Hospitals Play a Key Role in Building Pathways Out of Poverty

How Healthcare Providers Can Give Back to Their Neighborhoods, and Benefit from It

February 28, 2017

Planner / Architect, NBBJ

Editor’s Note: A version of this post was originally published by Next City.

As jobs in many low income neighborhoods have migrated to suburbs (or overseas), so have retailers and newer housing for those well-off enough to pull up roots and move out. Not so for the large hospitals that have substantial capital investments in existing buildings and, in many cases, social investments in existing communities. Public hospitals in particular tend to find themselves embedded in some of the most distressed communities in America.

As a planner working with many stressed cities in the “Rust Belt,” I frequently find local hospitals are the last and most committed economic anchors, but also the ones most impacted by economic decline in urban cores. City governments are searching for ways to leverage the economic benefits of these anchor institutions (hospital jobs certainly, but also subcontracting and services) for the benefit of the larger community. And some forward-thinking governments, along with aligned organizations and foundations, are now advancing policies and programs to do so.

For example, in Cleveland, the nonprofit development organization University Circle, Inc. has been cooperating with the city’s many world-renowned hospitals to enhance the surrounding neighborhoods. One such initiative, Greater Circle Living, is an employer-assisted housing program created to encourage eligible employees to live closer to their jobs, thus strengthening the local housing market and reducing traffic congestion on regional roadways. Another example, Next Step, encourages large institutions to focus their spending on local green businesses to supply cleaning services, food preparation or laundry. This not only advances green agendas but also bolsters local, and frequently minority-owned, enterprises and local employment in the services sector. Through programs such as these, local communities see direct benefits from the regional anchor institutions in their midst.

So how can regional healthcare institutions — that are struggling to provide quality care and attract new insured patients — benefit from these types of efforts and develop their own?


Think Local

By a biological analogy, a healthy organism thrives in a healthy environment. Under new accountable healthcare mandates, hospitals no longer necessarily profit from serving unhealthy populations as they may once have. Many local hospitals want to improve their positioning, marketing and general appearance for insured patients, but they also need to address the general health of the local populations which suffer from the highest preventable disease rates. Urban hospitals across the country treat residents in communities where nearly half the population is either uninsured or on Medicare. Treating population health issues and their causes is now more important than ever to reduce healthcare costs.

In the past, responses to poor local conditions may have led hospitals to clear blight in their vicinity, or to turn their backs on negative conditions in an effort to screen the problems and present a brighter face to their regional customers. Security frequently took the form of a siege mentality: fencing or large parking lots that separated troubled neighborhoods from secure zones within the campus. This approach did not do much to reverse neighborhood decline or negative impacts on the anchor institution, nor did it improve health outcomes of local residents.


Practice What You Preach

As in Cleveland, The Aultman Health Foundation (an integrated health system with two hospitals, a health plan and a college) in Canton, OH, is demonstrative of a more comprehensive approach to health. Aultman (and one other hospital, Mercy Medical Center) remains within the city limits, serving the city’s reduced urban population of 70,000 as well as the growing metropolitan-area population of 400,000. Employees and patients seeking specialized medical care must travel from far-flung suburbs and hamlets to one of Canton’s most distressed inner-city neighborhoods. While the neighborhood is arguably less blighted than the surroundings of other famous urban hospitals, the contrast is striking for patients and employees, and local conditions do not support healthy lifestyles for nearby residents.

The health district could eventually involve the entire neighborhood of 40 square blocks where, for example, existing residents would have access to a much-needed wellness (fitness) center, outpatient clinic, quality daycare and healthier food options. Local residents will share these resources with hospital staff, nursing students, patients and patients’ families. Nursing students, medical residents and staff will find housing in the immediate neighborhood in renovated homes or in new apartments. Redesigned roadways will reduce accidents and provide safer pedestrian crossings for kids and the elderly. Parks and tree-lined streets will encourage residents and patients to get outside in a safer neighborhood.


Be the Convener

As one might expect, some healthcare institutions are cautious about exercising skill sets beyond providing healthcare. They were rarely organized, or willing, to take on community blight or mixed-use development projects. But they are good at team-building. And this “Health District Strategy” takes many players — healthcare institutions, governments, foundations, private enterprises, even architects and planners — to succeed.

Aultman Health Foundation, by working with the City of Canton and their comprehensive plan, has begun to develop a comprehensive strategy for neighborhood transformation that involves an expanded group of stakeholders, city and state governments and the private development sector. At this point Aultman has convened city government, the Ohio Department of Transportation, the Canton Community Development Corporation, a local foundation and a private real estate developer to create a blueprint for a health district called “Aultman Health Village.” From fixing blighted houses to rebuilding roadways and adding needed retail and services, each of these players are addressing specific coordinated actions that are essential for success.

Aultman Health Foundation and Cleveland provide examples for other progressive healthcare institutions to follow. Anchor institutions can take a look at their surrounding communities to find win-win opportunities. One needn’t be a world-class center of medicine like the Cleveland Clinic to make a difference in one’s own community. Rather than retreat from each other in fear, institutions and communities can actively engage to reverse decline and surround the hospitals with the goods, services and housing that will heal both.

Photo courtesy of Pexels.

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When Everyone Shops Online, What Happens to Mixed-Use Retail?

How Changing Retail Trends Are Creating New Opportunities for Urban Experiences and Public Space

December 20, 2016

Partner, NBBJ

As more and more people desire an urban lifestyle, architects and developers are creating a large number of mixed-use projects — that is, developments and even single buildings that combine residential and commercial uses with retail and public space. A recent PricewaterhouseCoopers survey ranked mixed-use developments the highest-rated real estate niche for 2017 [PDF]. This paradigm is not new. What is new: everyone is wrestling with what to do with the ground floor, because retail is changing a lot.

In Seattle, the land use code either mandates retail at street level or exempts retail from counting against chargeable floor area. So developers and architects include it, either because they have to or because it is incentivized. But this part of the code was written a long time ago; retail then was different than it is today.

Many developers are now unsure what to do with retail at the ground floor, because most people now don’t go there to buy “stuff”: if you want something, you buy it on Amazon and have it delivered. But retail is such an important aspect of the street space and pedestrian experience. If retail at the street level is empty — and I see a lot of empty storefronts now in Seattle — it sends a bad message about the development, even when all the office space on the upper floors is full.

Restaurants open onto a public passageway at the new Amazon headquarters in Seattle.

Restaurants open onto a public passageway at the new Amazon headquarters in Seattle. (Kevin Scott/NBBJ)

Because we buy things differently, a lot of retail is now shifting to programs that deliver an experience, instead of showcasing objects for sale. Some of these new retail uses in Seattle include things like “doggie daycare,” which creates lively storefront experiences by showcasing the pets belonging to downtown residents who work during the day. And Amazon is now experimenting with “Amazon Go,” a new retail model based on a seamless experience rather than product display, where one can buy items with a smartphone and not have to go through a cashier.

Another common way to expand the experience is by extending the feeling of the space from the inside to the outside. For this reason, many restaurants are installing glass doors that slide out of the way in good weather. At the new Amazon headquarters in downtown Seattle, where all the ground-level uses are food-related, public space is integrated with the dining experience, with tables and chairs under glass canopies. These intimate spaces spill out onto the sidewalks, into a midblock thoroughfare or into a small plaza where the public can gather around a sculpture and eat lunches bought from food trucks.

So the question of open space is no longer just about building big parks like Central Park. Many architects are experimenting with creative ways to use the edges and leftover spaces around buildings to create activated gathering areas for small groups of people. And many developers are realizing that distributing public space in this way can bring added value to their properties. Retail is changing, and this provides new opportunities not just for developers and retailers, but for the city itself.

Image courtesy of Pexels.

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All I Know about Sustainability I Learned from an Italian Peasant Cook

Five Timeless Values for Sustainable Communities

December 6, 2016

President, Forterra

Gene Duvernoy is President of Forterra, a Seattle-based nonprofit which helps communities secure the places — urban, rural and wild — that are keystones of our sustainable future. This essay is adapted from his commencement address to the University of Washington College of Built Environments.


In my work at Forterra, a Seattle-based sustainability organization, we began an experiment several years ago we call the Cascade Agenda. It boils down to this: to save our natural and wild lands, our natural environments, we must change our built environments. We must make cities we in fact are drawn to, where we truly want to live and raise our families — prosperous places worthy of our children and grandchildren.

The progressive real estate and development world is now abuzz with the building of these new urban communities, which serve our many needs at a handy, even walkable distance. In fact, we have become so enamored with this old-fangled way of living, that we have given it a very new-fangled name. So while our grandparents may have just called them the home neighborhood, we proudly use the sobriquet “sustainable communities.”

To know when we are succeeding at these sustainable communities, we have invented measures and protocols, LEED categories and livable buildings standards. But let’s go behind this current vocabulary, to the lasting values of sustainability. For this, I will rely on the writings of Italian peasant cook Angelo Pellegrini.

Maybe you’ve heard of him? Angelo lived his first 10 years as a young and always hungry peasant in Italy and then, in about 1910, came to our own bountiful Olympic Peninsula. He grew up in what was the remote railroad town of McCleary and became — of all things — a University of Washington Shakespeare professor. Quite a career, but he is best known for his food writing. My favorites are Unprejudiced Palate (1948) and Lean Years, Happy Years (1983). He writes in these two books about sustainable kitchens, before we had such a fancy word — before the notion went to university.

Now here are the values he expressed through his writing:

First, he practiced a peasant’s crafty sense of frugality — how to get the most on the table today, without sacrificing future harvests.

Second, he promoted an Italian’s sense of quality — live life well, as your means best and prudently allow.

Third, he argued for the fresh and local over the exotic and remote — he was a locavore before his time.

He also deeply valued a host’s intrinsic responsibility for his guests. I think of this fourth as his most defining value. As a cook he understood that his role was really to elevate his guests’ spirits.

So all this I learned from reading Angelo. Sustainability arises from a frugality, commitment to quality, clear understanding of the fundamentals and respect for those he was serving.

Sustainability has gained an uptown polish as it has come to real estate. But, I mean to convince you that the values behind it remain the same.

Now to apply these five values to our job of building tomorrow’s sustainable communities.

Frugality — For sustainable communities, this means approaching a project with a clear intent to be cost-effective. But do not confuse frugality with parsimony, which leads to projects that serve narrow interests, while defeating the broader interests of our communities — like box stores on our diminishing farmlands. I mean frugality in a full sense of the term, where all externalities in fact are captured. For instance, we must concern ourselves with the multi-modal possibilities and commuting costs to a project, or the way stormwater may be handled onsite so it does not become a costlier problem offsite. As we get better at identifying and assessing all life-cycle costs and incorporating them in our design and building decisions, our choices naturally will be more sustainable.

Fundamentals of craft — We need to design and build our communities with the fundamentals readily available: affordable homes, jobs, transit, parks, shops, safety and schools. This may be a call to go “back to the future,” but these fundamentals are at the very core of sustainable communities.

Quality — Clearly livability demands a strong commitment to quality. Think like Angelo did about his table, where frugality and quality work synergistically. Again, as we become more cognizant of all life-cycle costs, this value too naturally moves to the forefront.

Good sense of business and profitability — Firms that are no longer in business, or projects that have gone underwater, are not contributing to cutting-edge sustainable communities. Admittedly, though, this value is a tricky one: Wall Street wants profits immediately. Bank and commercial financing are leery of innovation; they always have been. But the market itself — customers — are buying and proving sustainable buildings and communities are right. This is particularly true with a younger demographic. Ultimately, we will be building for clients who get it — the younger generation.

Regard for a project’s users — This is the value that I have the most trouble putting into words; the most elusive, yet maybe also the most important. Again, think like Angelo did about the guests at his table, with a deep regard for the ultimate users of the project.

As Lewis Mumford and many others have noted, we first started to build communities many thousands of years ago, in part to protect us from what was lurking in the woods. We have come full circle. Now we must protect these same woods from us. And — lucky for us — we are starting to do this by designing and building communities where people want to and can afford to live.

Sustainability in the built environment is being rediscovered. The technology is of-the-minute, but the values behind creating truly sustainable communities are time-tested, enduring. So I call on all of us — sincerely request each of you — to embed these values in our future work and practice.

Let us be the ones building communities where we will live well, gracefully and affordably — right alongside and respectful of our natural world.

Image courtesy of Pexels.

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