Tag Archives: Johns Hopkins Medical Institutions

Role of public health institutions in public health justice

PDF of slides from talk at Johns Hopkins School of Public Health.
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…In these times of historical and current accounting of the effect of anchor institutions in community, at home and abroad, how do we speak truth to power and forge new alliances toward justice? As the field of public health grapples with the social, political, and economic determinants of health, how has a powerful institution like JHU been influential in determining neighborhood health in East Baltimore? Has the development of the institution (and others like it) contributed to the growing wealth and health gap in East Baltimore (and elsewhere)?

Come join us for a discussion with Dr. Marisela Gomez this Wednesday, April 1st at 12pm in Room E6159 for a challenging discussion critical to the past, present, and future of health equity in Baltimore and beyond.

The history of prestigious institutions and their power to exploit those most vulnerable to grow power is vast. To be truthful participants in changing this history we must account for this history and repair it. Transparency begins to hold accountable the past transgressions and find solutions beyond what our fragile human nature has succumbed to thus far. Inequitable health outcomes, arrest rates, educational achievement, income and housing value are symptoms of inequitable communities, of power and privilege. Bridging within and across all our systems-community and economic development, education, criminal, housing, recreation- of society is a large task. How do we forge a path towards equity, while assuring everyone is at the table, and contributing?

Establishing values of inclusivity, accountability, transparency,and reflection/reflexivity in all processes is important. These values must infuse and be embedded in the tools of planning/policy development, practice/praxis, evaluation, public relations/media. And most, most importantly, WE THE PEOPLE, must be involved in all steps of the process toward justice…

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If interested in any slides of presentation, send a contact.

Contemplating peaceful and skillful means to justice,
Marisela

Social health, neoliberalism, and gentrification

What is meant by social health? And what does neoliberalism and gentrification have to do with health? In rebuilding communities through neoliberal practices that result in displacement, homelessness, and gentrification the health of the community is affected (1). The fact is that the social, political, and economic systems in a society such as the US affect the health of individuals and populations. These systems separate and place economic, social, and political values on populations according to categories of race/ethnicity, income level, education level, gender, immigrant status, religious affiliation, sexual orientation, place of birth, dominant language, physical and mental ability, and age. The socioeconomic and political economic systems use these hierarchies to determine our place in society which in turn determines our health.

Using race and class identity as examples, individuals who discriminate based on these two factors will negatively affect the psychological and physical health of low income people of color through the stress experienced daily by the effects of their implicit bias (2, Implicit Attitude Test, Experience of Discrimination). On an institutional level, the health outcomes of low income communities of color during redevelopment is partially determined by the discriminatory neoliberal policies and practices-a norm of the socioeconomic and political economic systems of the US. Such practices/policies include: policies which allowed disinvestment of low-income neighborhoods, mayoral-governments partnered with private developers, legislators passing and funding racist laws, lack of policies/laws which demand affordable housing and local hiring, city and state officials enacting education, housing, transportation policies and practices which benefit wealthy developers and displace community residents, developers building only market-rate housing in low and moderate-income communities, planning boards lacking community participation, corporate university and philanthropic boards who approve cleansing of low income and of color communities. Besides the collective stress experienced from being forced to move, the lack of affordable housing and products, the fear of eventual displacement, lack of ability to have decision-making in your community, displacement to other under-resourced communities (in school, livable employment, access to healthy and affordable food, infrastructure that allows physical activities, safety) are risk factors for poor health outcomes. Such neoliberal rebuilding practices which lead to displacement and gentrification can only occur in societies where the political economic and socioeconomic systems support them. This is the concept and action of social health, neoliberalism, and gentrification.

The mechanisms of neoliberal processes in community rebuilding such as tax subsidies and exemptions, rezoning, lack of transparency and accountability, ‘shadow governments’ of developers and corporate foundations navigated through public:private partnerships, state redistribution of land to private entities, propaganda media, greed, devaluing of non-productive members of society, non-participatory planning in community rebuilding and its social health impacts must be identified, reported, challenged, prevented-again and again. Such practices unleashed in communities of low and moderate income and color find little resistance due to the political economy of development capital and state politics. This process of community rebuilding is supported by strong ties between the developer and government which overwhelms the power of the local community to demand equitable development and community participation-there are minimal ties between the local community and government (3). Newly organized communities are displaced to different parts of the city, some county, loosing the growing power-base and social capital which could challenge the powerful developers and public partners. Because of the unfair advantage of such public:private partnerships social capital/economic and political benefit is accumulated disproportionately by the powerful developers.

For example, displacement of communities of low-income and color disinvested by government and neighboring institutions, for expansion of a prestigious institution like Johns Hopkins results in stress for residents and poor health outcomes: gentrification and health. The disruption of social networks, root shock, results in acute and chronic trauma to residents as they loose their familiar base and try to anchor themselves in new neighborhoods (4). Such continued serial displacement is a major social determinant of continued poor health outcomes. Children are particularly susceptible to these changes and have difficulty establishing new peer groups (5). In this example, neoliberal practices through public:private partnerships of the university, Annie E. Casey Foundation and others, and the city planned and carried out displacement, demolition, and construction of a new place/community unaffordable to previous residents and the peripheral communities. After more than 800 households were displaced less than 10% low income and minority families have been allowed back to inhabit the more than 700 units rehabbed or newly constructed to date. Construction of a new contract school, managed by JHU and supervised by a board of directors led by Hopkins assures that the neoliberal agenda of dispossession of education occurs-another risk factor for health (6, 7). This new school which selectively engineers a ratio of white and non-white, poor and non-poor for their neoliberal formula of experimental ‘urban’ education continues. The right of existing residents to attend the school is ignored, preference is offered to the powerful university and affiliates, while the department of education requires no meetings for transparency or accountability, and the wealthy developer and corporate philanthropists of Casey and other foundations continue on unimpeded. The school is a magnet for gentrification, attracting the race and class of people comfortable to the powerful Johns Hopkins University. Whether the children of the surrounding neighborhood have access to this new school is a determinant of health. Access to early childhood development resources and education is a determining factor for health of children as they grow to adulthood. Neoliberalism, gentrification, and the new urban education are factors determining the social health of East Baltimore and Baltimore because the neighborhoods displaced residents are forced to move into may be similarly disinvested, contributing to diminished health. Residents must be able to stay in the neighborhoods undergoing revitalization and participate in all the amenities (education, parks, housing, health, employment, transportation): this is a more participatory model of community rebuilding-one which emphasizes community participation before development to ensure that participation continues during and after, and does not result in gentrification, displacement, segregation and poor health. How do we do that?

Alameda County Public Health Department (ACPHD) along with Causa Justa:Just Cause’s (CJJC) recent report shows the negative health effects on communities in the Bay Area undergoing gentrification (8). Among others, they recommend Health Impact Assessments (HIA) before development occurs to determine potential negative health outcomes caused by gentrification and displacement; their recommendations emphasize the necessity of community participation in all processes of development. In 2009 similar recommendations were made by the Association of Bay Area Governments and Policy Link. However the current recommendations by ACPHD and CJJC is the first to directly show quantitative changes in population health during all stages of gentrification processes, clarifying the health consequences of displacement. HIAs can also be used to substantiate the need for community-driven rebuilding processes as done by the Los Angeles Community Action Network. They used a HIA to leverage a commitment for more than $20 million to limit displacement through affordable housing, local hiring, support for tenant rights and preventive health programs.

In 2003, Save Middle East Action Committee, Inc. requested that Hopkins/East Baltimore Development Inc. conduct a HIA before demolition and rebuilding began. This was particularly important because the majority of the housing stock was built during the period of lead-based paint and because previous studies of demolition by the university showed contamination of the surrounding air with lead. Even with this evidence, the timeline of the university’s first Biotech building was more important than the health of low income and African American residents. This type of public:private development project ignored the health of residents then just as a current development project in Los Angeles targeting public housing conversion into a mixed-income development is attempting to ignore the health of low income people of color (9). Such racism and classism driving neoliberal community rebuilding chooses to ignore existing communities where the majority of residents are people of color with little resources and the lowest life expectancy. These and previous examples confirm that the value placed on low income and racial/ethnic minority communities are minimal compared to that of higher income and white communities, and that the growth of inequitable power in majority white and higher income communities will continue to drive these unhealthy socioeconomic and political economic practices.

Gentrification and its neoliberal agenda has arrived in full force in the 21st century. New York’s Brooklyn and the Bronx, Sommerville, Portland, Chicago, Denver, and DC are facing the effects of gentrification and unaffordable housing, all risk factors and outcomes of displacement and negative health outcomes (10-16). Cities implementing new transportation systems face similar risk of gentrification and displacement as reported by a 2010 report: Maintaining Diversity in America’s Transit-rich neighborhoods: Tools for equitable neighborhood change (17). Neoliberalism’s new attire of greater public:private partnerships with the propaganda of equitable public benefit supported by the media drives gentrification through accumulation of land by the wealthy and dispossession of civil rights of the disenfranchised- in the US and abroad (18). Such inequitable societies lead to inequitable health of individuals and populations as seen with life expectancy differences between the rich and the poor of up to 19 years (19). Confronting and ending these violations of human rights through coalition building across struggles for equity of race, income, housing, food, education, environment and all other social factors is necessary and possible. It may be the only possible way to reclaim a collective right to occupy the city, making it balanced, healthy, and whole.

Holding Power Accountable: It’s a human rights issue

As privatization in development moves ahead in Baltimore, and government continues to pay tribute to private developers’ bottom line through public:private partnerships and tax subsides to the powerful, Baltimore and Maryland simply reflect a global trend-development which violates the human rights of individual citizens to participate and assure equitable benefit. Recent projects include the plan for privatization of public housing-subsidized by HUD- and transportation in the form of the Red Line in Baltimore and the Purple Line in the International Corridor (1, 2, 3, 4). Both are subsidized by federal and state dollars aimed at appeasing corporate power and threatening displacement and gentrification. This trend of public:private partnerships was highlighted at recent UN meetings on post-2015 sustainable development and the role of private power in drowning the voice of civil society, violating their human rights (4). They brought front and center the critical need to stop continued privatization and public:private partnerships which diminish democracy and minimize citizen participation, in its attempt to grow the profit of corporations.

In Maryland and nationally we continue to witness this same trend in non-sustainable development and public:private deals which drown out democracy and assure political and economic inequity. And just as the international civil sector demands greater accountability and transparency of public:private partnerships, tax subsidies, corporate profiteering, and lack of community participation, we demand the same. Specifically, the criteria offered to the UN to assure sustainable development post-2015 is an insightful framework for us to adapt in our call for public-lead development with a human rights-based ethic (5). Such criteria would investigate the powerful actors negotiating on their behalf while positing themselves as benefiting the local, national, and global economies and communities. The five criteria question:

– whether the private actor has a history or current status of serious allegations of abusing human rights or the environment, including in their cross-border activities;
– whether the private actor has a proven track record (or the potential to) deliver on sustainable development commitments emerging from the post-2015 process;
– whether the private actor has previous involvement in acts of corruption with government officials;
whether the private actor is fully transparent in its financial reporting and fully respecting existing tax responsibilities in all countries it operates, and not undermining sustainable development through tax avoidance;
– any conflicts of interest in order to eliminate potential private donors whose activities are antithetical or contradictory to the UN Charter, the Universal Declaration of Human Rights, and the SDG [sustainable development goals] framework (6).

Locally we can adapt similar criteria in discovering who’s at the table negotiating on their profit-making behalf and the extent to which public dollars subsidize unequal benefit for private developers-growing the health and wealth gap. The future of sustainable development requires an assurance that equitable partnerships exist going forward and previous corrupt corporate entities and their affiliates do not lead development or benefit disproportionately from public contracting or sub-contracting (7).

Baltimore can begin with an analysis of past developments to include amount of tax subsidies and ratio of benefit to developers and local communities, amount of benefit in the form of local hire, economic growth, local business ownership, live-able wages and benefits provided by new developments, affordable products for historic communities, affordable housing, presence of historic communities in revitalized areas, health of communities displaced and in the revitalized areas. An entity exists in Baltimore to conduct such an investigation, the Baltimore Development Corporation (BDC). BDC’s mission “is to make doing business in Baltimore, Maryland beneficial for the business community and the workforce so we can support continued economic growth, job creation and revitalization in Baltimore City”. In order to accomplish this mission they must evaluate the way development has occurred to assure future developments benefit all of Baltimore. We would like to see a report card. The departments of housing and community development, economic development, planning, transportation, health, parks and recreation can do similar assessments of impact of past and current development on their benchmarks. Such assessments would benefit from community participation.

Other ways to assure future development is participatory and respecting human rights include realistic community engagement at all levels of planning, implementing, and evaluating. Government funding for community leadership development and community organizing to ensure community leaders are informed and ready to participate would help to guarantee democratic participation. A city planning department with community organizers on staff working directly with neighborhood organizations to increase community engagement and social capital would begin to prepare residents for decision-making roles in current and future developments (8). If the city of Baltimore could do this in the 1960’s with some success, where is the political will to implement such community engagement practices in 2014?

Activism by citizens and community organizations remain key in assuring human rights is front and center of all development. Baltimore and Maryland is waking up to activism. Those still in by-stander activism mode can switch to engaged activism. We can vote elected officials out of office who maintain heads of departments who continue the same tried and true policies that support corporate welfare. We can publicly demand that such department heads who continue policies and practices which results in inequity in housing, economic, and community development, planning, health, transportation, public safety, parks and recreation, and education be placed on notice to show different outcomes in a specific period. We can be updated on these outcomes through annual report cards from these departments. We can call and email our public representatives each time we see the same patterns of development continue with inequitable outcomes.

Such opportunities for organized activism are upon us today. The Maryland Commission on Civil Rights offered a symposium last week on ‘Gentrification and Revitalization’. In regard an investigation of developer Johns Hopkins Medical Institutions’ expansion in East Baltimore over the past 60 years, HUD’s Baltimore office offered the audience direction in pursuing this. In a few weeks Baltimore’s Public Justice Center is hosting a discussion on residents’ demand for inclusion in housing policy and practices being administered through HABC and HUD’s Rental Assistance Demonstration (RAD) project-“Democratizing Development” (9, 10). Casa de Maryland continues to seek support to combat displacement of immigrant businesses and residents because of the expansion of the Purple Line in one of Maryland’s most diverse immigrant community (3). It’s Our Economy is hosting a wealth-building conference to address poverty in Baltimore in May (11). Johns Hopkins Hospital service workers will rally for a livable wage on May 10 after the hospital neglects to return to the negotiation table (12). The recent announcement by Baltimore Development Corporation and Housing Authority of Baltimore City inviting proposals for development of a portion of the Old Town neighborhood in East Baltimore offers us an opportunity to practice with the criteria listed above (13). Why? There exists an organized group of local community leaders and stakeholders who have been meeting, organizing residents, and drafting a community-informed master plan for almost 10 years for this area-Change-4-Real (14). They have done the hard work of building a democratic and community participatory model supporting equitable benefit through community-focused economic development. Whether they receive the contract for development of this area will speak volumes to the use of the above mentioned international criteria for sustainable development with human and civil rights agendas. Baltimore and Maryland must begin to hold public:private power accountable through participatory development that respects the dignity of every individual. Anything else is a violation of all our human rights.

1. Privatization of public housing
2. The power of public:private partnerships
3a. Corporate welfare
3b. The greed of power
4. Purple line in the International corridor
5. Post-2015 development criteria
6. Sustainable Development Goals
7. Private developers benefit from public subsidies
8. Baltimore Sun. December 15, 1968. Renewal with a difference
9. Rental Assistance Demonstration project
10. Democratizing Development. Public Justice Center May 6
11. It’s Our Economy
12. Hopkins workers rally for livable wage
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13. City announces plan for Old Town development
14. Change-4-Real