Health Beyond Healthcare

     Having seen and learned about communities where disinvestment occurred, and where "medical care" differs from "health care", such as was noted in the 1972 Lincoln Hospital House Staff brochure, and the particulars of the neighboring Southeast Bronx (NYCity) community: Tuberculosis was then six times the national average, VD/STD's were four times the national average, 85% of the housing was sub-standard or deteriorated, and leading cause of death in that community was heroin overdose, and the heroin addict population was estimated at 100,000. A public hospital (Lincoln) serving that neighborhood averaged 186,000 Emergency Room visits per year, in a 400 in-patient bed facility with an average daily in-patient census of 1,100. A street gang called "the Young Lords", ran the hospital's detox program, and provided [protective] accompaniment to both Internal Medicine and Pediatric physicians who made "House Calls" in that neighborhood. There was no "Family Practice" Residency program there. Most Banks had "Red-Lined" that neighborhood. 

     In the late 1970's, I attended a presentation by Alternative Economics staffer Floyd D'Agostino, at the [then] Franklin Pierce Law School, in Concord, N.H., and he gave 2 examples of Community Development Credit Unions working to revitalize communities: 1) in Anacostia in Washington, D.C., and 2) at the Navajo Nation-where proximate Banks would lower the exchange rate on Navajo notes when the new model year Pick-up Trucks came out. Most Folks in the Anacostia Community Development Credit Union were on Welfare, Unemployment, or Social Security...but, within about a year and one-half, they had about $1 million in assets, and they partnered with the Building Trades Unions-which offered apprenticeships to many unemployed in that neighborhood, and they purchased a street-corner building and rehabbed the upstairs apartments into safe-affordable housing, and built a Day Care Center on the street level-which hired neighborhood residents to staff it, then they bought the adjoining building, which they then rehabbed apartments upstairs, and installed a Bakery on the street level. And they continued along that street... I am not certain how they trained the day care center employees. A recent article by a physician working among the Navajo, began with how the physician addressed the Tribe's eldest male-according to his relationship with the villagers in that community, and offers some acknowledgment of/tribute to the tribe's "culture".

     I had occasion to attend a "Grand Rounds" Continuing Education presentation at Dartmouth (Geisel) Medical School in 2000, by an Epidemiologist noting 52% of Detroit [Michigan] Metropolitan Area Schoolchildren met the criteria for PTSD (before "Developmental Trauma" had been conceptualized, and before the U.S. CDC/Kaiser- Permanente ACE (Adverse Childhood Experiences) Study had become better known, and our understanding of how "toxic stress" from Poverty, proximity to Community and/or Domestic Violence can affect the neuro-development and future health of children beginning at conception through ages 3-7, and into adolescence. The Texas ACE sequel study of 6,600 participants, not all of whom had health insurance, was not published until April 2010 in Preventing Chronic Disease journal. Now, a number of communities are endeavoring to become "Trauma-Informed Communities", such as Tarpon Springs, Florida ("Peace4Tarpon.com"), and public housing trauma-informed endeavors, such as the Troy, New York Housing Authority's project is trying to address the "Trans-Generational" nature of trauma, in both family and elderly housing. One county in Florida was noted for it's partnership between the Sheriff and the Health Officer, who compared maps between highest health utilization numbers, and highest police call areas, and the two noted the maps were markedly similar. Many of these items have been noted in ACEsConnection.com

     The [Robert Wood Johnson Foundation funded] Community Resilience Cookbook notes 9 U.S., and one Canadian "Resilience Building" initiatives.

     The "Trauma-Informed Community Building: A Model for Strengthening Community in Trauma Affected Neighborhoods", of May 2011, by Weinstein, Walin, and Rose, which involved the Health Equity Institute at San Francisco State University and Bridge Housing Corporation, I found to be quite a noteworthy model from both a "Community Organizing world-view", and as someone who's experienced and/or witnessed more than enough trauma [and/or a shortage of Resilience]. ...

     Recognizing the Contributions of Epidemiology, Neuroscience, and NIH Alternative and Complementary Medicine[s], such as Chiropractic, Osteopathy, "Somatic Experiencing", etc. which may or may not be covered by insurance in some locales, may be worth collaborating on.