WHAT IF you used a land trust to build a grocery store and a movie theater — and give residents a greater sense of social connectedness and well-being?

This post is ninth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

With just four screens and an unassuming Art Deco marquee, the 24:1 Cinema in Pagedale, Mo., may not seem like much to an outside observer. But to Alderwoman Marla Smith, the one-year-old movie theater’s lights are “eye candy” and a herald of the renaissance she fervently wants for her city.

“When I was a little girl, Pagedale was popping,” says the 44-year-old mother of three. People owned their homes and lived in them in this small municipality that is one of two dozen northwest of St. Louis, Mo., known collectively as the 24:1 Community. Big employers such as the Lever Brothers soap factory and the Stix, Baer and Fuller department-store warehouse anchored the community.

But by the mid-1980s, many Pagedale businesses were in decline or had shuttered. Unemployment rose, and X-rated movies were showing at the Olympic Drive-in. There hadn’t been a grocery store since the 1960s. Houses went dark when homeowners lost their jobs and mortgages.

In the 1990s, Mayor Mary Louise Carter and the neighborhood development group Beyond Housing began working together to replace dilapidated homes and vacant lots with affordable housing. Then about 10 years ago, they began meeting with residents to ask what else would make their lives better.

“Everybody agreed that a grocery store they could walk to and get fresh fruits and vegetables and get healthy meals was one of the first things they wanted,” Carter says.

It seemed a simple enough wish, but enticing a developer to build a store in a low-income community proved challenging. In the end, Beyond Housing financed construction with local taxes, and discount supermarket chain Save-A-Lot agreed to run the store, which opened in 2010.

A flurry of other development projects aimed at making Pagedale more livable and walkable has since brought in senior housing, a bank, and the cinema—all within a few blocks of each other. The city has used grant funding to repave the formerly uneven, unlit sidewalks near the theater and supermarket and has added streetlamps. A barbershop, health clinic, and county social services center will open next to the theater this year.

Because the cinema and supermarket are owned by a community land trust, their profits fund neighborhood development, which is a boon for Pagedale and the surrounding municipalities.

Though it might take some time, one of Smith’s biggest hopes is to attract a family restaurant to downtown Pagedale.

“Who wouldn’t want to go have dinner and go to a movie?” she says.

WHAT IF you turned fire stations into intake centers for people addicted to opioids?

This post is eighth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

A bad month for opioids in Manchester, N.H., meant 30 overdoses when Chris Hickey first started working as a paramedic in the city 15 years ago. These days, the emergency medical services officer says Manchester’s emergency responders see 60 to 70 suspected overdoses each month. More than a half dozen of those are fatal, which represents a nearly 12-fold increase in the city’s overdose deaths between 2003 and 2015.

The spike mirrors a national trend, with opioid prescription drugs, heroin and illegally manufactured fentanyl fueling a 137 percent increase in deaths from drug overdoses between 2000 and 2014, the most recent year for which statistics are available.

“You have people of all backgrounds, of all ages who are all overdosing,” Hickey says. And those are just the emergency cases, he says. “We know that we have a large group of the population who are functioning addicts.”

How does one reach those who are addicted before they overdose? A small piece of the answer appeared to Hickey this spring when another firefighter’s stepbrother—homeless and struggling with heroin addiction—posted suicidal messages on Facebook and his family sent him to the fire department for help. It was the first time Hickey had encountered an addict who really wanted to take the first steps to get better. The two drove in Hickey’s pickup to Hope for New Hampshire Recovery, an organization that helps people overcome addiction. Three days later the man was in an inpatient treatment program, and Hickey was writing a proposal to Manchester’s mayor to turn fire stations into intake centers, where people could come without fear of being arrested.

Safe Station, as the initiative is called, launched in May 2016 in Manchester’s 10 fire stations. Within the first four months more than 420 people had sought help and been referred to treatment. Twelve people came in on Father’s Day, the program’s peak day. “They wanted to get better to be with their kids,” Mayor Ted Gatsas says.

Stephanie Bergeron, interim CEO of Serenity Place—a nonprofit treatment center in Manchester and a Safe Station partner—says all involved want to make the model as easy as possible for other communities to replicate. For her part, she would like to ramp up Serenity Place’s staffing on the weekends to accommodate Safe Station patients any time of the week.

“You want to catch people right at that moment when they’re ready to come in,” she says.

WHAT IF you used art as a tool for promoting better health?

This post is seventh in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

“I don’t think art in and of itself can do anything,” says Theo Edmonds, artist and co-founder of IDEAS xLab, an artist innovation company in Louisville, Ky. “But I think artists can change the world.”

More specifically, the former healthcare executive says artists can impact health in surprising ways. He’s found believers across Louisville, from the mayor’s office and local foundations to the area’s healthcare institutions and the University of Louisville. Together, they’re out to do transformative things across the city:

A vacant lot in the Smoketown neighborhood will become the venue for a drum circle as part of Project H.E.A.L., a five-year effort that will employ the arts to help residents look for solutions to community health needs.

This fall, a former liquor store will become home to the printmaking and bookbinding activities of Steam Exchange, a free after-school arts program.

A photovoice exhibit, featuring the photographs and written observations of West Louisville residents, will set the stage for a community meeting to pinpoint ways to start taking action to reduce violence in their neighborhoods, which have among the highest violent crime rates in the city.

Roots & Wings, a performing arts group made up of nine young adults of African descent, is addressing community violence, black identity and other topics in neighborhood workshops and main stage performances. They hope to get people talking and thinking about what they can do to level the playing field in Louisville and give everyone a fair shot at success.

In these projects and others, art has become a vehicle for change.

“The power is in the people,” says Hannah Drake, a poet and lead artist for Project H.E.A.L. “But sometimes you have to show people they have the power to change anything they want to.”

WHAT IF you created a wellness coalition to ensure health equity?

This post is sixth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

Under a century-old wood canoe suspended by wire from the ceiling, seven people sit at a round table with a full agenda of health matters to discuss for the next hour. But first, Charlene Nelson, chair of Washington’s Shoalwater Bay Indian Tribe, asks everyone to pause.

“Take a deep breath,” she says. “Let it happen. Take joy in what we’re doing.”

Once a month, the Pulling Together for Wellness group meets to discuss ideas for improving the tribe’s health and well-being. The American Indian Health Commission for Washington State—which works with all tribes in Washington—launched the initiative. Shoalwater tribe members were among the first to adopt the model, says Jan Ward Olmstead, a public health specialist for the commission.

Three years ago, the tribe formed a wellness coalition, creating a framework to discuss physical, emotional, spiritual and social health. “It’s where conversations are starting,” says Jamie Judkins, a member of the group.

Before drafting an action plan, the coalition enlisted teens to conduct a health survey. The move was intentional: Tribal elders wanted younger members to feel as if they, too, had a stake in their community’s future. Pairs went door-to-door to interview families about tobacco use, physical activity and access to nutritious food. The teens reported their findings at a community dinner and were asked for their ideas. They suggested ways to improve and link pathways for walking and biking and advocated for policies to prevent tobacco use.

“The challenges of the community were illuminated, and they could see themselves in that data,” Olmstead says. “It really set a clear path as to what direction the coalition would want to go in terms of their strategies.”

WHAT IF your community boosted homeownership by creating a ‘wealth accumulation center’?

This post is fifth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

Chris Krehmeyer, president and CEO of the neighborhood development group Beyond Housing, estimates that the 24 municipalities northwest of St. Louis, Mo., known collectively as the 24:1 Community lost 6 or 7 percent of their 15,000 households during the 2008 foreclosure crisis. And eight years later, he says, “We’re still struggling.”

Property values haven’t rebounded, and 24:1 now has more renters than ever, he says. “That doesn’t have to be bad, but there’s strength in homeownership.” Homeowners create stability in a neighborhood because they generally move less than renters, and often they are more invested in the property and the community. Their children are more likely to stay in the same school, and that continuity can benefit students academically and socially.

One can see the decline in homeownership on the street where Pagedale Alderwoman Marla Smith lives. Seven houses on her block are Beyond Housing subsidized rental homes. Three belong to the Housing Authority of St. Louis County. Six houses are vacant. Two have been torn down by the city.

“That leaves maybe six homeowners,” Smith says.

Beyond Housing is working to boost homeownership in 24:1 in a number of ways. Its nonprofit 24:1 Community Land Trust uses a variety of subsidies to make homeownership affordable for people who would otherwise be locked out of the market. Residents own their homes, but lease the land, which is owned by the trust. The houses stay affordable because the trust controls the price owners receive when they sell. Buyers receive financial and homeownership counseling before they buy, and supportive services after they sign the contract.

With its partners Prosperity Connection, a nonprofit financial education provider, and Red Dough, a lender that offers lower-interest alternatives to predatory payday loans, Beyond Housing has established a “Wealth Accumulation Center” in downtown Pagedale. The center offers free financial coaching and classes on home-buying, credit repair, college and retirement savings, and other topics.

“We help people be aware of what they’re doing with their money,” says Financial Education Specialist Evette Baker, “and pave the way to saving so they can have a family legacy.”

>Read more about the 24:1 Community’s journey to a Culture of Health.

Shifting Perspectives Through Altruism

As social media, technology, and personal data become ever more prevalent forces in our society, the world feels like a much smaller place. We are not only able to understand what’s going on in areas we’ve never visited, but we are also able to have an impact in ways that were previously impossible. In an age where geographical boundaries don’t impose the same limitations as before, the possibilities for affecting change across the globe are shifting dramatically. As a result, we are tasked with rethinking our perspectives on important issues in fields like healthcare, scientific research, and morality. We are proud to highlight just a few TEDMED 2016 Speakers and Innovators who are confronting these challenges and developing new ways to create a healthier future for us all.

As we become more aware of the events that take place outside of our own communities, through news coverage, social media, and the ease of travel, our values on the moral imperative to help others may be called into question. For many people, the increased exposure to the suffering that’s occurring around the world motivates action. For example, you might donate to a humanitarian organization or spend time volunteering at a local soup kitchen. But for the majority of people, the desire to help others does not result in a drastic change to our daily routines. This isn’t the case for individuals that are deemed “extreme altruists.” Larissa MacFarquhar, TEDMED 2016 Speaker and staff writer at The New Yorker, is intrigued by extremely altruistic people and has examined individuals who dedicate their lives to the alleviation of suffering, whether this means donating their kidneys to complete strangers, adopting 20 children, or donating a large percentage of their yearly salary to organizations that help people they will never get to meet. In her recent book, Strangers Drowning, Larissa takes a closer look at these “moral saints” – as some call them – and aims to understand why they act the way they do, why they make the rest of us feel so uncomfortable, and ultimately, why they only account for a minority of the population.

Image provided by Watsi.

Image provided by Watsi.

While we might not all be moral saints, one of the organizations in the 2016 Hive is making it easier for us all to be a bit more altruistic. Watsi, co-founded by Chase Adam, is a crowdfunding platform for healthcare. They’ve created a website that allows anyone, anywhere to fund life-saving treatments for those in need around the world. By creating the opportunity for individuals or communities to fund a medical treatment or procedure, Watsi is pushing us to rethink the way healthcare is paid for. And, along the way they are saving thousands of lives. Not only is Watsi taking an innovative approach to providing healthcare for everyone in the world, but they are also innovating the operational aspects behind non-profit organizations. With a policy of radical transparency, Watsi guarantees that 100% of each donation will directly fund the healthcare that you specify.

Another TEDMED 2016 Speaker rethinking a conventional system is Sharon Terry, President and CEO of Genetic Alliance. After both of her children were diagnosed with a rare genetic condition, called PXE, Sharon took it upon herself to advance the research in this field so that no other parent or patient would be faced with the same situation her family experienced. As she learned about PXE, they found that many scientists were rewarded for advancing their own careers, and couldn’t stay focused on helping the patients that could benefit from their research. Sharon was frustrated by the lack of communication and collaboration between scientists, and she saw firsthand how the competitive nature of scientific research could actually hinder the process of research and development. Instead of becoming defeated by a system that had failed her family, Sharon founded PXE International and has been an advocate for system reform ever since. She wants to make sure that the patient voice isn’t just heard; but that it is actually driving transformation of biomedical research and healthcare.

These TEDMED 2016 Speakers and Innovators are shifting perspectives on conventional thinking and making significant progress in the fields of scientific research, healthcare, and morality. We are proud to have them at TEDMED 2016 and we look forward to the conversations and collaborations their work will spark on site in Palm Springs, CA this November 30 – December 2nd. Register today to join us.

WHAT IF you collaborated with unlikely partners to solve your community’s health problems?

This post is fourth in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

Paul Lindberg’s new job is to connect the dots. Officially, he is a collective impact health specialist for the Columbia Gorge region, which straddles Oregon and Washington.

Translation: He encourages groups that may not be used to collaborating to solve problems, together. Then he helps them find funds to support their ideas through grants or other sources.

Many organizations would not have the resources to research funding opportunities or to apply for grants on their own. But collectively, they have found success, securing close to $3 million in public and private grants since 2014.

In one collaboration, four school districts, a clinic, health officials and private dentists secured a commitment of $290,000—spread over four years—to develop a comprehensive school-based dental program for every 1st and 2nd grader.

In another example of cross-pollination, the health department in The Dalles, Ore., the county seat of Wasco County, is starting walking groups to educate people on health, exercise and nutrition. By design, the routes will run past corner stores that the Gorge Grown Food Network is working to supply with more locally grown produce. The idea is that when walkers get to the stores, they can use “Veggie Rx” vouchers—another Gorge Grown initiative—to buy snacks. Both the walking groups and the healthy corner stores have received $50,000 apiece from the Knight Cancer Institute.

Lindberg says “the anchor” for his work are the goals set in the community health improvement plan required by the State of Oregon. “That’s the document that we all can point to and say, ‘That’s what our community said we need,’” he explains.

Lindberg works through United Way of the Columbia Gorge, which receives funding for his position via Providence Hood River Memorial Hospital. A former lawyer who moved to Hood River, Ore., in 2000, Lindberg connects with community groups, nonprofit organizations, medical providers, health departments, schools, private practitioners and social service providers.

“It’s a very community-based, very collaborative effort,” Lindberg says, “and that has been one of the key components to our success.”

Mark Thomas, the chaplain at Providence Hood River Memorial Hospital who also works on mission integration, sees Lindberg’s role fostering more eagerness among groups to work together. “The system is strengthening as momentum is building,” he says.

>Read more about the Columbia Gorge region’s journey to a Culture of Health.

Promoting physician-led innovation at the AMA

This is a guest blog post written by James L. Madara, CEO of the American Medical Association.

Advancements in digital health are rapidly changing health care, allowing physicians to care for patients virtually anywhere at any time. While physicians surely recognize the tremendous potential in digital health, they are looking to professional associations like the American Medical Association to help them make sense of the constantly evolving medical landscape and ensure that these new clinical tools are efficient, actionable and connected.

Physicians play a critical role in this effort, leveraging their clinical expertise and deep medical knowledge to take part in the development of new digital technologies. Across the nation, physicians are working directly with innovators and entrepreneurs and are strengthening their relationships with the tech community. To support them in this pursuit, the AMA has created several opportunities for physicians to connect and work directly with innovators and entrepreneurs.

Why is it so important to have physicians at the ground level of innovation? A practicing internist in Cambridge, Mass., sought a new way for emergency responders to deliver vital information to the hospital so that doctors can respond more quickly when a patient arrives. This internist, YiDing Yu, MD, and her team developed a smartphone app, which they have called Twiage, to relay urgent care information to emergency physicians faster, easier and more powerfully than traditional radios.

Imagine two patients traveling by ambulance to the hospital at the same time – one with a broken arm and one suffering a heart attack. Twiage allows paramedics to send the necessary information so that hospitals can better prioritize patients’ treatment when minutes can mean life or death.

Twiage, which won the AMA’s Innovation Challenge event earlier this year and is garnering national attention, has aided in the transport of more than 10,000 patients since its launch one year ago.

Innovative ideas like this one are changing health care for the better. Twiage is an example of what happens when physicians collaborate with tech developers on simple solutions to improve patient care.

The AMA’s innovation ecosystem is home to many such partnerships and a variety of other initiatives that bring diverse experts together to improve physicians’ processes and therefore patient care and outcomes.

We have partnered with Chicago’s health technology incubator called MATTER, which is home to more than 120 start-ups and an Interaction studio space where entrepreneurs and physicians can collaborate and think creatively about digital solutions to common health care frustrations.

In San Francisco earlier this year, we opened an independent, for-profit development studio called Health2047, bringing together some of the top innovators in medicine, technology and science.

We also recently launched the AMA Physician Innovation Network, which is, like a digital matchmaking website: a place where physicians and entrepreneurs can connect online and collaborate to develop digital health care solutions.

At the AMA, we believe physician-led and physician-informed innovation will drive better products and services and, ultimately, enhance the practice of medicine and improve patient care. Central to this are the relationships between physicians and patients. Patients deserve –– and the marketplace should expect – that physicians have lent their clinical expertise in the development of new ideas and technologies so that they meet the high standards that drive quality care.

This is the best way to ensure that new technologies in medicine deliver on their tremendous promise – freeing up physicians to spend more time with their patients and improving both the quality of care they provide but also their own professional satisfaction.

WHAT IF your community took a truly human approach to homelessness?

This post is third in a guest series from the Robert Wood Johnson Foundation, about the winners of its 2016 RWJF Culture of Health Prize.

It’s a little after 4 a.m. when two officers and a passenger step out of a police cruiser to talk to a middle-aged woman sitting on the sidewalk in Santa Monica, Calif. She wears very little.

“Good morning,” greets the passenger, kneeling down to speak to her. “It’s Brian from human services. It’s been awhile since we talked.”

Every day from 3 a.m. to 1 p.m., pairs of specially trained officers reach out to homeless individuals on the streets of Santa Monica. On this morning, the team is joined by Brian Hardgrave from the city’s Human Services Division. The trio know many of the people they encounter and asks everyone the same question again and again: “Would you like help?”

Santa Monica’s police street team includes six officers and one sergeant who are focused exclusively on homeless issues. “We use the police strategically to engage these individuals who might not normally seek traditional homeless services on their own,” Hardgrave says.

The unit is one of many initiatives in Santa Monica that addresses the problem of chronic homelessness. In the most recent one-day count taken last January, Santa Monica had 728 homeless people, 60 percent of whom were unsheltered. In comparison, in Los Angeles County—which includes Santa Monica—an estimated 47,000 people experience homelessness on any given night.

A network of Santa Monica partners—police and fire departments; city human services, health and housing offices; and nonprofit service providers—collaborates to find innovative ways to help the homeless. A guiding principle is the “housing first” philosophy, which maintains that it is not only more humane, but also more cost-effective, to house people as quickly as possible, and then make sure they receive services to resume stable lives.

Santa Monica was one of the first cities in the nation to develop a registry of the most vulnerable individuals experiencing chronic homelessness. And in 2007, it introduced another innovation—the Homeless Community Court. People who are cited for quality-of-life infractions such as trespassing or public intoxication are offered housing and treatment and, in the process, can clear their records.

Sgt. Jeff Glaser said an officer on his team recently received a thank-you email from a woman he helped. “He changed her life basically by waking her up one morning when she was living on the street,” Glaser says. “It’s those things that make us happy about what we do.”

>Read more about Santa Monica’s journey to a Culture of Health.

The Social Determinants of Health

Sixty-eight years ago when the World Health Organization was formed, they defined health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” The WHO has never changed that definition, and a growing attention to the social determinants of health – “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life” – is reinforcing the notion that health is, indeed, so much more than how we feel physically. Whether it’s housing, clean water, fair and safe employment, or basic health care, the ability for all members of a community – and of the nation more broadly – to enjoy these basic human rights is an essential component of creating a healthier society.

As the WHO clearly states, “access to quality housing and shelter and clean water” are basic human rights required for people to live a healthy life. They are also important social determinants of health that many Americans lack. On a given night in January, 564,708 Americans were homeless – defined as someone sleeping outside or in an emergency shelter or transitional housing program – and of those individuals, 15%, or 83,170 people, are chronically homeless, meaning they have been homeless for at least a year, or have experienced four or more episodes of homelessness over the course of the past 3 years, and have a disability, often a severe mental illness and/or physical illness. Addressing and ending homelessness and chronic homelessness is a difficult endeavor; one approach is the Housing First model that prioritizes getting the homeless and chronically homeless in permanent housing first and then providing supportive services on a voluntary basis. When Lloyd Pendleton, a former manager at the Ford Motor Company and the Church of Jesus Christ of Latter-day Saints, became the Director of Utah’s Homeless Task Force in 2006, Utah became the first state to adopt a statewide Housing First model, and the number of chronically homeless individuals dropped from 1,932 in 2005 to 168 in 2016. This drastic drop is a huge success and a continued commitment is essential to keep it on track. While the number of people who are chronically homeless in Utah has declined, the number of homeless people in Utah has grown over the past decade, from 11,275 to 12,685 – a 12.5% increase. Although Lloyd has recently retired from the Utah Homelessness Task Force, his commitment to ending chronic homelessness and decreasing homelessness remains strong as he consults with cities on their efforts to decrease homelessness and chronic homelessness.

Dr. Mona Hanna-Attisha examines a patient at Hurley Children’s Center in Flint, Mich. Photo Credit Laura McDermott for The New York Times http://www.nytimes.com/2016/03/27/opinion/sunday/the-future-for-flints-children.html

Dr. Mona Hanna-Attisha examines a patient at Hurley Children’s Center in Flint, Mich.
Credit Laura McDermott, The New York Times

Like access to quality housing, the basic human right to clean water is a social determinant of health that will be discussed on the TEDMED stage this year. Being able to turn on the faucet in our kitchen sink, fill a glass with water, and drink it is something many Americans do without much thought or worry. Indeed, it is what many families did in Flint, Michigan, until Dr. Mona Hanna-Attisha, a Detroit-raised pediatrician, exposed the dangerous levels of lead in the drinking water after testing the blood lead levels in the children she treated. The levels of lead in the water were nothing short of shocking – 5 times as high as the level of concern outlined by the Environmental Protection Agency. The impact of this lack of access to clean water is significant – children exposed to lead are at an increased risk for damage to cognition and behavior, while high exposure can lead to irreversible damage to the nervous system. Also shocking is that, in a town just 45 minutes away from Flint, the levels of lead in the water barely registered and were of no cause for concern. This is a stark example of how social determinants – where you are born and where you live and grow – significantly impact your health. But these determinants do not only impact health on the individual level; research suggests that lead exposure in women can lead to DNA changes in their grandchildren. The social determinants that affect our health have implications for generations.

Fair employment and decent work are also important social determinant of health, and as the WHO points out, when working conditions are good, individuals receive financial security and benefit from personal development, social relations and self-esteem, and are protected from many physical and psychosocial hazards. Susie Baldwin knows all too well what can happen when people are victims of unfair and dangerous working conditions. A Public Health and Preventive Medicine physician, Susie’s career has focused on sexual and reproductive health, and supporting survivors of human trafficking through clinical care, research, and advocacy. Fewer than 1% of trafficking victims in the US are are identified, and Susie, who co-founded HEAL Trafficking, works closely with physicians and health care providers to educate them on signs of trafficking to improve victim identification. Once victims have been identified, Susie and her colleagues at HEAL also help to train health providers to properly respond to and work with patients that are survivors of trafficking by creating environments where people feel safe and secure discussing their situation with their health care provider. By using public health interventions, Susie is heroically working to provide the essential support and care necessary to those whose basic human rights have been egregiously violated, while also working to build the systems necessary to support survivors once they have been identified.

So much of our health is determined by forces outside of our immediate control, and individuals like Lloyd, Mona, and Susie play an important part in ensuring that those forces – the social determinants of our health like housing, water, and labor – allow us to live better, healthier lives and not deter us from reaching our fullest potential. We are excited to hear their TEDMED talks in Palm Springs this year, and we hope to see you there!