New Approaches for Building Healthier Cities

Sue Siegel (from left), CEO of GE Ventures and healthymagination, Sandro Galea, Robert A. Knox Professor and SPH dean, and Monica Valdes Lupi (SPH’99), executive director of the Boston Public Health Commission, at the SPH Dean’s Symposium Building Healthy Cities: Boston and Beyond, on April 5.

How can cities become a model for generating healthy populations? What kind of innovative leadership and data ecosystems are required? Those were among the questions considered during a daylong School of Public Health Dean’s Symposium titled Building Healthy Cities: Boston and Beyond, held at SPH last Wednesday.

Cohosted by GE healthymagination, a General Electric initiative addressing global health challenges, the event brought together private and public sector health leaders to explore new and collaborative ways to make cities healthier and narrow health disparities between neighborhoods. Reshaping cities as places that promote better health through issues from walkability and clean air to housing and food, the speakers stressed, it’s imperative to involve all stakeholders, applying the resources and creativity of businesses to the problems cities face.

To make a population healthier, “it takes an entire community across various sectors, because health is beyond just health care,” featured speaker Sue Siegel, CEO of GE Ventures and healthymagination, said in her opening remarks.

“One of the questions on which this school has rested since its inception is, how can we be part of our urban environment towards creating a healthier city, to create healthier populations within this city?” Sandro Galea, SPH dean and Robert A. Knox Professor, noted in his introduction. “That very much animates the work we do as a school, and it animates the questions our faculty ask. It is a large part of the reason our students come to us and a large part of our practice engagements.”

Monica Valdes Lupi (SPH’99), executive director of the Boston Public Health Commission, one of two keynote speakers, pointed out that while Boston has an uninsured rate less than half the national average and a massive network of world-class hospitals and health centers, “there are also things that we’re not very proud of. We are ranked first in income inequality according to the Brookings Institution—we beat out Atlanta, New York City, and San Francisco. About one-third of our residents live in poverty and one in five of our kids lives in poverty.”

Inequality, she told the packed room, also means health disparity, with rates of diseases from diabetes to asthma to depression markedly higher in neighborhoods with lower incomes and education levels. “So much of what influences a community’s health happens outside of the clinic walls,” she said.

The city is working hard to level the playing field, from making neighborhoods safer and more walkable to making healthy food more available, she went on to say. That work takes data to pinpoint issues and solutions, “and unfortunately some of our surveillance systems at the public health level are not as nimble and agile as those in the private sector. Events like today’s and the work that we’ll be doing in partnership with GE provide a tremendous opportunity for us as a city to advance our work. We’re all in this battle together.”

Citing General Electric’s decision to move its corporate headquarters to Boston last year, Siegel spoke about the company’s commitment to invest approximately $50 million in the city’s education and health. After city officials pointed to opioid addiction as a major area needing support, she said, the GE Foundation began “working with the city of Boston to address this, in what hopefully will be an experiment for the country.”

She went on to describe how GE became interested in improving health on an urban scale. In 2009, its spending as a self-insuring company was unsustainable. Rather than waiting for state or federal government to come up with a solution, as a large, self-insured employer, GE decided to see if it could begin working with cities to drive changes that would make the population healthier.

“We started with Cincinnati, where we are one of the biggest employers because of our aviation unit there,” Siegel said. The GE Foundation partnered with its Developing Health US program to help develop more effective medical record systems, support local nonprofit health centers, and provide wellness incentives. The program proved so successful that GE soon expanded it to other cities where its employees are a large segment of the population: Erie, Pa., Louisville, Ky., and most recently, Houston, Tex.

She urged the audience to use cities as laboratories, to test innovations in miniature, “but also effectively show success, and then scale it up” to national or even international levels.

Flexibility has to be central to any collaboration focused on creating healthy populations, said Jennifer Edwards, director of Developing Health US, noting that when it moved to Boston last year, GE was “the new kid on the block, but we had experience working in community health and with underrepresented populations, so we came in with an idea.” After meeting with stakeholders throughout the city, from health care to academia to other funders, she said, it was clear behavioral health and addiction were major areas to address. “It wasn’t what we had had in mind,” she said. “We had to change direction, and we had to have the courage to go back to our board and say that this is what we are doing. What we are doing needs to be meaningful to the city of Boston and the commonwealth of Massachusetts, so we pivoted.”

It was a point echoed by other speakers. The key to making any collaboration work is to make sure parties can develop enough of a relationship to feel like they are truly working together instead of competing, said James S. Marks, executive vice president of the Robert Wood Johnson Foundation, a speaker on a panel about empowering communities. “That trust is best built before a crisis.”

Keynote speaker Maureen Disognano, a professor emerita and senior fellow at the Cambridge, Mass., nonprofit Institute for Healthcare Improvement, a leading innovator in improving health care, urged focusing on the strengths of a patient or population, not just the problems. “Health care workers need to move from what’s the matter? to what matters to you?” she said.

“What’s exciting about cities is the potential to do things that were not previously thought possible,” Galea said. “One day it’s impossible, the next day it’s bold, and the next day it’s been done all over the country.”

Among other symposium speakers were Jascha Franklin-Hodge, Boston’s chief information officer; Karen DeSalvo, former US Department of Health and Human Services acting assistant secretary for health; Jonathan Levy, an SPH professor of environmental health; and Tom Grilk, Boston Athletic Association/Boston Marathon CEO.

Michelle Samuels can be reached at msamuels@bu.edu.