 I'm really pleased to be here. I have to say yesterday was amazing. I think about this stuff all the time but I was really pushed and stretched and had some new ideas and me and my team have already been huddling and talking about how we want to incorporate some of the some of what we're learning into into our work. So I'm going to talk to you today about making Black Lives Matter and the making part is important because it implies action and so Black Lives Matter is a great slogan but it has to be more than that. It has to mean action and it has to mean intentionality about everything and so I loved the protests that happened nationally in the summer of 2020 that really brought this movement to the forefront of everyone's consciousness and now two years later I think we have lost some of the energy of that summer but if we are intentional about action and making Black Lives Matter we can continue to harness that energy towards change. So what I'm going to talk to you about today is how structural racism shapes neighborhoods. I want to talk to you about gun violence as a deadly symptom of structural racism and then I want to talk to you about place-based investments in Black neighborhoods to promote health and safety. So this is the Urban Health Lab team and five members of the team are here today. Can you guys wave your hands? Yes, amazing. So this is not all of our team but this is a good portion of it. Dean first emailed me in about a year ago, November of 2021. I did not see the email for a while because he sent it to an email address that I admittedly don't check that often which is the Urban Health Lab email address. So he emailed in November and then he emailed again in December. I was just you know checking in to see if he saw this email. I didn't see February. Yes and so but the email caught my eye because he not only invited me to come speak but he invited the team and I really really appreciated that. It's the first time I've gotten an invitation like that and so I immediately wrote back and said I'm so sorry it's been three months since you said that is this you know is this invitation still open because to be able to bring my team here and for them to showcase the work they do is really really special so thank you thank you so much. This is our vision racial environmental and economic justice for black and brown people and neighborhoods. I had when I sort of took over the Urban Health Lab it was just me and Kenny who's the his name is Milwaukee and so we were a very small group I sort of sat and wrote a mission and vision on my own. Once we had a larger team in April, Nikki who's the director and I sort of presented this to the group to say hey guys this is our vision and mission just that you were all sort of aware of this and their group was like um we don't really like this vision and vision and so we threw it out and together sort of went through a iterative process over many months to come up with our new vision and vision and so really proud of this. I think everyone on our team is really mission focused and passionate about the work and that's the most important thing that sort of brings us together to do what we do. So to jump in structural racism shapes neighborhoods so the defining feature of American neighborhoods is segregation that's just a fact and so whether you live on a tidy tree line street whether you live in a neighborhood that is has vacant lots of in buildings lots of trash those spaces and places around us impact our health and all of those factors are determined by structural racism and so I want to build a conceptual model for you that really shaped how I think about this connection between structural racism segregation and health which is you know I'm a physician and so I've always cared about health. This is a model from Anna Diaz who's the Dean of Public Health at Drexel in Philadelphia. This came out in 2010 when I was just starting a research fellowship and so this was really and I'm still using this conceptual model today this really was influential in how I think about all the work I do. You know in medical training in medical school we don't learn any of this it's all very individual and so that leaves a lot of people sort of walking away thinking that any health problems that people have is because of individual deficits you know because they smoke or they drink or or this and that and so this was really a great frame shift for me to step away from the sort of individualized focus of health and so in this model the immediate drivers of health are stress and behavior so of course our individual behavior influences our health but something we don't talk about enough is the way that stress in and of itself impacts health so there's lots of evidence around this you know the experience of stress which can be good you know I had a little bit of stress this morning because I was going to give a talk so but that's a good kind of stress to get you prepared but we all know that there's chronic and traumatic stress that a lot of people face that has harmful physiologic effects in our bodies so these are the immediate drivers of health but then what determines stress and behavior in this model is your neighborhood where you live and it's broken down to the physical environment and the social environment but which of course in reality are intertwined but for the purposes of this model are separated but the real reason I love this model is because it goes that extra step to say and ask the question well why do our neighborhoods look the way they do and the answer to that is segregation by race and socioeconomics and resource and ecology and underlying this model are of course individual characteristics because your biology your genes they do matter but in this model if they play they're sort of subsumed by these larger forces so just to dig into a little bit to this segregation piece so this is a map of Philadelphia broken down by census tracts this was created by Emily Seeberger who's an amazing data analyst in our group and so and this is showing the percentage of the population that's black in every census tract in Philadelphia so the point here so if we all lived together in the same places the whole map would be the same color but clearly it's not and there are neighborhoods that are predominantly black and that's in western southwest Philadelphia and in north Philadelphia and just to orient you to where Penn is we sit right here so this is you know showing how segregated our city is this is not unique to Philadelphia you can make a map like this in any city in the country and it basically will look the same why is our country so segregated you know obviously racism and so you know all of the major systems that we all exist in housing criminal justice education environment health care they're all shaped by structural racism and the history of structural racism and so this is a definition of structural racism that I really like it's a sort of a set of definitions and it's about policies institutional practices like that of university and cultural representations that work together in reinforcing ways to perpetuate racial group inequities structural racism we often you know focus on the the harm that people of color face because of structural racism but we have to acknowledge the flip side of that and that is that being white is a privilege whiteness is a privilege and it conveys specific benefits um and as was uh you know talked about yesterday a few times you know when you have extreme benefit on one side you are going to have extreme harm on the other side and that's what structural racism does um it shapes it shapes everything it shapes the world we all exist in and in some ways it it's tricky because it's often invisible if you're not looking for it and and so um part of part of what I've been trying to do in you know all the talks I I give and part of the reason why a conference like this is so important is because it makes the invisible visible so we can acknowledge um and interrogate the ways in which structural racism shows up in our daily lives and in our work and structural racism is the root of racial health disparities um in you know in academic medicine um oftentimes so work around health disparities has happened for a long time but it's often been divorced from the concepts of racism and structural racism um a year ago there was a paper published that um actually just looked how often in the top medical journals jam on doing the journal medicine landset um how often the word racism was used in papers and and you know in abstracts and titles in papers about health disparities and it was very very very little um people have stories about journal editors specifically um asked them to take out the word racism from papers describing racial health disparities and so um so you know academic medicine has um I think hid from from this for a long time um this is a quote from a really great paper that came out last year by Mary Bassett and Sandra Galeo about reparations as a public health strategy and this quote is a great paper um but this quote really stuck with me because it talks about power money and access to resources which are three of the main ways that um you know structural racism sort of uh works through mechanisms that it works through to influence health and so if we don't talk about power if we don't talk about money we don't talk about access to resources um we're not going to be able to disrupt these links um and so just a brief piece about money um I loved yesterday how Yasser sort of dropped at the end the reparations um reparations bomb that was amazing so um wealth is um wealth is really important this is this is the racial wealth gap in this country it's pretty profound um and hasn't changed over you know century and so um this is the median net worth of households um so this is not income wealth is different from income this is um uh median net worth um and you can see that the median net worth of white households hovers around 160 170 000 the median net worth of black and latino households is under 20 thousand dollars okay wealth is built intergenerally intergenerational and so um this is for a variety of reasons um something that has not changed over time and has profound causal effects on health and is related to concepts of investment and disinvestment in black neighborhoods um this is a paper that myself and two colleagues named by katteromity and george downberg wrote recently about the role that health systems as an institution can play in helping to close the racial um wealth gap and so um health systems are not going to be able to do it on their own the real thing we need is reparations but we believe that health systems as an institution and that could be extended to universities um have a role to play in addressing this wealth gap um so back to structural racism segregation you know why is this um the choices that we have of where to live are constrained it's not equal opportunity choices of where to live they're constrained both by historical and present day factors including um federal state and local government policy um real estate practices and bank lending practices those are probably the biggest buckets and again this is not just historical i think we all know about redlining that happened years ago um but current day real estate practices um are racist if you go to um in 2019 news day on long island published an investigative journalism article about um where they had they sent secret shoppers to a bunch of real estate agents across the island and basically showed that um couples of color were steered to neighborhoods that were predominantly of color from really black white couples were seared to white neighborhoods um these people had the secret shoppers all had the same like financial profile they were literally the same other than who showed up that was in 2019 bank lending practices um just google well spargo baltimore um 2008 and you'll see a whole a whole lot about how the one of the biggest banks in the country was um targeting um black and latino families and um this is also really important again to to say that white families have benefited from um segregation and structural racism so um you're very yesterday talked about it wasn't white flight it was the white people were pulled to the suburbs and what we don't talk about enough is that the white only suburbs were built with government money the government subsidized the creation of the white only suburbs and made the white only literally written into the deeds of the houses that were built it said you could not sell this house to a non-white family um so that's investment that was investment that went into building white neighborhoods while there was the evil and opposite disinvestment in black neighborhoods the federal housing administration which you know really changed the game on homeownership um they of all the mortgages that they backed between the 1930s and 1960s 98 percent of them went to white families and then things colorblind um economic investments such as the GI bill social security were nonetheless sort of structured in a way that they largely benefited white individuals and white families so again it's just really important to um sort of call out and recognize the ways in which white families have benefited from the things that have been so destructive for black families black neighborhoods and then I didn't create this image I found this in favor but I love it to remind us all why this is still so important so we had 250 years of slavery in this country we had another 100 years of Jim Crow legalized segregation so it's only been you know I'm not going to do a math on the spot but like 70 years or so um that we have in the eyes of the law all been equal so 70 years compared to 350 years um we have a lot of work to do it's going to take a lot of time to undo what was sort of built into this country over time so I want to pause and actually just have some ask you all some questions and maybe one or two people wouldn't mind sharing um you know how have you and your family either benefited from or been harmed by legacies of structural racism in the u.s um how do the realities of racial and economic segregation show up in your work um or anything else you want to say or comment on so here in this insane world we have um maybe unique history in terms of um health care and health education that was generated internally within the black community so I think it's important on a founder uh what's his name today I'm not going to sign in between atkins because the first nursing program and the first hospital for African-Americans was at Slater our regional school it wasn't sustainable over time but when it opened and I can't recall the date now uh Liberty Washington came out and this is interesting so um the Reynolds came they actually even gave their carriage and maybe their china um for the deception but it wasn't sustainable right and then eventually the KV Reynolds hospital was established now but it was uh it was the African American hospital but it closed in 71 but why was that hospital so important we can just think about what Dean Walker said last night so what happened with the murder of Mr. James Eller in 67 he went to make work he went to Baptist and he went to what is now your aunt and they said no we've x-rayed you there's nothing wrong then he went to KV Reynolds they found him fractured and he died so that hospital our founder he had to mediate I believe in the 20s because there was a bill this speaks to your structural basis but there was a bill put out for people to vote on your locally which would have had a Black director of the hospital but Dr. Atkins knew if that happened that then the hospital would never be whenever the evaluators would come if it would not happen right they'd get negative um evaluations and it would close and so he had to go around town and tell people do not vote for you that that's very manipulative but until that hospital closed in 71 it had the best practice for continuing infection in the whole country lack of white residents came from all over and yet that hospital closed right and so now the state has the remainder nursing program um but we continue to just see people equity the potential had been so high right and then racism people were very strategic in making sure that later kept up later hospital and then later on I came to hospital yeah it's it's yeah thank you thank you so much for that um there is a very interesting history in this country about um hospitals hospital desegregation and that was really led by Black physicians nurses and dentists um and through there's a connection between the passage of Medicare and hospital desegregation that's a really interesting story that I encourage you also maybe one more I soak your hands yes my name is James Grace I'm a resident lifelong resident my family has been in the construction business all my life so after I left got out of the war vietnam war came back home I didn't think I was going to work for the construction company because of the hard labor so uh but my dad was sick to make a long story short I got into business we got booming because I've been educated and all of this stuff and we made some inroads and then Nixon came along and passed set aside laws and the white contractors in town just stopped using us period so we lost everything and that's just you know sort of one significant tip and the other is being a part of the civil rights movement and what's to say I was a school in Greensboro and witness how people responded to the civil rights movement meaning that all of the leaders had to get together around one table which meant that they got to know one another in which to say that it was different corporate America that's risked all of the issues and started these uh governmental organizations like experiment self-reliance and all of those things so today still the leadership black leadership and wants to say them are still alienated they're just pockets of them that don't work together well thank you so much for sharing that um you know your experience of describing how you had this like thriving family business and then some policies and laws changed and that went away it happens over and over again and as you know black communities and black people have built wealth is often taken away sometimes through very violent means and that is a again a pattern in our country okay I'm going to move on so we're going to shift to the this middle part which is about gun violence and I you know this is a topic that's very near and near to me as an emergency medicine physician who takes care of victims of gun violence and this is a public health crisis and if the public health crisis was made worse by COVID this is a paper that shows in Philadelphia shootings and that dotted line is when COVID started and so you can see the sharp rise in shootings in Philadelphia and this is this is not just Philadelphia this happened in cities across the country um some people have tried to blame this rise in Philadelphia on our like very progressive DA in Philadelphia um but it's not that it's across the country so my colleagues and I in the ER felt this before we knew the data because what used to be you know once every few day occurrence um was every day multiple times a day and um that's why people often call like what's happening in the ER the canary and the coal mine because we see things before it's sort of known widely um I don't know a lot about Winston Salem it's been a lot to it's been great to learn more um but just a quick little search um about gun violence and Winston Salem um told me that this uh trip this rise has happened here too um and that gun violence is something that a lot of people here are thinking about um most victims of gun violence are young black men um homicide is the leading cause of death for black males in this country from age one to 44 the leading cause of death this is that these are numbers from Philadelphia um and this is sort of representative about what happens across the country and gun violence is a place-based problem that's concentrated in black neighborhoods which is why I call this it does be something of structural racism so this is that same map of Philadelphia and each of the red dots is the location of a fatal shooting in 2020 and so you can see how um shootings are concentrated in black neighborhoods in Philadelphia and then this that other sort of clustering in north Philadelphia is a predominantly Latino area um interestingly as I told you before Penn is right here and you can see this like invisible wall around Penn where there are no shootings and um I think that speaks to actually the themes of this conference why is that right um what has Penn done to create this invisible wall and let all the things that happen outside the wall happen over there but not not here um so more questions for you all to contemplate um so the thing about segregation is it's not just about the segregation of people it's about the concentration of resources for some and the concentration of risk for others and those are the root causes of gun violence um a common narrative that I hear in the emergency department is sort of about bad people doing bad things and that's not what gun violence is um what you have in neighborhoods that have been segregated is concentrated poverty lack of economic opportunity failing public schools mass incarceration and police surveillance and deteriorating neighborhood environments those are all the root causes of gun violence and so um you know our work is really focused on these root causes um and in particular I'm going to talk about our work that is around neighborhood environments um and then this is really important because gun violence has such a profound impact on our neighborhoods and in our neighborhoods um 50 percent of black children in this country have heard or witnessed shootings in their neighborhoods we know that gun violence is associated with increased depression anxiety PTSD it's actually also associated with physical health problems like cardiovascular disease um and we know um uh myself and a colleague did a study last year where we showed that um when you have a shooting on a block in the immediate aftermath of that shooting in the first uh you know seven days let's say for kids that live in that block in the block surrounding it you have an increase in mental health visits to the emergency room so there's like this immediate connection between exposures to shooting and what uh kids are experiencing now they don't go to the emergency room and say there was a shooting on my block I'm very stressed they go with symptoms and um there's and so I think physicians often are unaware of what's happening in our neighborhoods um and why people are coming to see them and then the last thing I'll say about this is that there is secondary trauma for the healthcare workforce because of gun violence and I've experienced that myself um and so this this is a really a big problem that impacts um all of us and so we'd love to hear from one or two of you all you know how has gun violence impacted your career in any way and then given that like Penn and Philadelphia universities and health systems are often situated in or adjacent to segregated black neighborhoods what is our responsibility to address something like gun violence? So I grew up in South Central Los Angeles I actually was a visiting professor who had in 2010 I was coming from Lancaster and was struck by the block because I would catch the handstone line and walk through Drexel from the station 34th Street where Perkins Street said and then walked to Penn and I was struck just how strong that overall was but growing up in in Watts in South Central Los Angeles uh gun violence was so prevalent that not only was it commonplace to hear gun fire but we all you know in the time that I lived there up until I was a young adult I could name five friends we would learn in our neighborhood on the streets that we saw uh or that we you know first on a big basis and that was a neighborhood linking to the first reflection that my grandmother and grandfather moved to they migrated from Louisiana to Central Louisiana in 1947 bought their first house there after accumulating their money in uh 1950 moved into that house in Watts which was a working class flight there in 1946 when the house which was built to so-called white flight uh but they were being told move out and they were up charging the homes so my grandmother and grandfather paid $8,000 for this home and their black friends said why are you paying that much money to live in that white neighborhood that would of course turn and become a black neighborhood they could she never sold off she's 94 years old and so she will never reap the the financial benefit of that house and she saw the neighborhood change in significant ways and in violent ways for so uh how that impacts the work that I do I I uh direct the center here at workforce center for research and collaboration about life around uh african-american food culture african-american religion and a lot of these questions and issues that you bring about interplay with the work that we're doing somewhat through the central ground and also through research so thank you so much yeah no thank you for that I it's it's so interesting to hear sort of very personal family stories that just bear out what you know sort of happened across the country so yeah thank you for sharing yes and it has benefited my career as a person who has never experienced combatants and this has created stress in other communities and things that are stressed uh people don't perform better at school they perform worse exams and then I can get better positions in my kids and get very close at schools and things like that so yes thank you for sharing um okay I'm going to move on to the next piece and then we'll have time for questions and answers at the end so um hopefully that sort of set up for you why I and my team have really focused on place-based investments in black neighborhoods um to promote health and safety um these are two op-eds that I wrote that I'm very proud of there's probably things that I've written in the life precedent I'm the most proud of um that uh summarize what I believe in and what I do and so this one in Washington Post at Black Lives Matter really matters we must invest in black neighborhoods and I think um you know coming out of the summer of 2020 one of the impacts of that for me was to really sharpen my language and to be very clear about um who I'm who I care about and what I'm working on in a way that I hadn't before I actually went back to a paper that we published in 2018 that I'm going to show you showing that vacant lock reading has an impact on gun violence and mental health um I went back and I'm very embarrassed to say that I didn't use the word racism in there and and I can say that's because I was I was a product of the environment that I was you know in in academia um and but that doesn't happen anymore so now the word racism is all over everything that I do and actually one of the things I do when I'm reviewing papers or grants um is to do a control R test control racism or control effery system um because I want to see like are we using the right language here um this other one was in the New York Times um so one thing about writing op-ed is that you don't usually don't have control over the title of the op-ed and so I really don't like the title of that but I didn't have any control over this one they actually let me um say the title um I think the other thing I'll say about this is that I think writing is such a powerful tool um to get ideas out to change narratives um and to um influence have influence and and so that's why I really enjoyed writing um and particularly writing op-eds in the way press so what am I talking about when I talk about sort of neighborhood environments so things like abandoned buildings Philadelphia is a city of row houses um which I know is very different from the landscape here but um we have you know streets that look like this um where you have abandoned buildings that are either boarded up or blown out windows and you also have people living in between um in these spaces um it looks like this this is a vacant lot in Philadelphia we have a ton of these um they're often uh filled with trash um people we have a huge problem with illegal dumping so contractors from who knows where will take their materials and come and just back up into a vacant lot and dump stuff there um or vacant lots in a growing season when weeds are growing may look like this and this is when we wanted vegetation um we may have industrial plants so these are all the sort of uh pieces of the neighborhood environment when I first moved to Philadelphia in 2010 um which is when I started learning about all of this I heard that there were 40,000 vacant lots in abandoned buildings in Philadelphia and I said there's no way that has to be a zero like an extra zero was added you mean 4,000 right and no 40,000 in the city of Philadelphia vacant lots in abandoned buildings and place impacts people um which is why place is so important this is a quote from um one of the first studies I did actually the first study I did when I moved to Philadelphia which is a qualitative study where I talked to residents and who lived in neighborhoods with high levels of vacancy in west and southwest Philadelphia and I wanted to know what they what was the impact like what impact they feel from these spaces and this person really crystallized that that connection between people in place this person said it makes me feel not important like I think that your surroundings your environment they get land affects your mood it affects your train of thought your emotions and seeing vacant lots in abandoned buildings to me that's a sign of neglect so I feel neglected so for some people um when they walk out of their homes they have to fight a sense of neglect by what they're seeing around them and that neglect is directly tied to the legacy and ongoing disinvestment that has happened in neighborhoods that has allowed the conditions of vacancy to to be grounded and so um a lot of my work has focused on um simple structural place-based interventions and what we have shown and found is that these interventions um have a big impact on violence prevention they're not the only thing it's one piece in you know what needs to be a full complement of interventions at different levels um but I think this is one piece of violence prevention that often gets forgotten and so um you know my reason for writing those app ads that I did was to raise the sort of collective consciousness about the importance of our surroundings and some simple sort of proven interventions that we know can work so I'm only going to talk about trees and vacant lot greening today for time but we have done work showing um the impact of abandoned house remediation on um gun violence we actually have a paper coming out in john internal medicine next month that shows um in a randomized controlled trial that gun violence goes down after you're remedied abandoned houses and then we've done work um around structural repairs to occupied homes so homes that people are living in we've done work showing that if you do structural repairs to those houses which I think about is sort of micro investments into the neighborhood there is an association with a drop in gun violence and the more homes on a block that you repair the steeper the drop in gun violence again they're sort of micro investments as concept of investing in a neighborhood so to focus on trees I never thought I'd be doing work on trees um I'm not really like a nature person um in my nature but but I followed evidence and this is where the evidence brought me so trees it turns out are a really vital aspect of neighborhood infrastructure um I love this picture that I found on google maps one time when I was looking up where I was going for community meeting because I imagine it's sort of a hot summer day and people are gathering and congregating and they're doing so under this big um magnificent tree probably because it provides shade and it's hot outside and a lot of people don't have air conditioning so coming outside gathering under this tree and you can imagine how in the process of doing that social connections are formed people are building you know the fabric of um of relationships on their block and you can actually see down the street and I don't think there's any other trees on that street sort of see trees in the background over here but trees are important um there's a big disparity in temperature within cities so on a given you know hot summer day in Philadelphia there's up to a 15 degree temperature differential in different neighborhoods of the city um largely determined by tree canopy also determined by some other built environment factors but that heat differential has like immediate health consequences we know when it's really hot there's more emergency department visits um and so trees are important for heat and then of course for um sort of air pollution but trees are patterned by race and income surprise surprise something that's beneficial and so these are some screenshots um from a New York Times um article from a couple years ago that I found so fascinating and what they did was they took these satellite pictures within the same city they showed the sort of poorest neighborhoods and the richest neighborhoods and showed the tree cover differential and they did this for cities across the country this is again not unique to any city in on the west coast of Portland on the east coast of Baltimore um and all cities in between you can see this profound difference in the relationship between tree canopy and income and then this was a study from last year um that I was not involved in but I really appreciate showing the relationship between neighborhoods that were redlined in the 1930s and present day tree canopy and so along the sort of x-axis in the bottom here you're going from the least amount of green space to the most amount of green space and then up the y-axis you're going from um de-rated neighborhoods which were the ones that were redlined and ineligible for any kind of any kind of government backed investment um which is also related to private investment and then up to a rated neighborhoods which were the best neighborhoods with excellent prospects and no neighbors or foreigners and you can see this um this relationship between the neighborhoods that were redlined compared to neighborhoods that got the best rating and the amount of tree canopy today so again these connections between history and present day conditions and then finally this was a study I was involved in showing the association between tree cover and adolescent gun assault and so this study was led by Colleen Michelle Condo and Doug Weed and this was a study where they um they enrolled about 250 adolescents in Philadelphia who had been assaulted with a gun and then 250 adolescents who were similar in demographics but were not assaulted and they had each of them trace their paths throughout the day leading up to when they were assaulted or the same time of day for the control group and um there was a lot of interesting stuff that came out of that but what we did was we overlaid tree canopy cover with the path points of where um kids were worth throughout their day and so we were able to to sort of calculate how much tree canopy they were under at the time of the shooting and leading up to that and what we found was that um being under trees or being near trees was protective against gun assault but only during the leaf growing season and so it was not protective when there were no leaves on the trees um so only when there were leaves on the trees and then in addition there was a lot of evidence some of which has been produced by me and mentees and colleagues about other benefits of trees so which is probably why all these other benefits is probably why it hasn't impacted gun violence better mental mental health better lower rates of hypertension diabetes and maternal health outcomes um so we myself and a colleague Heather Burris have a r1 that's we're actually studying the relationship between tree canopy and um hypertensive disorders of pregnancy which is a uh pregnancy outcome that's related to disparities in um black white maternal morbidity and mortality so trees are um important great so moving on to vacant monitoring um so this is a picture of a typical vacant lot in Philadelphia and this is the picture of that same vacant lot after the community intervention very simple intervention removing the trash planting grass a couple of trees and then this wooden posts and rail fence around the perimeter that does have openings so you can go inside the space to use it um but that that fence helps to prevent illegal dumping which is the purpose of that fence as well as sort of denote the space that this is now a space that's being taken care of um this um intervention was actually really pioneered by a CDC in Kensington and neighborhood in Philadelphia and then in partnership with the Pennsylvania Horticulture Society and so this has been a an intervention that the city has done for paid for for almost 10 years as a way to deal with vacant spaces these are some more pictures of before and after the vacant lot for any intervention um this is my one of my mentors my main mentor Charlie Rennes who when I came to Penn in 2010 he was you know we were paired together um based on some mutual interests and he sort of laid out all the things he was working on and said what do you want to work on he was just starting to think about these place-based interventions and I had never thought about that before um and so picked that as a thing I wanted to explore and so my fellowship project involved a pilot randomized control trial of this intervention um and then this is Keith Rennes who now directs the land care program at PHS but back when I met him what normal was the title was but he was at PHS he drove me around Philadelphia and like told me the story of every block um really sort of you know I was new to the area didn't know anything um and was really instrumental in helping me sort of learn about Philadelphia and particularly west and southwest of Philadelphia so I work with him to this day which is um really awesome and so all of this work culminated in a city-wide randomized control trial of vacant lot screening um as far as we know this was the first sort of place-based randomized control trial of its time so instead of randomizing people which is typically what we do in an RCT we randomize places and um because of the location of where they are in Philadelphia this was this study happened in majority block neighborhoods um we interviewed people um who lived near the lot before and after and then we looked at police reported crime um the three interventions that we studied were the full cleaning and graining intervention with uh five weekly maintenance just cleaning so not the graining but just cleaning the picking of trash and then lost that didn't get any intervention and so this sort of summarizes um this work in one slide and so first just to draw your attention to what we found was up to a 29 drop in gun violence around lots that received any intervention even just the trash pickup or the full cleaning intervention and the the results were the strongest in the poorest neighborhoods so the neighborhoods that have been the most disinvested from had the most to gain from this like very simple relatively low cost intervention um but we also found some other interesting findings so people that live near the LASA got the intervention um who didn't know that this is what we were doing just interviewed people didn't tell them what the intervention was um they reported going outside more and socializing with their neighbors more so this connection between the environment of what's happening around you and the ability for people to form social connections um which is very important for violence prevention and then the other um results that I love from this Teddy was just around lots that were grained um people that lived around those lots reported less feelings of depression and so this connection this sort of confirms this connection around nature and um mental health mental health symptomology um this wasn't a diagnosis of depression just feelings of depression and um shows that you can make these small changes to the environment and have a if an impact on people's experience of their neighborhood and the the beauty of this is that this was a randomized control trial so we can say there was a causal link between the intervention that we did and the outcomes that we saw all right so I'm going to move now into the last piece of this and to talk about two current um projects that we're doing that have been helped by one is one is called Ignite um and one is called to be rooted um Abby is the project manager for Ignite um so first for Ignite so this is sort of a culmination of um all of the work that we did and actually there's direct connections between me writing those two op-eds that I showed you and then sort of turning those ideas that I was talking about into a grant um and writing those op-eds helped me to sort of think through and solidify some of my thoughts around this and so this is the title of this study it's a randomized control trial of concentrated investment in black neighborhoods to address structural racism of the fundamental cause of poor health so you can see the connection between the op-ed titles and then the grant title here um and we we were very um uh explicit about what we were doing what we were trying to do so this is a nearly 10 million dollar NIH award we're in our uh second year now and this is run by myself and my colleague Athene Venkataramati who runs a really awesome lab called the opportunity for health lab um we actually went to medical school together we went to Wash U um from medical school and um lost touch for many many years I ran it to him in the hall at Penn a couple years ago and we sort of reconnected um always uh appreciated the other person's work and we're able to provide our work for this for this study and so what we're doing in this study is um a big push investment uh sort of concentrated investment we have taken 60 randomly selected clusters which are four by four blocks um and we chose the areas based on the percentage of um black population in the census track where these blocks are and then um and then as a subset of that the the blocks that had the lowest income so we're really trying to focus on the hardest hit most segregated black neighborhoods in Philadelphia and then we are enrolling um 720 adults um and we're doing that by knocking on doors um and Andre is here from our team is one of the people who's going out to talk to people knock on doors and get people enrolled in our in our study um and so what are we doing so there's a suite of economic focus interventions and a suite of environmental intervention so from the environmental side we're combining all the things that we've studied in isolation making left-braining abandoned house for the Asian tree planting and trash pickup and so each of these in each of these clusters um this will happen in the cluster um trash pickup by the way is actually really important. Philadelphia has a lot of trash um but some neighborhoods like center city you don't see the trash and that's because they hire people to pick up the trash every day so but when you live in a neighborhood without resources you don't have people to pick up the trash so it's not I think some people will look at this and be like oh you know those people are so they don't care about their environment they just throw a trash that's not true everyone throws trash in Philadelphia we're dirty city but some people I don't know why that is but it is some people um some neighborhoods have resources to pick up after people and others don't so we are um essentially doing what they do in center city with this and there's going to be a crew of people that goes around on a weekly basis to pick up all the trash that had that's on the ground um this is not like trash pickup like people put their trash out another thing that happens is like people put their trash out and the garbage um men come and put the trash in the trucks but like goes all over the place and they don't pick it up so um that this will help with that and then for the households in the same neighborhoods ever doing these environmental interventions um we have a suite for economic focus interventions including tax preparation to help people get the most money back into from their taxes and so you know money back into their pockets connection to public benefits um up to sort of 40 percent of families in Philadelphia are not maxed out on the public benefits that they're eligible for there's a lot of access issues so um by sort of going to the people we're hoping to be able to connect them to benefits um financial counseling and then a one-time emergency cash grant of $400 um this is our investigator team um me and Athena are up there with the MPIs George Danilberg who's a pediatrician at CHOP is the one who really pioneered the sort of concept of a medical financial partnership and so we're using a lot of that in in the intervention here and then this is our amazing study team um that some members up to the mark here today and then finally I want to tell you about deeply rooted um which is really about turning research into action so you know we've created all of this research and knowledge at Penn about um interventions that we know work and um I wanted to take that and say well if we know it works then we should be doing it and we should be putting money into things that we know work and so this is a community academic collaborative that really uses the healing power of nature to promote health and well-being in the black and brown Philadelphia neighborhoods um this is a six million dollar effort that's funded by Penn Medicine the health system and Children's Hospital of Philadelphia and I think it's a great example of health systems starting to um invest in a way that is going to be community focused and is uh is trying to um you know elevate neighborhoods without displacing people so the goal here is not displacement and that's why we are working so closely with our community partners to really guide everything that's happening um in deeply rooted now six million dollars I don't know if that sounds like a lot or a little it's really not a lot compared to all the money that Penn Medicine has but this is a start um this is a start and a lot of I see a lot of my role as trying to funnel as much money as possible you know from my institution back directly into our neighborhoods so we have four focus areas um we are working with communities to empower communities to just create new green space and that includes planting trees greening vacant lots and building mini parks um we have another project that I didn't talk about called the nature well-being project that Kenny is a project manager for um and she's going to talk a little bit more about in the workshop that the team is doing after this but we have this really awesome sort of community co-designed process for turning vacant lots into mini parks um and uh in in our neighborhoods so we're going to be able to do that roughly that in deeply rooted we're providing grants to community organizations and residents to do anything related to nature in any form or fashion as long as there's some like loose connection we want to fund people um and so we we just had our first round of this and so we are providing $50,000 worth of grants to just people residents um and leaders of small community groups who often are doing this work and paying for it out of their own pockets and so we really just want to be able to build capacity and support people who are doing important work in their neighborhoods so these grants range from $600 to $3,000 um this is the first round and we'll be having multiple rounds of this um and then we're gonna this is we haven't developed this piece out yet but we're gonna have a piece around career development and um leadership opportunities and then um advocating for policies and neighborhood investments that promote environmental justice the the main thing that has bubbled up from our conversations with our community partners is land justice land ownership who gets to own land um and who gets to do what was land we hadn't experienced in a park in um actually this is a picture of our a memorial garden um this is a painted plant day we did this space has been in the community stands for 20 years was created as a memorial to a man who was shot in this like formerly vacant lot stewarded by a community group called Urban Tree Connection and um as we were putting flyers up for um this community event Kenny actually is the one who found this like small sign on the fence that said you know this land has been sold and it's going to be developed um and our partner Urban Tree Connection didn't even know about it and so it turns out that this space that has been a community asset for 20 years um was put up for development for affordable housing um affordable housing is very important there are a lot of vacant lots of Philadelphia where you can put affordable housing um and not in a space that is not a vacant you know in the city's records this is a vacant lot but it's not as a thriving community space so um we also sort of work with them to um to canvas and get uh petition and get residents to sign a petition um to testify Nikki testified at a land bank hearing um to try to reverse this um decision which we have not been able to do half of the the land through this process has been given to Urban Tree Connection but half is still slated for development and um it's a really beautiful space it's a it's a shame that that's happening anyway um so what we're going to our initial sort of three-year metrics for people rooted is to plant 1500 trees, grain and maintenance work to make it land, provide 200 community grants and then current development opportunities and all of the sort of decisions about what to do where to do it is um really driven by our community partners so for example the community grants um who got their grants was decided by our community partners so we we administered it you know we advertise it we spread our call the information together but then our partners got together and made the decision about who's going to get the money and then we had a really awesome kickoff event um garden fest that Kenny turned into an event planner and planned this um we actually had we're in four neighborhoods in Philadelphia King Sassing, Haddington, Pops Creek and Mill Creek um Philadelphia as many cities like a city of small neighborhoods and so we're in four neighborhoods and we have a lead partner which is a CDC in each of those neighborhoods and then several core partners who are school and faith institutions but this was our our kickoff event last spring um and we had one of our city council women council woman Gautier who's a great supporter and our the CEO of our health system so the very last thing I just want to show you a quick video about people rooted every time we step out of our house the places and spaces around us are having an impact on us on our thought processes our moods our emotions and even our biology when you look at spaces invited and overrun with needs and nobody's invested anything into it you may walk past it and it may even make you have like a bad mood looking at the vacant lots right as a young person and just walking by they just become desensitized so they're not a part of the community deeply rooted as a joint initiative funded by both Penn Madison and the Children's Hospital in Philadelphia that is trying to leverage what we know to be the healing power of nature to promote health and safety and black and brown Philadelphia neighborhoods green spaces are important for events to have social gatherings to have other functions and the green spaces that we have are locked spaces and a lot of those are abandoned riddled with trash and just not accessible to have our typical gatherings we did the first large-scale randomized control trial of vacant lot greening we took vacant lots that were lighted with trash overgrown weeds dumping and turned them into clean and green spaces and what we found was remarkable these spaces led to reductions in gun violence up to 29 percent in neighborhoods below the poverty line people living nearby reported to us that they felt less depressed so there was this really strong connection between simple environmental interventions and people's mental health we're deeply rooted we're going to be building mini parks throughout west and southwest building we're also going to have community activation grant to support environmental justice and we're going to be developing a leadership and workforce development program our lead green space implementation partner is Pennsylvania Portable Social Society they're the ones who will be planting the trees we're going to be making lots it's the more best for the environment you know because kind of make your more healthier thing isn't it so if we have more things that is i think it's going to be more benefit to the community and doing this together as a community as well but something that's fun right something that's enjoyable thank you for talking about green things like it's cool you learn a little and if you have a green thumb you learn how to plant or you're enhancing those skills so it's a lot to offer for a lot of different people which is great because they really start to touch the community too community members really need to be at the center of all of this because they know their community best and we started clearing out those units behind the house the rest of this is going in the next week or so a lot of this has been done in the last two weeks hopefully we'll make this a beautiful space and make it a place that our community wants to come so we want to make sure that our community know how to plant know how to grow on their own so that they're able to build their own food and be able to sell those things i want herons in all of our neighborhoods we chose the name deeply rooted to reference the groundedness and the strength that is already in our community in the neighborhood this is a star something really wonderful something really huge and it's going to pick up so much momentum i'm excited this is what i just want to leave you with that place matters and it matters because it impacts all of us it impacts people and if black lives are going to matter then we have to invest in black