tough!), I went back to school for a Master in Public Health degree.

Over the last year I’ve been intrigued with hospital food and its obligation (or lack thereof) to ensure that everyone has access to healthy food – from its staff to patients and also to visitors. While I am not trained in therapeutic meal development, I am trained to assist in cafeteria food services. I’ve been fortunate, by way of hustling and networking, to be part of the NYC Department of Health and Mental Hygiene’s Healthy Hospitals and Colleges Initiatives. We are working with food distributors to get chefs and food service directors healthier products for their hospital or college. It’s an incredibly rewarding experience to be on the other side helping the chef. I would have loved this help when I was working.

Me: What inspires you on a daily basis, especially when things get hard?

AS: On a daily basis, knowing that I am a part of something larger gets me through tough times. I know inherently that I am making a difference by bringing in healthier options for people. Every time a consumer replaces an unhealthy product for a healthier option, I know that I helped facilitate that. And as we all know too well, establishing healthy behaviors takes time.

As a student with a part-time job, I’m constantly moving around, not being able to cook for myself nearly as much as I want to, paying copious amounts for transportation, and don’t have a social life. But, I know I will, and am looking forward to graduating next year, when I can stay put and focus on doing work for my community full-time.

Moreover, the people I work with are incredibly supportive and that support allows me to focus on doing well in school and do an even better job at work.

Me: Tell us more about MicroGreens. How did you get into the social impact space? Why is it important to reach underprivileged populations?

AS: We must think about sustainability when we design programs. That being said, MicroGreens was originally going to be funded by a fast casual restaurant I was going to open. It would serve as part of the capital going into the non-profit. I’ve always believed that business needs to be part of the equation when designing interventions such as MicroGreens. I got 70% funded for the project but then had to let it go. I came close though and I’m proud of that.

If we do not focus on creating upstream programs first, we are doing a disservice to our communities, whether they are privileged or not. It truly does come down to the old adage “Give a person a fish and feed them for a day. Teach a person to fish and you feed them for a lifetime.”

One of the most impactful experiences I had with MicroGreens was not related to cooking. A student who had taken the class before was walking by our teaching classroom and walked in to say hi. He walked over to one of the kids who was having trouble cutting carrots (cutting carrots is hard!) and said “If you ever need help, let me know. I’m MicroGreens alumni.” Not only had this student learned skills and put them into action, but the program had instilled pride and confidence to teach others. There was a kindred relationship forming, a mentorship. That made me so proud.

Me: What are the current needs in New York City as they relate to social determinants of health (i.e SES, poverty, access to care, transportation, safety, etc.)?

AS: 1 in 9 residents have diabetes in NYC. Communities have little access to healthy foods blocks from affluent neighborhoods with endless healthy food choices. Soda ads saturate low-income areas and schools are without outside playgrounds. All determinants of health are so greatly intertwined that it can be overwhelming, especially for public health officials trying to make a difference. We talk a lot about that at school. How do we design interventions that encompass all contextual factors? First, by working with community stakeholders.

Public Health’s ‘Moonshot’ – Part 2: A Local Context

context-matters

Courtesy of Inspector Insight

 

In the first post of this series, I briefly described healthcare system expenditures, as a percent of GDP, for the U.S. and a number of OECD member countries. When coupled with population health outcomes data, the amount spent per person on healthcare in the U.S. seems excessive and arguably wasteful. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Addressing the factors outside the healthcare system, through a reallocation of spending into social services such as employment programs and supportive housing, may play a key role in improving population health outcomes.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. As such, a contextual understanding of communities and their history is critical to tackling deep-seated social issues. Below, I focus on the community of Durham, North Carolina for place-based contextual understanding.

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The Robert Wood Johnson Foundation (RWJF) is the nation’s largest philanthropic organization dedicated to improve health. RWJF’s focus, once solely on innovation in the healthcare system, has evolved to address the social and environmental factors as well in “building a culture of health.” Shifting the way society viewed health – from the absence of illness – was an integral part in this movement. It emphasized health as a resource for living fulfilling lives and collectively contributing to a competitive and thriving nation. It developed and strengthened relationships with key stakeholders and facilitated cross-sector collaboration. And it’s engaging leaders in communities.

In 2013, RWJF named six communities with its “Culture of Health Prize.” Distinct from its traditional grantmaking program, this prize awards $25,000 to communities for the work and successes they have already achieved. By shining a spotlight on a selected group of communities each year, RWJF is able to share lessons and first-hand knowledge with community leaders nationwide. Durham, North Carolina, was one of six communities selected for the Culture of Health Prize in 2014 for the work the Partnership for a Healthy Durham has done since 2004. The Partnership is just one example of community-engaged efforts to improve the lives of Durham residents. A few additional innovative models will be introduced in subsequent posts to illustrate social impact at the local level and offer ideas to accelerate their collective impact.

Durham

Approximately 250 miles southwest of our Nation’s capital, Durham is situated at the northernmost point of North Carolina’s Research Triangle, with Raleigh and Chapel Hill to its east and west, respectively. In its former life, the city was well-known for tobacco and textile production, but fast forward to 2017 and the “City of Medicine” is in a constant state of transformation. Durham was recently anointed as a destination for foodies, “The South’s Tastiest Town,” and boasts a vibrant and diverse culinary and social scene. A major factor in its Renaissance was a collective effort to attract entrepreneurs and catalyze innovation. Community and business leaders invested a significant amount of resources to revitalize downtown and its efforts appear to be paying off. Once described a “nascent startup scene” by Madrigal in the Atlantic, now exudes self-confidence with two Durham-based startups collecting back-to-back wins in 2014 and 2015 at Google Demo Day in Silicon Valley. The startup community has also made waves nationwide for its efforts to empower and nurture diversity; its epicenter, American Underground, a Google Tech Hub, houses 48.2% minority- or female-led companies thanks to initiatives like Code 2040 – a nonprofit organization that creates pathways to the technology industry for underrepresented minorities – and strong partnerships within the Research Triangle.

History

In the early 20th century, Durham had the most African American millionaires per capita than any other city in the U.S. Their success in finance and insurance was evident with a section of downtown named “Black Wall Street” (Forbes) and the city was also known as the “Capital of the Black Middle Class”. The Hayti District, an independent black community founded shortly after the Civil War, became a self-sufficient community and housed residents of all social class along with a variety of businesses, schools, library, hotel and a hospital. African Americans owned and operated over 200 businesses within the boundaries of the District. It flourished for decades through the 1940s until an urban renewal project in the 1950s tore through more than 200 acres in the heart of Hayti, displacing residents and businesses alike. The project was intended to ease commuting for suburban residents by realigning streets and construction of “the Durham Freeway”, NC-147.

Historically, urban regeneration or renewal served as a method for social reform in England to address substandard and unsanitary living conditions in rapidly growing industrialized cities. In the U.S., it came in the form of federal policies used to “reshape” American cities. The Housing Acts of 1949 and 1954 disbursed federal funding for cities to “acquire” areas identified as “slums” and were given to private developers to construct new housing. Additionally, the Federal Aid Highway Act of 1956 allocated 90% of federal funding to states to construct new highways that connected to the larger Interstate System. Large urban cities including New York, Chicago, Pittsburgh and Boston undertook urban renewal projects like Durham in the 1950s. While urban renewal projects generated economic development and improved quality of life in those cities, the destruction of neighborhoods left former residents in dire situations.

Poverty

A slow decline in manufacturing of textile and tobacco in Durham in the 1950s resulted in rising unemployment among working-class black residents due to segregation and discrimination. Coupled with urban renewal in the 1950s and 1960s and Civil Rights movements, the divide between whites and blacks grew. Sarah Willets of Indy Week describes an initial divide between affluent landowners and its workers even when the city was incorporated in 1869. An initial divide in opportunity which persists to this day.

“While some parts of Durham have single-digit and even less-than-1-percent poverty rates, in other neighborhoods, half the residents struggle to make ends meet.” — Sarah Willets, Indy Week

“We’ve always been taught the story of America is one of upward mobility. Durham very much embodies that. But some of the darker sides of the American story are here too.” — Justin Cook, Photographer, Slate Magazine

Photographer Justin Cook’s series, “Made in Durham” and various other pieces in the Indy illustrate what Willets captures in her story on Mayor Bell’s lasting dichotomous legacy – a thriving upward mobility amongst young professionals contrasted with historically African American neighborhoods that struggle with staggering rates of poverty and violence.

Alison Templeton, a research assistant at the UNC Center on Poverty, Work and Opportunity, released an update on urban poverty in Durham using current Census data in 2013. Templeton identified census tracts as “distressed” based on its performance compared to the state’s average on the following: per capita income, unemployment and poverty rates. 22% distressed census tracts in Durham County were identified in the report, which rose from 15% back in 2000. Other poverty-related statistics in Durham’s distressed tracts:

Poverty 46.7%
Child poverty 55.2%
Elderly poverty 25.6%
HS graduation 72.6%
Families led by Single Mothers 66.5%
Homeownership 27.6%

Poverty and the consequences of sustained poverty for individuals and communities significantly impact population health outcomes. Understanding historical context is a crucial first step in adequately addressing deep-seated social issues.

Public Health’s ‘Moonshot’ – Part 1

Advocates for cancer research and prevention efforts converged in Washington, D.C. last week for One Voice Against Cancer’s (OVAC) annual lobby day on Capitol Hill. OVAC, a collaboration of roughly 50 national non-profit organizations, delivered a unified message to Members of Congress on June 6 on the need for increased cancer-related appropriations. A point of discussion in my meetings with legislative staff was the President’s Budget Proposal for FY 2018, which featured budget cuts at both the National Institutes of Health (NIH) and Centers for Disease Control and Prevention (CDC) and increases for the Department of Defense. Armed with OVAC “asks”, I decided to focus my meetings with legislative staff from Senators Burr and Tillis and Representative Butterfield on the economic impact in North Carolina if funding levels were reduced. North Carolina is home to three National Cancer Institute (NCI)-designated cancer centers, which are awarded over $2B in annual NIH funding and employs thousands of employees.

Our advocacy training included a presentation by Dr. Warren Kibbe from NCI on the state of NIH funding and a quick brief on the Cancer Moonshot Initiative. Led by former Vice President Joe Biden, the initiative focused on concentrated and collective action to accelerate a decade’s worth of progress in preventing, diagnosing and treating cancer into a five-year time frame. The Cancer Moonshot has buy-in from academic, public and private sector partnerships. My immediate thought: why doesn’t public health have this type of dedicated initiative with annual federally-appropriated funds?

The Robert Wood Johnson Foundation’s Culture of Health initiative is public health’s “moonshot”. Its Action Framework parallels the Cancer Moonshot Initiative in identifying focus areas and key performance metrics to measure progress. RWJF’s Culture of Health has achieved significant buy-in from a myriad of cross-sector stakeholders. The only distinction between the two initiatives, from my perspective, is dedicated federal support. Imagine the possibilities if public health’s “moonshot” received the same attention and resources as the Cancer Moonshot Initiative. A decade’s worth of progress in a 5-year timeline for the social determinants of health would really change the trajectory of the field of public health.

In the next few posts, I plan to take a deeper dive on exploring innovative ways to address the social determinants of health, specifically at the local level, in the city where I currently live – Durham, North Carolina.

Below, I offer background on the U.S.’s healthcare system to provide a larger context the many layers and contributors to an individual’s health outcomes.

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Healthcare expenditures in the United States was approximately $3.2T, or $9,900 per capita, in 2015 which accounted for 17.8% of its gross domestic product (GDP). When compared to 12 other high-income member countries of the Organization for Economic Cooperation and Development (OECD), the U.S. spent significantly more annually. According to the Commonwealth Fund, the U.S. spent roughly $3000 more than Switzerland, the runner-up in per capita spending, in 2013. As a result, it outspent the next highest spender, France, by 5.5% of GDP in 2013. But despite its additional spending, the U.S. underperforms on population health outcomes such as life expectancy and chronic disease prevalence when compared with other OECD countries. Additionally in its analysis, the Commonwealth Fund compared healthcare expenditures to those spent on social services – retirement, disability benefits, employment programs and supportive housing, among others – for 11 OECD countries. In this comparison, the U.S. spent the least on social services at 9% of GDP, with Canada and Australia spending 10% and 11% of GDP, respectively. France and Sweden spent the most on social services at 21% of GDP. This imbalance in spending, posit the authors, may contribute to the country’s poor health outcomes.

Policies to improve population health have historically focused on the healthcare system according to Kaiser Family Foundation’s Heiman and Artiga. The Affordable Care Act, signed into law in 2010, expanded access to healthcare services for millions of Americans. However, as the authors explain, research demonstrates that healthcare is a relatively weak health determinant. Individual health behaviors, genetics and a broad range of social and environmental factors account for 90% of an individual’s risk for premature death. Thus, addressing the factors outside of the healthcare system may play a key role in improving population health outcomes, and the value it generates could justify reallocation of current spending levels.

Social determinants of health are “the structural determinants and conditions in which people are born, grow, live, work and age”. Examples of social determinants of health include social economic status, educational attainment, the physical environment, employment and social support networks. Social determinants form the basic foundation for each individual and his/her life experience. It also sets a baseline for future health outcomes. For example, an individual who is unemployed for an extended period of time may become homeless, food insecure and have limited access to healthcare services. It’s reasonable to conclude that this individual may be at higher risk of premature death due to his/her life experience. Unfortunately people all over the world have lives filled with adversity and struggle. Social, economic and/or environmental disadvantage creates differences in health outcomes, also known as health disparities, in populations across the world. One goal of Healthy People 2020, a strategic 10-year plan to improve U.S. population health, is to achieve the highest level of health for all people. Health equity includes the elimination of health and healthcare disparities.

One population of interest are known as “high utilizers” or vulnerable patients with complex social, behavioral and health needs. According to Anderson, the top 5% of individual utilizers account for about 50% of overall healthcare expenditures. Programs that pair patient navigators, community health workers and behavioral health resources with identified “high utilizers” have been implemented recently with hopes of improving health outcomes and generating value. A thorough review and analysis of the results for impact and effectiveness in improving health and cutting costs for this subset of patients is a critical next step.