Nothing Works…but Everything Might

Sick of Food Deserts? Try California FreshWorks–And Have Some Jobs On The Side

The American Constitution Society Blog (ACSBlog) published my guest post about the launch of the California FreshWorks Fund today.  I’m cross-posting it here:

On July 19, first lady Michelle Obama announced the launch of the California FreshWorks Fund, a $200 million public-private partnership to provide financing to food retailers and distributors willing to locate in food deserts.  Spearheaded by The California Endowment (“TCE”), a private, statewide foundation with a public-health mission that it interprets increasingly broadly, the Fund pulls together an impressive array of banks, philanthropies, industry players, government agencies, and investors under the umbrella of healthy food.

Why food, and why now?  Food deserts — areas without access to healthy, fresh food, namely grocery stores, but usually with abundant access to unhealthy fast food — are disturbingly common attributes of lower-income neighborhoods.  Across California, four million people live in food deserts, which correlate with higher rates of obesity, heart disease, high blood pressure, and diabetes than areas with grocery stores. I’ve written previously in this space about the unhappy cohabitation of racially isolated poverty and diminished access to healthy food.  And we can little afford such poor healthy food access now, when our nation faces a tsunami of obesity and its attendant costs in health care and economic productivity.  As TCE Director of Community Health Marion Standish and I wrote here last week, the increasing rate of childhood obesity threatens to wreak even more havoc in future years as obese children become obese adults.  And we know that access to healthy food decreases the risk of obesity.

But that’s not all. California FreshWorks and initiatives like it bring more than fresh food to underserved communities: jobs, increased property values, and increased tax revenue roll into town too. And that’s why healthy food financing initiatives are precisely the right thing to do now, in the face of a sluggish economic recovery, including a stubbornly weak job market. On average, 24.3 new jobs are created for every 10,000 square feet of retail grocery space (grocery stores are usually 20,000 to 50,000 square feet in size). A similar initiative in Philadelphia resulted in a 4 percent to 7 percent increase in property value, along with further commercial development. And increased retail, employment, and property value means increased tax revenue.

While food deserts are often densely populated, meaning significant block-by-block income (though not per-capita income, the more usual measure) waiting to be spent in area stores, the high cost of entering food deserts has long deterred retailers — even though grocery stores in food deserts can become profitable. The Fund provides loans and some grants to retailers to help overcome this barrier to entry, with longer time horizons for payback so retailers can, over time, generate the necessary level of sales to be profitable.

The Fund, though it draws on philanthropy for some of its funding, is not itself a charitable endeavor traditionally conceived. This is Philanthropy 2.0 — a highly networked and intensely collaborative effort that seeks robust, lasting, large-scale change.  (Interested in new approaches to large-scale philanthropic efforts?  FSG Social Impact Consultants founder Mark Kramer’s work on Catalytic Philanthopy and follow-on book, Do More than Give, with Leslie Crutchfield and John Kania, are must-reads.) The Fund is in the business of investing in communities, and its industry partners and investors intend to make a profit — but the initiative only reaches its objective if a healthy share of that profit remains in the community in the form of jobs and increased tax revenue.  Keep your eye on this program as it goes to work on one of the nation’s toughest problems in a big, diverse, and economic crisis-ridden state. The combination of public health improvement and economic revival could be a tempting recipe.

Read more about cross-sector approaches to improving public health and education and fighting poverty from my blog, Nothing Works…But Everything Might.

Why Soda Sucks–And What You Can Do About It: FTC Requests Public Comment on Advertising Regulations

Today, the American Constitution Society published a post I co-authored with Marion Standish of The California Endowment on Big Food’s fight against proposed voluntary regulations of advertising to children.  I’m cross-posting it here.  Also check out SodaSucks.org, The California Endowment’s anti-soda initiative formed to promote public comment on the proposed regulations.

By Marion Standish, Director, Community Health, The California Endowment, and Mary Kelly Persyn, Associate, Ramsey & Ehrlich

A coalition of Big Food-makers, fast-food chains, and media giants calling itself the Sensible Food Policy Coalition has joined an all-out battle against voluntary nutritional guidelines for foods marketed to children.  Opponents are fighting for the right to continue advertising soda, fast food, sugared breakfast cereal, and a wide variety of other low-nutrition, high-calorie food products to the nation’s children without even voluntary restrictions. The yearly spend on direct marketing to kids?  About $2 billion. 

The draconian (albeit voluntary) guidelines they’re battling against?  Principle 1: encourage children to “choose foods that make a meaningful contribution to a healthful diet.”  Principle 2: encourage children to “minimize consumption of foods with significant amounts of nutrients that could have a negative impact on health or weight—specifically, sodium, saturated fat, trans fat, and added sugars.” Remember, the proposal doesn’t involve limitations on the food products themselves: these are marketing guidelines.

The proposed guidelines are the work of an interagency working group formed by a bipartisan Congressional directive; the group includes the FTC, the Centers for Disease Control and Prevention, the FDA, and the USDA, and the guidelines are supported by the American Heart Association, the American Cancer Society, and others.  Lining up in opposition is the Sensible Food Policy Coalition: Viacom, Time Warner, the U.S. Chamber of Commerce, PepsiCo, General Mills, Kellogg’s, the American Association of Ad Agencies, and others.  Together, the Coalition has spent about $60 million on lobbying during the Obama administration.

One side knows health; the other side knows the free market.  Or does it?  According to the Washington Post, “advertising agencies touted one economic analysis that suggested the government’s guidelines would kill 75,000 jobs annually,” and Rep. Jo Ann Emerson (R-Mo.) earnestly requested an economic impact analysis of the regulations before they are put into effect.

Game on, Rep. Emerson. It could well be that these regulations would cost thousands of jobs, and that would have an economic impact for sure.

But let’s look at the ultimate impact of all this marketing on the targeted public and the economy as a whole. Advertisers dangle Tony the Tiger, buckets of Pepsi, and bags of Doritos in front of young noses unable as of yet to sniff out and reject manipulative advertising.  That $2 billion a year goes directly into creating demand for low-nutrition, high-calorie food products and soda. The massive sales that result mean money in the coffers of Big Food, surely, and more jobs too.

And also more externalized cost.  Because here’s the thing: as children consume more and become afflicted by overweight and obesity, health costs soar—and as children grow up, the wave of obesity rises too.  It’s not just about health care, either; it’s also about productivity, and in children, it’s about the ability to concentrate and learn.  Let’s look at what the unbridled marketing of sugar, salt, and fat has wrought on the next generation of Americans.

  • One in three children is now overweight or obese, and the percentage is growing.  According to the CDC, obesity among children aged 6 to 11 years increased from 6.5 percent in 1980 to 19.6 percent in 2008.   The American Academy of Child & Adolescent Psychiatry notes that childhood obesity is extremely difficult to treat; and overweight children are much more likely to become overweight adults.
  • Children who watch more TV consume more of the high-calorie, low-nutrient foods they see advertised; the link to physical inactivity is not as strong as the link to junk-food marketing.  Randomized trials have demonstrated the link between TV exposure, food advertising, food choices, and intake levels.
  • The increasing prevalence of sugar-sweetened beverages is strongly linked to the rise in American obesity.  Soft drinks “contribute more energy to the diet than any other single type of food or beverage,” and they are some of the cheapest energy sources available.  Increasing portion sizes, decreasing prices, and increased marketing have very likely contributed to increased consumption of these beverages.

Make no mistake.  Whatever the big-food marketers may claim, this is about pushing unhealthy food on children who lack the cognitive skills to discern manipulative advertising or identify foods and drinks that stand a good chance of making them sick.  The battle for regulation of junk food marketing to children is one we must fight, again and again, in the years to come. 

And we cannot afford to loseOne estimate pegs thenational cost of childhood obesity at approximately $11 billion for children with private insurance and $3 billion for those with Medicaid; obese children are two to three times more likely to be hospitalized.  The CDC estimates the overall direct and indirect cost of obesity at approximately $147 billion in 2008 dollars.  And remember—obesity rates are rising, and quickly.  Obesity rates rosein 16 states in the past year.  They did not decrease in any.

Let’s return for a moment to that economic impact analysis that Rep. Emerson requested.  The voluntary regulations may cause job loss if (1) companies follow them (because the government would not have any enforcement power), and if (2) following them significantly decreases children’s demand for the products.   That job loss, where workers are unable to shift to another sector, could cause economic loss to an unspecified degree. But what happens if Big Food starts pushing healthy food products? Sales decreases and job losses are simply not necessary consequences of regulation.

If we make no changes to marketing, and the childhood obesity rate continues to increase, we are looking at costs associated with childhood obesity that stand at $3 billion and rising for Medicaid child patients alone, and $14 billion for all children.  And the big-food industry completely externalizes these costs: the bills are paid either directly or indirectly by the public—not by the profiting junk food purveyors.  Those costs do not stem entirely from marketing, of course, but consider the recent steep rise in childhood obesity and concomitant rise in exposure to food advertising.  The link is there.

If the voluntary regulations work as well as the Coalition claims they will, children will consume less low-nutrient, high-calorie food.  Even small changes here add up to big advantages, especially in obesity prevention.  And that translates to dollars coming off our common health care bill.

The FTC is taking public comment on the proposed voluntary regulations right now.  Please use this form to have your say by the July 14 deadline.   The California Endowment has also posted commentary and suggestions on this issue.

[image via awrose]

Moving the Needle on Poverty: Why Nothing Works, But Everything Might

Today, the American Constitution Society Blog published a post I wrote about poverty and collective impact.  I’m cross-posting it here:

Countless urban neighborhoods are drowning in a miserable mix of poverty, bad schools, food-deserts lacking grocery stores and food-swamps providing an overabundance of fast food (I’ve written previously in this space about health care reform and the power of real food), and a dearth of jobs. Every year, countless non-profit community agencies provide a stunning number of hours of service to these communities. Yet intergenerational poverty maintains its stubborn, iron grip. Time and again, children drop out of school and face pathless futures.

It’s easier to design solutions to discrete problems than to back up and look at an entire social system. And so we try to improve the educational lot of poor children by spending more money per child, by lowering the teacher-to-student ratio, by going “back to basics,” or some other idea intended to leave no child behind.  But think of all that these approaches leave to the side: healthy, fresh food, without which children cannot retain facts and learn how to think; physical education opportunities, without which children are at a much higher risk of obesity; public safety, without which children live amidst the kind of stress and fear that fractures their ability to learn; and child care, without which children lack the kind of consistent adult guidance necessary to sustained learning. And we haven’t even touched health care.

The scenario is similar if an agency tries to move the needle on unemployment by improving only an individual’s job-seeking skills.  We’ve left aside job development (are there even jobs to apply for?); public transit (where is the job, and can the person get there?); child care (who takes care of the children while Mom and Dad are working?); job skills; and — critically important but often overlooked — financial management skills like budgeting, saving, and improving credit scores.

We face a situation where nothing seems to work — the best-executed and best-intended interventions fail to move the needle, year after year after painful year.

But where nothing works, everything might.

Think about it.  What if we tried to solve an entire set of interconnected problems at once?

Sounds a little crazy, doesn’t it?

But we don’t have to wonder whether this will work; we already know it does.  Here are just a few examples from California and elsewhere:

Promise Neighborhoods.  Modeled on the Harlem Children’s Zone, this federal initiative, currently run out of the Department of Education, makes grants to communities to develop schools with wrap-around social services, “from cradle to career to college.”  The California Assembly recently passed a bill to create a state-level program; Senator Harkin has dropped a bill to make Promise Neighborhoods a permanent federal program. Follow its progress at PolicyLink’s Promise Neighborhoods Institute.

United Way SparkPoint Centers.  The Centers provide integrated financial counseling services to families with the goals of increasing assets, improving credit scores, increasing income, and a reduction of debt-to-income ratio.  I recently wrote about the United Way of the Bay Area’s ninth SparkPoint Center, soon to open in San Francisco’s Mission District.

California Endowment’s Building Healthy Communities program.  TCE’s ten-year strategic direction focuses on the importance of place to health.  The program’s milestones involve reducing childhood obesity and youth violence and increasing school attendance and access to quality health care. 

Oakland Unified School District’s African-American Male Achievement Initiative.  The Initiative will create systems that support prevention, intervention, and retention for African-American youth.  The Initiative actively seeks partnership with community organizations, the school district, parents, and foundations to build “full-service community schools” that include employment, language, and health care services alongside education.

Obvious challenges to this approach abound. The attempt to coordinate a large number of agencies could rapidly generate barely controlled chaos, and where those agencies must co-create an agenda and attack plan, patience and time are required in large measures. Funders like to give money to agencies working on discrete, easily measured problems, because it’s easier to quantify and describe clearly bounded outcomes. The kinds of projects we’re talking about have five- and ten- and twenty-year time horizons, and that’s longer than funders want to contemplate. Partnership with, and capacity-building within, the vulnerable communities most in need of these projects is critically important but arduous work.

But a sea change is coming. Boston-based FSG Social Impact Consultants leaders Mark Kramer and John Kania recently formulated a concept they call “collective impact,” denoting cross-sector collaborations that integrate and coordinate a wide range of services and programs focused on a single social challenge. In a blog post titled “Revolutionary Reboot,” I wrote that “collaborative projects powered by collective impact also function like a human body:  organic, proactive as well as reactive, and able to shift constantly in response to the conditions it encounters.” For organic problems, there are organic solutions with collaborative DNA.

You can track related developments at the Healthy Eating Active Living Convergence Partnership; PolicyLink; FSG Social Impact Consultants’ Knowledge Exchange; and many more sites, including my blog, Nothing Works…But Everything Might.

Sixth Circuit upholds the Affordable Care Act

President Obama’s Affordable Care Act won a significant victory today in Thomas More Law Center v. Obama.  The Sixth Circuit Court of Appeals upheld its constitutionality, and two of the judges on the panel are Republican appointees.

The political party is significant because, thus far, the constitutionality of the ACA has been upheld by Democratic appointees and rejected by Republican appointees.  Affirmation by this panel is (I hope) a big step forward for the ACA as it makes its way to Supreme Court review.

The original plaintiffs argued that the ACA unconstitutionally compelled them to purchase minimum-coverage health insurance.  They argued either that Congress exceeded its Commerce Clause power when it required this purchase, or that the penalty associated with failure to buy insurance is an unconstitutional tax.  The Sixth Circuit found that the ACA is valid under the Commerce Clause because it regulates economic activity with a substantial effect on interstate commerce (particularly because the costs of health care for the uninsured are passed on to health care providers, then to private insurers, then to consumers).  The court also rejected another popular anti-ACA argument: that it unconstitutionally regulates inactivity.  To the contrary, wrote the court: it regulates activity, since nearly every citizen is a consumer of health care.

I hope the trend keeps rolling in the federal appeals courts.  The ACA offers so much promise for people without access to health care–let’s give it a chance to show what it can accomplish.

Here are the opinion and the Wall Street Journal Blog coverage.

SparkPoint in the Mission: Collective Impact for Financial Self-Sufficiency

Sheltered by Twin Peaks to the west, the Mission District boasts more sun and warmth than any other part of San Francisco.  Vibrant, echoing with music and brimming with public art and neighborhood markets, the densely-populated Mission pulses with life.  Its roots strike deep: the Yelamu Indians lived here thousands of years before the arrival of the Spanish; and Mission San Francisco de Asis (now Mission Dolores), founded in 1776, is the oldest surviving structure in San Francisco.  For over fifty years, the Mission has been the city’s center of Latino art, culture, and music. 

And now the Mission’s residents face significant economic challenges.  The poverty rate here exceeds the city’s average, and the stubborn recession has made jobs especially hard to find. In a region where financial self-sufficiency exceeds the reach of so many families, and in a state where unemployment recently hit 11.9%, the Mission stands out.  But the Mission has the “fire in the belly” necessary to come roaring back, which is why the United Way of the Bay Area chose to site its ninth SparkPoint Center here. 

One core intuition drives the SparkPoint Centers: people living in poverty face multiple, inter-related problems, and therefore they need bundled services and personalized coaching.  Not earning enough money is often connected to a lack of job training or education, low credit scores coincide with insufficient assets and too much debt, and poverty often affects family health due to factors such as environmental quality and lack of access to recreation and healthy food.  Accessing help one service at a time is both overwhelming and confusing.  And as I wrote previously, isolating and treating only one of these problems is like using a band-aid to cover a scrape while ignoring a person’s broken arm and concussion.  Concerted action isn’t just more effective: it’s the only thing that will work.

Previous SparkPoint Centers tested the hypothesis that families will achieve economic self-sufficiency more dependably and more often if multiple services are bundled together under one roof, and if families take advantage of more than two services over an extended period (the Centers make multiple-year commitments to their client families).  The desired outcomes are quantifiable and measurable: livable income that reaches the self-sufficiency standard for the relevant geographic area ($65,000 for a family of four in San Francisco); a credit score of 650 or above; savings equal to three months of living expenses; and a debt-to-income ratio (DTI) of less than 40%.  The early evidence is in: and the answer is a resounding yes.  The Oakland SparkPoint Center measured client success against specific benchmarks including decreasing DTI by 5%; increasing income by 5%; increasing credit score by 50 points; and either accumulating two weeks of savings or meeting a specific savings goal. Interim outcome measurements at the Oakland SparkPoint center demonstrate that 65% of the families taking advantage of two integrated services reached intermediate benchmarks for the four outcomes.  For families enrolling in three or more services, the success rate was 85%. 

“One-stop resource centers” are hardly new.  What makes SparkPoint different?  Primarily, the power of collective impact.  Government and non-profit service providers don’t just occupy the same space–they work together to provide integrated services to clients, and they use one system and one set of metrics to track client progress in an Efforts to Outcome database.  And starting with the Mission SparkPoint, the partners will more consciously pursue the shared goals, priorities, and outcome measurements that collective-impact initiatives establish collaboratively.

The unified SparkPoint approach, encompassing livable income, credit score at least 650, three months of savings, and DTI less than 40%, produces robust and significant results impressive enough to draw industry’s notice.  On June 3, Chevron donated $1 million to the brand-new SparkPoint Center in Richmond.  Visitors have toured Bay Area centers from as far away as the Netherlands; the concept has been copied all over the country.  Its flexibility and scalability will likely be tested soon; the Mission SparkPoint leadership is currently considering adding partners to boost job development, public health, fresh food access, and more.  The core concept is collaboration on an equity basis with shared agenda, goals, and measurement: collective impact in motion.

On June 14, the group of ten community partners that will open the Center, led by the Mission Economic Development Agency, will sit down at a table at Plaza Adelante in the heart of the Mission to imagine–together–a supercharged Mission District revitalized by the power of small business, improved credit, increased assets, and financial self-sufficiency.  (Read the original San Francisco SparkPoint RFP, including a more detailed explanation of the SparkPoint concept and a list of FAQs.)  The Mission was born before San Francisco was even an idea.  Now, as the United Way sparks economic revitalization, entrepreneurship , and empowerment here, the Mission SparkPoint Center could provide a national-level model for community-based economic recovery.  I’ll periodically post about the Mission SparkPoint Center here.  (Disclosure: I am a founding member of the UWBA Women’s Leadership Circle, which supports the UWBA’s ten-year project to reduce Bay Area poverty by 50%.)

Adelante! 

Revolutionary Reboot

What if, in the next ten years, we could reduce poverty in the Bay Area by fifty percent?  What if reducing poverty also required increasing access to healthy, fresh food, improving environmental quality, adding open space and safe sidewalks in vulnerable communities, revising and expanding public transit to take people to jobs, buttressing public education, and impacting the social determinants of health, including public safety, obesity, and asthma?

Too audacious, you say?  Too much to expect in the midst of a recession–or ever?

Well, what if doing only one thing will accomplish nothing durable, but doing everything at once will move the world?  One simple, beautiful idea: what if multiple organizations worked together for a common goal, in the service of a common agenda and mission, with fully coordinated efforts?  Could we make a difference if we tried to do everything at once?

The United Way of the Bay Area is about to try (check out Make It Be).  Their project, which aims to reduce Bay Area poverty by fifty percent in ten years,    pulls in more partners daily.  And it’s fueled by “collective impact,” a concept that describes collaborative projects that can scale to sizes sufficient to really move the needle–finally–on some of the most stubborn social problems we confront. 

“Collaboration is nothing new,” John Kania and Mark Kramer of FSG Social Impact Consultants concede in their article Collective Impact.  But imagine collaboration enabled by a common agenda, shared values (and shared power), and a central staff.  That’s collective impact in action, and this kind of directed coordination across groups and sectors is the revolutionary reboot so desperately needed now.

Working together, organizations dedicated to collective impact reinforce each other’s work, creating a whole greater than the sum of its parts–and potentially able simultaneously to attack multiple dimensions of highly complex social problems like poverty.  Consider the examples from education, environmental conservancy, public health, and more, in the Kania and Kramer article and in the New York Times “Fixes” op-eds by David Bornstein, especially The Power of Partnerships and Coming Together to Give Schools a Boost

Archimedes famously said that given a long enough lever and a fulcrum, he could move the world.  But this image evokes a machine governed by the laws of physics and mathematics.  We cannot solve the problems in front of us with a simple lever and fulcrum; we can’t attack them one at a time.  No machine, and no mechanistic approach, will help.

That’s because large-scale social problems are organic, dynamic, and fantastically complex.  Take education, where we’re still looking for the magic bullet.  By turns, we sign on to the idea that fixing the curriculum will turn the tide.  Then, we’re certain it’s the teachers.  A while later, we’re on to class size.  But while education involves classes and teachers and books, it also involves nutrition, public safety, environmental quality, public transit, and many social determinants of health.  Trying to “fix” only the curriculum or the teacher is like bandaging a knee while studiously ignoring the fact that the patient is burning up with fever and has a broken arm.  We can’t “fix” education until we care for the whole child, and that challenge can seem insurmountable.

But that’s the power of collective impact.  By coordinating efforts in several dimensions–pulling together partners from the for-profit, non-profit, and public sectors to analyze and coordinate responses to a set of closely-related problems–collaborative projects powered by collective impact also function like a human body:  organic, proactive as well as reactive, and able to shift constantly in response to the conditions it encounters.  Partners seeking collective impact will need to function as part of an organic being, and that is a significant, considerable challenge.  Nevertheless, we must confront it.  Now is the time.

I created this blog to explore the revolutionary reboot.  The next post will focus on the United Way’s declaration of a renewed war on poverty–so audacious that it just might work.

 

Follow

Get every new post delivered to your Inbox.