Part 2: Reducing the Urban Health Penalty: 3 Ways Smart Cities can take on SDOH
(Part Two of a Two Part Series)
In Part One, we took a look at one of the major challenges of today’s reigning approach to designing Smart Cities: That the discussion and development veers towards surface level technology opportunities, rather than deeper, more systemic urban challenges, like the social determinants of health (SDOH). When left under-addressed, SDOH reinforce the so-called “urban health penalty,” which winds up costing us more in the short term, and reinforcing the intergenerational inequities that undermine our collective prosperity over time.
Across the country, hundreds of urban health innovations are bubbling up, aimed at issues ranging from homelessness to housing, transit to treatment, and many important programs in between. These may not be the same sort of “Smart City” initiatives that we’re all used to hearing about, but in many cases they embody the movement’s goals. Below are three different examples of initiatives or approaches that combine strategic use of data, public-private partnerships, and an eye towards more resource-efficient, human-centered urban living.
Improve Access to Health: Smart Directories for Cities
When people in healthcare talk about “access,” they tend to refer to insurance coverage and medical care, rather than the broader help that people need in order to live healthy lives at home, work, and in their neighborhoods. How can cities make it easier for people to gain access to food, childcare, or transportation options? In an era of accountable healthcare, what can be done to help organizations close the loop to ensure people are actually getting the support they need?
Several companies have developed digital tools to connect supply and demand for social services in cities:
One Degree offers a web-based resource directory with medical, social, legal, financial, and other categories. It’s used by more than 2.4k health and social workers, and serves more than 15k people each month in the Bay Area and down the California coast.
UniteUs is a similar startup on the east coast that takes a partnership approach to build infrastructure for community referral networks. Originally focused on connecting veterans with needed social, financial, and behavioral support, they’ve since expanded into other public sector initiatives in several cities and counties, and in one case, an entire state (though to be fair, it’s currently limited to Rhode Island).
Other suppliers include NowPow, Healthify, and a growing list of other startups. How might a Smart City incorporate such tools into their efforts? New York City offers one example. The city recently partnered with Aunt Bertha on their LinkNYC internet kiosk project to develop a “Yelp for Social Services.” Aunt Bertha, an Austin-based public benefit corporation, recently published a blog post with utilization data from the project, showing that housing, food, and money are top concerns for people in NYC.
Whether through consumer-facing kiosks, mobile apps, web browsers at public computers in schools or libraries, or by arming health workers with up-to-date data, improving access to social support represents low-hanging fruit for Smart Cities around the country.
Prevent Disease: The San Francisco Cancer Initiative
The San Francisco Cancer Initiative (SF CAN) is a collaborative effort led by the city’s public health department and UCSF that aims to prevent and reduce disparities in five leading types of cancer in the Bay Area. The program consists of a data-driven planning phase, coupled with five dedicated task forces that “explore the social determinants of cancer in San Francisco that lead to unhealthy environments and give rise to the “causes of the causes” of cancer.”
Minus the up-front data analysis and epidemiology, SF CAN is a surprisingly low-tech endeavor built on intensive, community-level assessments of social needs, education, and behavioral drivers of cancer, as well as a spate of real-world interventions. These range from mini-grants for church-based campaigns, to the development of picture-based screenings or multi-lingual phone lines and focus groups aimed at non-english communities.
The multi-year effort has only just begun, but holds a lot of opportunity for digital turbocharging, such as the use of geospatial tools or social media to enhance outreach and data analysis. Though the list of partners is extensive, including multiple health systems and over a dozen community coalitions, the absence of any tech firms or startups stands out - especially given the innovation-heavy reputation of the Bay Area.
Imagine what could be accomplished if a citywide public health campaign like SF CAN was able to partner with major telecom carriers, or a cell phone manufacturers, or mobile operating systems?
Solve a Wicked Problem: Cities Reduce Infant Mortality
Infant mortality has been called a national embarrassment, but reducing it is not a matter of pride - it’s a matter of principle. Not only is infant mortality highest in majority-minority urban centers like Detroit, Washington DC, or Cleveland, but within those cities, the problem is often concentrated in a handful of neighborhoods. In the US, babies dying simply because of where they are born is damning proof that our zip code matters more than our genetic code.
Several cities have taken notable efforts to address the issue. The city of Columbus, Ohio set up a task force that helped set a goal of a 40 percent reduction in infant mortality by the end of the decade, largely by improving transportation to needed medical care.
After this proposal helped Columbus win the Department of Transportation’s smart city award, city officials collected proposals from university researchers and private sector firms like Sidewalk Labs. These ranged from alternating bus routes to speed up city transit, to setting up dedicated kiosks in select neighborhoods, to SMS-based paging tools for women to get the rides they need. Unfortunately, this is where the ride came to a stop: Despite all the planning, the city has not yet taken action on any of these ideas.
This is an area where low-tech intervention beats inaction every time. The city of Baltimore has reduced infant mortality by 38 percent between 2009 and 2015 through a home-visit program for pregnant women and new mothers, as well as educational campaigns and dedicated task forces comprised of cross-sector experts who review case data and inform responsive policymaking on an ongoing basis.
Investing in nurses and social workers to visit homes instead of asking pregnant women to board a bus and cross a city may not seem particularly innovative, but it’s effective, it’s patient-centric, and importantly, there is increased funding for such investments thanks to a 2016 amendment to Medicaid managed care program.
Is 2018 the year that Smart Cities take on SDOH?
Despite ample opportunities to prevent disease, improve quality of people’s health and livelihood, and even save lives, serious challenges remain. For one, resources are tight, and healthcare programs remain on politically precarious ground. On the technology and data front, technical innovation in city government is simply not where it needs to be, due to limitations of cross-departmental data sharing or analysis (e.g. between housing and human services), or even the misunderstanding of federal privacy laws. Finally, the perverse culture of healthcare’s profit motives cannot be overstated.
Yet despite those barriers, there is still plenty that can be done, often without much more technology than a website or a rideshare app. Moreover, we’re seeing trickles of progress spring through those barriers. Impact Investing is a growing opportunity for cities to experiment how far they can stretch public health dollars. Some public health agencies have adopted cutting edge geospatial tools from vendors like PolicyMap or Conduent to help them turn staid data warehouses into interactive maps. And some hospitals are demonstrating a sense of self-awareness as a member of their city’s community beyond the medical care they deliver.
If private companies and local governments decide to herald in a new wave of progress around urban health as part of Smart City projects, they’ll need to partner up to identify and reverse engineer existing successes, scale up promising models, and lower the barriers to change that have plagued both the healthcare industry and the public sector for so long. Though we may not see the progress we hope for this year, or even in 2019, it’s on the Smart City community of thought leaders, public planners, and private innovators to piece together comprehensive, local visions that can serve as the canvas for tomorrow’s “smarter” approach to urban health.