Tag Archives: American Underground

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


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.


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.


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.


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.


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.


54 Hours to Innovate


Thursday, August 7: I had a lot on my mind for the night going into the TSWHealth weekend.  This was my first official (cliff) dive into a formal entrepreneurship setting and I was excited for it.  But I’d be lying if I didn’t at least acknowledge that a part of me was scared at the thought of being out of my element – not only was this my first “entrepreneurship” event, but I’m not even from the area.  Both elements gave me a tinge of anxiety, but if you heard about the previous 12 months, you would realize this event was not going to faze me…you would realize that I’m at a point in my life where I not only tolerate change and uncertainty, but actually embrace and savor each and every delicious uneasy second of it.  Can I get a second helping, please?  So the fact that I had a lot on my mind didn’t have anything to do with worries going into the weekend.  The fact that I couldn’t sleep was due to my level of excitement.  Think kid in a candy store, but since I’m a little off and love savory foods, think of me in a buffet without sweet stuff.  Yeah, so giddy doesn’t capture how excited I was to attend this event.  I technically didn’t have a place to stay until Thursday morning.  I was determined and even had the backup plan of sleeping in the bathroom (Sorry American Underground and TSWHealth staff) – I was not going to let a minor thing like sleeping stop me from savoring the experience.

Friday, August 8: My bus was scheduled to leave at 11:00 am and arrive in Durham at 4:30 pm.  Awesome as long as there’s no traffic.  Scratch that, this is the 95 on a Friday, of course there’s going to be traffic.  As long as there’s minimal traffic, I’ll make it in time to pitch one of the three ideas I had going into it.  Winning!  And there’s internet and Wifi on board, so I can be super productive for this 5 hour journey.  Yes, great plan.  Fast forward a few hours and I’m boarding the bus and getting comfortable in my window seat.  First setback of the trip – after several attempts, no Wifi connection.  Buzzkill…there goes my plan to be productive.  At least I brought a few back issues of the New Yorker to read.  I’ll have to force myself to relax…

It’s 4:35 pm and I have no idea where I am in Durham.  I know that the event is within walking distance to the bus station, but no more than that.  Technology saves the day yet again and I’m within 4 blocks.

I officially check-in and head into the American Underground co-working space to mix and mingle it up with local entrepreneurs and “wannabes” like me.  With my Google swag in hand, I drop off my backpack and luggage and jump in head first.  Familiar theme?  That’s my M.O.  Sorry I’m not sorry.

The program starts at 6 pm.  Initial pitches start at 7 pm.  Is this real life??

Internal monologue: Breathe.  Relax.  You wanted this, so don’t let fear get the best of you.  Be you.  Have some confidence in yourself for goodness sake.  Now distract yourself by eating food and drinking water.  Go on, stay distracted.

Speeches and official business flies by and we’re grouped into teams for an icebreaker.  The idea – pick two random words and pitch a product idea for those two words.  5 minutes to get a plan together and break it down.  Hilarity ensues.

The time has come.  Our facilitator, serial entrepreneur Shashi Jain, asks the crowd “so, who’s pitching tonight?”  Hands are raised.  Somehow beyond fear, I’m one of the first five to pitch – third in line as a matter of fact.

I’m pretty sure I blacked out because all I really remember is uttering words and seeing hands come up after I asked the audience a few questions then hearing a few laughs before seeing the clock with 10 seconds left.  I passed the mic over to the next in line and tried to process what just happened.

Many more pitches came and went – a total of 28 to be exact – and it was now time to vote.  Each attendee had 3 votes for their favorite pitches and these were used to narrow the number of ideas down to the final 10.  From here, attendees chose the idea and teammates they wanted to work with.

Unfortunately my idea didn’t make the final 10, but that will not stop me from pushing forward with it.  If you’re really curious to know what it is, let’s talk.  If you’re really curious and are a smartphone app developer, call me in 5 minutes.

Teams are formed and our initial idea: a way to improve care coordination in the healthcare system through a compatible card that connects all EHR/EMR systems.  Similar to the model already used successfully in Taiwan, among other countries.

My (super talented) Teammates

0810141450aMichael McNeil – MS4 student at Duke Medical School

Jared Pelo – ER Physician and Founder of EyeScribes

Thomas Hubschman – Guru of Software

Brandon Hill – Design Strategist

Akhil Karibandi – Engineer wunderkind from a little known soft drink company

Emily Mangone – PhD student at UNC Chapel Hill

Matthew Brown – MBA student at Clemson University

David Melgar – Owner of an IOS development company

GrassRoutes Networking – Honorary teammates, advisors, counselors, cheerleaders, purveyor of laughs

Saturday, August 9:  The purpose of today is to gain advice from the experts and do some market research about our idea/product.  9 am, our team reconvenes over breakfast and bonds over lack of sleep and dire need for caffeine.  The “getting to know you” phase of team dynamics.  I felt like I was at a speed dating event, but less pressure and more fun.  Maybe that’s another idea entirely…

We prep all the way until our mentors arrive to hear our idea/product.  The reason I still call it an idea, was because after a long night deliberating, we still have yet to reach a minimal viable product or MVP.  We are optimistic that conversations with our mentors will provide us with some valuable insight.

11 am – 5 minutes post conversation with our mentors.  The main takeaway: a legislation is in place to do the exact thing that we were planning to do.  Time to panic?  Yes, now would be a good time to start.

11 am – 1 pm – Panic.  Discuss.  Problem solve.  Discuss.  Brainstorm.  Panic.

1 pm – The team regroups and decides on the MVP.  Next step – mobilize into teams to tackle the following: 1) website and working demo, 2) consumer research and 3) presentation.

1 pm – 5 pm – Tons of progress at this point.  We have a working demo, tons of great feedback from the people and a barebones PowerPoint presentation.

The rest of the night is a blur.  All I want to do is eat or sleep.  My brain doesn’t work any more.  It is a mushy bowl of oatmeal.

Sunday, August 10:

5:30 am – Why my body automatically wakes me up at 5:30, I don’t know.  But it has been happening like this since July.  I suspect it has to do with efficiency and the fact that I really am most productive between the hours of 7 and lunch.  I choose not to fight being uber tired and actually am excited to finish strong a la Lance.  This is our Tour de France.

7 am – I’m the first one in the building again.  House cleaning staff knows my face and they think I’m part of the organizing team.  I politely smile and get started on my routine: open and respond to emails while listening to my playlist on Soundcloud.

9 am – Our team is in full strength and ready to slay dragons.  Mr. McNeil is our fearless leader is wearing Batman socks and is confident about the pitch.  Chances of pulling this one off for the gipper (and I’m somewhat of a betting man): 31%.


12 pm – Mandatory check-in with the group.  We are not only hungry, but now stressed about finishing the presentation and practicing the pitch.  Low blood sugar and stress turns me into Betty White like the Snickers commercials.  Not a happy camper because I just want to eat and finish this thing.

2 pm – Mandatory “cease fire.”  No more major changes to the pitches and PowerPoints.  Kegs arrive…my mood instantly picks up.

3 pm – The show starts and the rest is history.

Curious about what happened?

All you need to know is that each attendee walked in a “want-trepreneur” and walked out an entrepreneur.

“The most important reason for going from one place to another is to see what’s in between, and they took great pleasure in doing just that.” — Norton Juster

Why did I write this?

3 reasons:

1) I want to brag about my amazing teammates.  They energized me to look beyond the status quo and reinforced my main motivation to join this event – create a movement to improve health at the individual, community, state, national and international level through innovation.  I’m confident they will always be around to bounce ideas off of and keep me addicted to entrepreneur-ing.

2) I want to express my utmost appreciation to the TSWHealth organizing staff, volunteers, mentors and all the rest who were in one form or another involved in bringing this event together.  It was a huge success and I thank you for letting me be a part of it.

3) I want to inspire anyone who reads this to dream.  And dream big.  Dream your wildest dreams and then dream even wilder dreams.  The catch about entrepreneur-ing is this: there is no glass ceiling.