More communities need to integrate health care and public health programming: Prince George's County, DC, etc.
Update: Not only did DC announce ("Bowser strikes deals for new Howard hospital and new Southeast D.C. hospital," Washington Post) that they have inked an agreement with George Washington University Hospital/Universal Health Services to build and manage a new hospital in Southeast DC, they've agreed to pay $300 million toward a new hospital for Howard University, which is becoming integrated into the Washington Adventist health system ("Adventist HealthCare and Howard University Hospital Sign Management Services Agreement," press release).
According to the article the GWU project will include some East of the River clinics beyond the hospital.
One of my "complaints" about DC is that as the nation's only real city-state, not having to kow tow to conservative state legislatures, it has tremendous opportunity to be innovative, but it rarely avails itself of these capability.
Sure, Congress has oversight, but for the most part, the city can do what it wants unfettered (not on debt, and Republicans often pass restrictive legislation as it relates to particular culture war matters).
Health and wellness care is one area where the city could be truly innovative, and really isn't. This new deal is an example. It will do a bit more than the current setup, with the outreach clinics, but it could do so much more.
As I wrote in the comment stream, in 2007 I laid out a concept I called "HealthyDC" community clinics to deal with chronic disease management and wellness. It was inspired by the then new clinics being put in pharmacies.
But the reality is that in A Pattern Language: Towns, Buildings, Construction, Christopher Alexander et al. (List of patterns) outlined the same concept in the late 1970s as item #47 (Community) Health Centers, based on the Pioneer Health Centre experiment in Peckham, England.
- my first DC job was for a public health related organization
- the closure of DC General Hospital during the Williams Administration around when I started getting more involved in DC issues and when I started blogging
- a searing article in the no longer published Suburban Maryland Gazette newspapers in 2003 ("Shouldering the burden"), about the impact on Prince George's County with special negative impacts on Prince George's Hospital, from the forced displacement of poor DC residents to that county from the redevelopment of DC's public housing which also when it was rebuilt, was with fewer units than before;
-- "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
In 2018, I wrote a series outlining how a rebuild of United Medical Center in Ward 7/East of the River could be transformational both in terms of health care and public health outcomes as well as an economic development initiative, by marrying it with the simultaneous development of an advanced medical education and research program next door at the St. Elizabeths Campus, which the city has been trying to redevelop for more than a decade, with little to show for it.
-- "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"
-- "Update on DC's plans to build a new United Medical Center"
-- "Community Health Improvement Planning"
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital"
The influences on that program were far and wide, and as I come across other great programs new to me, I enter them in the comments on the various articles.
A few weeks ago, I wrote about how there was something I missed in that series, the need when building that hospital to plan in extra functions and potential capacity in case of epidemic or terrorism, the way that Rush Medical Center in Chicago was reconstructed after 9/11.
-- "Rush Medical Center (Chicago) clues us into a gap in state and regional health care planning: planning for disaster and epidemic response"
As I said, the economic and health outcomes problems faced by DC General, Howard University Hospital, and Prince George's Hospitals at the same time made me realize that this issue was regional, not jurisdiction specific. But I chalked that up mostly to poverty.
-- "When the problem is defects in the structure of "the market", financial incentives won't do much good: Maryland's health enterprise zones," 2013
Health disparities for people of color aren't just about income. But the issue of health disparity is more than just poverty, it can also be an issue of race, as indicated by the Washington Post article, "Covid-19 is ravaging one of the country’s wealthiest black counties."
Another example was outlined previously in reporting by the New York Times about black women and pregnancy complications, which affect women at all income levels ("Why America's Black Mothers and Babies Are in a Life-or-Death Crisis").
Minorities in Prince George's County dying from coronavirus aren't "just poor" or people with serious underlying health conditions, they are also healthy people with high incomes who happen to be people of color.
To deal with the problems of PG Hospital, the state facilitated its merger with the University of Maryland Medical System, which because the medical school is in Baltimore, has been less focused on the DC side of Maryland.
The program is now called UMMS Capital Region Health and the linchpin is a new hospital under construction in Largo, which will replace the existing PG Hospital.
-- "Prince George’s health system names permanent chief," Washington Business Journal
-- "New empire in Prince George's: The road ahead for UM Capital Region Health," Washington Business Journal
Probably every new hospital project needs to add capabilities to deal with epidemics and other potential health disasters. But like with my recommendations for United Medical Center and the recognition that the program should be expanded even further, along the lines of what the Rush Medical Center has done, my sense is that the UMMS program for the new hospital in Largo doesn't link health care and public health programming, and the hospital isn't likely to being outfitted in extranormal ways to deal with epidemics, terrorism events, and other threats.
(And yes, I know many hospitals, at least with catastrophic response to mass casualty events, are already doing some of this.)
PG County needs to do what I recommended DC do. Looks like Prince George's County, and presumably other communities with high population of people of color need to develop similar programs marrying health care and public health programming more directly.
For example, the Post writes about a similar situation in Milwaukee, "Covid-19 is ravaging black communities. A Milwaukee neighborhood is figuring out how to fight back," and there have been many articles about the hollowing out of the rural health care system ("Closed Hospitals Leave Rural Patients ‘Stranded’ as Coronavirus Spreads," New York Times; "1 In 4 Rural Hospitals Are At Risk Of Closure And The Problem Is Getting Worse," Forbes). These communities need better care as well as more care.
Like how UMC probably isn't being built the same way that Rush Medical Center was, to be of special use in times of pandemic, the same is probably true of the new UMMS hospital in Largo.
Transformational Projects Action Planning as an approach
This approach, oriented to wringing out every possible benefit from a large project as a way to transform a functional "service" like health and wellness care and public health, is an example of what I call "Transformational Projects Action Planning" applied to health and wellness planning more generally, and specifically to large scale projects, like the planning, development, construction and operation of a new hospital.
-- "Why can't the "Bilbao Effect" be reproduced? | Bilbao as an example of Transformational Projects Action Planning," 2017
-- "Downtown Edmonton cultural facilities development as an example of "Transformational Projects Action Planning"," 2018
-- "A "Transformational Projects Action Plan" for a statewide passenger railroad program in Maryland," 2019
-- "A "Transformational Projects Action Plan" for the Metrorail Blue Line," 2020
The Purple Line series in toto is an example of TPAP. All the relevant articles are linked within this update:
-- "Revisiting the Purple Line (series) and a more complete program of complementary improvements to the transit network," 2019