NJ Spotlight July 22, 2013

By Andrew Kitchenman

The health of New Jersey’s urban residents is worse than the health of state residents as a whole – and detailed new report focused on the state’s capital city draws a vivid portrait of the problem and its scope. http://www.trentonhealthteam.org/tht/TrentonCommunityHealthNeedsAssesssmentJuly2013.pdf

A new community health-needs assessment found that if healthcare providers in Trenton are going to successfully treat city residents, they must address daunting social problems including crime and low health literacy.

The assessment was conducted by the Trenton Health Team (THT)], an organization dedicated to coordinating the efforts of the city’s healthcare providers

The study ranked reducing crime and increasing health literacy as two of the top five healthcare priorities for the city, along with reducing obesity, substance abuse and chronic diseases.

THT Executive Director Dr. Ruth Perry noted that both urban crime (both directly through gunshot victims and indirectly through the pervasive fear it causes in a community) and health literacy (the ability to understand medical information and use it to make decisions) are related to the other health priorities.

The team heard from residents who said “We know we need to exercise, but we don’t feel safe walking in our communities,” Perry said.

Her conclusion: “You see how all of these five priorities are interrelated.”

The 2010 Affordable Care Act mandates that nonprofit hospitals conduct these assessments every three years. The assessments generally include analysis of hospital patient data and participation by local public health experts. This information must then be used to adopt plans to meet the needs of the community.

The amount of time and effort that hospitals commit to the assessments can vary, but officials with Capital Health, which operates Capital Health Regional Medical Center, and St. Francis Medical Center decided to work together in an intensive effort as part of the THT, which also includes Henry J. Austin Health Center and city officials. They were able to take a more comprehensive approach involving dozens of local community organizations, thanks to a grant from the Robert Wood Johnson Foundation.

Perry said the assessment was unique because it looked at the root causes of local health problems, rather than just tallying medical cases.

“If residents are afraid their kids going to get shot, then they’re not going to exercise,” Perry said.

St. Francis executive vice president Christy Stephenson, who codirected the assessment with Perry, said the new study was different from one her hospital conducted in 2010 because there was much more community involvement, including a series of public forums.

“It became clear after the second forum that the issues in Trenton were not confined to diabetes, hypertension, heart disease — it was like peeling an onion and people were talking about the environmental things as well as the social barriers” to achieving improved health, she said.

This led the group to directly ask residents what environmental and social factors affect healthcare.

“Crime and violence came up right away,” Stephenson said. “Many of the parents and grandparents felt that was one of the reasons that obesity was so high.”

The social factors came to the forefront in part because the assessment focused on city residents, rather than looking at the needs of the hospitals’ suburban patients.

“In some ways Mercer County is like the land of the haves and the have-nots,” Stephenson said. “That is very much the case where it comes to crime, violence and health literacy.”

Among non-English-speaking residents, language barriers affected residents’ health literacy, she noted. The assessment noted that 35.4 percent of Trenton residents speak a language other than English at home, higher than the 29.2-percent statewide average.

Perry added that if the THT can address health literacy, it would help residents to take care of themselves.

Dr. Robert Remstein, Capital Health’s vice president for accountable care, said the concerns about health literacy matched his own experience in the city. “If patients don’t have the basic fund of knowledge of what diabetes is,” as well as its complications and symptoms, Remstein said, “we’re not going to get off the dime with those patients and we’re really going to have bad outcomes.”

Remstein said the assessment was eye-opening for him. While he has worked as a doctor in Trenton since completing his residency in 1985, he had always thought of crime as a distinct problem, rather than as a cause of other health problems.

“The impact of where you live and the trauma of poverty around that area directly impacts your health,” he said. “I don’t think I ever realized that as an independent variable that can impact your health.”

He noted that as the THT conducted the assessment, scientific studies were published that linked stress to genetic changes.

Remstein said hospitals have traditionally based community health needs assessments on “the colored glasses of the organization.” Having an assessment that involved multiple hospitals led to a broader perspective.

Perry acknowledged that the THT took on an extremely difficult task by producing an assessment that focuses on major social problems.

“It can make it more difficult to address them, but I think here in Trenton we’re in a unique position” because every health provider, community organization and the city government are united in the effort, she said.

Perry gave another reason – based on economics — for investing in addressing these issues.

“I personally think that this is really key for Trenton because if we cannot get our population healthier and safer, then I think it limits Trenton’s ability to have a renaissance,” Perry said, noting that the chronic diseases that result from these factors affect the city’s workforce. “Businesses will not come if they think the community is not safe.”

The THT has assembled five working groups to look at each of the five priorities listed in the assessment. They will meet over the next two months with a goal of developing a plan to address the needs as soon as late September. Each of the group must develop concrete goals and objectives that can be measured, Perry said.

Stephenson sees the hospitals taking a new approach to addressing community needs as a result of the assessment. Rather than tailoring programs to meet individual diseases as concern about them arises, the hospitals will be able to prioritize their programs to address the larger priorities laid out in the assessment.

“They’re big (and)…audacious goals, but I think we’ll be much more effective not overlapping but working in concert,” she said.

New York Times, July 21, 2013

By Michael Kimmelman

NEWARK — Perhaps few places in America represent the urban trauma of the 1960s more than this city. Deindustrialization, corruption, suburban flight and calamitous planning gutted its core, tore up neighborhoods and helped fuel rebellion in the streets. The whole toxic environment was encapsulated in the desecration of the Passaic River, which borders Newark. It became a dumping ground for dioxin from the defunct Diamond Shamrock Chemicals Company, which manufactured Agent Orange.

But a quiet upheaval is turning that river, polluted as it may be, into a front line of reclamation. It’s a common approach these days, from Seoul to Madrid to San Francisco: upgrading cities by revamping ravaged waterfronts. Urban renewal strategies from decades past, which did so much to destroy places like Newark, are being turned on their heads. The idea here is to make the Passaic a point of pride. You can see the sign of change in a new stretch of fluorescent orange boardwalk along the riverfront, an eye catcher for passengers on trains rumbling over the bridge into Newark Penn Station.

Phase 1 of Riverfront Park, as it is called, was completed last summer: a $15 million complex of playing fields on formerly derelict land, a couple of miles north of a giant sewage treatment plant, in the Ironbound district. This traditionally Portuguese working-class neighborhood avoided urban renewal 50 years ago and has thrived, partly as a consequence.

The Ironbound also sidestepped the redevelopment movement of the 1980s, which produced alien, corporate sites like Battery Park City. Residents and vigorous neighborhood groups like the Ironbound Community Corporation welcomed the new fields, which, since opening, have become a citywide attraction.

Phase 2 is set to open on Aug. 3, just upriver from the fields: the 800-foot-long, $9.3 million orange boardwalk, designed by the veteran landscape architect Lee Weintraub, in collaboration with the city’s planning office.

In this cash-starved city, nearly half the money has come from the state, the rest from federal and county sources, along with private contributions solicited by the mayor, Cory A. Booker, and the nonprofit Trust for Public Land.

The ultimate goal, said Damon Rich, Newark’s planning director, is to create more than three miles of greenway, a riverfront ribbon with bike and walking paths stretching all the way through downtown to residential neighborhoods in the north.

Accomplishing that will require decades of political perseverance. “It doesn’t get more challenging than a waterfront park on a brownfield next to a Superfund site,” as Adrian Benepe, the director of City Park Development at the Trust for Public Land, and a former commissioner for New York City parks, put it. This is an especially tall order in a poor city notorious for unreliable governance. A timely coalition of environmental groups, Essex County leaders and Mr. Booker came together to complete the first phases. The mayor is now running for United States Senate. Whether early successes with the park will propel the project onward, whoever ends up in charge, is an obvious question.

Another is whether big change can happen here without gentrification driving out the very people the plan tries to help. The city administration says it wants to avoid exactly that. Many residents, accustomed to broken promises and fearful of investments that only produce quarantined office parks, are already wary.

“When the city center was destroyed by urban renewal, it became a place to avoid, a place to pass through,” said Mindy Fullilove, a professor at Columbia University and a New Jersey native who writes on urban affairs. “Now the riverfront can become an urban edge shared by everyone — a point from which to build the city back. The problem of urban renewal has been that when we’ve had an idea, it usually isn’t a good one, and when we have a good one, we don’t put money into it. The hope this time is that things will be different.”

These are changing times. Cities, which banked so much on fancy buildings, are increasingly finding new life and a fresh identity in public spaces that connect neighborhoods and communities. Planning gurus for years preached that waterfronts were no more than working ports and dumping grounds for industrial waste and the poor. Canals were paved with concrete and riverbanks lined with highways, factories, housing projects and railroads. According to this gospel, cars and freeways were good for failing cities, and urban density was bad.

The notion that industry might someday dry up, that economic development and public health would depend on clean, leisure-oriented waterfronts seemed almost inconceivable not even half a century ago. But environmental concerns and digital revolutions have reversed thinking. The proof is on the streets. Downtowns are coming back where residents and cities are stressing public transit over cars, density over sprawl, diversity over suburban flight.

In Newark’s case, repairing the damage will not be easy. Mr. Rich, the planning director, led the way on foot the other morning from the train station to the new boardwalk. The trip required crisscrossing streets with meager accommodation for pedestrians, clambering up the exit ramp of an old bridge and hugging the gutter of a four-lane boulevard that lacks traffic lights allowing people to cross into the park. Along the way, he pointed out a riverside brownfield, the former Market Street Gas Works, now a cleanup project for PSE&G, the utility company. Next door, a grim mirrored-glass office building, headquarters for New Jersey Transit and Horizon Blue Cross Blue Shield, squatted atop a multistory garage.

It’s hard to envision how Riverfront Park will get around those obstacles.

And then there is the river. A state court ruled two years ago that Occidental Chemical Corporation, the successor to Diamond Shamrock, was principally liable for the costs (from $1 billion to $4 billion) of cleaning up the Passaic, but the company has contested the ruling. The next phase of Riverfront Park, to be completed in the spring, envisions the boardwalk stretching toward Penn Station. Restoring parts of the riverfront in the ethnic and racial mix of northern neighborhoods, for equity’s sake, will present a whole fresh set of hurdles.

Still, what has been built so far goes a long way. If a single downtown building like the Blue Cross Blue Shield headquarters separates the city from its river, a modest stretch of boardwalk knits them back together. At a ball field across the boulevard from the new park, Marcelino Arce, a youth baseball coach, described how some children in the Ironbound neighborhood had no idea the river was even there. Now, they must dodge traffic on the boulevard; but once across, he told me, it’s “a whole new world.”

That world includes a few zigzagging walking paths, with signs, by MTWTF, a graphic design firm, recounting the history of the river and its industries. There is an osprey rookery built into a copse of trees at an overlook onto the river. The city still needs to install those traffic lights and the park needs more seating.

As for the boardwalk, made of recycled plastic, its bright orange can summon up what Christo and Jeanne-Claude called “saffron” to describe the color of their “Gates” in Central Park. But police cones may leap to mind. Or Agent Orange. For his part, Mr. Weintraub said the orange was picked after eliminating various gang-related colors. Whatever. It is not ideal.

Newark deserves an elegant waterfront. That said, the orange boardwalk also acts like a giant highlighter, drawing attention to the park — as the project hopes to draw people from all over the city back to the Passaic, one patch of recuperated riverfront at a time.

© 2013 The New York Times