NYT Article Promotes Neighborhood as the Unit of Change.

neighborhoods matter in every child's future

No, starfish are not saved one by one.

Oct. 18, 2018

You’ve probably heard the starfish story. There’s a boy on the beach who finds thousands of starfish washed ashore, dying. He picks one up and throws it back into the ocean. A passer-by asks him what’s the point of that. All these thousands of other starfish are still going to die. “Well,” the boy responds, “I saved that one.”

Many of our social programs are based on that theory of social change. We try to save people one at a time. We pick a promising kid in a neighborhood and give her a scholarship. Social programs and philanthropic efforts cream skim in a thousand ways. Or they mentor one at a time, assuming that the individual is the most important unit of social change.

Obviously it’s possible to do good that way. But you’re not really changing the structures and systems that shape lives.

Maybe the pool story is a better metaphor than the starfish story. As a friend of mine puts it, you can’t clean only the part of the pool you’re swimming in.

neighborhoods as the unity of change
Thinking in neighborhood terms means radical transformation in how change is done.Martha Irvine/Associated Press

It could be that the neighborhood, not the individual, is the essential unit of social change. If you’re trying to improve lives, maybe you have to think about changing many elements of a single neighborhood, in a systematic way, at a steady pace.

One of the signature facts of the internet age is that distance is not dead. Place matters as much as ever, and much more than we ever knew.

Read More https://www.nytimes.com/2018/10/18/opinion/neighborhood-social-infrastructure-community.html

Some research supporting the concept 

Low-income children who moved at birth from the low upward-mobility area of Seattle’s Central District to the high upward-mobility area of Shoreline earned, at age 35, $9,000 a year more than those who had made this move in their 20s.

Shoreline is 10 miles from the Central District.

In a classic study, the sociologist Eric Klinenberg showed just how important neighborhood is in determining who survives in a crisis. Klinenberg compared deaths in two Chicago neighborhoods during a heat wave in 1995. More than six times as many people died in North Lawndale as in South Lawndale, even though the two places are demographically comparable.

The fact is that human behavior happens in contagious, networked ways. Suicide, obesity and decreasing social mobility spread as contagions…

David Brooks, NYT 10.19.18

Thinking in neighborhood terms requires a radical realignment in how you see power structures. Does the neighborhood control its own networks of care, or are there service providers coming down from above? Do the local norms of interaction need to be changed? For example, do people feel it’s normal to knock on a neighbor’s door and visit, or would that be considered a dangerous invasion of privacy? Are there forums where the neighborhood can tell its collective story?

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David Brooks has been a columnist with The Times since 2003. He is the author of “The Road to Character” and the forthcoming book “The Committed Life: When You Give Yourself Away.”

Consequences of Unaffordable Care


We often speak only about the direct costs of care: health visits, cost of drugs, hospital stays.  

But it’s important to remember that the consequences are far more expansive than immediate costs.  The total costs stretch to all sectors of the economy.  

Economics affect all parts of our lives

Whether we are discussing clean water and climate change or education, immigration, and so many more issues, there is a cost to most of not all sectors our communities.  Often, there is a national cost that can be measured, too.  

It’s for this reason that we present our first chart for you:

When people can’t get care, or they can’t make enough to fund their deductible account, there are consequences.  Usually we focus on the direct problems of missing treatments, canceling physician appointments, or even missed days at work.  This chart tells quite a bit more about what happens when care is not received or paid for.  It’s a huge statement on the kinds of factors affected by unaffordable insurance. 

Social Determinants of Health

impact of SDOH on health outcomes

Many of us in the health care and economic fields have known for decades that even the best health care, by itself, does not deliver the best outcomes.  About a decade ago, the University of Wisconsin in partnership with JAMA and the Kaiser Family Foundation published the earliest charts of what social factors influence health outcomes.  You may be familiar with smoking and poor diets.  But the Social Determinants of Health #SDOH encompass much more.  

Social determinants very often are predictors of better (or worse) health outcomes.  Some of these include exercise, support community, neighborhood, clean food, clean water… and still more.  You can see the list in the chart below.  

social determinants of health

You can see that these assets (or, risk factors, if they don’t exist) can disable a great diagnosis and treatment plan.  Many of the great success stories in cancer, diabetes, depression and most assuredly, addiction, are successes because they included so many of these factors in order to achieve the success.

When we withhold funding, put barriers to affordability or access, or deny people the basic education, food, or clean water in our great economy, we are hindering their life expectancy and social mobility as well. 

Martin Luther King said it best: 

Of all the forms of inequality, injustice in health careis the most shocking and inhumane.


Voters Worried about Health Care Costs, Again

voters are worried about health care costs

Kaiser Family Foundation is a trusted source for health care data, surveys and year over year monitoring.  Just as Pew Organization surveys culture impact, KFF monitors many dimensions of health care impact.  In this survey, it is painfully obvious that voters are worried about health care costs and affordability. Sixty-seven percent (67%) are concerned.

voters are worried about health care costs

Drew Altman, of KFF, explains more about this problem in a post for Axios:

  • It helps explain why so many people name health their top issue, despite the progress that has been made in covering the uninsured. And everyone who’s sick and can’t afford medical care has family members and friends who see what they are going through, creating a political multiplier effect.
  • It is also why health care is substantially an economic issue as well as an issue of access to care. When people have trouble paying medical bills, it’s a hard hit to their family budgets — causing many people to take a second job, roll up more debt, borrow money, and forego other important family needs.

You can read more here, in a summary article from Axios 

Health Care Whacked by GOP

The GOP keeps hammering at health care and specifically at the Affordable Care Act (ACA).  In many ways, these efforts look like moments for election ads.  Except, of course, that there are real people who are going to get hurt.

worrying about healthcare

Removing essential benefits, one of which is coverage for pre-existing conditions, is a key portion of the ACA (otherwise known as Obamacare).  The democrats in the Senate proposed a measure to keep the coverage of pre-existing conditions, but, NOPE, the GOP didn’t buy in. 

We all know that people without health insurance cost more money than those who are able to get the care they need.  My work in this field has shown 10-50% higher costs for patients with pre-existing conditions who are not compliant with their treatments (medicine, physical therapy, tests, etc).  The average cost of the patient who is not compliant is 30% higher than a compliant patient.  And when folks can’t afford to use the insurance because the deductible or copay is too high, the uncovered treatment becomes the tax payers’ problem, as hospitals and clinicians demand payment.

Read More Below from The Grit 

GOP Votes No to Pre-Existing Conditions Just Before Midterms

In a 50-50 vote, Republicans defeated a Democratic measure to stop the return of denying health coverage for pre-existing conditions. The measure was part of a Democratic attempt to bring healthcare to the forefront of the campaign for control of Congress in November.

Under the Affordable Care Act (also known as Obamacare) insurers were no longer allowed to deny coverage or charge higher premiums to people who had a medical condition at the time of seeking insurance. This included everything from pregnancyto just being transgender among as many as 400 other conditions. President Trump reversed course on this, however.

This was possible because the short-term health plans Trump has been pushing don’t need to adhere to the standards of normal plans governed by the Affordable Care Act.

“The Trump administration is rewriting the rules on guaranteed health care protections that millions of Americans depend on,” stated Senator Tammy Baldwin(D-Wisconsin), who is up for reelection in November. “These junk insurance plans can deny coverage to people with pre-existing conditions and don’t have to provide essential health services like prescription drugs, emergency room visits and maternity care.”

It was Baldwin who filed the petition to reconsider Trump’s weakening of pre-existing condition protections.

After a year of failed attempts to repeal the Affordable Care Act, Republicans began employing a new strategy — corrode it until it no longer had any meaning. This “collapse and replace” strategy has been working fairly well for opponents of Obamacare.