 First of all, I want to thank you all for coming out on a Friday afternoon. I'm Professor Molo Hudson. I'm a professor of urban planning here and also the director of the Urban Community and Health Equity Lab. We hopefully will have a wonderful panel discussion and presentation by Professor Jason Corburn. And we want it to be very interactive, so we hope to talk for about an hour or so and then we can take questions from the audience. I know it's a very interesting and diverse crowd, people with wonderful experience. So we really want to encourage you to share that experience with us today. And let's really have a dialogue. Before I get started with my official remarks, I do want to thank all the people who made this event possible. Paul Amatai in the back from the dean's office. I want to thank you for all the hard work that you've done to make this possible. I have lots of emails with the panelists and so forth. And of course, all of the GSAP dean's office staff who work on this. So I want to thank you very much for that. Again, I'm Professor Molo Hudson. I direct the Urban Community and Health Equity Lab. And the real focus of the lab, which was launched in November of 2017, so very new. I also just arrived here from Berkeley in August, so I'm also the family member here. But the last focus is really to break down the silos that we often see in academia. To connect with architecture and planning and policy and public health and sociology and on and on engineering. To really address some of the most complex issues that our society faces today. As you know, I don't have to tell you it's very depressing, but we have forced migration. I just returned from the Middle East where you have literally hundreds of thousands of people who are being displaced. With no housing, no water, no supplies. We have an environmental crisis, issues around climate change. The housing crisis. See, I'm a depressing professor for my students that is going on with all the problems. But I can go on and on. You all know this. And the real question is not what are the problems, but how do we solve those problems? And I was trained in a way that says to solve some of the most complex problems, you need to talk to the people who have solutions to those problems. At the community level, at the state level, at the international level, neighborhood residents and so forth. You can learn from everyone. So the idea is that this would be an opportunity for us to get together today to discuss some of the experience that we have as scholars, practitioners, working at the local level all the way to the global level. The urban community health equity library has three areas of focus. The first is the built environment and natural environment. The second is community and economic development. And the third is law and governance. We just try to include everything in there. But actually we have some lines of research and I will talk about, in my case today, about some food systems work I'm doing in the state of California with colleagues. So with that said, let me just shift gears. I want to introduce our moderator for today's panel, Justin Garrett Moore. I'm convinced that Justin has a twin because he just returned from the Canary Islands on Tuesday nights just before the storm. We had a short conversation Wednesday and he said, don't worry, ma'am, I'll be in questions for the panelists. So I didn't hear from Justin Wednesday. I realized he's sleeping. He's adjusting. And we wake up and Justin sends nine paragraphs of questions. Nine paragraphs of questions. So you get the point. Justin's a wonderful colleague of mine. He's an adjunct associate professor of architecture at Columbia GSAP. He teaches an urban design and urban planning. He is an urban designer and the executive director of the New York City Public Design Commission. He has extensive experience in urban design and city planning, from large-scale urban systems, policies and projects, to grassroots community-focused planning, design, arts initiatives. I won't go on and on into his bio, but he's a fantastic person. He is also the co-founder of the Urban Patch, a social enterprise based in Indianapolis that focuses on community revitalization, design in American inner cities. His professional affiliations include the American Institute of Certified Planners, the Urban Design Forum, and Next City's Vanguard. He also serves as a board member of IAB.org, Marry Miss City as Living Laboratory, and May in Brownsville. So thank you very much, Justin. Welcome. Now I have the pleasure of introducing today's keynote speaker, Professor Jason Corburn. I've known Jason for a long time. We were classmates at MIT together. Classmates and colleagues at, I guess, colleagues at Birmingham, literally our offices were next door to each other. And I came from his research lab, the Institute of Urban and Regional Development, where we really try to build a lot across the Berkeley campus and elsewhere. Jason Corburn is a professor in the Department of City and Regional Planning, and the School of Public Health. He directs the Institute of Urban and Regional Development, which has been around since 1962, and the Center for Global Healthy Cities at UC Berkeley. He also coordinates the joint master of city planning and master of public health degree program at UC Berkeley. His research focuses on the links between environmental health and social justice in cities, notions of expertise in science-based policymaking, and the role of local knowledge in addressing environmental and public health problems. Professor Corburn is currently a leader of the Richmond Health Equity Partnership, a coalition that includes the City of Richmond, California, the Contra Costa County Public Health Department, West County Unified School District, and a number of non-profit organizations all working to reduce health inequities in Richmond. Professor Corburn also leads a co-leads a participatory planning team working to improve the lives of residents and the informal settlements of Nairobi, Kenya. He has numerous books, including Street Science, Community Knowledge, and Environmental Health, Justice, which won the 2007 Paul Davidoff Best Book Award from the Association of Collegiate Schools of Planning. He is also the author of Toward the Healthy City, Healthy City Planning, Healthy City's critical concepts in the built environment, and his most recent book, Slum Health, from Cell to the Street. As you can see, he's quite productive. He also is one of the top teachers at Berkeley. He's the winner of the 2016 Chancellor's Award for Public Service. His Street Science book is the fourth most frequently read book at Brandeis University, and he received the 2013 United Nations Association Local Citizen Award. So when I want to grow up, I want to be like you. So I want to welcome Professor Jason Corburn. It's great to be here. It's a little bittersweet. Can you hear me? Is it okay? Yeah. I was born and raised in a few blocks from here, and New York is still in my blood, although I've been in the Bay Area for over a decade now. So it's great to come back, always come back to New York, come back to Columbia, wonderful institution. The bitterness is that my dear, dear friend, brother and colleague Professor Hudson is now here, and we've lost him, and he's separated from his roots in California, but you are so lucky to have Malo here with you. This can work? Yes. Okay. Great. So I'm going to talk about my work and the work that we're doing in partnership with communities, local governments around the world to really focus on this notion of health equity. I'm delighted that the focus of this event is really on equity, not just health. And I want to emphasize what I mean by that. And I'm going to try to address or grapple with three key questions for us this afternoon and invite you to help us figure this out with our wonderful panel. So what I'm really concerned about also is how do we not just rethink the built environment, particular aspects that might make it more equitable and healthy, but how do we also redesign the institutions that make decisions? This is what I mean by urban governance and who's involved in that? And then what are the new demands that it places on us as scientists, as researchers, as policymakers, as practitioners? We can't continue to do the same thing the same way and expect different outcomes. And I'll give you some examples of that in a moment. And also, how do we build some new understandings in biology around the notion of trauma and toxic stress and what that does in our bodies and how we can make that explicit in the way that we work with and rebuild and support community development. And I'm going to try to walk you through some of these ideas and examples in three locations around the world, three cities. Again, where I'm working. There's no pointer here. It's okay. In Nairobi, in Kenya, in Medellin, in Colombia and in Richmond, California, which is a small city in the San Francisco Bay Area, just a situation about the journey I'm going to try to take you on in the next few minutes. So just a little background. I don't know if I have to say too much about this for this audience, but we are on an urban planet. And what that means is that the complexities and opportunities of cities and urbanization create great opportunity. People come to cities for social expression, cultural expression, gender equity, education, but also we see rising inequalities. Amala was mentioning migration, internal immigration, inequalities. And we see this also in the rise of informal settlements or sometimes called slums. And I don't like that word, but the UN uses it. So part of our challenge is as we urbanize, as this planet urbanizes, how do we at the same time put equity at the front and center of that urbanization and of that development? Well, the sustainable development goals you may have heard about trying to do that, although some may disagree on how explicit and how clear that needs to be. And there's two particular SDGs on health and cities that I think are particularly relevant to work that I'm going to talk about. But I think, yeah, that's a little tiny green thing. There isn't much connection. There isn't much connection that I see between these two SDGs just yet. One of the things that's really explicit and clear is that place matters. We've seen this right here in New York City. Where you live matters. Where you grow up, what you're exposed to, what's happening in those places. And it's not just unique to New York or cities in the United States. This is Paris. Similar dynamic, the top red there, those bars are lower life expectancy on the Parisian metro. And part of this, from my perspective, is what I call community malpractice. These situations of incredible inequality and poverty right next to incredible wealth and opportunity don't happen by accident. They happen either by a lack of planning and policy or explicit policies that create these inequalities. So, of course, the folks living in this favela on the left are cleaning the pools and taking care of the children and doing all of the risky, often low-paid, high-risk labor for the wealthy on the right. And, of course, we can talk about spatial and place-based inequalities without also talking about how they're patterned by race and ethnicity. And here is some data from Alameda County in the Bay Area, San Francisco Bay Area. And we can see that while everybody seems to be getting healthier in terms of life expectancy, the gap, the inequality between whites, in this case, and African-Americans is growing. And we also see this pattern by different health outcomes. Name your health outcome. We'll see the same pattern, chronic disease, life expectancy around the United States and in many, many, many cities across the world. So, racism has to be put at the center of our conversation about equity. There's been a lot of international programs and reports and meetings and special issues of some of our leading journals, science and nature, for example, about this notion of urbanization and even to some extent health. But a couple of observations from my perspective is that this work in science is still really still disconnected from the urban communities that need to benefit the most and are most burdened, say, in issues of climate vulnerability, pollution, inequalities, and often urban decision-makers, still too disconnected. And that technology and urban design alone is not going to improve urban well-being for all. We can still see that general population increase, but within certain populations and communities, we're not going to close that gap that health inequality. So we need new attention to how we do this work, who participates, and the institutions that we hope to redesign. Now, I know this isn't necessarily an all-public health audience, but for those public health folks that this may be review, I apologize, but for the planners or non-public health people. When I talk about health equity, I just want to be clear about where I'm coming from. So much of public health, and I would argue a lot of interesting, important work in health is down here on your right-hand side, what we call the biomedical model or health care, health interventions. Hey, eat better, change your behaviors. We can help you do that if we just give you the right information or the right app or whatever it might be. If people need access to care, Affordable Care Act is important for certain aspects of it at least. But this, of course, in public health is what we know as disease management. This is not public health in my view. This is not prevention. This is not promoting population health and health equity. If we want to really work towards health equity and improving community health, we've got to move to the left-hand side of this model here, to the living conditions, institutional inequalities and social inequalities, some of which Malo mentioned in his introduction. And how do we do that? It's not just talking about built environment or where you live or housing. Or this segregation as a result of housing and city policies or federal government policies and discrimination and racism around immigration that's happening today. But how do we build those partnerships? How do we engage community? And what are the explicit policies that need to change? The inequalities we see today in cities like New York, San Francisco, Nairobi, Colombia, where I'll talk about have taken in many cases decades and even century or more to be produced. So we're not going to change these inequalities overnight. We need explicit changes, though, in our policies and institutions. So we're not going to change those inequalities of how we're trying to do this in three seemingly different, but I'll try to tie these three places together in this work. So first I'll bring you to East Africa, to Kenya and Nairobi in a partnership with these folks here, some of our partners. We've been working for about 10 years together on this work. So I'll give you what we've done over 10 years and 10 minutes. We've engaged partnerships. And I'll say more about that maybe in the Q&A. We've been working in two particular communities. Here's Nairobi, a community called Mathare, and another one called Makulu, and I'll give you some specific examples of what we've been doing to try to change living conditions and some of those structural inequalities. This is typically what a community, what a neighborhood looks like. And when I say a community, these are cities these are somewhere between 300, 400,000 people within the city of Nairobi living in informal settlements. 65 to 70% of the city of Nairobi is informal settlements. And that goes for Kampala and Dar es Salaam and many, many cities in southern Haran Africa. So this is not unique to Nairobi. What's also not unique is this. This is the strategy that the city, county of Nairobi and the Kenyan government have put forward a response to informality and inequality. Let's build the next Silicon Savannah. We looked too closely at the Bay Area and fell in love with Silicon Valley, but this is a tattoo city a satellite city that says, hey, forget about improving those communities. That's going to be too hard. Let's go out and build a new city from scratch with all the energy and green and climate innovation. Hard to imagine how the folks living on $5 a day in Ku, Mathare are going to benefit from this shiny design city. So what have we done with our partners? This is really driven by NGO partners and partnerships on the ground. The first thing that it starts with is something called micro savings. You may have heard of micro credit. This is a little bit different. This is where women led groups save small amounts of money per day, pennies really per day to bring people together basically a community organizing strategy. But what they do explicitly is they begin to put themselves on the map. They organize and survey themselves. Just like in the United States, many poor folks in poor communities are not counted or undercounted, underrepresented and so for the elite and decision makers they sometimes don't appear. So we actually literally map the community and this is critically important in a strategy that's used not just in Nairobi but around the world and all of that feeds into network power because every neighborhood savings group is networked to one across the entire city of Nairobi and then every or almost every large community in Kenya has a similar set of organizations and they have a network across Kenya of over 160,000 household members in this network of savings building power and actually building some financial capital to negotiate often with government and international organizations. So we've also partnered by bringing our students, our Cal Berkeley students to partner with University of Nairobi students and community residents to map and do things like studio classes that you do here. That data becomes really important to make the case in partnership with community residents that their conditions particularly their health conditions are not all the same. They face different issues and there's often a real intensive effort to focus on infectious disease but you can see here that also chronic illness and hypertension is a really significant issue particularly in this community the orange is Matharius. So not all informal settlements is what we're showing in the same city just like not all neighborhoods in New York City face the same challenges or need the same strategy. So you need to know that before you develop a strategy for intervention. A couple strategies we've used. This what you're seeing here is the water system. It's a drinking water system. Drinking water pipes these little tiny things here call them spaghetti pipes. They're on the surface you can see how vulnerable they are to being punctured or contamination and that is what happens often and what you also see is solid and human waste on the surface drainage so that gets contaminated. So part of our mapping and data collection was to actually map out in this entire community where are the water points, where are people accessing water and we put that in context like good public health researchers would with the sphere humanitarian standards. I don't know if anybody has heard of that but when there's an earthquake or a typhoon or some major emergency internally displays people and an emergency camp has to be set up basically overnight. The sphere standards are what the red cross or some UN UNICEF agency would use to build that 10 city basically and they recommend 50 people per water point. What we found is the everyday emergency that folks in these communities are experiencing. The everyday emergency that needed emergency attention and that's what we tried to do. We went from that before to the design to getting every household in one community metered a water connection like you would expect when you go home tonight to turn on a tap and have a tap in their house of clean water. But that wasn't enough. The engineers were happy and they left. What we know from planning in public health is if it's not properly managed a gang or a cartel might take it over and extort the price for people or it may fall into disrepair so we needed that savings group including young people to be the leaders to actually manage this whole process to make sure it's maintained to collect the fees for the water meters and here's what it looks like in the house and we've done some evaluation after about a year and a half of this to see what were some of the health impacts for the populations. A couple of things I'll point out is the weight burden for women were almost exclusively ones collecting water outside the home burdening women also young girls who were joining them to miss school days and the economic benefits of having clean water in addition to the things we might expect around disease were significant. This has become a model called the Mothari Coastal Water Model so it's institutionalized into policy now for many upgrading projects across Kenya but there are also the four who can't afford that or they rent this out I'm not going to pay for a meter of tap in my house so now we have these ATMs where you put in a charge card so you don't have to carry cash and you get clean water and you fill it up and it's managed and maintained also by the water company. Food insecurity is also a major issue like it is in many urban communities people paying 50, 60% or more of their income on food. We did a food survey with community health workers residents in the community to try to figure out the hazards and risks that they face. We found over 40% of children under 5 are stunted in part because of lack of food but also for nutrient absorption because of the quality of food. People who are skipping meals and really just serving many young women selling themselves for sex to feed them if there's children or themselves on a regular basis. Some of our NGO partners from international organizations Kenya has a really interesting program where they have free clinics for free HIV antiretroviral drugs and TB drugs. So it's an amazing program across Kenya and has been seen as really successful in some context to reduce rates of infection for HIV yet when people don't have food those drugs are not effective and in fact we found that people were trading those drugs for food so we see this steam increase in HIV rates particularly in women and multi drug resistant tuberculosis and that's something that happened in New York City in the 1970s and we should have learned from that about the relational dynamic of what's happening in communities. Part of our response to that was to develop a food vendor cooperative in this community so many people are eating food from streets from vendors because of poverty and other things they're not cooking at home which was another thing that many development folks were focused on let's get people cook stoves that's not what people are eating 65-70% of their meals are coming from street food so focus on where are people getting their food can we make it cleaner can we provide transportation for good food to support price fluctuations and things like that Another serious issue is that there are a lot of people who are living in cities around the world whether it's from New York to Delhi to Beijing, air pollution killing more people now in our cities than HIV, malaria, tobacco Part of that is poverty and fuel choice here not any choice but this is the typical fuel for both cooking, sometimes heating inside homes in the Nairobi informal zones with one of our partners, we've been doing a community citizen science project of monitoring the air and bringing that back into solutions particularly about waste burning and waste management some outdoor cooking you see some of our partners, some of our young people in the neighborhood wearing backpacks here that basically take real-time air samples we're able to do that and map this spatially again I used to work for New York City government I think at the time we had about six regional air monitors for the entire city of New York it's probably maybe double that now San Francisco Bay Area big area, lots of pollution from cars we have maybe about six Nairobi has two so to get good data, good accurate information about the hazard of air pollution at the local level it's almost impossible from the air districts from your normal government agencies with two or even six or even a dozen monitors so that on the ground monitoring is critical you can see what we found and then how we use our technologies and spatial tools to see where are the hotspots where can we intervene most intently which is what we try to do recognizing that not everybody is exposed the same way and to try to shift from dirty sorry, to cleaner energy particularly electricity last example probably the most critical issue in informal settlements around the world particularly in Nairobi is sanitation and toilets and the disproportionate burden that that places on women and young girls particularly about sexual violence and other serious issues again we were able to map where are the toilets and what are the different kinds of toilets I'm going to get into it in detail here but it's not all just the pit latrine some of them are have a lock, some don't some are in a yard, some are in grouped within so knowing where they are, how accessible they are if a gang controls them the social dynamics around that is critical again you're seeing two toilets here and some of these are also bathing facilities draining right into this river and you can imagine when a flood which has been very recently in Nairobi with heavy rains all of that wastes all the pathogens getting into where people are walking and living actually this is a picture from just last week in Nairobi and expected to increase with climate vulnerability so linking this work to a climate adaptation and resilience plan is what we're doing on the right here you're seeing a study from the World Bank you may have seen just released a few months ago about where there's going to be climate refugees basically where there's going to be out migration which is the blue and then in migration which is the red and Nairobi and other cities like Kampala here in Uganda expected to have a great increase and we're going to see this around the world where are people going to going to cities and increasing the pressures on informal settlements so this work is more and more important and to have a plan and a response is going to be critical this is a tough issue one of the things we've done is to try to get international attention by publishing this work engaging young people has been critical to tell their story to raise their voice about their experiences with young girls our participants had an essay contest and here's our young guys doing some films and making some videos which are all available on YouTube I'm happy to give you that link documenting their experience what they see as the challenges and ways of improving their own community part of that has led to the first civil action lawsuit on behalf of over 12,000 Kenyan slum girl and women marching and suing the Kenyan government because the Kenyan constitution revised in 2010 gives every person a right to sanitation, to health and to a clean environment U.S. Constitution doesn't have any of that in there and so they're suing the government to guarantee that to address these living conditions I'm happy to report that some of that is actually happening now this is a recent proposal of interest and contracting that the Kenyan government and the city county of Nairobi to improve and upgrade 26 informal settlements a lot of that strategy is now happening and how it's happening, what are they prioritizing in terms of infrastructure, housing who's involved through some of the data that we've collected with our partners second quick example another really amazing city amazing country of Medellin and also a city with great vast inequalities like many cities in Latin America or around the world particularly in Medellin you have up on the slopes on the hillsides on the body hills you have more impoverished residents and then you have very high wealth in some other areas of the city so vast disparities and of course most of you may associate Colombia with I don't know if anybody's watching Darko's is that still on which my Colombian partners hate that show but they know folks are watching it but the story really is the most violent city in the world how do you reduce violence and violence as we know many communities affects everything people stress whether they go outside and exercise whether they can enjoy the schools or go to school even eat, you name it so in the early 90s everybody associated Medellin with violence and it was the number one most violent gun homicide city in the world here it is today just a few years ago now under 20 an incredible story and an incredible decline how did that happen that's what we've been looking at and trying to understand and the population health impacts beyond just gun violence of that work it's been recognized globally as the city if you aren't studying Medellin it's one every prize and every media outlet is saying this is a miracle, this is a model we're a little skeptical of that but we're happy that they're focusing on that so how did that happen in part it happened through community leadership and engagement they have something called participatory budgeting we're community residents and this is one case in one of the most impoverished communities called Populom developed a plan a health equity action plan of things of projects, of the built environment of transportation, of social programs of education, of improved services linked to a comprehensive city-wide what they call an integrated development plan and what we're asking with our partners at the University of Antiochia is what would have been the population and health equity impacts you may have heard of the Metro Calde the ski lift I don't know if anybody here enjoys the snow I'm a warm weather guy but apparently ski lifts help you get up the steep slopes and so Medellin was the first city in the world to make that an integrated part of its public transportation system other cities now Brazil and others have taken on that idea but you went from an hour and a half steep walk of a dangerous set of stairs or dirt paths to a 15 to 20 minute ride you can imagine the change and the dynamic but also what's amazing is that you know, 6 to 10 people sit in that car who don't know each other and there hasn't been one incident of violence in the Metro Calde since it's been built this whole culture of community of coming together, of reopening up the public space, the public sphere has been a critical contribution of this they also use the radical technology called escalators but has also part of its public transportation system so again, the most impoverished community is getting these interventions first and serving this community now it's a great tourist attraction they have art and music 24 hours and it's an amazing, amazing sight they turned also at the innovation and request of residents to turn the city dump into an eco park and that's what you're seeing here the top is the city's dump site the bottom is now this which is an eco education site where they're reintroducing native species doing bio research and a whole host of things employing local people and really rethinking their role as in environmental leadership many of the urban and poor communities on the hillside had no public space no playgrounds, no place to gather kids playing in the street kids used to come together they said, hey, but we've got all of these walled in behind barbed wire fence water towers or water storage facilities why not open those up to be public space to be community, design, and operated spaces and that's what they did they employed local architects, young people to redesign these into what you see here, Ulva's or their life articulated units they have their play spaces, their cultural centers arts, music, and community centers where people can come together they also built education and community engagement sites in places that were formerly places of depth this is one of my favorite examples it's a former bull ring and they designed the school and the community center just like the kind of architecture around what the bull ring but now it's also a place of lifelong learning bringing people together particularly about conflict resolution and as you know, just recently signing a peace agreement Columbia has the second highest number of internally displaced people because of war and other activities, particularly drug trafficking and people are coming to the cities and so the city needs a plan a program to integrate folks to resolve conflict and to build community engagement and this is what they're doing they're also recognizing in an explicit way the history and memory of that conflict, everybody you meet if there's any Colombians in the room I bet they would have a story about a relative or a friend that's been kidnapped or killed has touched everyone in society making that part of the narrative, part of the culture of healing, of trauma recovery and not doing this in downtown so you go down to you know, over the east side or you go to lower Manhattan for where are your museums and arts and culture are the most beautiful parks, the most beautiful museums library parks, all of that public transportation that I just talked about was implemented first in the poorest, most violent neighborhoods, it would be like saying we're going to build the most beautiful museum in New York in the South Bronx and East Harlem first, before all the rest of the museums get any investment and that's what they did particularly around community space and the challenges we see violence here going down but then we see things like this is respiratory illness cardiovascular disease slightly on the uptake so we want to try to see who's benefiting what have been the population health impacts of this and we're continuing to study this what have we learned from that that I think is particularly important for both places like Nairobi and the San Francisco Bay Area which I'll talk about in a moment, well they have a particular philosophy of social urbanism which again is this idea that urban development, urbanization, urban architecture should first have a social equity mission secondly be efficient and that part of that ethics of aesthetics is the most beautiful and functional projects that go into the poorest communities first with deep, deep community participation in the design, implementation and operations. Community residents are working at all those schools getting jobs and benefiting from that investment and that part of that is that the targeted approach not a citywide operating strategy first benefits everybody that's the notion of targeted universalism, they do have a unique situation where they have a utility that's a monopoly so that it's all the water and sewer and electricity but they also have an innovative law that says 30% of their profits have to be go back to the city for social projects and social programs that's a lot of where they get their funding and I think part of the story about reducing this violence has been to reorient the face and function of the state in Medellin and we see really a reverse of some of this in Latin America now where the armed military are the strategy to violence in bodys and torelas or even in the United States and what Medellin really did I think significantly was say hey the state is not just about weapons and artillery, military but it's about public space it's about integration, it's about schools it's about providing services and new spaces and opportunities for everyone, particularly the urban forward finally I'll talk about our work in my new neighborhood Richmond, California Richmond is here here's Oakland, Berkeley, San Francisco if you don't know that other coast and Richmond some people talk about Richmond you know as the industrial dumping ground of the Bay Area and it was for a long time but it was also a site of interesting industrialization the kaiser shipyard of World War II which brought over 50,000 African-Americans from the south of the United States there an incredible rise in population but it's also an amazing sanctuary city and it has been for a long time one of the oldest sanctuary cities in the state of California for new immigrants Laotian, Latino, Vietnamese so that history is really critical also the most violent city in the United States when we first started in 2007, 2009 and the lowest life expectancy and the question was how can we transform after 10 years of work which I'll talk about you see some of this we can't take credit for unemployment although we take credit wherever we can but things like self-rated health we have a survey of every two years of people including low income folks and folks of color and that's increasing these are just general for the entire city but we're also really focused again on being qualities of discrimination and racism this is a positive sign of self-reported that going down place for youth and again gun homicides major, major change one of the most successful programs that I'll talk about in a moment we're happy that other folks are paying attention to what's happening in Richmond because we do think there are some lessons like for Nairobi and Medellin for other communities and it really starts and started with deep community engagement and community members coming together to document what they thought were both the problems but also what did they want instead of asking hey what's wrong here much of this work asks what do you think needs to happen here for this to be health of place, of health of equity in a city for life and that's what these two reports documented and that work really influenced and acknowledged that history was important that you can't do planning and public health today without recognizing where folks have come from the legacy of the place and the population particularly Japanese incarceration and tournament and the land that was stolen in Richmond from folks and the impact that was having on communities today and also Black Panther movement critical and open but also many of the leaders were implementing some of the most innovative community health programs from breakfast programs and outreach in Richmond as well so it's still a legacy of folks who remember that and were involved in that critical social movement both of those the history and the community ideas and narratives were built into two innovative laws and policies that we drafted in Richmond the first time you're left was the Richmond's general plan so I know there's some planners in the room we actually do planning in California coming from New York sometimes planning doesn't seem to exist too much but by law every jurisdiction in California has to have a planner of course mostly we do plans and this high and sit on the shelf and hopefully someone looks at them but not many people do so what we did in Richmond well entirely because it was pressure from community groups who were doing this research and engagement they said hey you're going to do one of those land use community plans and no one's going to read it we want environmental justice we want health equity we want gun violence which are our three major concerns in your land use plan so of course the land use consultants looked around and said we don't know how to do that you've never done that before and in fact it had never been done in the state of California to put health equity as an explicit chapter of course we do all the things in these general plans like transportation and energy and housing and all the things we talk about in planning but not health, particularly not health equity and at the community's pressure and with some support from the local foundation we were able to do that using research and action and putting strategies, policies and measures, indicators of progress into the general plan the first health element was called in the state of California now we're 50 jurisdictions have done the same thing in the state of California and it's really a model in many many communities across the country and that's the first ordinance of any city in the United States of health and all policies and it's really health equity in all policies some of you may know what this is but it's really taking a health equity framework and putting it into a screening in some ways into almost every decision that the city makes so when it does its five year budget or its annual budget when it goes to contract with all of the folks it contracts with cities are mostly contracting with your tax dollars adding on where they're going to pay streets or invest in parks or put up fencing or improve drainage where is that happening especially who's benefiting those are the kinds of questions and Richmond is also part of the government alliance for race and equity and part of this is really being a part of that conversation so institutionalizing this work particularly with the structural inequality and structural racism framework has been critical the framework that drives the health equity plan and the health and all policies is really around the notion of multiple toxic stressors and I know some of you from public health this is going to be not too exciting for you but a lot of folks think hey if we just get one of these right we'll improve communities like Richmond or Nairobi or Medellin or East Harlem if we just get housing or we just get you know, address food security or just address violence or poor education but the reality is is folks in communities like Richmond and others who face multiple stressors across the lifetime even in utero before they're born so we can't just continue to do the same thing segment fragmented work one at a time and that's really what we heard in multiple languages from residents so we really wanted to build that into the work just to review what's the biology behind this is that stress is good final or midterm Professor Hudson's administer we get stressed out and that's good for you that's the flight or flight mechanism and you get this hormone release your body gets heightened your blood pressure goes up your heart rate goes up and hopefully your body performs and when that stress disappears you can really return back to normal but under a toxic chronic stress situation multiple stressors in people's neighborhoods and life across the life force from early life throughout aging that stress release doesn't turn off and that's the notion of toxic stress the constant release on these hormones cortisol and adrenaline and that many folks argue and our approach is what's contributing to this rise in chronic disease not that people aren't exercising enough not that the sidewalks aren't wide enough not that there isn't a community garden in their neighborhood those are great but if we don't address these fundamental stressors all of that surface stuff isn't going to matter for both these chronic illnesses immune system diseases which we see an increased significant rise epigenetics we've talked about telemeters which are the caps on the end of our chromosomes that protect us from aging premature aging early death suspected of this chronic stress so how did we do that I'll take questions in a sec one was to focus on community responses to what they wanted in the neighborhood in terms of changes in designs we didn't ignore neighborhood needs in terms of access to resources built environment particularly folks who were and have experienced trauma like gun violence and making space and access important for folks with disabilities we've also focused on housing which has become the first city in the United States to adopt something called a social impact bond instead of floating a normal city bond for a return on that investment for a social return and our social return is affordability and affordable housing and building supportive housing which includes services right in the neighborhood in the unit itself and importantly in Richmond we have a program called Richmond Build which is partially funded by the US EPA although I don't think that's going to continue much longer where young people from Richmond are trained in the construction industry solar installation and energy efficiency which is also happening to build the housing and they can afford to live in it and that's the idea we're building affordable housing in some places but the folks doing the construction can't afford to live in that house so we wanted to really change that dynamic we also took the clues from Latin America and said hey we're going to focus in on particular neighborhoods that are most hardest hit this is one called the iron triangle because of this railroad tracks that order of this one now is turned into a greenway the most violent, most impoverished 100% folks of color, mostly African Americans and Latino and we decided our community residents said hey this park here can act as the heartbeat of this neighborhood to revitalize and pump more life and health into our community and part of that general plan we set aside some resources and an explicit intervention into this called Elm Play Lot and Pogo Park and what had happened was that little park the city spent $100,000 which isn't much and they bought a beautiful play structure from a firm in Texas and they came and put it into that park and everybody was really happy because the park had been vandalized and was behind fence and they took it down and they had a ribbon cutting and everybody all the mayors and everybody were happy and the next day you can guess what happened it was fully tagged out some of the local gangs were back in that park controlling it and no one had access so the idea was to reclaim this public space and community members designed and they designed it incrementally with what they wanted and in fact they were trained and learned the skills to build the play equipment themselves so instead of buying it from some firm somewhere else they actually learned how to well and do the park benches the fencing the pathways and importantly today they work and program at that space that park acts as one of the sites that gives out more food in summer programs than any other institution in the city of Richmond to young people so they participate in food programs they have a community kitchen they do a whole host of things that are community driven trauma also a significant and continues to be a significant issue in Richmond in part because of gun violence but also poverty and these toxic stressors I was talking about this is an organization called Rise and they have were founded by young people 16 to 18 year old young people said we need to save space we need a place to come together and they did and after now about 8 to 10 years they have their own community center that they've outgrown and that are facing new challenges they're no longer 16 or 18 now they have young families and they're in their 20s or older so they've embarked with our partnership on what we're calling trauma informed community development of something called Rise Commons which is a new community space that's incorporating ideas from community health centers to youth led public space to really micro enterprise to really engaging in the broader community into how do they do a space that's healing and finally again just like in cities like Medellin gun violence was crippling neighborhoods but it was really just focused in some parts of Richmond it wasn't the whole city that was kind of under siege so one of the things that came out of our health equity work was again to rethink city governance and one suggestion was hey let's create an office of peacemaking California they would never do that here maybe that's true but we said hey you got an office a planning you got a city agency for transportation for all of these other issues why not peace and we know it's not happening in the police department we know that the police are incarcerating folks and locking people up and killing people they're not peace officers by any means we need to take peacemaking outside of the police so we negotiated with the city council and the city manager for two years to create the office of neighborhood safety that was a big lift but we said hey not only do we want this office we want it to be staffed and run by all former felons folks who were all from Richmond who went away for six to sixty years for life some for murder and spent time in prison we want them to run it all felons public servants they said oh you are really crazy that's against the law we're not going to hire felons to be part of city government so we fought for that and we argued for that and we actually won that battle after two years so we created this office of neighborhood safety that incredible success the model just briefly is about street level outreach to the really under 200 or so no one are suspected gun offenders mostly young people it's true in many many cities from Chicago to New York to Baltimore, St. Louis and Richmond Sacramento most of the violence is retaliatory gun violence and it's perpetrated by a lot of folks so if you could reach them what's the strategy and engage them see the humanity in these young people maybe we could turn that around and that's what we try to do and that's what the office of neighborhood safety has done an incredible reduction in gun homicides firearm assaults this is the strategy it's an 18 month fellowship where we engage people in the streets and after six months if they're ready we engage them in an 18 month fellowship they go into graduate school where they get a life map, they get mentoring opportunities to travel opportunities to do internships and jobs and if they participate they also get some cash and that's been really controversial I want to say something about that in a second and show you a video to close out on this work but that also saves money the biggest expenditure for every city in the world often is their police department so if you're reducing the cost of overtime, of investigations of ER visits of ER costs for a gunshot you can reinvest that into the community and that's what we're doing and that's also what we're evaluating particularly a peace dividend to Craig & Minden to see if we can address this really crisis of low birth weight and maternal mortality in the African American community and adverse childhood experiences I'm talking about in a moment but just to wrap up what we think about what are the lessons from these three places what are the limits, what are the opportunities to think about health equity as you develop an action research strategy here and in other places around the world primarily we got to start with community involvement community expertise as really leading and defining not just problems but assets and neighborhoods from the histories of places and often the biographies and folks who live there engaging with this idea of multiple toxic stressors understanding the biology and the impact on our brain our cognitive development impulse control and seeing some of this as ways of how do we develop community responses and a trauma informed youth led approach this idea of really drilling down and I know New York City is doing some of that now into neighborhoods and communities hardest hit and where folks need resources, support services the most and not trying to do this as broad comprehensive city or regional wide but everybody benefits when we have these targeted strategies and importantly in our work putting this into policy, institutionalizing this codifying this into law has been critical often we think that this work however we think about it is the role for nonprofits or community groups and NGOs and foundations to fund on a two year grant cycle it's not going to work we need to rethink the institutions of government and make this work at the heart of those new institutions can't be on the fringe it's got to be built into the city's budget it's got to be built into the new institutions and funded with new folks who are real experts like our O&S team and really this is about not waiting until we have all the answers in public health we have a tendency to wait way too long epidemiology is a great science to count dead people and sick people and that's you know that's not acceptable but we need to act and no we may be wrong we would like to be wrong but we need to adjust and learn as we go learn from practice, learn from action again with community residents as both defining those issues acting and being a part and leaders again in that process there are no couchall solutions we can see this often integrated it's messy it takes a long time there's no one shot one solution that's going to get us there we need to think in an integrated critical way and really prioritize that use our wonderful panel here so we have Newberg Charity she is a brick builder and translator in the fields of urban planning and public health she serves as a program officer for the New York state health foundation and she has developed an employment strategies to support residents communities and neighborhoods to build a rush we also have Manu Sen she is a program manager at the regional plan association working primarily on the the new fourth regional plan really important project here in the urban region she focuses on long term planning and public health and equity and works to translate the impact of digital technologies into policies around infrastructure and governments and of course our host Professor Maulah Hudson who is the director here of the urban planning urban community and health equity lab at NSAP so what we're going to have to do is to really just give our panelists who have I think a range of expertise and experiences around really tackling health and equity and their reflections on their work and really how it connects to some of the board that have publications that Professor Maulah Hudson just talked about so we can start then sure so I have to start off and say that this panel is a little bit of potentially this is your lane and I got to say that because when I was studying first when I started to work in India when I came back to this country and I started my urban planning public health work and then Maulah in Michigan at the age of maybe 22 or 23 then shifted to New York and ended up getting my public health degree by Columbia here and read Jason's work Street Signs and then stayed in New York for many many years 10 maybe 12 years now got to meet Justin in my work in Brownsville and now very lovely we get to serve on the board being Brownsville together and have gotten to know Maulah Hudson because of her amazing work around developing the forward vision plan so it's really an honor and a delight to spend this Friday afternoon with all of these great folks who have been such a part of my work and my practice here in New York so as Justin mentioned I'm a pro-mauser at the New York State Health Foundation the New York State Health Foundation is what they call a health conversion foundation so there are a lot of healthcare organizations about 10 to 15 years ago that were going from it's either from for-profit to non-profit and non-profit to for-profit but anyways they were converting and they had to actually get rid of a large amount of their their money in specific ways so that's why you see a lot of statewide health foundations like the Blue Cross Blue Shield Foundation in Minnesota the California Endowment is a health conversion foundation so the New York State Health Foundation is one of those and we're from Blue Cross Blue Shield money and they basically created the foundation a little over 10 years ago and then walked away and so we really with the help of the state government that actually appoints our board we actually really decide and shape our priorities for what we think to be most beneficial for the health of all New Yorkers and very similar to what Jason was talking about really thinking about health and health care and having that be kind of a bulk of the work that was happening you can see that trajectory through the history of the New York State Health Foundation they were very well known for a lot of the work around diabetes and diabetes care and I would say about maybe three to four years ago they were realizing that a lot of the investments that the foundation was making in preventing and kind of really managing diabetes really wasn't working and we were trying to think more upstream which is what brought me to the foundation the priority area called Building Healthy Communities so we primarily focus on six communities across New York State three in the city so East Harlem, the Lower East Side and Brownsville and then upstate we focus on Niagara Falls Syracuse and Clinton County Clinton County is a whole county but it's 85,000 which is the same population as Brownsville so whether it's a neighborhood or a county you're in the city. But so part of it is that we really wanted to focus on the neighborhood as a unit of analysis and understand that really focusing on clinics and health care was really not the way to go if we're thinking about obesity, we're thinking about diabetes if we're thinking about hypertension we need to be thinking about the neighborhoods the spaces, the places and the people and so the Building Healthy Communities priority area is one that really lends to the example Jason that you gave around urban acupuncture really focusing in on six neighborhoods across the state that have disproportionately high health outcomes as related to diabetes obesity, hypertension, etc and really focusing in on the community residents the community organizations and the community stakeholders that have been there and will continue to be there and investing in the work that they have been doing for a while. Thank you First of all, wow, to follow up Jason's presentation, that's a heavy lift So thank you Mala for organizing this Okay, regional plan association and I'll talk just a little bit more about this, but first of all just thanks it's you know really it's the first time we have here in New York convening sort of that brings together people from different angles of the health and urban planning It's really the first time I think we've had such a public event facing an event that brings together people from the health and planning world on both sides in such an intense way to talk about actually how to do the work so thank you very much Mala for bringing us all together and really excited about the discussion So I would regional plan association just actually a quick question how many of you are urban planning students and how many of you are public health students how many of you are something else? Designers Designers They exist Thank you. So we have a really proud, which is great and you're all working as APL by the way and this is what we're here to tell you I work in regional plan association and we're an organization that by now we've almost say we've been around for a century and really we're a civic group that was formed in the 1920s to connect New York City that was sort of exploding into all the development activity that was happening right outside of New York City and at that time it was mostly connected by highways We did that by publishing the first regional plan which was the first plan in our history and since then we've published by now three additional plans including the final one called the fourth regional plan originally we just came to a few months ago and I'll get back to that in a minute but really, you know, a civic group has been here based in New York City for a hundred years we really kind of, you know, we reflect and we've expressed the history of the region and the history of planning of the region in the United States overall So the first regional plan came together because of a group who have decision makers in the region including, you know, sort of basically the who and who of New York society sort of saw a need and came to meet it and this was not a government entity and we're still to this day we're a civic group and we're not a government entity and the reason for that is effectively the metropolitan region of New York so the shared economy the shared transportation system the shared community items of where do you live versus where do you work crosses not just municipal but state boundaries, right New York every day from New Jersey from Connecticut they might commute from Hudson Valley to Connecticut or vice versa from online into Manhattan this is sort of the rhythm of the region the economy of the region and this also means that if you're making an investment in New Jersey you're actually influencing the overall economy of the entire region and the reason we were a civic group is that not only do we have three states controlling this region New York, New Jersey and Connecticut but also 782 municipalities and only one of them is New York City and today we have 23 million people and about 11 million jobs in this metropolitan region that's completely crisscrossed and completely divided by every possible boundary that you can imagine and so going back just a little bit to our history the first time like I said was about connecting the region with the wind analysis and roads and we really didn't need a lot of those roads maybe we were a little overeager the second plan came in the 60s and this was really a response to rapid sub-organization and the overbuilding of roads and really emphasize the amazing centers that New York has and try to move back to this idea of a multi-center region with different hubs the third plan in the 1990s was sort of the first time that we really specifically put equity on the agenda emphasis on the pre-ease equity environment it caught me it's out of fashion so much for that and and that was really a sight of a crisis it was a crisis slide that was a response to a crisis in New York City only beginning to emerge from the downturn still in the age of sub-organization just the beginning of people looking back into cities the fourth plan that came out in November 2017 the pieces that are still coming out so you can check it out on the fourthplan.org is really in light of three crises that have been happening in the region the first is inequality you know even after we don't need to tell anyone even after the financial crisis and recovery you still see deep inequality deepening gaps in income and who gains from growing economy and related housing crisis and underneath a lot of that of course the legacy of institutional racism and segregation of policies that we all have to live with the second piece is climate change so we're starting to understand it was a huge wave of call and you never waste a crisis the third was sort of anti-infrastructure at the time a lot of people have been saying for a while that the New York infrastructure is crumbling the New York region is crumbling of course now we're all living it it was so hard to see we didn't expect actually to see the infrastructure crumble so quickly and underlying all that though is the real crisis in governance and I think this is where health comes in real crisis is the ability to make decision making because a lot of the decisions we're talking about are common sense decisions around which you actually do have a fair amount of consensus but it was really hard to get done so come to the fourthplan and its solutions and I won't take too much time to talk about the broad they were talking about especially when it comes to health equity broad affordability by rebuilding around the various huge potential around the train stations all across the region and in the city whether it's places like Queen and Riverdale as well as places like you know Long Island and part of New Jersey and Hudson Valley we have amazing train stations and a lot of parking lots that will soon be vacant and a lot of places where you can have ADUs additional housing units within single family detached homes etc. but also deep affordability and really targeting displacement putting all the resources you need to target displacement just like that needless to say there was a really aggressive proposals around the subway the one that made a lot of noise was the one around it was actually just a line but potentially considering closing the train for seven is actually just sort of one way and the reason I'm raising it is not even because it's sort of a firm recommendation but it shows the kind of tradeoffs that we need to manage and why health has a role that's great I want to talk today about institutions so I'm available in institutions I'm a professor here at Columbia and director of the lab I talk about it but the question I have for you is what is the role of the 21st century university this what is the role and I'm going to tell you a short story about many people ask me as a professor how are you able to combine fear game practice and I actually don't see them being separate from each other because what I do is how I try to live my life in the classroom and institutions as well as in the real world so I feel the world and the role of universities is to solve complex issues plain and simple there are a number of issues out there you have incredible resources at university all of the human capital here to think about how do we be very innovative how do we think outside the box and how do we go and transform the world by working with institutions and organizations and community groups and so forth so in 2010 I got a phone call from Oakland Unified School District it was the general counsel who said we heard you do community development very well we have a big problem can you come to a meeting tomorrow so I said of course I'll come down to the school and they said we want to build a central kitchen in urban farm and education center to bring locally sourced food to the children of Oakland Unified School District the children of Oakland Unified School District over 70% qualified for free and reduced lunch and yet they were served frozen packaged food every day and this radical idea that the school district had was hey right in California we have a central valley right near us right now we have a sphere that's being grown in South America flown to China for packaging and it's flown to the Bay Area 17,000 miles and we have a central valley that grows to serve us right nearby so I thought what go wrong I'm at this meeting everything sounds great and they said the community's not supporting us and so the lesson learned from the students in either room I said well who have you talked to no one in the community they had plans for the project they had lots of support for the project you have the Center for Equal Literacy which does wonderful work really beating this project and yet from the school district side of things they had not knocked on any doors and so the first thing I said is if I take on this project then you have to stop everything you're doing and allow us to engage my team to engage with the community so they agreed to that and I said one other caveat I had no answer to the general counsel because I wanted to take policy side of things and just go in knock on lots of doors engage residents they had to ride across the street from this proposed site keep letting them talk to them about it and whether you're for it or not one thing that people do not like is when you make plans and not include them in that process and so that's what literally was starting to happen is that being people were starting to be against the project not because they didn't think it was a good project as I said maybe I could use the project I don't like the process so from there to make a lot of sure we ended being the project approved engage the community very deeply and then as a professor so this is through my firm and then as a professor I said I could keep taking the school districts money by doing this engagement or I could actually leverage being at Berkeley at the time as a professor and take this and really focus on policy and research and what I did is I was able to put a team together from law planning, education and public health to say we have a natural experiment here we have a situation where students are now in the school school program we talk to teachers saying many children are not eating so it was a bad situation so we ended up getting grant money to now study this process so actually see what's happening now engage with parents in focus groups and through that we start to find out many are unaccompanied minors many have come from elsewhere because of war and violence and so from there we did not even know each other the school lunches were not culturally appropriate and so what happened was the Center for Equal Literacy decided to launch a program called Rethinking School Lunch Open which is to serve locally sourced food to students on Thursdays and then eventually start doing it many other days a week it's now a statewide program and I won't get into that right now but to fast forward we've been engaging in this process for now about four years and it's now a long statewide to look at what's happening in the food system and we recently finished a project with the California Department of Food and Agriculture who is saying we need as a state a state of 40 million people we now need to start thinking about our food system and what we looked at was procurement so what happened to a school district so it's saying we will buy locally from you we will buy locally from you we will go to you as a farmer and what that does to the school in terms of building relationships in the community also bringing parents to the table and engaging them in the process bringing teachers to the table so they looked pretty short it's not all perfect but we're very happy with how things have turned out and we're able to now publish on this we're able to try to push through on policy and I tell you it's very empowering we can go to Sacramento that we did in agriculture and say this is something that's a priority for me and we really want your advice on how we can move this forward so there are ways to combine theory and practice I would say many of us here in Columbia an institution with a tremendous amount of resources there's a lot we can do so I'll do that but that's what we might have today is talk about institutions from primarily universities and the relationship we could build with proper organizations that are meant so I'll only leave one question because I want to get time for comments from the audience but I would really like to hear from all of you about really how we prioritize these issues in our work whether it's in academia and practice or within various institutions you know I always say that cities are people it's like the very simplest way to kind of understand what we do which is really to my point it's all in the same field which is really reconciling that notion that cities are people so there are so many ways there's sustainability there's resilience smart cities all these kind of trends that are really demanding the power, the money, the attention from government from private practice there are so many kind of directions what are some of the ways that you all have found to bring this equity and health focus to being central to being kind of an anchor point or a lens to really advance the work that needs to be done and even you've been working in this kind of global context right so working with you know all the different kinds of partners how do you get so many different types of constituents to kind of land on this point in your work I was hoping for an easier question I think a lot of this has been sort of said already first is there's an idea from New York when people would come to New York to say hey we think we can help with this problem we would say hey New York is like no other place so you really can't help us because you don't really know New York and then the Bay Area San Francisco they said you know California is like no other place and then we were working in Kenya and no no no every place is like no other place and I think the lesson there is that folks really need to be listened to about what they understand about their own place and where are people at how are they defining their community as healthy, unhealthy needs, resources, relationships of institutions with big like universities others like government private sector etc so I think that approaching a problem with great humility and critical listening skills is the first thing about how do you prioritize you don't prioritize you listen and try to understand where people are coming from and then try to kind out some of those thoughts I would just add to that I think early on in my work a lot of it was focused on you know health with a big age when planning with a big U but as I started working in Brownsville as Brownsville partnerships health coordinator our conversation was always about Brownsville it was always about the neighborhood what makes sense for the neighborhood what makes sense for this space in place what makes sense for these people and to do that knowing that I am not a resident of Brownsville although I reported to Brownsville every day I invariably had to connect with to and work alongside people who are from Brownsville who live in Brownsville, who are born and raised in Brownsville and so a lot of my work now as a program officer is that I focus on six neighborhoods some of which like Brownsville that I know very well some of which like Niagara Falls that I still continue to get to know and it is a matter of having a as a program officer I sit in a place of power and privilege and people coming to me saying I have the solution and I have the answer and here's how much it will cost and what I have to do then is that I have to then say got it awesome fabulous great and then I have to turn around and I have to say friends in Niagara Falls I'm going to come up for a couple of days and I have a couple of proposals in part of me and I want to talk to you about them because they're telling me that this is a solution I'm not completely sold because this makes sense for you because for me from where I sit I'm lucky in the sense that my priority area is thinking about six neighborhoods so the neighborhood is always a unit of analysis it is always what does this do and how does this affect the neighborhood itself so invariably it goes back to having conversations with both grantees that I currently run but also stakeholders that I know in each of those neighborhoods saying that I have X, Y and Z thoughts or a report is coming out from the West Coast could this happen in New York if so what would it look like would you be interested in working with me on that thank you there's this theme of kind of conversations both with people stakeholders but you know you're working with how many different jurisdictions and how do you have some of those conversations so I would say we are regional on scope we have arguments for major investments and data is always really important and having that health data the data that already exists about the gaps between life expectancy it's just an incredibly powerful way to talk about equity to an audience that does not necessarily get equity it really takes all these discussions that seem abstract and makes it real and you know regional planning is a practice that's driven by numbers and that's a number that's really, really good to argue with and it's been very powerful and I think the 4th regional plan has 4 subject areas to evaluate areas to our prosperity and sustainability which are currently sandwiched with money but to our health and equity and they really go together and it couldn't have happened without each other really forcing but I think in the long term we need to insist that our institutions not just foundations but our institutions that has conversations to come but it is their job and we lost track of that we have a fabulous planning process that's very theoretical and it doesn't really happen here I don't know how the civic engagement rates in California I have some questions about that but we really need to be insisting to have that up I would just say that it's important to listen have compassion understand what we bring to the table we're a community resident so we're a professor of community development and whenever I go into a community it's the list I can say yes there's some things like whether it be GIS or surveying, I can do that data analysis but you have to be able to define the problem and having traveled to many communities around the world there's something that you all have in common they want to be treated with dignity they want human rights they want to be free of violence I've never met a community that doesn't want to invest in what they want is to be at the table to determine what that investment looks like in their community what they don't want is that one size fits all let's just, you know, the Starbucks the area and the same they have their ideal for them what community development means and being a professor of urban planning I'm fortunate enough to be able to have some skill sets that I've agreed to the table but I think the most important thing of all is that I teach my students to listen to think about what people are saying to be vulnerable have humility and, you know, don't think they even solve all the problems but you can bring something to the table and together with residents and institutions and others that might build faults and problems it's really great and I think the conversation about what an institution does or the university do does get to that point about kind of connecting to people and really ethics, right we're all in the same profession is one idea but then I think the ethical responsibility for our different types of practice our different types of ways of working with communities is really important so it's sort of about kind of valuing conversations, valuing what people know that you don't know valuing the responsibility to kind of do the research to kind of make the connections that people may not have access to especially in some of the most needed communities so I did want to leave enough time to have the conversation be with the room to illustrate that point so I think if we have some questions I'm a lot older than any of you and you know Professor Cohnert I heard almost your identical lecture in the 1960s surrounding the law and poverty and the great society you know everybody knows that you got to get people to talk to each other and all that but we were never able to get past it and I mean we find it very discouraging now I'm pretty depressive to begin with is that we hadn't learned anything over all these decades this country does not believe in planning Europe believes in national planning in Germany or in France but we don't believe in that here land use planning is done by real estate developers the role of the New York City planning department is minor and there's always been that way when a kid grows up in the Brownsville or the Fed establishes East New York a poor kid he realized by the age of 10 that his wife's chance is a zero and so he starts working around his neighborhood to see who's making it and who's making it a little hustler it has always been that way you've contributed nothing new to this discussion at least from my literature and my decades of dealing with public policy issues we don't even have a comprehensive plan of conservation and development in this city and so planning is done in a random, chaotic way in one question I would like to ask the health people here one percent of the physicians associated with your clinics got their training outside of this country in Mexico or the South America the Caribbean and all that could you know that so your question is what percentage of physicians practicing in the U.S. have got their training practicing in your clinics so New York City Health Foundation doesn't have clinics we're a statewide health foundation that finds alright and deal with poor people what you're saying what's the logic other questions yeah I think Jason alluded to the various traumas that are in a lot of these neighborhoods and I wonder what's the role of mental health in health equity what does it look like as far as deliverables and tracing increases or decreases in health good specific good question it's definitely important in terms of the idea of toxic stress it's often an outcome of those stressors and so I think what we need to do is stop separating mental health from chronic disease from community opportunity and education and all the rest of it and begin to see these things from a more preventative public health approach rather than just treating individual which is important people need that support they need that counseling they need that initial trauma recovery what I do in Richmond is also include place based opportunities include economic opportunities include you know trying to get at some of those broader stressors across the life of people's lives that contribute to poor mental health so it's not to ignore but it's to move away from just an individual focused kind of treatment approach and to combine that with this trauma informed community development strategy I think the question I was just going to add that in I also work in New York City Government and it's been an incredible priority of the current administration especially the leadership of the first lady city Sean McCrae and actually just this week an executive director in charge of the THRIVE NYC program which is the city's kind of comprehensive mental health program that is a cross agency primary sector approach working with government with nonprofit groups and really at the 3D level and to start building the institutions building the conversations around mental health becoming part of the decision making process and the doing business of the city so I think more and more people are recognizing the importance and value and the kind of connections it has level of different factors to what THRIVE does right whether it's our supportive housing and doing homelessness or environmental considerations yeah and we've been stressing mental health being small throughout but I'd say one reason the key priority for us has been performing process planning and the 4-3 health plan has been because the process of planning itself could be a vehicle to build connections within communities I think everything Jason talks about is really a model for that and that's one of but that's actually a really good reason to invest in it so I have experience working with youth in areas that experience lots of violence and I can tell you that they suffer from a lot of trauma and interestingly enough even in areas where there's lots of development that's happening because they also suffer from trauma but especially young people is that the role of community organizations places where they can go so I have a former student now who sat doing a residency at Yale and she looked at post-traumatic stress disorder among youth in SOVA and we were working at an organization called Club Rising that was providing a number of services for young people between ages 13 and 24 and through this study what she found is that it not only hoped in terms of their mental health, the challenges they're facing but especially for women because what we found in the community is women, if they walk out of the street they're often harassed or don't feel safe they're at home, they're out of burden they're taking care of children and doing all these other things the community center was the one place that they could go to and have some kind of feel safe, have a group that they can relate to and be counseling and so she's that wonderful worker her name is Tanya Majuma I have a question for Professor Forman I'm interested in the case of Madeline and we know that the community we know that the community is a dynamic so how to deal with the community mobility for example the health of migration for friends for friends for friends coming and local residents moving out to another environment because we do guarantee health equally not only for local residents but also for friends and migration coming in yeah, so important dynamic in all communities there is some movement although we know that there's a limited residential mobility often for folks often because of racial residential segregation even in Madeline there is clearly some segregation for short this is also the importance of planning I would argue that we need not just neighborhood and community scale strategies but also city wide and regional strategies for inclusive neighborhoods we talked a lot about you know and I focused probably too much on the interventions and strategies needed in lower income communities that are already vulnerable we also need to highlight the high wealth already privileged places and open them up in the same ways to opportunity for affordability for more people for breaking down segregation and that's what they've tried to do in Medellin with their integrated plan they have a very focused plan about integrated housing in your kind of social class in buildings in parts of the community so it's an imperfect strategy but it's really attentive to both the racial segregation and the class segregation in both high wealth and low income communities I see the need to connect the doubt here and I guess that about five years ago the New York State Health Foundation founded a study that showed that social inequality and social determinants wound up filling emergency rooms and hospital beds and that won a year to two hundred million dollars and so the State of New York started addressing itself and so what we have now is what we may call a revolution or transformation it's in the early stages mind body paradigm is different terminology is used but the mind body paradigm is emerging in the medical model it's called integrated primary care behavioral health so there's a lot of movement and then the last comment and I was a former writer here about the school of architecture and planning and the school of recovery the last comment is that sort of severe response by the gentlemen who spoke recently but you do see extraordinary movement like I'm in the South Bronx and so you have a community college called Hunts Point Longwood Coordination that began emerging from institutions and it's looking at precisely not to repeat we're not quite where you are, we'd love to have you a speaker but we're moving in that direction where we're attempting to solve this question while still being overwhelmed because gentrification is moving rapidly people being displaced in senior housing in the South Bronx so we are constantly vigilant and mobilizing the community planning board and things like that but there is that movement that's taking place at community level at the micro world I think your comments are really important to remember the momentum and the motion that we move towards we were actually just talking about this just before you're absolutely right in terms of thinking through the social determinants of health and what that means for healthcare providers and there's this movement right now in terms of healthcare providers when they are actually seeing patients they have to track diagnoses through CPT codes so that's what they actually build to insurances there's actually this movement now to think about social determinants of health measures or social determinants of health indicators as Z codes so are there ways that physicians and practitioners can start tracking those things so that when a patient is going from physician to physician or is coming back for example it is already highlighted that there is either domestic abuse or a threat of fiction or things like that and that it actually is being coded so institutionalized within the health system rather than just within the medical notes so thank you for bringing that up so we established a public health council it's four years old we haven't tried to figure that out but that's exactly what we're trying to do we have an annual medicine plan and we're trying to figure out how to spread out and not just look at the initial clinical great, great, sorry and I am so glad I think I've got to see you it's wonderful to be here I think I followed all of your work I'm a native before medical school I work in community development and I find myself with sort of unfinished business in terms of training because I'm like I'm not really there seems to be a lot of new conversations to have as we try to shape healthier whole cities to have whole people, right and so as someone I appreciate you, you know I went so I went to medical school abroad, I did missions work in Africa so I've been to all these places and I'm trying to think about place matters but I'm also I have two things there's a editorial about Paul Grogan and the Boston Grove about Boston and inequality as you build this technical city as you shape the new innovative city how steel, the same people are closed out of the conversation as maybe 60 years ago and yet there is, I feel like we're on the edge of something very new because I ask myself now, well where do I want to live, do I want to live in a house or what so I'm having a conversation with myself but I wanted you all to try to pause it you know because one of my things about the west coast so I just told y'all I went to medical school in a foreign country and when I got out to the west coast I'm like why am I lost, I'm from New York I should be able to do this but you helped me so much but any quality means different things in different places there's the local conversation that you have, there's historical racism, there's contemporary nuances to racism that as we build I want to be about building, I don't think I can I really don't think there are things we can tear down but I think we can build we can shape, we can do you know that's how my engine is working so I wanted you all to be able to really speak to inequality and if I add my last two cents as I move through the new and old new roads in New York City sometimes I'm staying with large scale development I'm like well at least it's happening last because the public housing is already built there's some middle housing and now there's a large scale building so it's kind of in reverse and for people who the thing about low people in the video you showed, some people who have never left Richmond I spent a lot of my time with people just trying to go down to the World Trade Center and look out for window so talk about some inequality tools tools to help us think about the gap so always so wonderful to see and thank you for participating in our conversation always so I'll say that you know the reason why the New York State Health Foundation is in the neighborhoods that we are in is because these are neighborhoods that have suffered decades of racist policies, historical injustices and medical perfect so that's just baseline right tools to overcome tools to build so I will give a shout out to the University of Orange that's in the room right now I will say full disclaimer, I will the board member of the University of Orange and prior to my being at the New York State Health Foundation University of Orange was funded to support Niagara Falls in thinking through their organizing strategy but University of Orange put together I want to say about three or two years ago as the foundation in conjunction with Columbia's Center for Epidemiology or Epidemiology Department within the School of Public Health, thinking about the health effects of gentrification and displacement they put together a video called the Domino the Domino Effect which is on Vimeo, you can google it is a 8 minute 30 seconds video that walks through the historical injustices and leaves the moment open for community conversation in terms of what is next so I think in terms of off the top of my head a really solid tool is a community screening of the Domino Effect with a conversation around what folks can work together towards if I can tackle that from a sort of a longer term policy, I mean we need to invest in council we need to invest in in the existing housing there's a lot of money in positive tools and how to find them so first of all, having the health sector at the table at every point in this discussion being there, being in another ally and talking about it and then specifically jumping on a really successful model of supportive housing units and where quantifying the impacts on the most extreme cases of homelessness and people coming in and out of emergency rooms actually managing the policy so what else can we quantify that can actually convince the community to make these little decisions that this is a work investment which we all know it's a work investment but you know the more resources we can mobilize the more chances of success we have and I'm just going to add a point which is that design is very important of those tools right so imagining a different future is a really critical kind of tool and strategy I think that communities can use more that a lot of communities don't really have access to and still find ways for our institutions, our kind of interdisciplinary network to bring the idea of kind of creation and visioning to people that often don't have access to it so it's a really important next step that I think people are starting to pay attention to. Thank you, my name is Karen and I work for Norverse for Parts here in the city and I know we've been talking a lot about listening to communities and letting communities lead the work that we do and of course since we know communities aren't always more Olympic, there may be even different opinions within a community however you define it and I was wondering if you could offer some thoughts or experiences on how you balance or prioritize a lot of these competing voices I can speak I'm sorry I can speak to that as a professional development, I mean yes you're actually right when you're working there are lots of different opinions and voices and you're never going to reach consensus but I think it's okay that's the time as a professional you can say well we should look at what's happening in X neighborhood somewhere else there are plenty of examples around the world that we can draw upon and even if they're just inspiration to say well that's not exactly what this particular community wants but there are elements that we can bring in and one of the things that I think as I've learned through my work is the word compromise oftentimes many people do not want to compromise and I think part of democracy is incorporating people in the process thinking of ways to incorporate people in the process so we think about all the technological innovations we've made and yet we still have plenty of needs at the same time they're all those acronyms we can do so much more in terms of incorporating people in the process starting with young people all the way up to the elderly right so I think that it's important to help with the vision process it's important to bring people along through the process to be transparent accountable responsible all those things are incredibly important in the planning process and you just can't get caught up in the paralysis of analysis either and at some point you have to say we have to make the decision not everyone is going to be happy with that decision but if you go through the best process is possible and that various like community but as long as you're accountable and transparent as possible I think you can try to come up with something that's better and over time you can shift things around I think a public apartment in Richmond you know how it first started out and they got tagged the next day and incorporating community and people in the process it really does start to make a big difference I've actually thrown in my experience that even within the planning world we're supposedly we're supposed to know what the process is there is a lot of criticism that there's a lot of work that we should do some people are just really good at creating a community process and it's often like kind of consulting these people in practice in the field and then you have a bad process in poor outcomes and everybody wondering what's wrong it was actually the process that was brought so really paying attention to that it's critical I think we're sure on time we can just take two quick questions we can just take two quick questions and we'll try to into it and wrap up Hi my name is Great Eden I come from a food policy background really focusing on increasing equitable access to healthy and affordable food one of the things that I think is most interesting in our space is these unconventional partnerships where food groups are talking to healthcare groups food groups talking to affordable housing groups food groups talking to veterans and I'm wondering from your experiences if you've seen any examples of how we're focusing on unconventional partnerships under this health equity space Hi I'm Ceciel I'm a medical student from the Bronx and I'm going to be starting as a physician there soon I was just wondering you're talking about a program about the ethics in this edict and I was wondering in the process of building all these social events and projects and many how did they decide that I have a lot of more on-the-ground basis like necessities like sheltering more basic infrastructure like electricity and water and building more massive projects that build a lot of pride in the communities but at the same time kind of didn't address some of their more basic needs how did they make that compromise in that sacrifice yeah two good questions I mean maybe one response particularly for this second question they were very unconventional partnerships at least for there where you had a utility company and community organizations gender rights groups and others focusing on what to prioritize in communities there's a whole story that I didn't tell for some time that there was a 10 year investment already in support infrastructure in many communities so 90 plus percent had water, sewer, electricity the part I didn't say which is not a successful part of this story is they didn't do a lot of work around housing and that's still a challenge that they're working on now and other people raised that issue so in any place it's an incomplete process getting back to hey you thought we had this solve or a model in the 60s whenever it was it's incomplete which means we need to continue to have sharp attention to the work to who's included, who's excluded what projects are counting, what partnerships are built what institutions are changing what inequalities and privilege is being addressed or not addressed along the way so it's not thinking about this as project work or one off events or we're done and let's move on to the next community but figuring out how to have a sustained deep commitment that integrates issues, that integrates partners that tracks is it working and for whom and if not what do we change who else do we need to include whose voice isn't being heard in the community or in the partnership and are we also doing this work at the right scale so community is one thing but we also need the city and larger scale interventions for this to really have the impact that it needs to have on the long term I think the idea of the unconventional partnerships with unique partnerships the question I ask is for whom so for me the fact that the New York City Health Foundation has its core funding in Niagara Falls with the 501C3 that is primarily a resident led organization that has no real paid staff that got its status maybe six months before we gave them their initial grant for me that makes the most sense because those are folks who got together who knew what health meant for them in their neighborhood who knew that their neighborhood was being disinvested in while Niagara Falls was being heavily invested in as a tourist destination and they wanted to do something about it for New York City Health Foundation as a foundation that comes from insurance money who primarily focuses on healthcare that is an unconventional partnership so I think the question is for whom but I think going back to our colleague at New Yorkers for Parks by thinking about the space and the place over a period of time and I think Jason you mentioned something along this line that it's not thinking about the project but you're thinking about the space and place over the trajectory of time you're able to layer the work one on top of another and you're able to start having that work speak to each other so our core funding going to a community-based resident led organization has then led to partnerships with the city has then led to partnerships with the university has then led to larger organizations who if you were to think about it traditionally would have been the grant seeker and kind of the traditional grantee but starting from a very different place you're able to reach consensus in a different way because you're starting to think about bringing more and more folks to the table and thinking about it because we have the luxury of having a five-year initiative which is very rare for foundations and to be thinking about focusing on a neighborhood for five years plus allows us to say we may not get it right in the first year and we may not be funding the right people in the first year but we can build off of that in year two, year three, and year four so I think that would be our last sort of series of questions I did one of the obviously thank you on this wonderful panel for all of their insights and really to all of you for contributing to this conversation I think this is really the start of building these kind of connections and unconventional links and institutions and so we encourage all of you to kind of connect to network to do that work as well Thank you for convening this