Thursday, November 20, 2014

Starting a Fire, to Improve Health

“If a community wants to bring organizations together to carry out a project to improve health, what’s the most effective way to get action started?”

A member of the audience asked that question, after I delivered a talk at the National Press Club in Washington, D.C. on the day after Election Day. I had described some of the results from national research conducted by Wilder Research and the Federal Reserve Bank of Minneapolis that examined collaboration between the health and community development sectors in the United States. My talk and a related panel discussion were hosted by Health Affairs, who brought together several authors from their November 2014 issue, Collaborating for Community Health, to shed light on new strategies, partnerships, and measurement tools that show great promise for addressing the health needs of our communities.

Why is this important? Because your health and my health depend on much more than medical care. The condition of our bodies, the illnesses we get, and even how long we live depend largely on the social determinants of health. These social determinants include our housing, our income, the availability of nutritious food, air quality, the level of crime in our neighborhood, facilities to promote physical activity, and other aspects of our environment. In short, health care leaders have come to recognize that many of the factors that lead to illness, or promote good health, lie outside of the health care system.

Risa Lavizzo-Mourey, who heads the Robert Wood Johnson Foundation, recognized that both the health and community development sectors devote significant attention to achieving better health for all by addressing these social determinants. However, they have traditionally worked in their own spheres, with little to no collaboration. She promoted a national movement (including The Commission to Build a Healthier America) to align their efforts.

A few years ago, Wilder Research teamed up with the Federal Reserve Bank of Minneapolis and the Robert Wood Johnson Foundation, to support this movement. We carried out national research to explore current collaboration between the health and community development sectors, to identify factors that underlie successful cross-sector initiatives, to identify obstacles that prevent successful efforts, and to determine how to best support additional collaboration.

So, back to the question, “What’s the most effective way to get action started?” I pointed to “leadership.” When members of a community recognize the importance of addressing social determinants of health and when they understand the increased effectiveness of working together rather than separately – that provides the fuel for cross-sector collaboration. The fire ignites from the spark of a person or some organization who reaches out to unfamiliar partners who share similar goals and invites them to sit at the same table and work jointly.

Do successful collaborations occur now, and how do you increase the quality and quantity of that work? Some of the most interesting findings from our research, included in an article in the most recent issue of Health Affairs, were:

·         In most parts of the U.S., health and community development organizations have begun to work with one another to collaborate to improve health.
·         To date, this work is limited; much opportunity exists for expanding these efforts.
·         Organizations within the health and community development sectors continue to lack a full understanding of one another’s activities; they also lack understanding of the roles one another can play in community health initiatives. For example, public health agencies rarely think of community development finance institutions as potential sources of health information for people who need care, but they could make such information available to people who use their services.
·         Initiatives to improve health seek better measures, to understand their accomplishments and to develop strategies for improvement. Standard, commonly-accepted measures of success do not currently exist. As Risa Lavizzo-Mourey has also said, “You can’t improve what you do not measure.”

Another audience member asked a question you might expect on the day after Election Day: “What implications do election results around the country have for cross-sector collaboration to improve health?” I suggested that cross-sector collaboration is non-political and can appeal to individuals across the political spectrum. Public officials who want to promote effectiveness and greater access to health care can see collaboration as a means for influencing social determinants of health and improving services for those in need. Public officials who want to reduce cost and promote efficiency can see collaboration as a means for leveraging limited dollars for greater impact.

We look forward to continued participation in this movement to improve the health of all residents of our communities.

Monday, September 08, 2014

We can't shape effective community action in a vacuum

Police have a racist predisposition to shoot black males – true or false? Do we have any evidence to know the extent to which this statement has validity? Sadly enough, we do not, contends Michael Wines, whose recent column in the New York Times noted that statistics which could support or refute the contention that police shootings unfairly target blacks “do not exist. And because of that, the current national debate over the role of race in police killings is being conducted more or less in a vacuum.”

While not a criminologist, I did attempt to search for data on the prevalence of shootings, including homicides, by police in the United States. Academic and government statistics provide little insight. More than 20 years ago, the federal Office of Justice Programs noted the absence of data on police use of deadly force and called for a national reporting system. Such a system never evolved; sound data about shootings by the police does not seem to exist.

The St. Louis Post Dispatch reported, as did Wines, on one of the few credible studies of the topic. Interestingly, in Wines’ view, the St. Louis study revealed something counterintuitive: that black police officers shared participation, in proportion to their numbers in the department, in the homicides of black male suspects. Nothing to change the assumption that racism plays a role, but the study results suggest that simple-minded thinking about black and white might not sufficiently address a serious social problem, which Wines labels “the plague of shootings of black men by white police officers.”

Please note that I do not offer an opinion about the Ferguson situation. The shooting of an unarmed teenager seems immoral; no conclusive evidence has yet emerged to justify the use of lethal force and the death of Michael Brown. We will see what develops.

However, the attempt to discuss, understand, and address that shooting in Ferguson raises a larger concern: the need to shape our thinking and make decisions about social issues and social programs based on sound information, rather than acting in a vacuum where myths and inaccuracies can all too easily lead us down the wrong path.

That’s why, at Wilder Research, we engage in work that can drive thinking, resources, and policies in the most productive and humane direction. For example:

  • That’s why we work in the field of education, partnering with others in Generation Next and the Promise Neighborhoods, for example, to identify empirically what our children throughout the community need and what works and doesn't work for improving their academic success. Progress requires initially building upon what we know with confidence, then exploring different approaches, experimenting to see what works, and continuing to build on our successes.

  • That’s why we partnered with several foundations and the State of Minnesota to determine the value of supportive housing. Anecdotes had previously implied how it worked; but with a systematic study, we could illuminate the strengths and limitations of supportive housing. We could provide guidance and a baseline for improvement.

  • That’s why we partnered with the Metropolitan Area Agency on Aging to study informal caregivers in the Twin Cities (family members, friends, neighbors who care for aging people) and learn the ways in which those caregivers might be better served through available resources.

A new and exciting study for the state of Minnesota will examine long-term supports and services for older adults, people with disabilities, adults with long-term mental health needs, and children with long-term mental health needs in all 87 counties of the state, in order to identify gaps that need remedying. Policymakers will have the opportunity to allocate resources best aligned with needs.

Our communities need information, insight, and wisdom – of practical significance, to make the best possible choices (even if sometimes difficult and wrenching) about how to shape policies and allocate resources. But also at a higher level, we need sound understanding, based in facts rather than myths, prejudices, and stereotypes, to live out our values and achieve our aspirations for an optimal and equitable quality of life for all people.

Saturday, July 19, 2014

Prairie Home Companion, Wilder Research

Prairie Home Companion recently celebrated its 40th Anniversary with special events and a national broadcast at Macalester College. The program has grown successfully since its first broadcast which included an audience of very few people four decades ago. I did not have tickets for the two evenings of performances, but I sat just outside the fence, with a decent view of the stage and the ability to hear all that occurred.

I wondered: What ingredients make for the success of a program (radio or other), or for the success of an initiative, or for the success of any organization, for-profit, government, or nonprofit? What lessons might Prairie Home Companion have for Wilder Research? How could those lessons help us in our continuous effort to improve and increase our impact on the community? What parallels exist between the development of this radio program and the development of Wilder Research which grew from just a couple of staff , at about the same time that Garrison Keillor brought Prairie Home Companion to the airwaves 40 years ago, to the almost 100 staff that we have today?

For the radio program, several ingredients seem immediately evident:

Creativity. Garrison Keillor, his producers, writers, and others have continually looked for new ways to entertain and to meet the needs of their audience.

Commitment to a mission. The regular and guest performers sought to entertain, but, also to educate and enlighten.
Persistence. Not everything worked the first time; listenership did not blossom immediately; sometimes the performance venues had many empty seats. Nonetheless, the show carried on over the years to build a following.

Quality. All who play a role in the production strive to create the best performances, again and again.

Team work. The show depends on many. Some have greater visibility, but, especially in viewing a production live, you realize the large number of people required behind the scenes who run the show and deliver it to the radio network for worldwide listening.

Old-time religion. Values that Garrison grew up with come through in everything from the songs that are sung to the Lake Wobegon monologues.

Do I see these qualities in Wilder Research? We begin our business year every July 1st. We always want to do a little better each year than the year before, as we try to evolve to meet community needs. Looking forward on “New Year’s Day” this July, I asked myself how we should search for new ways of carrying out our work and how we should strive to improve.

If you like, please let us know how we can best improve to better meet the needs of your organization and the communities you serve. The ingredients for success, listed above, might prompt some thoughts; you might have other ingredients to mention.

Creatively, we hope to bring our many products and services to the next level – to name a few, our program evaluation work, community indicators (e.g., through Compass), return-on-investment studies, and new ways of gathering information through phone and web surveys, focus groups, and other means that we have developed in the past but want to improve. Our Speaking for Ourselves study, which involved a variety of cultural groups in innovative ways, will give new insight that should stimulate creativity. We will release the results of that study during the coming months.

Commitment to mission and persistence in our work have oriented and motivated us over the years. We strive to meet the needs of individuals, families, and communities through research and we look forward to hearing how to better do that during the coming year.

Quality constitutes a strong value. While never perfect, we seek to do the best; we welcome suggestions as to how we can do even better.

Team work. Just as in radio, many people comprise an effective research organization. Some of those people you see (at least their names; some you don’t. All do their part – designing research, collecting data, analyzing data, doing word processing and graphics production, maintaining our library and connections to sources of information, and creating our communications. That team is essential to our Wilder Research impact.

Old-time religion. Wilder Research staff bring strong values to their work. Whether from religious roots, secular humanism, or the many other sources of inspiration that people have, staff at Wilder Research choose to work in an environment where they can apply their professional skills in a way that helps others.

Wishing you the best in your work as you apply your values and talents to your mission of improving the quality of life of our communities!

Thursday, June 12, 2014

War on Poverty - Winning economically and morally

Has the War on Poverty succeeded or failed? January of 2014 marked the 50th anniversary of President Lyndon Johnson’s “declaration of war” against poverty. As Johnson put it, "Our aim is not only to relieve the symptoms of poverty, but to cure it and, above all, to prevent it." During the first half of this year, some columnists and pundits have questioned whether we have won this war or lost it.

Arguments contending the war has failed: 
  • When the War on Poverty began, the national poverty rate stood at 19%. It now stands at about 15%. A four percentage point decline does not constitute “victory.”
  • Many Americans, both those living below the poverty line, plus some who live above the line, report difficulty affording necessities such as housing and food. (See, for example the Minnesota Compass housing burden trends.) 
Arguments contending the war has succeeded: 
  • Many people in this country have supports that did not exist before the war. Medicare and Medicaid, for example, have provided a safety net. Conditions have significantly improved for older people, who had great risk of living in poverty prior to the 1960s.
  • “Apples to apples” analysis of poverty over time, with a good methodology, reveals that many more people would have lived in poverty over the past 50 years if we had not taken the steps we did with the war. 
The seeming intractability of the official poverty rate does trouble me. Maybe as someone who has worked for social justice since the 1960s, in various volunteer capacities from the neighborhood to the international level, I don’t want to admit failure.  However, I tend to subscribe to the latter arguments, concluding that deeper analysis (such as that done at the Columbia Population Research Center) reveals some economic success as a result of the health, nutrition, and preschool programs developed as part of the war. Some segments of our society, older people and children for example, would fare much worse without the programs we have established.

A new foe in the war, some suggest, is that economic growth does not lead to poverty reduction, as it once did. Because of rising income inequality, the poor do not experience financial gains from economic growth the way that they did for much of the 20th century.

Although we must pay attention to the numbers, I don’t think we lose the war when we see a trend go in an un-hoped-for direction. I think we lose the war if and when we ever give up.

Our effort in and of itself constitutes a partial victory – the effort we expend to make sure that all children receive a good education and graduate from high school ready for college and career – the effort we expend locally, nationally, and internationally to close gaps that have the potential to reduce everyone’s quality of life and threaten our democratic institutions – the effort we expend to enhance the quality of life of every one of our community residents, from richest to poorest, as we tackle the social, economic, and environmental challenges of the 21st century.

We might not see the bad numbers soon drop to zero, but working together to push them as close to null as possible – translating our efforts into tangible economic results for low-income people – that brings us together as a community and enables us to win this war. Economically, we win by increasing economic opportunities that provide real gains for people at every step of the income ladder. Morally, we win by joining together in the fight.

Friday, May 02, 2014

Wilder Research Staff Sharing Globally, Acting Locally

How do youth development and education issues in other countries resemble those of our own? Have our international peers developed programs or strategies that we ought to consider here?

Richard Chase and I traveled in different directions out of the U.S. last month, to learn, share, reflect, and return to Saint Paul with information that might have value for promoting healthy youth development.

Rick, a senior research manager at Wilder Research, jetted westward with Betty Emarita, an ideation and strategic change consultant, to the Global Summit on Childhood, in Vancouver, Canada.  Their presentation – Promoting and measuring family and community engagement for healthy early childhood development – was part of a roundtable discussion with other presenters under the heading Family, Home, and Indigenous Knowledge.

Rick and Betty have developed two tools – an Early Childhood Assessment; and an Early Childhood Program Quality Rating – that blend family and community knowledge systems (indigenous knowledge) into measures of child development and program quality. When used together, these tools can promote and measure family and community engagement that goes deeper than language and logistics and is based upon valuing and respecting family and community wisdom and including families as an integral part of program design and decisions.  They informed the audience as to how the use of the assessment and the quality rating and the information from those tools empower immigrant and rural communities and communities of color that often feel that mainstream institutions and programs do not support or reflect their own knowledge, experience, and values. If interested, take a look at an overview of their work.

During the Summit, Rick learned about how central governments in developing African, Asian, and Latin American countries, with the support of UNESCO, are investing in early childhood education as a key economic development and nation-building strategy. Invariably, early education programs begin with curriculum and methods based on western standards of quality but then experience push-back from local and indigenous communities who find those standards biased, and even harmful, as they struggle to preserve their traditional, holistic practices under the pressures of globalization. Rick also learned that the use of these tools resonated with researchers and educators working in developing countries to produce culturally supportive early education experiences. 

I jetted eastward to Dublin, Ireland, to present at a conference on What’s Working for Young People, and then to Belfast, Northern Ireland, for meetings and to do a presentation at Stormont, the Parliament building.

Northern Ireland, while past “The Troubles” in some respects, still retains a significant legacy of conflict. I’ve been working on research and development of a project called WIMPS (Where Is My Public Servant). This project attempts to change young people’s political knowledge, attitudes, and behaviors within a culture which is deeply segregated (in housing, education, etc.), which runs on a tribal form of party politics, and where young people too often must choose between allegiance to paramilitary groups and participation in civil, democratic forms of community decision-making.

WIMPS involves young people in educational and experiential activities, to increase their understanding of politics and to develop their skills in media production. They put what they learn to use in “campaigns” intended to change public knowledge, attitudes, and government policies. For example, during the past few years, WIMPS participants engaged in successful campaigns to end paramilitary beatings and shootings known as “punishment attacks;” they successfully persuaded the Northern Ireland Assembly to debate voting at age 16; they campaigned for suicide prevention in schools and for better rural transportation services.

Evidence shows that the program significantly increases the knowledge and skills of young people, promotes the development of “social capital,” and increases young people’s interaction with public officials at all levels. It was worthwhile to talk with an international audience about our findings to date and to hear their suggestions for program improvement and additional research.

While at the conference, I also had the opportunity to learn from international colleagues about “what’s working for young people.” Much of the research pointed to programs which can influence features of children’s environments that Ann Masten placed on her “short list of resilience factors,” things like caring parents and other adults, prosocial peers, effective teachers, and safe communities. The culture and activities within some communities create these features naturally. Other communities need help, which various programs/interventions in a number of countries have provided. Similarities across national boundaries – both negative, such as issues related to inequality, achievement gaps, etc., and positive, such as a focus on outcomes and improved understanding of what can promote healthy youth development – stood out more than the differences among people living within different borders.

International conversation with colleagues who pursue similar aims always offers insights and encourages thinking outside of the box. We returned intellectually enriched, ready to share knowledge and engage in community-building efforts here, and of course, appreciating that there’s no place like home.