Little Free Naloxone Libraries

When I go to health fairs, there will be a table where they offer naloxone to have on hand if you see someone overdosing.  I'm just not in the position to ever come across someone in that situation.

Photo from "Utah fights against opioid overdoses through naloxone initiative," ABC4 Utah.  From the article:

To increase access to naloxone, the Salt Lake Harm Reduction Project created a “Naloxey-Boxey,” a box that allows people to pick up naloxone anonymously or after hours. This initiative aims to make it easier for people to have naloxone on hand when it’s needed, potentially saving lives during opioid overdoses.

The State of Utah is investing in a pro-nuclear public affairs campaign leading up to getting one of those new mini nuclear reactors

Decades ago when I worked for the Center for Science in the Public, I learned about corporate campaigns to promote industrial production of various products that were often harmful, like tobacco (Tobacco Advertising: The Great Seduction).

Food companies did advertising too pushing unhealthy products.  I once made a comment to a journalist at the Atlanta Journal-Constitution about how McDonald's spent more on advertising in one day than CSPI's annual budget.

CSPI was really big on fighting alcohol advertising.  At the time liquor companies had an agreement to not advertise on television but that started changing around the time I worked there.  CSPI fought it.

Personally I didn't think it was a big deal as beer and wine were advertised and it seemed unreasonable to ban advertising of products when 80% of the population had no problem with it.

OTOH, advertising would increase consumption leading to more problems.  Like with sports betting today ("The impact of exposure to wagering advertisements and inducements on intended and actual betting expenditure: An ecological momentary assessment study," Journal of Behavioral Addictions) or vaping ("How Social Media Promotion of Vaping Targets Teens," Yale School of Medicine).

CSPI published a couple small books on "Marketing Booze to Blacks" and "Marketing Disease to Hispanics," back when alcohol and tobacco companies were big supporters of minority group organizations, minority media, and museums, aimed at selling their product disproportionately to people in distressed circumstances.

I was proud when I got a blurb in a column in the Columbia Journalism Review about a black media company specifically criticizing CSPI when hawking for ads.

Later there's been good coverage about this wrt plastics ("Plastic Wars: Industry Spent Millions Selling Recycling — To Sell More Plastic," NPR).  When we were in DC, there was a campaign against an city legislation to start a recycling deposit program, with the message that it would impose burdens on small stores.

Communications presentation board on the dangers of tobacco, Harambee African American Tobacco and Health Network.

WRT smoking, I was pleasantly surprised to go to a Juneteenth event in Ogden Utah and saw that two different organization booths featured anti smoking campaigns.

Anyway, for awhile the State of Utah has been running a campaign to "counter the mis-beliefs we have about nuclear energy" without acknowledging that there are reasonable concerns.  I've heard radio spots, but hadn't seen online ads.  This one is over the top.  It costs a f* of a lot more to pay for storing one barrel of nuclear waste and it isn't safer than properly packaging leftovers.

-- 3 Advanced Reactor Systems to Watch by 2030, US Department of Energy

-- "Utah and Industry Leaders Announce Major Nuclear Energy Partnership in Brigham City," Brigham City

-- "Utah officials announce Brigham City as state’s ‘nuclear hub’," Trementon Leader

The cost to store one barrel of nuclear waste ranges from $2,000 for low grade waste to many hundred thousands of dollars for highly radioactive waste.  One advantage of the new reactors is that are supposed to not generate as much waste and I think they claim they'll be able to use existing waste as feedstock.

Of course, the other big pro-corporate campaigning going on now is for data centers--it supports your use of the Internet ("Meta Campaigns to Change Opinions on Data Centers," New York Times).

From the article:

Meta, OpenAI, Google, Microsoft and Amazon have embarked on a building spree in the A.I. race, investing hundreds of billions of dollars to erect data centers to develop the technology. In doing so, they have fueled an increasingly political issue, with President Trump and lawmakers across the country criticizing the computing sites for driving up energy costs and straining local water supplies.

So in November and December, Meta spent $6.4 million to run a series of ads — including the one about Altoona — in the television markets of eight state capitals such as Sacramento, Salt Lake City and Tallahassee, Fla., as well as Washington, D.C., according to data from AdImpact, an analytics firm.

Market on the Green nonprofit supermarket from ProMedica Health System, Toledo

Market on the Green is located in the ProMedica Ebeid Institute building, which is in a low income neighborhood, separate from but near some of the system's hospitals.

I was re-reading a past blog entry on hospital planning in the Salt Lake City area ("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") and among the best practices it mentioned for activating the first and second floors beyond traditional medical series, I listed the "Market on the Green" supermarket in Toledo.  

I must have found out about it from this Wall Street Journal article, "Take Two Aspirin—and a Serving of Kale." 

Given that supermarkets run by cities--proposals in Chicago, New York City, and DC--are all the rage it's important to look at what works and what doesn't.  This piece discusses the failure of urban markets ("Grocery stores in cities: the failure of the "15 minute grocery store"").  Also the opportunity of food cooperatives as an alternative model ("Revisiting Takoma Junction and the Takoma Co-op development issue | A chance to start over").

Yard sign announcing a household's support for the Wasatch Community Food Co-op.

Food coops do need initial capital and that can be hard to raise.  

The Wasatch Community Food Co-op finally opens this month--they've spent 15+ years organizing, raising capital, and finding and building out a space.

And there is the public market model ("Eastern Market DC's 150th anniversary last weekend | And my unrealized master plan for the market").  

In distressed areas I think that model is adaptable and adoptable as a way forward because you divide the various functions into departments, called "market stands," and from an entrepreneurial standpoint they can be run by individuals rather than "the city," and with fewer capital requirements compared to running a grocery store as a single operator.

City-run supermarkets.  I am skeptical about city-run markets because the profit margins are so low--I tried to get a creative donation from the supermarket business cooperative in the Intermountain States, along with some of their local affiliates, and they lamented their extremely low margins of 1.5% or less, and that was before the effect of tariffs and now the War with Iran which impacts both transportation costs and consumer spending even more.

And because cities aren't known for innovative management in governmental matters.  Running a retail business is a stretch beyond that, although it can be addressed by hiring people with industry experience.  But letting people with a retail background act like retailers is still a tough decision for a city government.

Public markets are a truly rare form of public-nonprofit management.  Most public markets are owned  by the city but operate with independent management.  For those that don't, half are probably successful and dynamic, like Reading Terminal Market and Lancaster Central Market, and the others, and I would include Eastern Market DC where I served on the board for 13 years, static--even though Eastern Market seems to always be rated highly in consumer voting contests ("Shop, savor, and stroll these 10 must-visit public markets," USA Today).

Managerially, one of my favorite examples is the Milwaukee Public Market.  

It was built by the city and run by a nonprofit, but the nonprofit was overwhelmed and management shifted to the Milwaukee Downtown Business Improvement District, and it gets high ratings ("Milwaukee Public Market gets back to business," "From one market to another: Milwaukee Public Market’s advice for Brookfield," Milwaukee Business Journal).

Reading the second article, archive.ph version for those without access, you can tell they really get it.

"I think taking this as a model and plopping it anywhere, it's not always going to work in every setting, every environment, every city," Schwartz said. "These are not always easy operations."

We've had the benefit of time, reputation and experience. We've also developed this into not just a place where people can get food, but we can host regular events and cooking classes. We embrace an outdoor element for experiences, whether it's the Palapa at St. Paul Fish Co. or a beer truck outside. So, I think you have to be multi-dimensional.

At Eastern Market in DC there is zilch innovative design associated with the individual stands.  

Not so for St. Paul Fish Company at Milwaukee Public Market.  

Brand promise is communicated and strengthened by a strategic choice of seafood creature sculptures.

Turnover and new tenants is not always a bad thing. It's sometimes a mutual, "Hey, I'm gonna do this for a few years, experience it, and then I'm gonna concentrate on another brick-and-mortar." There's a level of rotation that adds freshness and newness. It can be beneficial. Probably 34% of our tenants are originals. We always try to find a mix of not only the right food products, but also ownership, representation and businesses that will help add something from the neighborhood, not just the market.

If you are a true destination for residents and people from out of town, I think you need to embody as many types of experiences as possible and cast a wide net, whether it's for families who are coming in from out of town or somebody who lives in a condo that's popping over here to have a glass of wine, grab a steak and make it at home.

One of the problems with ratings is the tension between selling prepared food, more typical of what are called food halls, and fresh food to prepare at home, and maybe with some prepared food vendors.  A lot of the other markets do fresh food better, and most that specialize in it, like Reading Terminal Market in Philadelphia or Grand Central Market in Los Angeles, do way better.  And Pike Place Market in Seattle didn't even make the top 10!

Why has Market on the Green been successful, when similar ventures fail?  

Compared to many nonprofit grocery initiatives, it's still standing after years, when many have failed long before that kind of tenure.  

It's not a grim space.  It has positive design qualities.  While it's one tenth the size of a for profit supermarket, it offers the same array of goods, even beer and wine.

It was funded by a donation from the lead philanthropist supporting the ProMedica System.  It's located in the Uptown neighborhood which is defined by USDA as a "food desert" and where they started their community development program ("Seaway standing strong," Toledo Blade). 

Originally the market didn't have a more traditional (and hopefully outdoor sign.  Now they do.

The building is owned by the health system, and the second floor has a teaching kitchen, other community services, and workforce training (two more floors for other stuff).  

They support local vendors and stock and market their products ("Farmers First Coffee release party at Market on the Green" and "Beer Sampling at Market on the Green," Toledo City Paper)--the beer sampling up in the teaching kitchen with better access controls.  

And they're innovative, unlike a lot of public markets, they offer online ordering and delivery ("Market on the Green offers online shopping and delivery," Toledo City Paper).  

I tried to have that done at Eastern Market and you wouldn't believe the pushback--"Eastern Market is all about the face-to-face experience" they said.  For some it is, for others it isn't.  Maximizing your ability to reach multiple market segments in the face of ever increasing competition is key.

The store has been open for 11 years, which is a great run so far.--and it's still going.

But it may have taxed managerial resources, because in 2023 outsourced management to a local grocery store operator ("ProMedica grocery store in UpTown Toledo gets new local management," Toledo Blade).  

As a whole the hospital system has run some  deficits and this saves them not just money, but "managerial burden," involved in running the store ("ProMedica scraps new Monroe hospital as losses mount," Toledo Blade).  Since they've cut back on plans for new buildings, sold off their nursing home division, and ended event and venue sponsorships.

Success factors for Market on the Green.  I think the key elements are (1) philanthropic donation to provide capital, (2) and to buy the building, (3) which means they can be patient, (4) because they have "patient capital" to support the business, (5) without interest fees (6) and probably no rent, (7) so, as long as it doesn't lose money on operations, (8) because of the high degree of management and board commitment separately (9) and as a key element of their place-based community development initiative, Ebeid Neighborhood Promise.

Initiatives at other hospitals include food stands within the hospital's first floor, food pantries offering free food to people in need ("Micro-markets inside health centers could be just what the doctor ordered," Grocery Dive), community gardens, and farmers markets held on campus.  St. Joseph Mercy Hospital in Ypsilanti, Michigan goes even further, allotting 25 acres on its campus to a local produce farmer, using some of the food in their food service program, donating to food banks, etc.

Social determinants of health.  The justification is what are called "social determinants of health," how lifestyle and other factors like place contribute to people's health/problems and providing food access reduces income hindrances that can make it hard to buy healthier and fresh foods.

According to Next City ("Why Health-Care Systems Are Funding (Or Building) Grocery Stores") such stores funded by, supported by, or run by hospital systems support both personal and community health, so it may help them when preparing their Community Health Assessment Plans required as one element of Obama Care.  From the article:

There’s been a lot of talk and research about the importance of access to healthy food as a social determinant of health. Obesity, diabetes, heart disease — all are linked to diet. So putting a full-service grocery store in the heart of low-income, under-resourced neighborhoods, where health disparities are high and persistent, seems like a sensible thing.

City incentive programs.  Rather than open and operate stores, many cities like DC and even states, like Pennsylvania (although it's not much money, especially when you consider how big the state is) have tax incentives and other programs to subsidize the cost of putting stores in less economically well off areas. This Reddit entry is great, listing the five incentive programs in DC.

There are also programs to expand the array of healthy foods available in corner stores and bodegas, who might not normally carry such products because of spoilage and other concerns, and familiarity as they mostly sold non-fresh foods.  

In NYC Shop Healthy NYC, formerly the Healthy Bodegas Initiative, is a city program.  In Philadelphia and Camden, New Jersey programs are coordinated by the nonprofit Food Trust.  In a study of bodegas in New York City:

Most consumers shopped at the bodega because it was close to their home (52%). The majority (68%) reported shopping at the bodega at least once per day. The five most commonly purchased items were sugary beverages, (29.27%), sugary snacks (22.34%), coffee, (13.99%), sandwiches, (13.09%) and non-baked potato chips (12.2%). Nearly 60% of bodega customers reported their purchase to be healthy.

It would have been even cooler, but more expensive if the outdoor sign rendered the more detailed logo, in neon.

Conclusion.  While I think these initiatives are great, as the Milwaukee Public Market director said:

"I think taking this as a model and plopping it anywhere, it's not always going to work in every setting, every environment, every city," Schwartz said. "These are not always easy operations."

pertains here too.  The reason(s) for success of Market on the Green rather than failure is because the factors that are key to their success are usually opposite the conditions faced of other ventures, for example:

• patient capital versus impatient capital
• no interest on financing versus interest on financing
• no rent versus paying rent
• knowledge and skill in operations versus good intentions
• organizational commitment versus bottom line focus

are all key factors.  Government can be a source of patient capital, but they definitely lack operational expertise.  And government grant programs come with lots of strings and reporting requirements, and usually have more demand than funds.

ProMedica has tapped Summit Foods and owner Ed Beczynski to manage its Market on the Green grocery store in UpTown.  Mr. Beczynski is a local restaurateur whose family has run Summit Foods for 25 years.  Toledo Blade photo.

Because people have to eat, whether or not a store is immediately close by, even in food store deprived areas, people have developed ways to provide access and a means to travel to existing supermarkets (Lack of access doesn't deter shoppers from visiting large grocery stores," FoodDive,  "The Influence of Foodstore Access on Grocery Shopping and Food Spending," Economic Research Service, USDA).

Retail trade areas.  Plus people's complaints of lack of immediately accessible food stores runs into the retail trade area issue--an RTA radius for a supermarket in a city is up to 5 miles, even more for specialty stores.

Granted it presumes use of a car.  But an RTA of say 3 mile radius is still an area of 28 square miles.  That's almost half the size of Washington, DC.

A three mile radius or retail trade area, drawn with 6500 Piney Branch Road NW as the central point.

During our unsuccessful fight against Walmart entering DC ("Walmart closing one of its three DC stores," with links to 11 other blog entries, and my op-ed in the Washington Business Journal, "Temper Walmart Glee With Planning") the then planning director talked about the areas they wanted to locate being food deserts.  

They weren't except in SE DC, and they ended up not even opening that store even though they "promised."  

At that time, within the radius of the store for Georgia Avenue, there were at least four Giants, three Safeways, multiple ethnic markets (I used to cycle to them at University Boulevard and New Hampshire Avenue to the great Latino market), a Save-a-Lot (since closed), at least two Shoppers Food Warehouse stores, two Aldis, a Price Rite (the cheap brand for Shoprite), and one Whole Foods.  Plus others on the west side of Georgia Avenue, and on the east further into Prince George's County.

There are even more options now, including an Aldi at Fort Totten, Lidl in Columbia Heights, a Whole Foods at Walter Reed, Wegman's on Wisconsin Avenue NW.

15 Minute City.  The reason the "15 Minute [Walking] City" concept bugs me isn't the aspiration--that most everything you want is within 3/4 mile walking distance which for able bodied people is about 15 minutes--it's because the provision of retail and services don't work, at least if you want them to be cost competitive at such distances.

Note that a "15 Minute Bicycling City" makes way more sense.  That's a 2.5 mile area radius riding at 12mph and an area of 19 square miles.  Pushing it out just a bit further, our Manor Park house is accessible to so many places, not just in DC, but across the border in Maryland like Silver Spring, University Boulevard, and the University of Maryland College Park, and 5 or so miles to Downtown DC, Union Station, etc.

About food stores on the nonprofit side, there are at least five motivations, a lack of stores (without regard to retail trade area), campaign promises, ideology, good intentions, and market reality.

Balancing amongst them, and creating a store that remains successful in the long term is tricky.

Casinos in Massachusetts/New England deliberately target Asians

 (There's a reason gaming in Macao has been so successful. And why there are really good Asian restaurants in Las Vegas.)

Traditional lion dancers paraded through a large crowd and a sea of slot machines at the Encore Boston Harbor casino during a Lunar New Year celebration. (John Tlumacki/Globe Staff)

A long time ago, when discussing the "Chinese buses" the inter-city buses operated from Chinatown to Chinatown in the Mid-Atlantic--dropping bus ticket prices significantly compared to traditional inter-city buses and Amtrak--a commenter made the point that these services got their start taking Chinese workers and patrons to casinos.

The Boston Globe has a three part series about how casinos there deliberately target Asians.  That as a result the Wynn Encore Casino in Everett across the river from Boston, is the most successful casino in the US outside of two in Las Vegas.

Of course, how these casinos target Asians is but a microcosm of how casinos target market segments with a propensity to gamble. Ever growing lines of credit offered by casinos can drive people to ruin. Others are wealthy and losses are merely the cost of entertainment.  

In terms of urban development, I don't favor casinos, but it's the case of "everybody's doing it" we ought to just to be on an equal playing field.  That's why cities like Chicago and New York are adding casinos--NYC to be able to compete with Atlantic City and tribal casinos and against other cities for conventions; Chicago to compete for conventions.

-- "How casinos in New England are exploiting Asian communities for profit"
-- "Within the confines of Boston’s Chinatown, there are dozens of illegal gambling parlors. What is the city doing about it?"
-- "In Greater Boston’s Asian communities, gambling can build social ties — and fuel addiction. Here’s how residents are fighting back"

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.

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.

Hennepin County/Minneapolis turns around children and family services, reverses high rate of repeat problems

Great series in the Minneapolis Star Tribune.

-- "Reunification at all costs," part 1

-- "'Friendly’ approach to child protection fails Minnesota families, leads to more abuse" part 2

-- "An inadequate approach to drug abuse," part 3

-- "Hennepin County reduced repeat abuse of kids. Are there lessons for the rest of Minnesota?," part 4

Not rocket science.

• more money
• more staff
• more training
• more supervision
• more monitoring
• reduced case loads
• better organization of and provision of services to families in need

An insight from my brother on societal supports and social infrastructure

 I hadn't seen my brother, who lives in Florida, for many many years.  He came to see me, all too briefly, when I was in the hospital two weeks ago.

As men do, we didn't express dying love for each other, we just talked about stuff.

One of the points he made is that why are so many state governments focusing on legalizing drugs ("How America got high as a kite," Financial Times).  For the money, and sometimes, theoretically, to be able to focus on helping people instead of criminalizing them, although the Oregon initiative isn't really working ("Oregon Decriminalized Hard Drugs. It Isn't Working," ) and it seems that the Portugal policy too has diminishing returns ("Portugal's drug decriminalization faces opposition as addiction multiplies," Washington Post).

I had no idea until a couple years ago, that the death rate from overdoses is significantly higher than that from murders or car accidents.  

We talked about legalizing drugs as a form of anesthetization.  This is called by some economists, sociologists and health researchers, "Deaths of Despair."  It and covid are contributing to the US's decline in lifespan ("Life expectancy in U.S. is falling amid surges in chronic illness," Washington Post).

He said instead of legalizing drugs we should be investing in people.  We didn't talk about national health care.  He mentioned investing in arts programs for people, for expanded educational opportunities, for investments in civic assets.

What Eric Klinenberg calls Social Infrastructure.  And how I write about social urbanism.

Of course, he's right.

Change takes forever: plastic bag bans, liquor stores and crime

I noticed an article that Baltimore County, Maryland is on the verge of passing a plastic bag ban.  DC did that in 2009.

There is an article from Fox45 in Baltimore that states: "Law enforcement expert says liquor stores are hotspots for crime in Baltimore City."  From the article:

According to a 2018 Johns Hopkins University study, every 10% increase where alcohol outlets were located, there was also a 4.2% increase in violent crimes.

A FOX45 investigation determined three deadly shootings in the first month of the year, were just a few hundred feet from a liquor store. ...

Retired FBI Agent Tyrone Powers says liquor stores lead many of the things city leaders have been sounding the alarm about.

“We don’t talk about those open-air liquor stores which attract drug dealing, which attracts the violence that we’re talking about," said Powers.

The cited paper:

-- "Outlet Type, Access to Alcohol, and Violent Crime," Alcoholism: Clinical Experimentation and Research (2018)

Overconcentration of liquor stores and the connection to crime was one of the first issues I worked on once I got involved in revitalization efforts, then centered on the H Street NE neighborhood and commercial district in Washington, DC.

In the early 2000s!  In fact I was featured on the front page of the Metro section, albeit below the fold, in the Washington Post on Labor Day 2003, on the issue, in an article written by Craig Timberg. That article is almost 20 years old.

-- "Neighbors Fight Single-Beer Sales; H Street Merchants Decry Effort as an Attack on Northeast Businesses, Poor" (accessible using Proquest Newsstand, available at many public libraries)

We certainly haven't made much progress in many communities, have we?

One of the justifications to restrict sales in places like Seattle was the high cost of providing emergency services to regular users, and their service calls were usually associated with alcohol use.

Some blog entries

-- "Alcoholic beverage sales restrictions moving forward in Seattle," 2006
-- "Disproportionate link between Circle K convenience stores and crime in Phoenix suburbs," 2011
-- "The sales of alcoholic beverages in cities (DC vs. Chicago)," 2012

Journal article

-- "Regulating Availability: How Access to Alcohol Affects Drinking and Problems in Youth and Adults," Alcohol Research and Health (2011).  "This article briefly outlines the history of this work over four areas, focusing on the minimum legal drinking age, the privatization of alcohol control systems, outlet densities, and hours and days of sale."

Wake County North Carolina offers an EMS subscription for "free" ambulance rides | Why not just collect such money as a tax and provide free ambulance rides

 

Some communities have area-wide ambulance/EMS services, funded by taxes.  Although most of the systems will still bill insurance for costs.

The average cost of an ambulance ride is $400 to $1,000.  

Wake County, North Carolina where Raleigh is, offers a subscription to cover the costs that insurance won't cover, $60 per year.

Although one family, living in Wake County but on the border with Johnson County, got a big bill, because "no Wake County ambulances were available" ("Raleigh couple says Wake County ambulance subscription program failed them," WRAL-TV).  And they were served by a Johnson County ambulance, and the subscription program didn't cover the extra cost.

Why not just raise every household's taxes by $60 /year and pay for the service that way?

 

Planning for heat/climate change | Public health

Yesterday, I really wanted to check out some parks in South Salt Lake, and I went for a bike ride to do so when the temperature was 106°.  

Not too smart (did help me lose some weight).  I was struck by how this one playground facility in Fitts Park was the only one I've ever seen with shade screens.

I doubt it was to deal with the heat specifically.  

More for design aesthetics probably, but increasingly these kinds of measures should be taken within parks and place planning, to make places more resilient wrt heat and sun. 

Las Vegas Boulevard, May 25th, 2017.  Photo: Richard Brian, Las Vegas Review-Journal.

For example, in bike planning, I keep mentioning misters. But misters probably should be deployed more widely as a matter of public space management.

I've discussed a few times, Heat Wave, the book by sociologist Eric Klinenberg which studied the impact of a heat wave on the vulnerable in Chicago, and the conditions and characteristics between neighborhoods with similar demographics concerning the poor and less resourced, and how these conditions shaped outcomes positively or negatively.

-- "Documentary -- Cooked: Survival by Zip Code | PBS Independent Lens"

There's been been writings recently on Phoenix especially, with summer temperatures over 120°, the impact on vulnerable populations, and their response ("As Phoenix swelters, the nights are even worse than the boiling days," "Unhoused in Phoenix’s perilous heat: ‘If I don’t keep cool, I’ll die’," Guardian).

Phoenix was one of the first cities to appoint a "heat officer," to coordinate municipal action and response on the issues ("Climate change is already here in many US communities | "Heat Officers" versus Climate Change Officers").

The Washington Post has three articles today on the topic:

-- "U.K. braces for record temperatures as ‘heat apocalypse’ hits Europe."  As Europe has experienced rising temperatures over the past 20 years, institutions are taking more measures to reduce the negative impact.  For example, 75% of housing in France doesn't have air conditioning.  French nursing homes are taking measures to provide for "extreme" cooling in the face of extreme heat, etc.

-- "Climate change is pushing hospitals to tipping point."  From the article:

Each of the organizations that signed onto the pledge — which included public hospitals, health-care centers, pharmaceutical companies, medical-device makers and suppliers — are expected to develop climate-resilience plans for their facilities, including plans to support individuals or communities most vulnerable to the effects of climate change.

According to Ebi, any plan should mention what she called the “low-hanging fruit,” including:

• Understanding your patient base, and how it could shift with climate change
• Outlining community vulnerabilities to global warming (for example, care centers that are based in a flood plain)
• Planning personnel schedules around forecast weather events, or rescheduling surgeries to ensure anticipated surge capacity
• Providing opportunities for patients that benefit their health and the environment, such as a garden to supply fresh food for the cafeteria

-- "A Texas meteorologist warned of power outages. Then the lights went out." This has to do with managing energy demands in the face of extreme conditions.  It's interesting that as part of weather forecasting, television meteorologists report on electricity availability. 

Increasingly, Texas' energy generation system is stressed whether it's hot or cold.   But it's not just an energy production and regulation issue, it's a matter of public health.  

-- "Cold wave: the Texas power debacle disproportionately impacts the less well off"

For example, Texas public water systems were damaged by the power outage in the extreme cold, health facilities and their ability to provide services are affected, and of course, the weather-related deaths, which arguably totaled in the thousands.

Also see "Heat impact calculator: Not all neighborhoods suffer equally," Orange County Register.

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Plus there are other climate change risks, like wildfires, flooding, etc.

School lunch (and breakfast) as an opportunity for learning

 The Washington Post has an opinion piece, "The unjust shaming of a little girl highlights the broad issue of institutional food waste," about an incident in Lorain, Ohio where a child threw out her uneaten lunch and was forced to take it out of the trash and attempts were made to force her to eat it. The cafeteria worker and the principal eventually lost their jobs. 

The op-ed positions the event in terms of food waste.  And that's reasonable given how many of us were taught to clean our plates -- "there are children in China who go hungry."  

We didn't think about it in terms of waste, but that was an element.

But while the waste element is true, it misses the basic point, that schools don't treat mealtime as an opportunity for learning. 

The child tossed pop up waffles.  I eat waffles (and pancakes) with yogurt, sometimes adding fruit. Yes there was a teaching moment there. But the cafeteria worker wasn't trained in such an approach. 

And plenty of principals don't think that way either, despite their position--they see food service as a function to provide, with potential problems, not as a learning opportunity..

Kids need to be given opportunities to try different foods and modify what they eat so that they want to eat it.   

I think I've written about this in terms of DC.  My first DC job was for a nutrition organization, and I dealt with this issue back then, 30+ years ago. One of the things we did was produce an educational film on fast food, and I showed it in some DC schools, talked with some home ec teachers about the issue, etc.

These days it's even worse.  Schools see food as a cost center, something to manage and reduce.

Basically, schools don't get much money per meal, mostly have outsourced meal production, and many schools no longer have kitchen equipment.

1.  There is a charter school, in Columbia Heights that treats school lunch as a community family meal. The home economics teacher I talked with many years ago from Eastern High School made the point that many of her students hadn't had a meal around a table with others until her class.  

2.  The Post has written about Capital City Public Charter School and its creation of a "food forest" and other food-related programs ("For D.C. students, lessons in growth, of the garden variety").  Relatedly is the Edible Schoolyard program created by Alice Waters.  There's a similar program in DC.

A third-grader serves milk at the Umejima Elementary School lunchroom. Ko Sasaki/For The Washington Post.

3.  In Japan, school kids clean the schools as a form of learning and they also serve school lunches. 

School meals are treated as a learning opportunity and a way to teach responsibility ("Everyone's Favorite, a Mouth-Watering Lunch Menu Every Day!," Kids Web Japan, "Japanese School Lunch: Why it’s Awesome and One Reason it’s Not," Japanese Food Guide). 

It turns out the Post wrote about this many years ago ("On Japan’s school lunch menu: A healthy meal, made from scratch").

Other interesting programs are a kid food community center in Toyko ("Open house: A Tokyo community centre with food at its heart is helping to nourish the whole neighbourhood.," Monocle Magazine) and in response to the pandemic, community cafeterias for hungry children and families ("Fast-Growing ‘Children’s Cafeteria’ Provides Kids With Food And A Coveted Community In The Pandemic," Forbes).

4.  Toronto has a number of interesting food security groups that do amazing things.  

One is The Stop, and there is a book about it. ("Food activist Nick Saul on why we’re ripe for a revolution," "Nick Saul: The man who built the foodie bank," and "Rethinking the food bank: It’s no longer just about handing out food to the hungry," Toronto Star).

Nick Saul has since left The Stop to start an organization, Community Food Centres Canada, working with other communities on creating or repositioning their food bank programs.

Another is FoodShare, which among its programs has a better food program for schools, including salad bars ("Farm-to-School program boosts health of students and food economy," Toronto Globe and Mail, " Toronto chef Jesus Gomez makes vegetable-focused school cafeteria food kids will actually eat," Toronto Star).

5. ChopChop Family is a print magazine and online program supporting better nutrition for kids and families.  They also run stories on innovative programs ("COOKING CLASSES IN MICHIGAN ARE CHANGING KIDS LIVES").

6. Just watched a PBS Independent Lens documentary on the original Rainbow Coalition in Chicago repeated on the PBS World Channel (sadly not available in the DC area, but is in Utah).

It's amazing to think that the innovation of school breakfast programs come from the Black Panthers in Oakland ("How the Black Panthers’ Breakfast Program Both Inspired and Threatened the Government," History Channel). The Young Lords did the same in Chicago. 

Young Chefs Winter Break Cooking Camp, Fairway Market, NYC

7.  A number of supermarkets have cooking classes, and many have sessions for kids. And there are various programs, usually for profit, as part of community cooking schools.  

Farmers and Public Markets too.  

This photo shows a class of children in the Teaching Kitchen at the River Market in Little Rock.

-- Boqueria Kitchen School, Barcelona

Get vaccinated

 In a comment on a Washington Post article, the person wrote that the rest of us shouldn't try to impose vaccination on a "small minority."  I commented that 33% of the population is 109 million people.  That's not small ("As Omicron Spreads and Cases Soar, the Unvaccinated Remain Defiant," New York Times).

Chart from Statista.

Hospital systems and public health departments never thought they'd have to plan for 33% of the population actively refusing vaccinations in the face of a pandemic and the consequences that would result--an overwhelming of ICU and emergency care departments.

The hospital systems in the Cleveland region put an ad in the Cleveland Plain Dealer calling on people to get vaccination ("Ohio hospitals urge COVID-19 vaccinations in powerful ad," NBC Today).

It's hard to say what's going on with the virus.  Omicron appears to be better at evading the power of the vaccine unless you are boosted ("Omicron is a game-changer for Covid-19 vaccines," CNN).  It's much more contagious, but less deadly.  Even so, people who are vaccinated are much less likely to experience severe symptoms, the need for hospitalization, or the likelihood of death.

I am totally unable to process how 33% of the population could be so fundamentally bad at calculating risk.

Orange County Register coronavirus tracker graphic is a great model

Showing the value of local media in communicating locally important information, the newspaper is focused on only the one county, but it's a big county in population, more than 3 million residents.

It's also a decent example, in the vein of the work on graphical illustration of information by Edward Tufte, showing the power of multimedia to communicate.

Documentary -- Cooked: Survival by Zip Code | PBS Independent Lens

Cooked: Survival by Zip Code, premiered on the PBS Independent Lens documentary series a couple weeks ago.  

It's being repeated on PBS World Channel as well as stations, and is still viewable online.  (World Channel is carried by many PBS stations as one of their HDTV channels.  Unfortunately, it's not available in the DC area.)

The program is about the 1995 heat wave in Chicago, which killed more than 700 people, which was chronicled in the dissertation and later a book by sociologist Eric Klinenberg.

-- "Denaturalizing disaster: A social autopsy of the 1995 Chicago heat wave," Theory and Society, 1999, original journal article by Klinenberg, free to download

The documentary is about "natural disasters" that are in fact the logical outcomes of social disparities.

The filmmaker, Judith Helfland, is struck by the oddity of how the US emergency management and disaster response system is focused on catastrophic events -- earthquakes, tornadoes, hurricanes, etc. -- and not the kinds of socially determined "disasters" that are the result of economic, racial, and class disparities of the kinds that resulted in the heat related deaths in Chicago.  

According to the film, there are about 3,200 premature deaths each year in Chicago that for the most part, result from poverty.

-- Social determinants of health, CDC

What happened in Chicago was that poor people, mostly older, with fewer resources, in communities with fewer resources, died from heat-related causes as the temperature exceeded 100° for multiple days in a row in July 1995, while wealthier communities pretty much got through the heat wave unscathed.

One of the interesting findings in Klinenberg's book is that communities with the same kinds of demographics, but positive differences in social capital, community organizations and institutions, didn't have the same high rates of death.

The shaded areas in this map of Chicago neighborhoods show the high poverty neighborhoods, which pretty much track other high rates of negative indicators (health, low educational attainment, etc.).  They also track the neighborhood redlining maps from the 1930s.

Steve Whitman/Sinai Urban Health Institute.  One of the people featured in the documentary is epidemiologist Steve Whitman.  At the time of the heat wave he was a Deputy Commissioner of Health for the City of Chicago.  He left the city in 2000 to start the Sinai Urban Health Institute at Sinai Hospital.  He died in 2014 ("Steven Whitman, social epidemiologist, 1943-2014," Chicago Tribune).

SUHI conducts community health surveys and aims to address chronic health conditions and disparities resulting from poverty.

-- Improving Community Health Survey, 2004, SUHI

They published a book, Urban health: combating disparities with local data, which outlines the "Sinai model" which is based on the idea that by collecting health data at the scale of neighborhoods, effective responses can be developed to reduce health disparities. 

Interestingly, footage showing Mayor Daley at press conferences during the heat wave shows the same kind of blockheadedness demonstrated during the nation's most significant public health disaster--the response to covid19.

Daley downplayed the deaths, blamed the victims, etc.  The city does have a regularized response program for heat waves, so they don't experience the same level of premature death that they did in 1995, but they haven't extended the approach to poverty or chronic health conditions more generally.

I've written about this general issue in "More communities need to integrate health care and public health programming: Prince George's County, DC, etc." (2020).  It builds on a series in 2017 and follow ups, taking a "transformational projects action planning" approach to rebuilding the United Medical Center in Southeast DC, in a manner that would link public health and hospital care with a focus on addressing chronic medical conditions that tend to be a problem in low income communities.

The Sinai Urban Health Institute is another best practice program that should be incorporated into that concept.

Disaster response as a root of federal social welfare systems.  The documentary also interviews Stanford professor Michele Dauber, who's written The Sympathetic State: Disaster Relief and the Origins of the American Welfare State.  That's another book I need to track down and read.

The thesis is that FDR's New Deal used the long time examples of federal response to disaster and disaster relief as a way to justify the creation of social welfare programs like Social Security.

This lecture from 2013 outlines the arguments of the book.