Transforming Baltimore: Public Health as a Social Justice Engine

A Q&A with Dr. Leana Wen, Baltimore City Health Commissioner

Dr  Wen 011215 Official1 (1)During her first year as Baltimore city’s health commissioner, Dr. Leana Wen has taken on the tough, chronic issues that plague the city—poverty, violence, and drug abuse. We spoke with Dr. Wen about her efforts to turn Baltimore into a trauma-informed community and a national model for overdose prevention and drug treatment. She talks about the critical steps needed to tackle these deeply entrenched and intertwined challenges.

Baltimore is still recovering from Freddie Gray’s death and the protests and riots that ensued seven months ago. What is the approach you’ve taken to helping the city recover?

Though the period of severe unrest may be behind us, the underlying problems that caused them have not gone away. Violence, poverty, and health disparities have many inputs. In Baltimore and in many other places across the country, these are closely tied to substance use and mental health problems, and to historical policies of mass arrest and incarceration. By focusing on the root causes of violence, poverty, and health disparities, we can turn this challenging moment into an opportunity to transform our city into a national model by demonstrating how public health can be a powerful tool for social justice.

How are you addressing violence prevention in Baltimore?

Violence prevention is a key function of public health. In many ways, violence is no different from an infectious disease. Just like measles or the flu, it is contagious and spreads from person to person. It creates fear and wreaks havoc. It results in illness, trauma, and death.

But this also means that there is hope, because, like any disease, violence can be prevented, and it can be treated. We can implement interventions to interrupt the violence, and we can prevent violence from happening in the first place.

Last year, our Safe Streets program—in which “violence interrupters”, many of whom are recently returned citizens, walk the streets and intervene in potentially violent situations—mediated 880 conflicts, 80 percent of which were deemed “likely” or “very likely” to end in gun violence.

Meanwhile, we are teaching middle school students to recognize the signs of relationship violence and empowering them to change the norms around dating. And we are working with health care providers, who have a valuable opportunity to intervene and help address the underlying issues of violence when a patient comes in with an injury.

We know that preventing violence is far from simple and requires a combination of approaches. Ultimately, violence has its roots in poverty, substance addiction, unmet mental health needs, and rampant disparities. All of these underlying issues must also be addressed for us to have a just and safe city. So we must continue to target our efforts on evidence-based, public health strategies that serve our neighborhoods and save the lives of our residents.

How are you working to change mindsets around violence, crime and trauma?

We are training all of Baltimore’s front-line city employees—including teachers, social workers, police officers, and other outreach workers—on understanding and treating the effects of trauma. When someone is arrested, we can’t just look at that individual as a perpetrator of violence. We need to understand and treat the effects of the trauma they’ve experienced.

Social issues, like poverty, homelessness, mental health, and substance abuse addiction, often underlie deep trauma. We want to make sure all of our front-line city workers have this mentality when we are approaching our residents.

You’re also working to make Baltimore a national model for overdose prevention and drug treatment. Why did you decide to prioritize these issues?

In my city, more people die from drug and alcohol overdoses than from homicide. Nationally, drugs account for more deaths than car crashes, shootings, or alcohol, according to data from the Centers for Disease Control and Prevention. The CDC estimates that 120 Americans die from drug overdoses every day.

The majority of overdose deaths are from opioids, which include heroin and prescription painkillers such as oxycodone. People who overdose on opioids stop breathing, and within minutes can suffer brain damage and death.

What is most tragic about these deaths from opioid overdose is that there is an antidote that is safe, effective, and literally lifesaving: naloxone, also called Narcan. It’s easy for almost anyone to administer.

In Baltimore, we have been training people with heroin addiction to use naloxone since 2004, including targeted training in hot spots, such as shooting alleys, recovery housing, and prisons. In fact, we’ve trained over 6,000 Baltimoreans this year alone, including community members, legislators, and even police officers.

We advocated for a change in state law that enables us to train anyone who wants to learn to administer Narcan and allows me to prescribe Naloxone to any of our 600,000 residents.

To be sure, treating overdose isn’t the only solution. Addiction treatment requires long-term medications and psychosocial support. We also have to focus on prevention, stop drug trafficking, and teach doctors more careful prescribing.

But if it’s one lesson that I’ve learned from the ER, it’s that if we can’t save a life today, there’s no chance for a better tomorrow.

Baltimore has long been known as the heroin capital of the country. I want Baltimore to be known as a model for recovery and resilience.

You’re tackling some of the most persistent problems facing American cities. What are some of the key steps to accomplishing this work?

Baltimore has a long history of innovation in public health. We are the oldest public health department in the country, and we have a long history of taking on different issues. It is our job to make the case that public health is tied to everything—that we cannot talk about poverty without also addressing the heroin epidemic and what it’s done in terms of crime and unemployment for citizens. We cannot talk about better health care and better jobs if we’re not addressing the core problems that people have when it comes to shelter and employment that also tie closely into health.

We also know the most credible messenger is not necessarily a medical professional, but people who are from the communities they serve. We all have a role to play. We need to work closely with those stakeholders—young people, neighbors, community doctors, nurses—as well as our partners in local government, law enforcement, and hospitals to move the needle and see progress as we take on these challenges.

Collaboration is key. B’more for Healthy Babies for example, is a partnership of more than 100 city agencies, health care providers, insurers, and nonprofits, all of which have signed on to a citywide strategy for reducing infant mortality. Through this collective impact model we have worked together to drop Baltimore’s infant mortality rate by over 20 percent, hitting its lowest point ever recorded in 2012. And as a result of the success of programs like this, we are expanding B’more for Healthy Babies into the B’more for Healthy Youth and B’more for Healthy Teens programs as part of a comprehensive youth health and wellness campaign.

What lessons would you like to share with others working in public health?

Public health is a powerful social justice tool through which we can develop a framework to level the playing field of inequality. We have to change the mindset to acknowledge, for example, that racism is also a pressing public health issue.

By changing the conversation around how we view public health, by directly engaging people in their communities, and by recruiting the most credible messengers, we can find innovative ways to move the needle over the short term, while catalyzing social change that will improve outcomes for generations of Americans.

Reflections: Dr. Pamela Wible, Physicians’ Guardian Angel Describes “Ideal Health Care”

Pamela Wible
Pamela Wible, a speaker in our Human Explorations session.

An estimated 400 physicians commit suicide each year and many more suffer from emotional illnesses and addiction. Estimating that each doctor cares for 2,300 patients, this means that every year close to one million people lose their doctor to suicide. Their loss is tragic, painful and frightening – and, for the families, friends and colleagues of the victim, the repercussions of the suicide are lifelong.

In a presentation that managed to be both fierce and deeply vulnerable, angry and loving, Dr. Pamela Wible shared with the TEDMED community her insights and possible remedies for the physician plights. She described, in detail, what it would look like to care for the people who care for us. She makes a strong case that a major contributor to the problem is our system for medical training: Broken people are perpetuating a broken system.

Pamela exhorts the TEDMED community to commit to changing the plight of the people who give care. Her words were meant to inspire not only those who train doctors but also those of us who are patients. Like all positive care experiences, trusting relationships are at the core of optimizing outcomes.

Pamela challenged listeners to type the words “Doctors Are” into the Google search bar, and see how it auto-populates with the most common search queries. So we did.

Google
Google reveals which adjectives people most often type into the search bar after “doctors are …”. Pamela believes medical training creates this situation.

This represents a public mindset. It is not “wrong” in the sense of being inaccurate, since it is how people are feeling as a result of their engagements with doctors and the outcomes. But it is wrong in the sense of reality. The people who care for us are our best and brightest, they work unreasonable hours, face untenable pressures and struggle to stay viable in an ever-changing system that fights against what, for many doctors, is the soul of their work: relationships with their patients. The 2014 Physician Foundation Study revealed that approximately 80% of physicians rated patient relationships well above prestige and pay … yet, says Pamela, this is what gets lost in the real life of doctors.

We, doctors and patients, are in this together. It takes two to start and build a relationship. Shifting our goal to creating a “culture of health” demands that we find ways to celebrate and enhance the doctor patient relationship.

Live and In Person: Different Ways to Experience TEDMED 2015

Liz Branch and Megan McCarthy
Liz Branch and Megan McCarthy, organizers of Baptist Health Care’s TEDMED Live event at the Blue Wahoos baseball stadium in Pensacola, FL.

On a beautiful Friday morning, hundreds of residents from the Pensacola, Fla., region are converging on the waterfront Blue Wahoos Double-A baseball stadium to experience TEDMED Live as a community. The event, free and hosted by local experts in health and medicine, is a way to inspire passion and a commitment to a healthier lifestyle. “The truth is, we are probably one of the least healthy counties in Florida and we want to spread the word and help people make changes,” says Liz Branch, corporate service line marketing director for Baptist Health Care. Forward-thinkers in making health a shared value, Baptist Health Care has collaborated with its competitors (other local hospitals) to create a coalition to improve health in their community. Several hospitals went “smoke free” together and, with this event, Baptist Health Care has invited hospital employees from around the region, along with community leaders, medical and nursing students and anyone with an interest in sharing the TEDMED Live experience to the free event, which runs Friday, November 20, from 9 am – 2 pm.

In the spirit of promoting healthy behaviors, careful attention was given to health-promoting details: Carpooling is encouraged, the event is promoted as “breastfeeding-friendly” and there is a downloadable event kit, which comes with an exhortation to take notes and “cascade what you have learned to your organizations, churches, family and friends!”

Lisa Fitzpatrick
Lisa Fitzpatrick, a physician exploring alternative ways to deliver healthcare – even on city streets.

Describing herself as a medical doctor with an entrepreneurial spirit, Lisa Fitzpatrick’s motivation for attending TEDMED to explore ways healthcare can be more flexible and responsive to patient’s needs and most particularly for needful patients in the inner city. “I believe we need to shift healthcare out of buildings and into the community, even if it means offering it on the streets where people are congregating,” she says, noting that she has tried this. “We had a patient who was diagnosed with HIV and because the diagnosis terrified him he would not come into the office. I was told that he was depressed, afraid and potentially suicidal.  Each member of our multidisciplinary team (the nurse, social worker, navigator, receptionist and psychotherapist) contacted him to try to convince him to come in. When nothing else worked, they asked me to contact him. I huddled with the team to find out what everyone had tried up to that point. Armed with that information, I called him and told him he didn’t have to come in and I would come to him if he would just give me a few minutes. I left the hospital and drove to where he was. We met in the middle of the block and stood there, having a conversation. I was able to explain the treatment and science to him and as we say, ‘talk him off the ledge.’ He came into the clinic the next day. He has an addiction, and through a combination of phone calls, texting and in- person visits, we were able to get him started him on HIV medication. He has been in treatment since. These efforts are labor intensive but necessary if we mean what we say about improving health outcomes.”

Denise Terry
Denise Terry, co-founder, EmbraceFamily Health (Woodside, Calif.) takes a working break in Palm Springs.

Careers in sales, marketing and as a labor doula have led Denise Terry, co-founder of EmbraceFamily Health, to her current mission: Breaking through barriers in maternal-child healthcare delivery, with a digital health solution for pregnancy and parenting that she describes as being like having your “OB in your pocket.” In partnership with the obstetrician who delivered her twins (now 8 years old), Terry’s company creates and delivers medical-grade, personalized information on pregnancy and parenting, with the goal of “helping moms build healthy families,” she said. Her goals at TEDMED include making synergistic connections and, she hopes, doing some fundraising. Seed-funded thus far, Terry says the company hopes to connect with strategic corporate partners “who might be able to help us get to the next level.”

Breaking Through to Create a Culture of Health: One Table’s Process at the RWJF “Creating a Culture of Health” Luncheon

Luncheon

We had a problem to solve.

How can business positively impact society’s health?

Our hybrid group of thinkers had four physicians, three marketers and four agency leaders.

We coalesced on what business is and isn’t; on what health is and isn’t. Perspectives varied, experiences motivated answers and, as a group, we found that our hybridity and disciplinary disparity led us to insights we would not have reached separately. For those of us who aspire to create a culture of health by selling goods and services is a multifaceted endeavor. Producers and retailers need to be incented and involved in creating and selling health-promoting products. Employers have an obligation to support health, but also achieve immense benefit by inspiring and enabling healthier places to work and incenting and rewarding healthful decisions.

The most beautiful sentiment, which summed up the conversation, came to our group from Dr. Param Dedhia, who set our true north with a simple observation: positive health changes – at their core – must bring us joy.

What a wonderful breakthrough.

Transforming the Way We Think About Race in Medicine

RWJF - Roberts

By Dorothy Roberts

Dorothy Roberts’ work in law and public policy focuses on urgent contemporary issues in health, social justice, and bioethics, especially as they impact the lives of black women and their families. She is the George A. Weiss University Professor of Law and Sociology and the Raymond Pace and Sadie Tanner Mossell Alexander Professor of Civil Rights at the University of Pennsylvania.

An 8-year-old black girl is repeatedly hospitalized for lung infections. None of her doctors can figure out what’s wrong. Finally, a doctor looks at her X-ray without knowing her race and correctly diagnoses her with cystic fibrosis. None of the other medical professionals had considered cystic fibrosis because of the myth that certain genetic traits exist only in certain races—the myth that black people don’t get cystic fibrosis. It’s a classic case of misdiagnosis based on racial assumptions.

The racial concept of disease—that people of different races suffer from different diseases and experience common diseases differently—goes back centuries to the promotion of slavery. White slaveholders argued that, because of their biological peculiarities, enslavement was the only condition in which black people could be healthy, productive, and disciplined.

Today, medicine perpetuates this long history of defining disease in racial terms. Medical students are taught to treat their patients according to race, and this contributes to the racial inequities that plague every aspect of medical care. For example, studies show that blacks and Latinos are less likely than white patients to receive pain medication for the same injuries. Some theories attribute this to stereotypes among healthcare providers that blacks and Latinos are more likely to exaggerate their pain, can stand more pain, or are predisposed to drug addiction.

This problem persists in medical devices and tests, such as the test that is used to evaluate a patient’s risk of kidney failure. Patients who self-report as black will get a different result than those who self-report as white. The calculation measuring kidney function is set to interpret the level of creatinine concentration in the patient’s blood differently if the patient is black. This is based on the absurd assumption that black people have more muscle mass than people of other races. Assumptions such as these are often extrapolated from old studies that get from one generation to the next.

Countless research projects also search for genetic causes to racial gaps in asthma, infant mortality, diabetes, cancer, and other medical conditions. But scientists routinely use sloppy, inconsistent, and ambiguous definitions of racial categories in biomedical and genetic research, and leap to genetic conclusions without ruling out more logical social explanations for health disparities.

Although studies typically attempt to control for participants’ socioeconomic status, researchers routinely fail to account for many other unmeasured factors—such as the experience of racial discrimination or differences in wealth, not just income, or rates of incarceration—that are also related to health outcomes and differ by race. Any one of these unmeasured factors might explain why health outcomes vary by race. We would expect social groups that have been systematically deprived for centuries to have worse health than social groups that have been systematically privileged—but the reasons are social, not genetic.

The hypothesis that health disparities are caused by genetic difference is founded on a misunderstanding of race as a naturally created biological division, rather than a politically invented social division. Race is a political construct that has staggering biological consequences because of the impact that social inequality has on people’s health. As a result of race-based medicine, health inequities persist — and divert attention and resources from work that could actually help address the social inequities that produce these gaps in health.

Understanding race as a political construct that affects health reframes the way scientists approach the relationship between race and biology. A growing number of researchers from a variety of disciplines, including medicine, biology, psychology, anthropology, and epidemiology, are investigating how racial inequities in wealth, housing, and education, along with experiences of stigma and discrimination, translate into bad health.

We need to work together to transform the way the medical profession thinks about race. We must change medical school curriculum to incorporate a stronger understanding of the social and structural determinants of health, so that future providers will be trained in treating the whole patient.

We need to stop treating patients by race. We need to start valuing people equally as human beings, while working to understand the impact that racism and social inequality have on their health. And we need to join the forefront of the movement to end the structural inequities that produce racial gaps in health.

From Trauma, Inspiration: 3 TEDMED Scholars and Their Journeys to Palm Springs

Vania Deonizio, Founder, Dancin Power
Vania Deonizio, a musician/dancer and founder of Dancin Power, crowd-sourced her way to TEDMED2015.

Integral to our TEDMED mission is assembling a diverse mix of Delegates to present a variety of perspectives on new ideas, trends, treatments or technologies that can contribute to health and medicine. Some exceptional individuals – people we believe would make outstanding Delegates, who would benefit greatly from joining us – qualify for scholarship subsidies if financial obstacles stand in the way of their attendance. Their stories are often inspirational, to say the least. Here are several we’re delighted to welcome to this year’s conference, kicking off today:

Vania Deonizio, Founder, Dancin Power

Dancin' Power

 

“I was born in Rio de Janeiro, Brazil to a family of musicians, and was introduced to various rhythm of music and dance very early. Growing up I faced a major childhood trauma that almost took my life. That is when I found in dance a way to escape from that horrible situation, along with freedom and hope for a better life. I started Dancin Power (we use the healing power of music and dance to improve the quality of life of hospitalized kids) to help children who, like me, find themselves stuck in difficult situations they didn’t ask for. Dancin Power gives these kids a way to express themselves in a safe welcoming environment. It provides them with an outlet to experience joy and laughter, and most importantly, it reminds them that even though they are sick and in a hospital room, they are still kids and have the right to be happy!

“A few weeks ago I found myself searching for inspiration in TED talks about innovative ideas in health; that’s when I came across TEDMED for the first time. I immediately connected with its concept and felt that Dancin Power and I belong here. We are a small nonprofit; despite the fact that I didn’t have the funds/resources to apply, I didn’t allow that to stop me from going after what I believe should happen. I did my homework and sought who I should connect with via LinkedIn and then was awarded a Partial Frontline Scholars grant. Through crowdfunding I was able to raise the remainder amount to attend the conference within 48 hours! Today I am here and couldn’t be more excited for all that is about to happen! May the inspiration, connections and opportunities for collaboration begin!”

http://www.dancinpower.org/

Jessica Harthcock, Founder, Utilize Health

Utilize Health“We all find our career or our calling through different means – maybe it’s an interest we’ve had since we were 5. Maybe it’s a hobby-turned-career. Maybe we just ‘fell into it’ (yep, that’s a pun… and it’s what I did). For me, it was an up-close and personal experience I had with the healthcare system.

“In 2004 I was practicing my springboard diving routine at a gymnastics studio, when I landed wrong and heard a crunch: I couldn’t move. I was paralyzed. My official diagnosis was a spinal cord injury with paralysis at the T3-4 level. That meant I could move my arms, but nothing below my sternum. The doctors told me the damage was permanent, and I would never walk again.

“I spent years traveling across the U.S. searching for treatment options. I enrolled in a research study, explored alternative medicines, and continued very traditional forms of physical therapy. After nearly three years, I took a step and eventually that step turned into 10 more steps. Slowly but surely I progressed. Today, I am 11 years post-injury and walk unassisted.

“Throughout the recovery process, I realized that finding treatment options wasn’t efficient. It could be improved upon in many areas; time, financial resources and energy were drained. I wasn’t alone; countless others shared my experience. Many of them heard of my success and reached out for help. By the 100th patient, I knew there had to be a better way.

“Thus, Utilize Health was born. Dedicated to making the treatment process easier for patients, Utilize Health aspires to improve patient outcomes, decrease costs, and change the lives of patients for the better.

“I started watching TED talks years ago – and now, I am inspired daily by people who share my passion for helping others and making our healthcare system better. TEDMED has been a bucket list item for several years. I’ve always been inspired by the doers and dreamers of the world (which is everyone at TEDMED). I still have to pinch myself that I’ll actually be there this year!”

http://www.utilizehealth.co

Amy Price, PhD

Amy Price, PhD“I came to this from a drastic car crash where I had significant brain and spine injuries. It was a tough path and I wanted to make it easier for others. First I was a patient advocate but the company was run by a group that ran afoul of the FDA and I realized I did not know what real research was.

“As part of my rehab and to redefine my destiny I ended up at Oxford where I am completing a DPHIL on running Public Led Online Trials where the public can research questions of interest to them and we can learn together. Here is some more information on what I am doing: One is a blog written for Oxford; another for the British Medical Journal; the third item is a video Oxford did with me in it for students with disabilities. I plan to blog for my college on this, specifically for the Oxford Thinking Campaign and on our website.”

How the DIY Mindset Can Help Us Build a Culture of Health

Maker Nurse
An idea-in-process at Maker Nurse.

By Anna Young, Co-Founder of MakerNurse

With the right tools, anyone can use their creativity to invent or re-imagine devices that heal.

For the past six years, I’ve traveled the globe to explore—and invent—do-it-yourself (DIY) health technologies and understand how to best bridge the “maker movement” and health care to bring tangible solutions directly to the bedside.

Makers are the tinkerers, inventors, and everyday people who mash up old-school crafting with computer wizardry to put a new spin on common products or build new things—from kettles and toasters to robots and drones. With an explosion of personal technology such as 3D printers and microcontrollers, and a shift toward open communities of practice, where people freely share their ideas and designs to be replicated or modified, a whole culture of making has emerged. Now, anyone with a DIY mindset can shape, form, assemble, and transform objects using their own hands-on skills and ingenuity.

And it’s happening in healthcare. There is a growing community of “stealth innovators” who experiment, modify and create medical devices.

So, who are these medical makers?

Throughout my travels, one thing has been consistent: Nurses are quietly tinkering with everyday medical devices and hacking materials from the supply closet to create new tools to care for their patients.

For the past two years, with support from the Robert Wood Johnson Foundation, my colleagues and I have focused on uncovering nurse making in U.S. hospitals to identify resources that could help bring their ideas to fruition and lead to improvements in patient care.

In our explorations, we have found nurses whose making helped reduce costs and improve patient outcomes. Yet, because their inventions have no billing code or published research behind them, they go completely unrecognized by the system. So, we started to imagine what might happen if we moved their prototyping and ideas out of the supply closet and into the spotlight—and gave them access to the same tools and materials used by professional designers and engineers, radically democratized by the maker movement.

Last month, we brought these tools and materials directly to the bedside. We opened the doors to the country’s first medical maker space on a patient floor of John Sealy Hospital at UTMB in Galveston, Texas. Although nurses at UTMB spearheaded the project, the makerspace is open to all medical staff and health professions students, and patients and caregivers are invited to join providers in co-creating tools and devices. Stocked with equipment ranging from pliers and sewing needles to 3D printers and laser cutters, the makerspace also includes a new class of healthcare prototyping tools not found in your average makerspace: modular “vital signs” construction sets, sterilizible materials, biocompatible adhesives, and safety procedures for scaling prototypes.

This is a culture shift. We’re not just reinventing the provider’s instrument bag. We’re re-instrumenting a hospital. And we’re reinventing healthcare. Through medical making, those on the frontlines can develop solutions and introduce new hardware into the care-delivery process faster than a traditional medical device company. Closer to the patient than a biomedical engineer, they can deliver truly personalized medicine and n=1 devices.

We are continuing to develop new tools and resources to help providers, patients, families, caregivers and others “in the trenches” make health. Our new MakerHealth Create site, which launches on November 19, is our first step to turning more ideas into practical devices. And helping bring makers, their devices and their patients out of the shadows.

My hope is that one day, your doctor prescribes not just a pill, but a blueprint for making an easy-to-open pill box. And you go not just to a pharmacy, but to a craft store with your occupational therapist. And that if you have an idea for improving healthcare, you go to a medical makerspace and make it!

It’s time to democratize innovation. When we all take part in devising solutions to improve health, we will accelerate a Culture of Health in this country.

A Healthcare Initiative Disguised as a Grocery Store

Doug Rauch
Daily Table in Dorchester, Mass.

By Doug Rauch
Founder and President of Daily Table

At Daily Table, we are on a mission to make the healthy choice the easy choice for residents in our community. As one of the first fully nonprofit grocery stores in the U.S., Daily Table is an experiment that uses one pressing challenge – wasted food – as a solution for another — hunger and malnutrition in low-income communities.

Our mission is to sell delicious, wholesome food at very affordable prices. Daily Table is designed to reach food-insecure individuals who struggle to eat well, many of whom also face health issues that stem from a poor diet.  Responding to the sad truth that nutrients are expensive and calories are cheap, Daily Table believes that the solution to hunger and obesity in America is not just a full stomach, but a healthy, affordable meal. In short, Daily Table is a healthcare initiative disguised as a grocery store.

We sell fresh produce and groceries, as well as prepared meals that are cooked onsite in a professional kitchen every day. We believe that the food we eat with our families plays a big role in our well-being, so we make sure that everything we offer has our customers’ health (and wallets) in mind. Every food item in the store meets strict nutritional guidelines for salt, sugar and fiber, and can be purchased with Supplemental Nutrition Assistance Program (SNAP) funds. Because customers get to come in and choose what they want in a normal shopping environment, it increases the likelihood the food will be consumed. You choose it; you use it. And our customers have the power of the purse; we have to earn their patronage every day. This engenders a sense of self-worth and dignity often missing from charitable handouts.

Our unique sourcing strategy distinguishes Daily Table from the average neighborhood food market. Although one in six Americans is food-insecure, up to 40 percent of the food produced in this country is wasted: It is tilled back into the soil at farms, left in dumpsters behind supermarkets, and thrown into wastebaskets in our homes. Daily Table relies on manufacturers, growers and supermarkets to donate their perfectly edible, excess food as a primary source of our food supply. In this way, Daily Table can keep its prices so low that they are comparable to traditional fast-food alternatives in the neighborhood.

As a retail store, Daily Table’s flagship location is anchored in the Dorchester community outside of Boston. It has created about 30 new jobs, with 75 percent of the store’s retail and kitchen hires living within a two-mile radius of the store. The retail space is bright, clean, and inviting, and the store team treats customers with respect and warmth, creating a welcome and enjoyable shopping experience for all.

We all have a role to play in transforming our communities and changing our culture to one that doesn’t simply value health, but delivers tangible opportunities for our communities to live healthy lives.

Daily Table’s model simultaneously addresses food insecurity and health in a respectful, dignified manner for our customers. It also presents a unique, market-based solution to the problem of wasted food. We’re confident that this combination will help the communities where we open stores to build a Culture of Health, and give us a solid foundation to expand into other markets. After all, the need for affordable, delicious, convenient and wholesome food is everywhere.


Watch Doug Rauch’s TEDMED 2015 talk, “A dignified solution for wasted food”, here

Breaking New Ground for the Future of Medicine

Chris Mason
In this Big Think video, Chris Mason explains why our human future requires colonization of outer space.

When asked to name the person, alive or dead, with whom he’d most like to collaborate, Chris Mason – a biophysicist and expert in computational genomics – has a ready answer: “Isaac Asimov.” Why? “Because he’d help right away.”

This makes perfect sense for Chris, a “proud contributor to the 500-Year Plan” who is working with NASA to create the “metagenome” as part of the long-term survival of Earth’s inhabitants. A “systems thinker” who is, perhaps, best known for building the first genetic profile of a metropolitan transit system, created by collecting DNA swabs from the benches, turnstiles and handrails throughout New York City’s subway system, Chris characterizes multinomic data in a variety of environments, from cruise ships to Chernobyl-struck villages to outer space.

Understanding the collective microbiome has important implications for public health — past, present and future, Chris explains. His bacteria-collection project provided “a forensic ability to learn about the ancestry of the people who transit a station,” he said. The DNA people leave in their wake provides information about their ethnicity, the places they’ve visited, the illnesses they’ve had, even the foods they’ve eaten. This information can be used to predict and plan for challenges that lie ahead – on earth or elsewhere. “I am #BreakingThrough the central dogma of molecular biology, single-planet planning, and limits on DNA/RNA detection, function, & design,” Chris says.

Also focused on the mysterious frontier of bacterial life is Chris’s fellow speaker Ken Nealson, the Wrigley Chair of Environmental Studies and Professor of Earth Sciences and Biological Sciences at the University of Southern California. Ken tells us that he is “#BreakingThrough by challenging current paradigms of microbial life via ground-breaking revelations of bacteria that ‘breathe rocks’ and ‘eat electrons.’” As a highly experienced senior scientist and mentor to many, Ken is at the forefront of electromicrobiology, a new branch of science that examines how bacteria produce and react to electricity, focusing on practical implications. “They turn out to have an incredible talent for sewage treatment, for example,” Ken says. “Stick an electrical anode in human waste and it attracts communities of bacteria that eat feces and breathe electrons. Hook them up to a fuel cell and you have a self-powered wastewater treatment system that produces significantly less sludge.”

Understanding these processes (which Ken and his team discovered) offers insights into challenges as disparate as toxic waste recycling, water reclamation, energy production, the control of harmful medical or dental biofilms, and even the search for extreme life. However, Ken sees one potential application as especially urgent: “My personal goal is developing these systems to a point where we could fly them into villages in the third world [so] people would bring their sewage to the treatment plant and get clean water, and you wouldn’t need any outside power.”

The human nervous system has super powers too, as it turns out. In our Catalyzing Great Science session, neurosurgeon Kevin Tracey, a pioneer in bioelectronics medicine (where molecular medicine, bioengineering and neuroscience converge), will share the frontiers of this new, hybrid field. Kevin’s unusual career path has produced a series of innovative discoveries, spawning clinical trials, start-up companies, and numerous accolades; right now, he says, he is “#BreakingThrough bioelectronic medicine by identifying mechanisms to exploit nerves to make drugs.”

Kevin is working on creating safe bioelectronics devices to replace the ineffective, toxic drugs used to treat diseases such as rheumatoid arthritis, inflammatory bowel disease, diabetes and even cancer. The “aha” moment that introduced this possibility occurred when Kevin succeeded at using an electrode to stimulate a nerve to trigger an immune response to inflammation. “It was immediately clear that neural circuits reflexively control the immune system, and that by identifying and mapping these, it would be possible to develop bioelectronic devices to replace anti-inflammatory drugs,” Kevin says.

Asked how he keeps himself focused, energized and inspired to continually push the boundaries of what’s possible, Kevin told us that he regularly asks himself “What experiment can I do, right now, to help the most people tomorrow?”

 

 

 

It Starts at Home: Making Health a Shared Value in Housing

NYC skyline housing
The Bronx by Axel Drainville is licensed under CC BY-NC 2.0

By Diana Hernández, PhD

Diana Hernández’s community-oriented research examines the intersections between the built environment (housing and neighborhoods), poverty, equity, and health, with a particular emphasis on energy insecurity. She is an assistant professor of sociomedical sciences at the Mailman School of Public Health at Columbia University and JPB environmental health fellow at the Harvard T.H. Chan School of Public Health.

“We were intervening too far downstream in the lives of our clients,” said Health Leads’ Rebeccca Onie in her 2012 TEDMED talk. “By the time they came to us, they were already in crisis.”

Onie was describing her days as a young law student fighting for the rights of low-income families. Her clients were grappling with the challenging intersection of health problems and housing problems, such as a man who couldn’t pay his rent because he was paying for his HIV medication or a young girl with asthma who regularly woke up covered in cockroaches. Rebecca took a hands-on approach, visiting her clients’ homes, collecting the cockroaches, and presenting them to the judges in the courtroom. This experience, among others, ultimately led Onie to found Health Leads, an innovative program that enables healthcare providers to prescribe basic resources like food, heat and housing, and then connects patients with those services.

We know that housing—particularly the affordability, adequacy and stability of housing—is one of several areas with vital implications for our health and overall well-being. Affordable housing ensures that residents can meet other basic needs, such as food and medical expenses. Adequate housing conditions help prevent the onset and exacerbation of asthma and other chronic health conditions, and promote better mental health and cognitive development. Stable housing ensures that people have continued social support and institutional ties.

It is imperative that we make health a shared value in the housing sector. There is a growing body of evidence supporting the links between housing and health, but engaging stakeholders in this effort remains a challenge. Three key stakeholders can play a more central role in creating value, particularly in low-income, multiple-unit housing: real estate developers, property managers, and residents.

Affordable housing creates opportunities for low-income individuals and families to maintain a home while on a limited household budget. Real estate developers have benefited from a variety of financing tools, such as low-income housing tax credits and new market tax credits, to create projects that would otherwise not be financially feasible. However, only recently have building standards begun to factor in health. For example, the 2015 Enterprise Green Communities (EGC) Criteria incorporate health into each dimension, from design and material selection to considerations of the neighborhood fabric, and devote an entire section to creating a healthy living environment. These criteria will build a solid foundation for healthy and sustainable affordable housing development, while paving the way for health to be viewed as an important value in the housing sector.

But it is not enough to design buildings for health—they also need to be maintained in ways that protect health over time. For instance, due to limited investment in regular maintenance and necessary upgrades, today’s public housing is dilapidated, jeopardizing the health and dignity of our nation’s most vulnerable residents. The U.S. Department of Housing and Urban Development has recently created the Rental Assistance Demonstration program to allow public housing authorities to preserve and improve properties and “address the $26 billion dollar nationwide backlog of deferred maintenance.” While this investment is crucial, we also need stringent stipulations to avoid a similar crisis in the future. Stricter maintenance policies should also be extended to private housing to ensure that health becomes a priority across all housing types.

Residents themselves also have a vital role to play in this effort—their knowledge and engagement are essential to promoting health. I’m collaborating on a project that is focused on smoke-free housing policy compliance and enforcement, and my community partners and I have implemented a “building ambassador” model. Building ambassadors (BAs) are residents who champion smoke-free living environments and health, acting as liaisons between tenants, the property manager and the research team. BAs are modeled after community health workers, who promote health in at-risk groups by supporting such issues as chronic disease management and reducing environmental triggers that cause asthma. Trained to understand the health consequences of smoking and how smoke-free buildings can help reduce exposures to health risks, the BAs assist with health education activities for their buildings. BAs work to build a Culture of Health right at home by reminding fellow tenants to consider their health and the health of their neighbors.

Greater attention to health as a key value in housing, especially in low-income housing, will increase demand for healthier design and improved maintenance while also driving social support from family and neighbors. Making health a shared value in housing requires the engagement of housing developers, property managers and residents who are charged with creating, maintaining and supporting opportunities for health in a primary physical and social environment—the home.