The "new" Washington Post editorial page blows a chance to be innovative | Nudging versus "nannyism" and senior health care

I was gonna end my online subscription to the Washington Post, but some of the articles from years ago I cited in the recently submitted grant application for a playground at Sugar House Park in Salt Lake ("Forget rest stops. Plan your road trip around playgrounds," "Kids getting burned on swings and slides? Here’s how to fix it"), made me realize that despite the destruction of the Metro and Sports sections, the devastation of the Editorial Page and how the range of op ed writings went from lean progressive to "personal freedom and markets," I still get value from a subscription, both for new articles and old (and often better) articles too.

But not from the editorial page.  And the national and international coverage is still holding up, despite many gaps resulting from staff firings.

Nudging is the behavioral economic theory that people who should change their behavior but won't because it requires a change in their routine or to act, will make the right choice given a nudge.

Nudge theory is a behavioral science concept proposing that subtle changes to the environment—known as "choice architecture"—can guide people to make better decisions without restricting their freedom of choice or altering financial incentives

Nannyism is a term popularized by the English Tories who believe that encouraging people to make positive behavioral changes with "nudges" is an overinvolvement by government in people's lives, that they should be allowed the freedom to f* up and impose the costs from doing so onto the State.

According to Wikipedia:

The term was coined by MP Iain Macleod in (1965) to describe a government that over-regulates personal lifestyle choices. 

In the Nanny State Index, the UK consistently ranks among the most heavy-handed countries in Europe for dictating health and consumer regulations.

The concept manifests across several specific areas of public policy:

• Tobacco & Vaping: The UK has pushed heavily toward a "smoke-free generation," alongside severe restrictions and proposed taxes on disposable vapes.
• Diet & Food: Following the implementation of a national sugar tax, England has enforced strict rules including calorie labels on restaurant menus and bans on junk food advertising near checkouts and on TV.
• Alcohol: Measures like minimum unit pricing aim to curb consumption by hiking the cost of cheaper alcohol.

Instead, the Tories would rather pay the high costs resulting from chronic health conditions resulting from poor behaviors and choices.  After all, higher than necessary costs from health care and a static tax base means government has to shrink to pay for people's bad choices, and that's in the Tory interest because they believe government ("we the people") is unnecessary.  

I call it anarcholibertarianism.

A great example of "nudge theory" decades before the theory was coined was how the now famed criminology professor, Ronald V. Clarke, was the creation of a theory called "preventing crime in situations":

Their theory of situational crime prevention used locks, access control and vigilance. Yet the most impressive demonstration of the theory examined the relationship between the lethality of household gas usage and suicide rates in England and Wales. Their research led to decades of innovations in the design of crime prevention measures, largely following their clear theoretical framework.

Prime example: Less lethal oven gas reduced suicides Between 1963 and 1975, there was an unexpected decline in the number of suicides in England and Wales. Clarke and Mayhew then reviewed the evidence to look for any change in the opportunity structure to prevent suicide. In 1988 they published a report showing that the decline was clearly due, at least in part, to a reduction of lethality in the chemical composition of household gas. It simply became more difficult to commit suicide by just turning on the gas and lying down – then waking up alive with a headache. They concluded that the practical feasibility of carrying out a particular act has a major impact on whether or not the act will be committed – and at what rate of occurrence.

Situational crime prevention theory is but a form of "choice architecture."

The Post is all in on being against "nannyism" even with clear economic/cost-benefits.  The editorial, "Seniors are adults: They don’t need the federal government to buy them bath mats.," criticizes Senator Angus King who wants to send everyone on Medicare (that includes me) a bathmat to help reduce the likelihood of falls, because bathroom falls by the aged cost the health care system a lot of money.

Older adults with assistive devices walking on a trail in the Sawtooth National Forest, Ketchum, Idaho.

Medicare doesn't pay for prevention measures like bath mats, grab bars, and shower chairs.  

According to a pre-Trump Administration report which is scrubbed from the HUD website, Overcoming Obstacles to Policies for Preventing Falls by the Elderly Final Report,  by the Department of Housing and Urban Development, the annual cost of health care from elderly falls is at least $80 billion per year.

To put that number in perspective, if Jeff Bezos who is one of the globe's wealthiest and owns the Washington Post, was responsible for covering that cost year after year, his fortune would be wiped out in 3 years and 2 months.

Although note that Senior Housing Services programs, which used to be funded by HUD, will make these kinds of fixes, as part of broader renovation assistance aimed at keeping seniors in their homes despite infirmities--keeping people at home as long as feasible costs a lot less than nursing homes, another major health care cost, but for Medicaid.

Housing renovation data by age and economic and physical circumstances.  Years ago I saw a presentation from the Joint Center for Housing Studies.  

Right: house in the Trinidad neighborhood of DC showing severely deteriorated roof conditions.

It contrasted overall housing remodeling statistics with statistics for lower income households.

Most households do one major remodeling project annually, targeting one key element of the house, either repair, maintenance, or the creation of a new feature.  Annually, the average household spends $2,400 on improvements and $700 on repairs.

Their research finds that a disabled household spends 10% less than the average, senior households 20% less, minority households 30% less, households with houses under $100,000 in value 50% less, and households with under $20,000 annual income spend 50% less.

Households with all of these characteristics spend an average of $500 year on repairs and improvements, less than one-sixth of the national average, and a majority of these households spend no money at all.

Nursing homes/social care.  The US is running into a fiscal cliff as society ages and Medicare doesn't provide nursing home care ("New Study Explores the Need for Expanded Long-Term Care Services to Support Aging-in-Place," JHU).  

And what about social security?  Plus the fiscal cliff of Social Security benefits having to be cut because Republicans won't take proactive steps, they'd rather "defund" part of the government by letting it fail naturally ("Waiting To Rescue Social Security Has Weakened Our Options," CRFB)

In England, local government is responsible for providing what they call "social care" for the disabled and aged, and it's driving cities into bankruptcy ("Social care is bankrupting councils. Why aren't we angry?," New Statesman).  Families are sending their relatives needing care to Thailand because it is cheaper ("Families sending relatives with dementia to Thailand for care," Guardian).  Anti-nannyism has real and escalating costs.

Waiting for a ride.

These costs demonsrate the value of changing the policy on assistive devices.

In my comment on the Post editorial, I said that Medicare could make bath mats a "joining premium" like how PBS and NPR give you premiums (gifts) in return for donations.

It's an intellectual and policy failure of great proportions for the Post to not acknowledge the reality of the severe economic cost of falls.

The other thing, while the term "ableist" is in decline these days by Trump mandates against inclusion, you really get insight into the need for universal design--in the old days, the Post published articles about it, such as:

-- "Adapting Your Home To Maximize Mobility," 2006
-- "A Safe Home, Step by Step," 2010
-- "Making the case for cottage homes," 2019
-- "A major renovation yields a multigenerational home on Capitol Hill," 2021

to better deal with the changes in psychomotor prowess that come from illness, disability, and or age.  Instead, the Post's worldview is shaped by its writers being able, not infirm.

At one time too, the Post had an award winning Health section focusing on wellness and behavior change.

Last year they did one of their "Washington Post Live" events on the "Future of health policy in the United States."  Times sure have changed.

My circumstances changed in a flash.

I went from biking to work for 30 years to being a hospital "frequent flyer," but for good reason.

I had colon cancer, presented heart failure in post-op after surgery, and the biopsy found I also had an aggressive rare Lymphoma, so I started chemotherapy within a month of the colon surgery.  Without treatment for the Lymphoma the oncologist said I'd be dead within a year.

Chemotherapy f*s you up.  

I was so weak, but I didn't vomit.  Though once it did take me 3-4 hours to have a bowel movement.  Suzanne said the prednisone made me mean.  It did help my appetite.

I did use chairs in the shower some because my FIL had dementia before he died, and we kept the equipment.  I even used a transporter because for a time I couldn't handle the "long walk" from the entrance of the hospital to my heart doctors or to the radiology/lab testing section. For more than two years, I was pretty damn weak, especially because even more medical things happened:

• I was hospitalized for covid, 
• probably could have died thank god for remdesivir, but it did worsen my heart
• got a heart pacemaker
• then an additional lead
• then a stent, even though less than a year before my angiogram found limited plaques, and 
• serious reduction in appetite as a complication from chemotherapy and the medicine, 
• which led me to a few months of enteral nutrition feeding + regular eating--enteral really sucks, the tubes can clog easily, and emergency rooms aren't set up to deal with feeding tube clogs.

Plus, one of the medicines I took made me cough constantly--it turned out it was from a medicine I didn't really need, fortunately, and once I got off it, and other medication changes my appetite improved.  Although I still only weigh 20ish more pounds than my low of 110.  From a high of about 175.

Today's shower.  

And that was after I went through chemotherapy swimmingly.  I had three treatments, then covid, so treatment stopped.  In preparation for resumption 14 weeks later, testing found I no longer had the Lymphoma (thank you to mRNA maybe).

But it took me until about the past two months when everything finally came together "at once" and I am super better.  (I'm still susceptible to illnesses like norovirus which can wipe me out.)

Yet only two years ago I thought I was a candidate for a heart transplant.  My ejection fraction could be better, but I haven't been tested since my recovery kicked in.

Our shower has a "natural grab bar" the soap dish, and is a pretty tight squeeze so I could lean against the walls.  But I was damn tired, had balance problems etc.  I think I might have had assistance once or twice...

Now I don't.  It helps that last summer I joined the JCC Wagner in Salt Lake first for the pool, and weight lifting really started only this year (not much so far 30-60 pounds depending on the machine or free weights), cycling (I've just started being able to bike a bit "in the wild," after not having done so since September 2023), spa, and pool walking.  The JCC has indoor and outdoor pools, that + the spa have been incredible for me.

Another premium that should be part of Medicare: fitness memberships/a MAHA agenda for aging.  I'm not part of Medicare Advantage, so I pay from my limited social security income the monthly cost of JCC membership.  The local rec center is cheaper especially with a senior discount, but there is no pool.  The County rec centers with pools happen to be much less convenient for me to get to, triple the time.

But Medicare should consider paying for fitness memberships for all enrollees, regardless of the type of plan, because lifting weights and other fitness activities have so many positive benefits (Physical Activity Benefits for Adults 65 or Older, CDC, "Resisting decline: the neuroprotective role of resistance exercise in supporting cerebrovascular function and brain health in aging," Frontiers in Physiology, "How can strength training build healthier bodies as we age?," National Institutes on Aging).

Or a deduction program funding the purchase of bicycles like in England or Ireland ("The Benefits of Biking for Seniors, Including the Mental and Physical Payoffs," Bicycling), but instead of deducting from your payroll check, from your Social Security check.

They could do this in conjunction with County and City Recreation Centers, Senior Centers, and yes, for profits.  Better that fitness centers make money off of Medicare than prescription mills and other fraudulent activity.

If we were really about MAHA, "Make America Healthy Again," ("Dr Oz at the Center for Medicare and Medicaid Services: a chance to improve food service in hospitals") those are the kind of preventative care measures we should be instituting.  

A FitLot exercise station at the Columbus Center in the City of South Salt Lake.

While RFK has done stupid PR stunts with unhealthy people like Kid Rock ("RFK Jr.'s erotic workout video with Kid Rock sure is weird," USA Today), imagine if the FitLot exercise equipment station piloted by AARP on its 50th anniversary--they funded one, but just one, in every state--were rolled out to playgrounds and parks across the country.  

(I am working to install one at Sugar House Park.)  Especially because it turns out they aren't just used by the elderly, but by people wanting to maintain and improve their fitness.

My energy level has rebounded significantly.  The past week, although I developed a cold as a result, I worked 10 hour days for about 9 days on the grant application, doing some 8-15 discrete tasks each day.  Before the last  two months, I maybe could have done 3-4, took naps many days of the week, etc.  Now I am waking up before 7am which is what I used to do naturally, before I was sick.  I'm not taking naps.

(Oh, and I am drinking alcohol some again, and coffee.)

What about the people who are in a permanent state of debilitation?  But most people who are debilitated remain debilitated, no Lazarus Effect for them.  They need compassion and assistance.  The Post really fell down by not considering this issue more broadly than the opportunity that they saw to shoot an arrow at "government waste" and overinvolvement of government in our lives rather than "personal freedom" to be really sick and unhealthy.

Fuck you Washington Post editorial page, until your writers have similar kinds of experiences and develop some empathy.

Just based on my response, the Post clearly missed an opportunity to move better policy choices forward.

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These are articles I wrote suggesting DC could develop a wellness oriented program in association with building a new hospital in Southeast DC, where suffering from chronic conditions is high.  Of course, DC took the least innovative path.

-- "Health equity devolves to cities and states as the federal government cuts taxes for the wealthy," (2025)

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River" (2018)
-- "Revisiting East of the River medical care: United Medical Center" (2018)
-- "Update on DC's plans to build a new United Medical Center" (2018)
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital" (2018)

-- "Community Health Improvement Planning" (2019)

-- "Hospitals as urban anchors/revitalization levers, not usually, but with great potential to serve communities in important ways: Examples are two forthcoming projects by Intermountain Health and University of Utah Health" (2023)

-- "Big omission in blog series on advance hospital/health and wellness planning, public health planning: addiction services" (2024)

-- "Costly failures in the mental health system" (2025)

Housing at hospitals as a benefit for longevity for the wealthy, and housing aimed at achieving health equity goals

Hospital adjacent housing for the well off.  A new hospital development in West Palm Beach, Florida will include mixed use retail and housing ("New Good Samaritan Hospital, with luxury housing and retail planned in West Palm Beach," South Florida Sun-Sentinel).  

The new hospital, which Tenet is calling a next-generation Center of Excellence for health care, will be part of a larger, mixed-use project by Easton Street Capital that will include luxury condominiums, rentals, retail and a hotel.

“We will be reimaging the Good Samaritan campus,” said Maggie Gill, group president of Tenet Healthcare. “In partnership with Easton Street Capital, we are redeveloping the site for housing, wellness and health care. This is a well-funded plan to make state-of-the-art health care facilities and technology more accessible to the region.”

...“The focus of the entire campus is a place where you can live, work and receive health care with an emphasis on wellness and longevity,” Gill said. “We think of it as an integrative approach to looking at the person holistically to help them stay healthy.”

... Housing will include rentals for the hospital workforce, as well as luxury condominiums to attract baby boomers seeking easy access to health care, an alternative to senior living. “I want to build longevity living where we’re trying to enhance the health span and the lifespan of the baby boomers,” Crowell said. “We think there will be buyers from around the country who come into this project.”

Also see "Good Samaritan Medical Center in West Palm Beach plans massive redo," Palm Beach Post. 

I have been somewhat "down" on mixed use proposals like what the Coalition for Smart Growth wanted for the new Prince George's County hospital with the University of Maryland ("University of Maryland could seed a complementary biotechnology and medical education initiative in Prince George's County") because my experience doing some consulting in Pittsburgh was that hospitals pretty much are inward facing places--people don't have much time to eat off campus, shop, etc.  

According to my next door neighbor, a doctor, now, some hospitals even offer private dining facilities with meals prepared by a chef, for physicians.  Try to get them to go to a nearby diner...

However, I have written about the St. Anthony Hospital project in Chicago, which will have housing ("New St. Anthony Hospital to be part of $600 million development at former trade school site in Little Village," Chicago Sun-Times).

Finished affordable housing units for sale in Baltimore with a great interest rate and relatively low cost.

And how Bon Secours Hospital System in Baltimore has developed senior and affordable housing as a part of providing better living facilities for older patients ("Royal Farms, Y of Central Maryland join Saint Agnes' Gibbons Commons project," Baltimore Business Journal. Bon Secours Community Development).  

They have 800 units, plus 147 units in development.  That's a decent amount.

Separately, they are rehabilitating 20 vacant houses and will make them available for sale ("8 things to know: Health system revives 20 vacant West Baltimore homes," Baltimore Business Journal).  

Not a huge project, but given Baltimore's straits, a worthy one, and a risk where others seem to sit back.

Dunn House, Toronto.

And while slightly more oriented to the homeless, there are a couple initiatives in Toronto sparked by hospitals, where they provide housing to chronically homeless or health needy people, in large part because it's cheaper to treat them when they have housing, than when they don't ("This Toronto philanthropist has millions to spend. Here’s why she’s pouring it into the homelessness crisis," "These Toronto hospitals are quietly sheltering homeless patients themselves to avoid discharging them into the cold," "Jason Miles’ addiction cost $260,000 in emergency room, shelter and jail stays. A Toronto hospital’s radical solution: just give him a home," Toronto Star, "Toronto’s University Health Network Takes on the Housing Crisis," Azure).

More on longevity housing projects in Florida ("New condo concept blends real estate and wellness. The goal? Staying young," Sun-Sentinel). 

Florida already has become home to hundreds of medical providers and clinics that promote treatments to slow aging and combat aging-related conditions.

“There is so much interest in it right now,” said Zhe He, director of Florida State University’s Institute for Successful Longevity. Aging, he said, is becoming viewed as a potentially modifiable condition that could be improved with certain interventions. He said that loneliness or social isolation can contribute to aging, so this type of longevity-promoting community environment could in itself have health benefits.

Cromwell said about 300 units in Easton Street Capital’s luxury condominium building will be marketed for $5 million to $25 million each. “The pricing is going to be expensive, but we are also fortunate that the baby boomers have accumulated more wealth than any other generation, and now, as they’re 80, there are two things in their lives that are the most important,” Cromwell said. “One is family and two is living longer because they want to be with their family.”

To help fund the preventive care services, Cromwell said Easton Street Capital plans to sell longevity center memberships. “This allows the general public to come in to access some of these services to cover and drive down the costs to the residents.”

There is two projects, by THE WELL group.

In North Miami-Dade, a condominium with a similar concept is expected to open by the end of the month. THE WELL in Bay Harbor Islands has combined a wellness center with 66 condominium units and some workspace.

Kane Sarhan, co-founder and chief creative officer of THE WELL brand, said the wellness center in the condominium building has a full gym, a bathhouse with a steam room, an infrared sauna, and a cold plunge. There are treatment rooms for IV vitamin therapy and access to functional medicine doctors, hyperbaric oxygen therapy, skin care, acupuncture, physical therapy, and energy work. There is also an organic cafe and grocery store that offers meal programs, and a movement studio for yoga, meditation, and fitness classes.

... Further south in Coconut Grove, THE WELL is underway with a second location: a larger condominium building with 194 residences. The units are larger and more expensive, from $1.5 to more than $10 million, but the concept remains the same — residences combined with 13,000 square feet of fitness and wellness spaces. Like its other locations, the wellness center will include visits with functional medicine doctors, health coaches, nutritionists and massage therapists.

RN Melissa Shaw checked on an IV drip bag for client John Blazo.John Tlumacki/Globe Staff

It will be interesting to see if the "new age-y medicine stuff" which isn't research backed in terms of health benefits will feed into the hospital centric projects ("People are spending hundreds of dollars at IV drip bars in Boston. Are they worth the hype?," Boston Globe).

I had a colonoscopy last week and in talking with the doctor before the procedure, I was talking about people and their belief in things like "detoxing" your liver (I have some liver damage because of the various medicines I take).  We joked about it, and he said he's thought about creating a clinic that caters to that thinking--he'd make a lot of money from it, but he said he couldn't do it ethically.

Health equity and health-housing for the less well off.  The former examples are more about the well off wanting to live longer.  

But why not have housing on hospital campuses for the less well off, as a way to better achieve high ratings when it comes to "social determinants of health"? ("Health equity devolves to cities and states as the federal government cuts taxes for the wealthy").  

Bon Secours, hopefully Focal Point, and various workforce housing initiatives show a way forward, so that such services and benefits may not be limited only to the wealthy.

Tracking waste water for diseases/epidemiology

The website WastewaterScan is a dashboard reporting out on various markers  for infectious disease found by studying waste water.  But only for those places collecting and reporting the data.  So you can get it for Salt Lake City, but not Washington, DC.

Costly failures in the mental health system | Chicago Sun-Times

The Chicago Sun-Times has a six part series of article on structural failure in the provision of mental health care in Illinois, which often has dire consequences:

To try to understand the reasons behind a spate of shocking crimes in downtown Chicago between 2021 and 2024, the Chicago Sun-Times examined four unprovoked killings and two nonfatal attacks, including a bizarre assault on a flight attendant from Mexico. Most of the attacks happened during the day. The victims: people who were just going about their lives. I 

n each case, the people charged — three who’ve been convicted — had a history of serious mental illness or delusional behavior and had drifted in and out of jails and hospitals, sometimes for decades, their conditions never regularly treated. 

Reporters pored over thousands of pages of police reports and court records, went to court hearings for a year for those who were charged, and interviewed family members, mental health experts, law enforcement authorities and government officials. 

What emerged most clearly from this reporting is that there is no system in Chicago to identify — let alone to help — the small percentage of severely mentally ill and violent people who commit these crimes. In each of these cases, it was only when they have been accused of murder or some other terrible crime that they were put on regular mental health medication — a finding that experts say is troubling but not surprising.

I realize in my series of articles on a more ideal health and wellness care system, there needs to be a separate article on mental health care, which is both a health and wellness care issue, as well as one of public safety.

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River." (2018)
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus," (2018)
-- "Part three: the potential for donations around an expanded program," (2018)
-- "Revisiting East of the River medical care: United Medical Center," (2018)
-- "Update on DC's plans to build a new United Medical Center," (2018)

-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital," (2018)

-- "Community Health Improvement Planning," (2019)

-- "Big omission in blog series on advance hospital/health and wellness planning, public health planning: addiction services," (2024)

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"Failure to treat, failure to project," main homepage, Chicago Sun-Times series on mental health care issues

-- "For accused mentally ill killers and their victims, help comes too little too late"

-- "Family still grieves for grad student prosecutors say was killed by a man 'terrorizing downtown' Chicago"

-- "A killer’s brother and mother: Fix mental health system so others don’t die"

-- "Cheerful day on North Michigan Avenue turns into a ‘nightmare’ for young flight attendant"

-- "How can Illinois prevent violent outcomes with better mental health treatment?"

-- "Released from the hospital and left on a sidewalk: ‘He literally fell through the cracks’"

From article 5:

• There’s no single entity overseeing the mental health care system in Chicago. That means, for instance, that homeless patients discharged from private hospitals might be given a bottle of medication and told to follow up at a clinic without what experts say should be a “warm handoff” to a treatment provider.
• Even though people experiencing homelessness and severe mental illness are more likely to become victims than perpetrators of crime, a small but visible number of them repeatedly cycles through the criminal legal system.
• With only about 1,200 state psychiatric beds in Illinois, he says more funding for community mental health would allow people who don’t need 24/7 hospitalization to leave state mental hospitals — meaning hospital spots could go to people in even greater need.
• But replacing long stays at state mental hospitals like the one in Elgin with comprehensive outpatient treatment would require a radical shift in thinking — away from retribution and toward treatment aimed at reducing suffering.
• It also would require supporting mechanisms that largely don’t exist, like providing housing for homeless people who have severe mental illness so they can be reached by medical and social service providers.
• “If the person who doesn’t get decent services commits a crime, now we have a crime victim, and that’s a cost,” he says. “And we have the cost of prosecuting her or him, and that’s a cost. And who’s paying for that?”
• Illinois spent an average of $49,271 on each person in prison in 2024, far more expensive than the cost of so-called wraparound services to keep people in treatment. The two biggest Chicago social service providers pegged these intensive services at $15,000 to $35,000 per client per year, depending on the person’s needs — which is as much as 70% less expensive than incarceration.
• Ideally, Antholt says, when mentally ill people are arrested, they’d get help before their release with housing, employment, disability services and mental health treatment, which currently exist in “very siloed” systems.
• ... He says the “magic bullet” for solving the problem is a “very good use of resources up front instead of very expensive institutionalization” because “the cost of prison and jails and hospitals and ERs is very expensive, and we can’t afford this in the long run.”
• ... She says that, when she went to the Elgin hospital to ask about her missing brother, she was told, “ ‘Oh, we’re not responsible. Once he’s released, our responsibility is just to drop them off. We don’t have to walk them into the actual shelter.’ ”

Some exemplary programs 

Nonprofit providers say they’re doing their best to keep people healthy and out of the criminal legal system. 

Some, including the largest in Chicago, Thresholds, run “Assertive Community Treatment,” or ACT, teams, providing intensive wraparound services to people with severe mental illness. The teams meet people as they’re being discharged from hospitals and take them home, get their prescriptions filled, make sure they have food, connect them with psychiatrists and work out immediate transportation needs.

The new Cedar Hill Regional Hospital opens in Southeast DC

Aneathia Brown, 25, poses for a portrait with her daughter Angel, 4, outside of Cedar Hill Regional Medical Center GW Health in Southeast Washington on April 15. (Craig Hudson/For the Washington Post)

See "When minutes matter: A community finally gets the trauma center it needs," Washington Post.

Planning for the new hospital there led me to write a series of articles and follow ups on how the city could do a lot more than merely open a rote hospital.  Although one of the architectural firms involved begs to differ with my take ("Cedar Hill Regional Medical Center GW Health: A model for community-centered-healthcare design/," HOK)

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River." (2018)
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus," (2018)
-- "Part three: the potential for donations around an expanded program," (2018)
-- "Revisiting East of the River medical care: United Medical Center," (2018)
-- "Update on DC's plans to build a new United Medical Center," (2018)

-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital," (2018)

-- "Community Health Improvement Planning," (2019)

-- "Big omission in blog series on advance hospital/health and wellness planning, public health planning: addiction services," (2024)

One of the examples I mentioned of a facility proposal offering more to the community, is St. Anthony Hospital in Chicago, which just moved forward on creating a hospital campus with a variety of community serving facilities ("St. Anthony finally moves forward on building new hospital in Little Village," Crain's Chicago Business, "Saint Anthony plans big for southwest Chicago campus," Catholic Health World, St. Anthony Community Health Needs Assessment).

From the second article:

Besides the hospital, the campus will have affordable housing, an outpatient clinic, educational centers for children and adults, a recreation center, athletics fields and green space, a venue for private events and retail shops. 

The building site is 1.5 miles from the 126-year-old Saint Anthony Hospital, a Catholic nonprofit facility unaffiliated with a larger system. The new campus and the existing hospital are in a section of the city largely populated by working-class or impoverished families, many of them Black, Hispanic or Asian and many of them immigrants.

... The size and plans for the Focal Point campus grew in the many years since it was first envisioned. Medaglia and Sifuentes say that is a result of input from residents of the surrounding neighborhoods. At forums that Saint Anthony hosted about the project, residents said they wanted not just quality health care but childcare, programs to keep kids off the streets, vocational training and more.

"That's how we realized that the initial 11 acres that the city was going to sell us was really not enough," Medaglia says. It also became clear that those programs couldn't be financed on hospital revenue alone, which comes mostly from Medicaid and other public insurance programs. 

I outlined a similar program for some facilities in Salt Lake County ("Hospitals as urban anchors/revitalization levers, not usually, but with great potential to serve communities in important ways: Examples are two forthcoming projects by Intermountain Health and University of Utah Health").  

WRT Intermountain in Downtown, the city's planning processes gave them no leverage to try to do anything.  For example, I suggested that the needs to be replaced Central City Recreation Center could be incorporated.

Profits versus community grants.  Some of the comments on this Post article, "Residents welcome new hospital in Southeast D.C.: ‘We need this’," criticized DC for picking a for profit hospital chain, Universal Health Services, to run the Cedar Hill.  I would have felt the same way before my myriad hospital stays, but my primary hospital is run by HCA, and they do okay.  Although they drop services that are in need, like nutrition counseling and diabetes management, that aren't profitable.

HCA doesn't do much in the way of benevolence.  Making a profit is key and that is repatriated to headquarters.

An interesting element of the St. Anthony project is that they say they will direct "profits" to community grants.

Seeding grassroots programs Once the campus is in full operation, Medaglia says the financial plan shows it will generate $7 million more than needed to cover costs every year. He adds that the extra funds will be awarded in grants to not-for-profit organizations serving the surrounding community. 

Sifuentes says that is one way the campus will be transformational to the approximately 440,000 people who live within its service area. The grants will be a reliable source of funding for the many church and community organizations that address food and housing insecurity and other social issues that affect health and well-being.

Dr Oz at the Center for Medicare and Medicaid Services: a chance to improve food service in hospitals

The people Trump proposes for the cabinet are mostly unqualified. And except for the fact that Trump wants to tear down government ("Trump takes aim at government as public faith in US institutions continues to erode," USA Today, "A big win for the Blow It Up Party, but what then?," Washington Post) not aiming for innovation ("Healthcare innovation: process redesign and innovation in DC and Prince George's County," 2011), so goes it for Dr. Oz, who has promoted Medicare Advantage plans, which tend to be a bad deal for patients and government spending ("Mehmet Oz loves promoting this inferior Medicare substitute," MSNBC, "The Great Medicare Advantage Marketing Scam," American Prospect). 

I have been admitted to the hospital a lot this year--5 times--once for 8 days (covid, pneumonia, myocarditis). One of the things that has surprised me about the hospital I use, which is a for profit owned by the largest hospital chain in the country, is that depending on time and availability, they send people from various units to talk to the patients, room by room (all private).  It turns out all for profit hospitals are not the devil.  And this one hasn't outsourced food service.

Last week when I was hospitalized, the leaders of the food service department happened to come around, and I had a long conversation with them (given my background in hospitality and familiar with some industry trends, it was pretty lively).  Despite various limitations, a few of their items are restaurant quality already, but certain key dishes are not and a majority of dishes are not.  

Opal Gordon and Sumei Rodriguez prepare fruit plates for patients at Lenox Hill Hospital. (Jeenah Moon for The Washington Post)

CMMS, among other things, regulates hospitals in many ways, including food service.  

While there are programs at various hospitals to improve ("Corewell Health among healthcare systems leveraging local farms for healthy food options," Rapid Growth, "Hospital Food You Can Get Excited About," New York Times, "Hospital food is a punchline. These chefs are redefining it," Washington Post) some of these efforts are hindered by CMMS.

One of the requirements is cooking proteins to extra well done.  Which makes eating cooked meat and fish--salmon should be medium rare--often intolerable when it comes to eating.  And I'd prefer to order salmon when it's offered because it is heart healthy.

"Dissatisfaction with food quality" was an element mentioned in the academic paper, "Hospital Food Service Strategies to Improve Food Intakes among Inpatients: A Systematic Review," Nutrients, 2021.

During his unsuccessful campaign for Senate two years ago, Oz complained about the high cost of crudités (a vegetable plate), for which he was pilloried for being out of touch ("Mehmet Oz’s crudité video gave opponent John Fetterman a golden opportunity," NBC News).  Regular people offer vegetable platters or trays and don't call it a crudité.

Instead Oz could redeem himself and focus on improving food service outcomes in hospitals.  

Except for that fact that the last thing the second Trump Administration cares about is improving services.

People claim government can't do (and there are serious problems with this, which I will write about), but Obama, Pelosi, the Affordable Care Act, Utah voters forcing the government to expand Medicaid, and Medicaid have saved my life.

I'm certain that is the case at least a million other times.  And there is plenty that the federal government does that is exemplary.  However, Republicans by focusing on cutting taxes, have made it impossible to provide the right amount of money to agencies necessary to fully fund services.

Another reason for a broader approach to healthcare planning

Massachusetts. Steward Health Care, a private firm that owns hospitals and other care facilities in multiple states, and 9 in Massachusetts, is in danger of going out of business, putting thousands of people out of work, and making health services much harder to obtain ("Steward Health Care’s financial issues could spell catastrophe for the state" and "Steward’s medical devices were repossessed. Weeks later, a new mother died," Boston Globe).  Bills have been left unpaid for as much as one year.

One of the reasons the company is in financial distress is that the real estate ownership was separated from hospitals, so they have to pay big rent bills, on which they are behind.  When hospitals own their real estate they don't have to pay rent.

While various elected officials are talking receivership, they haven't already developed such powers, making quick action difficult.

Rural hospitals are going out of business at a high rate leaving many communities without close by medical care ("Saving Rural Hospitals - The Crisis in Rural Health Care," "Rural Hospitals Are Shuttering Their Maternity Units," New York Times), or getting bought up by private equity.  From the article:

More than 100 rural hospitals have closed over the past decade, and more than 600 additional rural hospitals — 30% of all rural hospitals in the country — are at risk of closing in the near future. Rural hospitals are at risk of closure because they lose money delivering services to patients. In the past, many hospitals have received grants, local tax revenues, or subsidies from other businesses that offset these losses, but there is no guarantee that these funds will continue to be available or sufficient to cover the higher costs hospitals are experiencing. Millions of people could be directly harmed if these hospitals close.

Although one issue with rural hospitals is that they perform fewer procedures, meaning their care may not be as good as busier hospitals.

Chicago.  There's a great article about Mercy Hospital in Chicago, which was owned by a private sector firm, which intended to close it ("The Left-for-Dead Hospital That Got a Second Chance for $1," Bloomberg).  It ended up getting bought by an innovative private health care firm based in Flint, Michigan, for $1.  But it was touch and go for awhile.  And has had a hard time recovering because a lot of staff left during the period when the original owner said the hospital was closing.  And even while it was negotiating the sale, it was closing programs, and the new owners are struggling to restore them.

Delaware County, Pennsylvania.  Crozer Health has been closing hospitals in Pennsylvania, and has failed to execute various attempts at being acquired by better funded entities (" Cash-strapped Crozer Health turns to Temple and Jefferson for help maintaining services," ). It's owned by private equity too.

Philadelphia.  A few years ago Hahnemann Hospital, which served the city's neediest closed, after being acquired by private equity ("Philly's tough hospital market - not greed - did in Hahnemann," Inquirer).  But like with Mercy Hospital in Chicago, it's hard to keep a hospital open when it serves low income patients who are either uninsured or on Medicaid and Medicare, which pay much less for care compared to private insurance.

A piece in the Guardian discusses the difference between working in a private hospital versus a public hospital with few private insurance patients ("‘At the private hospital, the disrespect was just more subtle’: a tale of America’s two healthcare systems").

Idaho News 2 ICBS) photo.

Idaho.  Intermountain Health, a multi-state nonprofit that has been acquiring or merging with other systems at a break neck pace, is closing a multi-location medical practice it bought.  At this point, the 11 location Saltzer Health set of clinics and facilities are likely to close without finding a buyer ("Intermountain Healthcare to close or sell Saltzer Health locations in the Treasure Valley," KTVB-TV).

Receivership is a way to take over hospitals in financial distress.  But you need procedures and potentially financing in place in order to pull it off.  But as the Mercy article points out, governments have been trying to get out of the hospital business because it is so costly.  Getting back in is the last thing they want to do.  Ideally, the federal government could step in as a backstop, but this is very difficult considering Republican opposition to public support of health care ("The Congressional Republican Agenda: Repealing the Affordable Care Act and Slashing Medicaid," White House).  Extending government involvement is the last thing they want to do.

Scenario planning and monitoring.  The provision of health care is extremely important to local, state and federal governments.  Given the precarious state of so many health care institutions, the rising participation of private equity ("What Happens When Private Equity Takes Over a Hospital," Harvard, "Private Equity Investments in Health Care May Increase Costs and Degrade Quality," Columbia), to be ahead of the problem, governments need to engage in much closer monitoring and developing contingency plans to be able to step in as needed.

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Interestingly, while I go to a privately owned hospital, another hospital owned by the same company faces closure over quality of care issues ("Conditions at Asheville’s Mission Hospital pose ‘immediate jeopardy to patients’ health and safety,’ state investigators report," North Carolina Health News).

There are some interesting journal articles suggesting private hospitals could do more community-related programming that they don't typically do, but is done by nonprofit hospitals.

Big omission in blog series on advance hospital/health and wellness planning, public health planning: addiction services

The Denver Post has just published a four-part series on the cost of alcohol-related deaths in the state.

From the article:

Part 1: Colorado alcohol deaths surged 60% in 4 years, but there’s been no public outcry or push to save lives Coloradans die from the effects of alcohol at one of the highest rates in the country, but, in comparison to fentanyl, the state’s reaction has been a shrug. Legislators haven’t seriously considered measures to discourage drinking, and voters expanded access to alcohol in grocery stores. 

Part 2: Colorado has some of the lowest alcohol taxes and highest drinking deaths. That’s no coincidence, experts say. Experts say raising state alcohol taxes also would make more money available for programs aimed at preventing unhealthy drinking and to enforce the state’s liquor laws. Currently, the department charged with regulating Colorado’s alcohol outlets can’t afford to fill all its open positions. 

Part 3: Beer and wine became more widely available in Colorado even as drinking deaths rose. Five years ago, a workgroup tasked with finding ways to reduce Colorado’s rate of drinking-related deaths issued a simple recommendation: cut back on when and where people can buy alcohol. Since then, however, the state has only expanded access to alcohol.

Part 4: Alcohol addiction treatment is available in Colorado, but people struggle to get the help they need. Despite the availability of addiction programs, people who are concerned about their own drinking or a loved one’s don’t always know where to turn. Treatment options may not meet patients’ preferences, aren’t easily accessible in certain parts of the state, or don’t necessarily accept all forms of insurance, including Medicare and Medicaid. 

From the first article:

Alcohol killed 1,547 people statewide in 2022 — fewer than the 1,799 who died of overdoses. 

This table from the first article lists the leading causes of death in Colorado as of 2022.  It didn't list the 387 murders, nor 754 traffic fatalities statewide that year.

We think of murder rates as high, and yet traffic- related deaths tend to be much higher.  

But these numbers are significantly eclipsed by addiction related deaths, and deaths from disease, including chronic health conditions.

One of the interesting points in the first article is how alcohol increases inflammation, and inflammation is an accelerator of many health problems.  Inflammation over all isn't countered by the benefits of antioxidants in wine.

In the article on addiction services, it took me a long time to recognize and they don't exactly emphasize it, is that failure is part of the process, that it likely takes people more than one attempt to succeed.  

The article discusses how health insurance is supposed to cover addiction treatment equal to other elements, and when in-network services aren't available, people are supposed to have insurance cover out of network services.  It also discusses how traditional 12-step and similar programs don't work for a lot of people, and prescription drug support that can reduce cravings often isn't available.

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In 2017 I wrote a bunch of articles, and then some follow ups, on broader health, wellness and public health planning and programming that could be integrated into a hospital complex and more broadly across the community, given DC's commitment to build a new hospital to replace the United Medical Center (formerly Greater Southwest Hospital) in Ward 7, "East of the River."  

Oh, DC isn't really doing this, although the city does have a good commitment to health insurance coverage access, and support for community health clinics.  In addition the city is adding more clinics, I can't remember exactly how, to Wards 7 and 8.  Some are affiliated with the new hospital ("Mayor Bowser Celebrates the Topping Out of Cedar Hill Regional Medical Center GW Health on the St. Elizabeths East Campus," press release).

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River"
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus"
-- "Part three: the potential for donations around an expanded program"
-- "Revisiting East of the River medical care: United Medical Center"
-- "Update on DC's plans to build a new United Medical Center," 2018

-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital," 2018

-- "Community Health Improvement Planning," 2019

In 2020, with onset of covid I wrote two related articles about gaps in the original series in terms of disaster planning, including pandemics/epidemics and public health:

-- "More communities need to integrate health care and public health programming: Prince George's County, DC, etc.," 2020
-- "Rush Medical Center (Chicago) clues us into a gap in state and regional health care planning: planning for disaster and epidemic response," 2020

And there are two articles relevant to the second article on creating a graduate health and biotechnology research initiative:

-- "How the closure of a Pfizer research center in Ann Arbor, Michigan led to the development of a more robust and independent biotech sector," 2021

-- "University of Maryland could seed a complementary biotechnology and medical education initiative in Prince George's County," 2021

And one last year, applying these concepts to two hospital projects in Salt Lake City and West Valley City here in Utah.

-- "Hospitals as urban anchors/revitalization levers, not usually, but with great potential to serve communities in important ways: Examples are two forthcoming projects by Intermountain Health and University of Utah Health,"  2023

DC is worse than Colorado  |  Writing biases reflect "lived experience": failure to mention the need for expanded addiction treatment services as a public health measure.  I drink very little, especially now, and I don't use illegal drugs.  E.g., I haven't touched marijuana in about 30 years.  

So it's unfortunate, given that DC's overdose deaths and alcohol deaths in DC are actually worse than Colorado, the focus of the Denver Post series--if Colorado had DC's rate of alcohol deaths, it would be close to 2,100 deaths, almost 50% higher that it is, that I didn't mention specialized and expanded addiction treatment services as part of a broader health, wellness, and public health approach for what is now being called the Cedar Hill Regional Medical Center.  

Sure part of that is captured indirectly in how the series focuses on addressing chronic medical conditions.  But it's also ironic in that my first DC job was for a public health related group, which had an alcohol policies project, and for awhile a program on Hispanic health which included a focus on tobacco consumption.  (For the most part the group didn't focus on tobacco because it was and is covered so well by other organizations.)

Since all those articles, I do update them with relevant programs and information I come across in the comments, and addiction treatment programs were mentioned there.  But it's a major oversight in a city like DC, where addiction is high, for example 461 opioid-related overdose deaths in 2022.  With a minimum estimated number of 311 alcohol-related deaths, based on the imputed rate by an NIH related institute and the total adult population.  Colorado has an adult population 6.67x greater than that of DC.

In the next iteration of the main article, e.g., the last iteration was on Utah, I will be sure to add addiction treatment services to the main set of programs.

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An article in the Guardian mentions public health as an economic development lever  ("his article is more than 11 months old Without health there is no wealth. Why do so few governments understand this?"), in an article on the failures of the National Health Service there to keep up with demand, especially as Tory austerity has resulted in significantly poorer health outcomes and premature deaths on the part of a significant proportion of the population ("Austerity blamed for life expectancy stalling for first time in century") even before covid.

Hospitals as urban anchors/revitalization levers, not usually, but with great potential to serve communities in important ways: Examples are two forthcoming projects by Intermountain Health and University of Utah Health

I have an extensive series of pieces about how DC could have used the reconstruction of a hospital East of the River to create a world class community and public health centric hospital with a complementary medical education and biotechnology research and development initiative.  

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River," 2018
-- "Part Two: Creating a graduate health and biotechnology research initiative on the St. Elizabeths campus," 2018
-- "Part three: the potential for donations around an expanded program," 2018
-- "Update on DC's plans to build a new United Medical Center," 2018

I argue that "a building" isn't enough, you have to have a plan to address health inequities in innovative and novel ways.  Plan + program + building.  

And ideally, a "transformational projects action plan" approach to boot.

This set of articles is a bit broader, more about integrating health and wellness planning and hospitals.

-- "Health planning vs. hospital planning redux," 2006
-- "Piling on the hospital issue," 2006
-- "An opportunity for rethinking health and wellness care in the District of Columbia," 2006
-- "Speaking of rethinking how to offer "public services" and medical care," 2007
-- "Community Health Improvement Planning," 2019
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital," 2018
-- "More communities need to integrate health care and public health programming: Prince George's County, DC, etc.," 2020
-- "Rush Medical Center (Chicago) clues us into a gap in state and regional health care planning: planning for disaster and epidemic response," 2020

Even though DC has failed to think big about the new East of the River hospital, that doesn't mean these concepts can't be applied elsewhere.

Salt Lake.  Both Intermountain Health ("Intermountain Health says it wants planned urban hospital to be 'an anchor' in Salt Lake City," KSL-TV) and University of Utah Health ("Here’s the latest on that big hospital coming to WVC — and why it differs from other U. centers," Salt Lake Tribune) are building new hospitals, the former in Central Salt Lake City, the latter in West Valley City to the west of Salt Lake.

The Intermountain hospital will replace a neighborhood-embedded hospital a couple miles away that isn't centrally located and is hard to get to.  The WVC facility for Utah Health will be its first foray into a secondary facility that functions as a hospital.  While they have lots of clinics in the region, Utah Health hasn't bought other hospitals throughout the state the way that other university-affiliated health care systems have in other states.

Both say they want the facilities to be community centric, good neighbors, contribute to the community, etc.  Utah Health say they want the WVC facility to promote jobs and educational opportunities for the Valley's west side.  From the second article:

The goals of the future hospital, he said, are to provide meaningful economic impact to the west side by employing residents who live near the facility, and to improve the health of a city that faces lower life expectancy and higher rates of serious conditions compared with the overall county.

The $800 million complex at 3750 S. 5600 West also represents a chance, Randall said, for the U. to dramatically diversify its workforce.

“If we’re going to have societal impact,” he said, “we have to be engaged in the communities and help them achieve their desires and dreams.”

Revitalization effect, not much.  Financial and employment engines, yes.  The thing is that hospitals, except when they are embedded in neighborhoods--and that's with a big maybe--don't have a lot to offer to revitalization efforts.  Their main effects are financial and as large employers. 

Hospitals are internally focused.  Workers don't have time to eat or shop off campus.  Both patients and visitors are focused on the task at hand, not spending time off campus.  The buildings are big, with lots of employees.  They aren't permeable.  There can be a lot of parking.

I became more focused on this when I was doing some consulting in Pittsburgh.  Allegheny Hospital is a big player in the Northside neighborhood, and West Penn Hospital, affiliated with Allegheny, is located on the main street of the Bloomfield commercial district.  

At the time the Children's Hospital of Pittsburgh was building a new facility in Lawrenceville and everyone was touting its potential for revitalization benefits ("Big move: The new Children's Hospital already has an impact," Pittsburgh Post-Gazette).

But neither the Northside and Bloomfield facilities contributed spillover benefits to business district or neighborhood improvement in substantive ways, at least as customer generators.  And UPMC CHOP is located away from Lawrenceville's commercial centers.

Architecture is tough when you design for the car.  Inga Saffron of the Philadelphia Inquirer makes the point that because hospital planning is in large part focused on accommodating cars in parking, etc., providing high quality people spaces within a hospital complex becomes very difficult ("Penn’s new hospital belatedly recognizes pedestrian space is a public health issue").

Relatedly, in 2008, Saffron wrote that the city's newest hospital building was designed for the suburbs, not the city ("Penn got a trophy, not a triumph, in hospital design").  From the article:

After all the promises we heard about how the Perelman Center for Advanced Medicine would bring order to the university's congested hospital district and help forge a more pedestrian-friendly environment, it's hugely disappointing to see that the results are no better than any of the previous trophy medical buildings along Civic Center Boulevard. The Big Driveway rules again.

Perhaps the architects, Rafael Vinoly and Perkins Eastman, were under the mistaken impression they were designing for a suburban office park, rather than a busy West Philadelphia corner. Looking at their contorted hybrid, which pairs a banal low-rise, ribbon-window structure with a towering cube of slick glass, you have the feeling you're witnessing the architectural equivalent of a car crash.

If the screech of incompatible materials and forms isn't dissonant enough, just try walking up to the front door. Instead of a gracious, approachable welcome, we get curlicues of driveway ramps and "Don't Go There"-style planting beds. Pedestrians will have to play dodgeball with cars as they make their way past the building.

Transit adjacency is a plus for employee transportation.  One reason to locate hospitals at high capacity transit stations, is because of there being so many employees. But I haven't seen a good transportation demand management study of hospital workers trip to work.  (In the DC area, the Coalition for Smart Growth was a big proponent of the new Prince George's County Hospital being located at the Largo Metrorail Station, which it was.  But I argued all along that while that was important, it wouldn't have the revitalization impact they touted.)

University of Utah Hospitals have two light rail stops, but the complementary university bus shuttle system needs to be more tightly integrated, at least for the medical campus, to make it easier, especially for patients, to get to health facilities located some distance away from the transit stations.

HealthLine in Cleveland.

In Cleveland, health institutions supported the development of the HealthLine (the name was chosen based on financial sponsorship), a bus rapid transit line serving a number of neighborhoods, including the University Circle district and Cleveland Clinic and the University Hospital system and Downtown.

Hospitals can be strong supporters of community development efforts, but it has to be designed into the program from the outset.  FWIW, Allegheny Hospital in particular is a best practice example in their support of local community development corporations, providing grants to staff towards housing purchases near the hospital, which extends to West Penn in Bloomfield, etc.  

In Philadelphia, Frankford Hospital and Penn Hospitals contribute to local business improvement districts, Penn being a major player in the University City District there.

And some hospitals are refocusing some of their purchasing on local businesses, thereby strengthening the local economy ("When a Steady Paycheck Is Good Medicine" New York Times).

Nationwide Children's Hospital in Columbus ("When a Hospital Plays Housing Developer," CityLab) is leading a neighborhood revitalization effort, probably out of necessity, to preserve the value of its location and the willingness of people with choices to continue to patronize them. 

MetroHealth in Cleveland is doing something similar ("MetroHealth’s new $759 million Glick Center opens Nov. 5, signaling a new era of healthcare," Cleveland Plain Dealer).  They call it "hospital in a park" but Inga Saffron might differ?

In August [2022], the hospital system opened its affordable housing project Vía Sana in Cleveland’s Clark-Fulton neighborhood. Vía Sana – meaning “healthy way” in Spanish -- is the first $15 million investment in MetroHealth’s $60 million mixed-use development aimed at improving both the physical and economic health of the community adjacent to its main campus. ...

Construction of the new $140 million outpatient care facility and administrative building, called the Apex Project, began last year. delivers on MetroHealth’s promise to turn its main campus into a “hospital in a park” and to create a more welcoming neighborhood. The Apex Project includes renovation of the hospital’s Rammelkamp Center for Education and Research and a 700-car parking garage for patients and visitors.

A couple hospitals, like Bon Secours in Baltimore have developed housing to support out-of-hospital patient care and healthy communities.

The potential exception: hospitals that are more neighborhood-embedded.  The current LDS Hospital is in The Avenues neighborhood, less well connected to the city at large.  Theoretically, because it is neighborhood embedded, it could provide more neighborhood-focused services, but I don't think it does.

St. Anthony Hospital, Chicago has proposed (they haven't actually done it) a new hospital in a low income area, Lawndale, with community facilities like wellness and recreation facilities built into the campus

From "Chicago safety-net hospitals face uncertain future amid changes to health care system: Area has 20 safety-net hospitals, which are a stop-gap medical system for the poor" in the Chicago Tribune:

When now-CEO Guy Medaglia arrived as a consultant in 2007, the 151-bed hospital was losing millions of dollars annually. Medaglia was tasked by its then owner, Ascension Health, with closing or selling it.

Instead, he emboldened the hospital's board to break away from the chain in 2009 and become independent.  Despite that commercial insurance covers fewer than 1 percent of its patients, St. Anthony has posted operating income nearly every year since.

St. Anthony embarked on its turnaround after assessing the needs of its community and tailoring its services to match. It now functions as a de facto community hub, teaching language classes and hosting courses for people studying to take high-school equivalency tests. It also added health services like dialysis and occupational health and expanded its infusion, pediatric and maternal centers.

"If you're doing what the community needs, you become very valuable to them," Medaglia said. "And to continue to serve them, you really have to think out of the box. You have to think: What can we do that's different, that can service this community at a lower cost and higher quality?"

St. Anthony is pushing forward with plans to build a 1 million-square-foot commercial development at 31st Street and Kedzie Avenue anchored by a 100-bed replacement hospital.

The $430 million Focal Point [Community Campus] development is slated to be built on 11 acres acquired from the city for $1 by a nonprofit affiliated with St. Anthony. The complex is set to include two schools, retail stores, a child-care center, an indoor recreation facility and an athletic field.

How to make a hospital a hub.  The point about the hospital as a community hub makes more sense in a neighborhood where the hospital is more integral and central and where they aim to develop and strengthen hub opportunities.  

The new Intermountain Hospital on the edge of Salt Lake's downtown won't be part of a residential area, but it could offer specialty urban health care programming.  Similarly the University of Utah West Valley Hospital could take its cue from St. Anthony and other programs listed below.

Potential urban health functions at Intermountain. Here are some examples that Intermountain could consider incorporating as a way to provide specially focused services to urban populations.

Church Health, Memphis.  Rather than from a hospital setting like what St. Anthony intends in Chicago, Church Health, an organization founded by churches, provides care to the uninsured in a clinic setting, although they have a comparable and expansive mission.

Services include medical, dental ("Church Health dentists improve patients' smiles, life prospects," Memphis Commercial Appeal), eye, family care and pediatrics, behavioral health, physical therapy, and pharmacy. 

Last year it moved into a consolidated facility of 150,000 s.f.  ("Just what Church Health will do with all its Midtown buildings," MCA; "Church Health Center rebrands in preparation for Crosstown Concourse move," Memphis Business Journal; "Holistic Healthcare for Medically Uninsured: The Church Health Center of Memphis," Ethnicity & Disease Journal).

Wellness programs, also delivered off-site to local churches, include a 25,000 s.f. YMCA facility ("New Church Health Center YMCA opens in Crosstown," MCA) adjacent to the consolidated clinics at Crosstown Concourse Center in Downtown Memphis, which is the adaptive reuse of a former Sears Department Store and catalog distribution center, and a food and nutrition program ("Church Health's Memphis Teaching Kitchen Promotes Healthy Bodies and Communities," Parade Magazine).

HealthOnBroadway: El Rio Community Health Center and Tucson Medical Center.  HealthOn Tucson is a joint program of the community health program and the city's major medical hospital ("New downtown Tucson health clinic offers a different patient experience," Arizona Daily Star).

Not unlike "urgent care clinics" and clinic operations in pharmacies like Walgreen's and CVS, their first venture is the creation of a community wellness and "emergency care center" on Broadway Avenue in Downtown Tucson.  The facility is open six days/week, most nights til 9 pm, and is highly visible. According to the article, these are innovations implemented in the center:

-- high quality and modern design (Photos: BWS Architects)
-- self check-in
-- "Dialogue rooms" where people can talk to health care providers without being in an exam room
-- on site classes, including a conference room that doubles as an exercise room
-- health coaches
-- online appointment booking, including the use of virtual applications functioning like telemedicine
-- hours beyond office hours.

But the facility is more than just a place to drop in for a flu shot, as they have a broader focus on working with the patient over time such as with health coaches, offering free wellness programming, etc. 

University of Houston College of Medicine Direct Primary Care Clinic ("Monthly subscription for low-cost healthcare is now available through University of Houston clinic," KHOU-TV).  This clinic is offering low cost basic health care access to people who couldn't otherwise afford it, for $60 per month.
Houston has the highest rate of uninsured residents in the nation, according to a press release from UH.

Startup costs for the pilot clinic were funded by a $1 million gift from The Cullen Trust for Health Care.

In Fort Worth, Texas ("His insulin would have been $1,000 per month. At Fort Worth hospital, he pays $10," Fort Worth Star-Telegram) the Texas Resources Hospital system has a program operating in 9 hospitals, to provide focused care of chronic health conditions for the uninsured.  

The initiative, the Healthy Education Lifestyles Program, offers low-cost health care to anyone 18 and older who is uninsured and has diabetes, hypertension, high cholesterol or congestive heart failure. For $10 a month, patients get a monthly check-up from a nurse or other health care provider, education on how to manage their disease, and help navigating the complex health system to find prescriptions that are affordable.

Continuum of care programs (relevant to both).  "Penn receives record $125 million to offer free tuition to nurse practitioners to work in underserved communities." Philadelphia Inquirer.

Jackson County Michigan has a "community integrated paramedicine" program where EMS personnel are utilized as a way to provide "continuity of care" between hospital release and home, with the aim of increasing care compliance and reducing readmissions.  Regions Hospital in Minnesota also has a community paramedicine program.

Potential community hub functions at West Valley: Social determinants of health.   The basic idea is addressing what are called the "social determinants of health" ("An Effective Way to Tackle the Social Causes of Poor Health," Harvard Business Review).  According to the St. David's Healthcare system in Austin, Texas:

20% of health care outcomes to do with access to care; the other 80% dependent on family structure, where you live, access to food, parks, etc.

I don't know much about the West Valley City location that University Health is building on.  But through the University Neighborhood Partners program ("University of Utah University Neighborhood Partners program and community revitalization in West side Salt Lake City/County") the University of Utah is focusing on that part of the Valley.

I do think that they should study carefully the St. Anthony Focal Point Community Campus initiative.  And there are other examples listed below.  These kinds of programs could be great components of a community health outreach initiative on the west side.

 
Latino Health Access, Orange County, California.   Focused on providing health care to the Latino community, which has traditionally been underserved, the organization focuses on education, prevention and participation, training a cadre--many thousands over the years--of paraprofessionals and volunteers working in and already part of the community, to deliver health education, focused on chronic diseases, such as diabetes.

The organization was featured in a four-part HBO documentary “The Weight of the Nation,” on addressing obesity.

The organization sponsors an annual health walk, has built a park and community center in an impoverished neighborhood that lacked such facilities ("Residents Bring First-Ever Park to California’s 92701 Zip Code," Salud America!), and the organization's main clinic has a community room with space for exercise classes, fitness equipment, and space, a "Youth Room," for adolescents.

LHA has published a workbook, Recruiting the Heart, Training the Brain: The Work of Latino Health Access, discussing what they do, how they built the organization, and their care model.

Other programs.  As part of medical school programming, Columbia University has opened the "Community Wellness Center" in Upper Manhattan which provides health services, and some free services, and also "trains residents of Harlem and the surrounding area to serve as community health advocates."

But outside of certain screenings, like for blood pressure and cholesterol, they don't provide medical services.

Share Cancer Support, a Manhattan-based breast- and ovarian-cancer nonprofit, has an African-American Ambassador program providing education and training sessions in communities of color ("A cancer survivor does outreach in communities of color," Crain's New York Business). 

3rd Street Youth Center and Clinic in the Bayview Hunters Point neighborhood, San Francisco, offers an interesting ladder of programming to develop youth self-knowledge about health issues.  And a year long program involving various institutions introducing youth to health careers.

Mental Health Center of Denver in the Park Hill neighborhood will marry a family health clinic with farm and greenhouse. The overall redevelopment of a shopping center site includes senior housing, affordable housing, and a family health clinic. The Mental Health clinic will include a community space, community gym facility, teaching kitchen, and dental clinic also ("Community input shaped new mental health clinic in Denver’s Park Hill," Denver Post).

Community engagement facilities.  The University of Maryland Baltimore, a health-focused campus, built a 20,000 s.f. community engagement center in the neighborhood adjacent to its campus ("UMB breaks ground on community center in West Baltimore," Baltimore Business Journal).  From the article:

Programs offered at the new center will include workforce training, a legal clinic, weekly markets with fresh fruits and vegetables, computer access and exercise and yoga classes.

The expanded center will add a new UMB Health Alliance, a faculty and student-led program that will focus on preventative health education for asthma, hypertension, diabetes and mental health. It will also offer academic programs for middle and high school students and house UMB's Police Athletics-Activities League for youth.

Athletic fields are being installed as part of a new health campus in Greater Pittsburgh ("Allegheny Health Network serves notice to its rivals with Coraopolis athletic, outpatient center," PPG).

Sure Start and similar initiatives.  Sure Start centers in the UK have been decimated by the Conservatives, but were created to provide extra services to impoverished families preceding childbirth til 4 years of age ("Sure Start saved NHS millions," Guardian).   

A Boston Globe article, "The ‘fourth trimester’ and plight of new mothers during a pandemic," calls this period the "fourth trimester." 

The Sisters in Birth clinic in Jackson Mississippi, focused on assisting women of color in pregnancy, as black mothers die nearly 3x more often than whites of pregnancy related causes ("Sisters in Birth, Standing by Expecting Mothers," Jackson Free Press).

From the Pittsburgh Post-Gazette story, "Allegheny Health Network launches new effort to tackle Black infant mortality":

In Pittsburgh, Black infants are more than four times as likely than white babies to die before they reach their first birthday.

This grim gap is the reason for a new initiative launched by Allegheny Health Network called First Steps and Beyond. The program aims to monitor the health and well-being of African American parents and their babies through the first year of life by expanding prenatal, perinatal, birthing and fatherhood services to residents. In doing so, it hopes to slash infant mortality of Black babies by at least 28% over the next five years.

Separately, "Leeds only major UK city to see a drop in child obesity," Guardian.  It's attributed to the HENRY program: Health, Exercise, Nutrition for the Really Young.

Finland has a best practice program wrt childhood obesity ("The Fit Children of Seinäjoki," Der Spiegel). 

Reading room.  The Salt Lake County Library system runs a library "reading room" in the South Main Public Health Clinic in Salt Lake City, which serves a predominately low income population. A big element of the service is providing free books to children ("Clinic's reading room making a big difference for low-income kids," KSL-TV)

Some library systems have special health and wellness collections.  Why not create one as part of a community-serving hospital? 

Teaching Kitchens.  The Teaching Kitchen Collaborative supports hospitals and public health clinics offering nutrition and cooking programming.  Boston Hospital has a Teaching Kitchen ("At Boston Medical Center, cooking classes aim to restore health after addiction," AP).

The ProMedica health system in Toledo (1) created the Ebeid Institute for Population Health as a way to serve underserved communities and (2) on the ground floor of the building created a 65000 s.f. "Market on the Green" nonprofit supermarket. A hospital nutritionist does programming, cooking glasses and store tours.  (3) there is a Financial Opportunity Center program too, GED classes, etc.

The workforce development program of Ebeid is integrated with the staffing program for the supermarket.

CVS Health Hub concept.  According to Drug Store News ("CVS Health debuts first Health Hub Location"):

During a ribbon-cutting event at the company's HealthHUB location at 687 Johnson Ferry Rd. in Marietta, Ga. the community celebrated the new, innovative store format that features a broader range of health care services to help patients better manage chronic conditions, more products and services focused on overall health and wellness, and personalized care.