live / 2014



Idea submitted in the My LA2050 Maker Challenge by LINCOLN HEIGHTS HEALTH INITIATIVE

Transforming Lincoln Heights by creating access to health services and nutritional food through new internal transportation networks.

Please describe yourself.

Collaboration (partners are signed up and ready to hit the ground running!)

In one sentence, please describe your idea or project.

Independent City Planners affecting change through innovative, opportunistic, community-based projects.

Does your project impact Los Angeles County?

Yes (benefits a population of LA County)

Which area(s) of LA does your project benefit?

  • East LA

What is your idea/project in more detail?

The overall HEALTH of a community can be understood within a complex system of social determinants. In fact Lincoln Heights can best be defined by the inaccessibility to solutions that are already found within it. Our initiative creates access to existing health infrastructure while building supportive community services. Goals: To promote accessible healthcare and healthy living options for LH residents. Connect local health centers, childcare, schools, low-income housing, and healthy food providers, through a physical network of transportation routes. Foster collaboration among healthcare providers, community members, and local government to implement targeted health programs and infrastructure informed by data-driven best practices.

What will you do to implement this idea/project?

This project will create a framework to implement programs that address public health, connectivity, and maximizing local health infrastructure. The logistics will operate as two symbiotic initiatives: the “community hub” and the transportation network. Technology will also play a vital role. Mobile applications can facilitate the efficiency and integration of our programs. Using this technology, a user could purchase fresh produce located at the hub, track and easily access the shuttle service, and communicate with health service centers. This mobile app will also help to collect data, and create metrics of analysis.

• Community Hub: We envision an innovative entity that consolidates public services into a singular site. This hub will contain health services, a daily produce market (recently funded by USC), and a central transportation stop—the hub will be a point of ingress to LACUSC Med Center and throughout the community. Given the lack of access to fresh produce, we have already partnered with USC to create a weekly farmers’ market and daily produce market. Complimented by preventative health services, providing a consistent source of fresh produce will help a community that is vulnerable to nutritional diseases. As part of our comprehensive health program and effort to bring USC Med Center and Los Angeles County Hospital further into the community, we are partnering with the medical school to bring preventative health services administered by USC. Located on the same site, these services could include mobile testing units, health information kiosk, and an active residency/internship program.

• Transportation Network: Lincoln Heights has internal gaps in transportation infrastructure, and barriers exist within the built environment that inhibit movement, access to public services, and connections to the larger network. To transcend these impediments and create a more robust system, we are creating a service network that connects the community hub, Metro Gold Line, the LACUSC campuses, and other underserved areas such as the Ramona Gardens Housing Projects. The community hub, therefore, becomes an emanation point to access supportive services, hard to access medical services, and the larger public transportation network. This program can be implemented quickly through local operators and become phased into MTA service.

How will your idea/project help make LA the healthiest place to LIVE today? In 2050?

In LA, mobility is an issue of equity. The size of LA has allowed a great diversity of people to live within its sprawl. The unsustainable compromise, however, is that this lack of density creates areas without adequate support. The result is that entire neighborhoods, often segregated by their socio-economic circumstance, are bereft of services and therefore vulnerable to poor health. In LA, access to transportation can define the health of a community. While the city is making improvements to the subway system, underserved neighborhoods need better pathways to connect to services and the larger transportation network. The LHHI model is designed to create access to health services, supported by community-based transportation and the concentration of public services. The Lincoln Heights’ demographics and risk factors are similar to many areas throughout East and South LA; the impact of creating independent nodes that support health would be profound.

This engagement reflects the disparate nature of the city itself. Within the sprawl, thriving diverse communities are isolated from one another. A healthier LA will be one that can move throughout the city with ease, within the neighborhood and beyond. If replicated, the underserved communities of Los Angeles will create nodal networks that overcome the disparities of access to health and healthy environments. Additionally, these nodes would generate investment and development, bending the built environment to service its most vulnerable residents.

Major health institutions will have a model for community engagement and accessibility that reflects the comprehensive care model mandated by the new Affordable Care Act. To wit, health care providers must institute preventative mechanisms to offset the unsustainable cost curve of treating chronic and endemic diseases prevalent in underserved communities. According to the American Public Health Association, 7 in 10 deaths in the US are related to chronic conditions such as obesity, diabetes, high blood pressure and heart disease, which are often preventable. Shockingly, 75% of our health care dollars are spent on treating such diseases while only 3% are spent on prevention.

LHHI will target the nearly 40,000 residents in the neighborhood, supporting the population before the individual is affected. The project is designed to be replicated in similar conditions throughout the city.

Whom will your project benefit?

The LHHI will represent a consortium of care providers, business leaders, and community partners that will drive holistic, community-based strategies for achieving a healthy, equitable, and sustainable LH. The initiative combines the best practices of an accountable care organization with a neighborhood improvement district to address simultaneously public health disparities and connectivity concerns. Its mission is informed by the alarming disconnect between the economic and spatial dominance of the LACUSC Med Center and the public health vulnerability of the community. In response to data describing the current condition in Lincoln Heights, it is apparent that a holistic development strategy would benefit the majority of the community.

48% - High School Graduation Rate 46.2% - Experience Housing Burden $29.825 – Median Household Income 65.8% - Federal Poverty Level

Cross referencing the social determinants of health with the LH ethnographic data, the Latino and Asian/Pacific Islander populations are severely at-risk. The Latino population is at risk for metabolic, nutritional, and cardiovascular disease, while chronic hepatitis B and C are prevalent in Asian/Pacific Islander populations. Both are precursors for increased incidence of liver cancer. Untreated, these conditions can have serious health effects throughout a population. This project, however, is meant to reach beyond access to direct medical services and address the larger environment. The social determinants of health affect those in the population who are not necessarily sick, but do not have the resources to support healthy living and become vulnerable. These determinants are being increasingly recognized as interconnected.

Former Secretary of HUD, Shaun Donovan articulated this when describing new metrics for measuring housing affordability as factors of transportation costs, noting that for most families, transportation is their second-highest monthly expense after housing. This project will benefit the nearly 20,000 people who experience housing burden in LH who may not have the available resources to address health and transportation. Engaging quality of care on this scale will initiate a redistribution of resources that will affect other social determinants of health.

Please identify any partners or collaborators who will work with you on this project.

Citymart: is a tech company based in Europe that generates and disseminates “smartcity” solutions to governments and developers. We will contract with this forward thinking group to develop and license the mobile applications used our transportation and service networks.

LA PREP, LA KITCHEN: LA PREP will house incubator and training kitchens for local entrepreneurs and non-profits dedicated to social enterprise and culinary programs. These entities are confirmed partners and collaborators on our farmers’ market grant.

Diabetes and Obesity Research Institute: DORI will provide medical and research expertise and design and administer the health metrics to measure success. DORI is located in Lincoln Heights and is familiar with the area, demographics, and health risks.

USC Violence Intervention and Prevention Clinic: An early supporter of our initiative, Dr. Astrid Heger and the VIP work to create healthy environments and pathways to supportive services. Dr. Heger has acted as a consultant and facilitator within USC for the LHHI.

UCLA-USC CENTER FOR POPULATION HEALTH AND HEALTH DISPARITIES: Like the DORI, this center is essential to facilitating and providing the best support for the public health of this population. We will collaborate with them to generate and analyze data, commission studies, and consult on strategy.

EL ARCA: Provides essential services to the developmentally disabled population of Greater LA. EL ARCA operates a bus fleet to transport their clients throughout the city, which we may contract for our transportation network. We have worked closely with this group on the farmers’ market grant.

Clinica Romero: Another important community health center, as they conduct outreach to the Ramona Gardens Housing Project. We hope to learn from their experience and include them in the connectivity network.

Arroyo Vista Family Health Center: Their services and presence will help to establish a wellness district along the Broadway corridor.

LACUSC Med Center: The objectives of the LHHI, align with LACUSC strategic interests as it seeks to minimize costs and improve community relations.

CITY OF LA: Aligns with many of the public health, transportations, and economic development strategies pursued by various city agencies. By pooling the resources of the city and health centers, the LHHI can promote the area as an ideal location for health targeted industry clusters and health infrastructure.

How will your project impact the LA2050 “Live” metrics?

  • Access to healthy food
  • Healthcare access
  • Number of households below the self-sufficiency standard
  • Obesity rates
  • Walk/bike/transit score
  • Percentage of LA communities that are resilient (Dream Metric)
  • Percentage of residents receiving coordinated healthcare services (Dream Metric)

Please elaborate on how your project will impact the above metrics.

Please refer to the following question regarding evaluation, which addresses the above metrics comprehensively.

Please explain how you will evaluate your project.

The LHHI relies upon data-driven metrics to measure and react to services in real time. Each component of the system: transportation, the community hub, and health services will generate data to evaluate the program individually and collectively.

Transportation: Through the development of our mobile application, we will gather data on ridership and distance travelled. We will also evaluate alternative nodes as they emerge in real-time, adjusting routes if ridership and connectivity demand. If the LACUSC health services provide a specialty clinic, for example, the application would communicate this to users and adjust the shuttle capacity as needed.

HEALTH: LACUSC, as LH’s anchor institutions, they are essential partners in the administration and evaluation of the project’s health metrics. Specifically, collaborations with USC’s Diabetes and Obesity Research Institute, and UCLA’s Center for Population Health and Health Disparities, which studies East LA community health. Both these institutes specialize in East LA demographics and health realities as well as research best practices. They have established the “before” snapshot of the community’s health and will determine progress metrics based on this baseline data. Health metrics may include: Assessing cardio vascular risk factors, obesity and diabetes rates in the Latino Population (approx 75% of LH population); monitoring rates of hepatitis B and hepatitis as high risk factors for liver cancer in Asian/Pacific Islander population (approx 20% of LH population). We also intend to commission a study with a sample population, which would include interviews, focus groups, and further clinical engagement.

Community Hub: The services provided at the Community Hub will include satellite health services administered by USC Med Center, a daily produce market, and other healthy food vendors. This is also the location of the central stop on the transportation node. With the assistance of the mobile application, which streamlines the shuttle service, health and food service programs, we can evaluate data on patronage. This will include number of WIC and SNAP exchanges for nutritional food purchases.

The strength of this integrated platform is the evaluation of data across programs. When this information is analyzed against one another, we will begin to assemble a real metric of success. For instance, does ridership and trips to the community hub correlate to obesity and diabetes rates over time?

What two lessons have informed your solution or project?

  1. Change comes from within: As trained City Planners, we are looking at the entire system of Lincoln Heights and the social determinants of health in the built environment. We are evaluating the impact of large city projects such as investments along the River as well as the community’s access to nutritional food. The bird’s eye view of LH shows a neighborhood that is severed from amenities on all sides. The rail and freeway, implemented during urban renewal from the last century, have bisected historic connections to downtown, LACUSC, and the central business districts to the north. This relative isolation has contributed to the disparities of access that LH experiences and requires innovative engagements to repair these pathways. However, an important lesson for City Planners and developers is that even best intentions have the potential to negatively affect or destroy the culture of a neighborhood. The city’s abundant freeways, meant to move the people and economies throughout the region, resulted in the opposite condition for much of East LA and its residents. The task for many governments and planners in the 21st century has been to undo or transcend the barriers constructed in the previous century. In our view, the solutions should not be imposed upon this community. Rather, we will provide the infrastructure to empower them to dictate their own development.

  2. Health is the basis for all Engagement: LH remains vulnerable and at risk despite the many amenities and resources within and surrounding the neighborhood. If the issue cannot be a matter of supply, then why does the community experience health disparities? As described by the Camden Coalition of Healthcare Providers, “Frequently in large, urban environments across the country, healthcare delivery is fragmented, episodic, uncoordinated and extremely inefficient.” The philosophy of this initiative is that social determinants of health are the basis for engagement. Making these critical connections and building supportive health services should be the primary force of development. Healthier communities and environments translate to vibrant economies and increased real estate value. Without healthy people, there cannot be healthy places. This project is building the foundation for growth by addressing the most vital and prescient issues that affect the majority of the LH community—HEALTH ACCESS.

Explain how implementing your project within the next twelve months is an achievable goal.

Implementing the LHHI within twelve months is an achievable goal because the majority of the programming and infrastructure already exists. The strength of this initiative is its simplicity. The health institutions are within the neighborhood, yet slightly out of reach. The concentrations of public and residential life, such as metro rail stop and Ramona Gardens Housing Project, are disparately located with negligible pathways between them. Our goals are facilitating connections, rather than remaking the wheel. Major Initiatives:

• Securing a site to house and build out community hub.

•The enlistment of a shuttle and local networks and the licensing of a mobile application to create efficiency of service across programs. Technology has allowed for reactive transportation solutions like Lyft and Uber to provide efficient movement as alternatives modes. This program will have similar roots, but will serve a community on a specific route rather than an individual. This model is prevalent internationally in underserved communities from Brooklyn to Brazil, as informal means of transportation deliver people from the periphery into city centers. We will innovate one step further and create an internal loop servicing an entire neighborhood. Mobile applications will streamline payment, display location of buses, and integrate within the other programs. However, not having access to mobile smart devices will not inhibit participation.
Long Term Objectives:

• Market LH as the site of innovative, community-focused health care practice and research, and repurpose underutilized and vacant industrial and commercial sites for use by health industry firms and organizations.

• Link health care providers and local growth industries, and incubate start-up firms.

•Develop the local workforce through educational and career opportunities, especially in the health and science fields.

• Ultimately, LH needs a strategy to prepare and market the district’s warehouse and small industrial sites to tenants that contribute to this area’s health infrastructure. A coordinated effort between the LHHI and LACUSC could acquire, combine, remediate, and market these sites to medical device manufactures and health-related service providers. Buyer arrangements with local health institutions for health-related materials produced within the district could reduce costs for institutions and motivate new business to locate to the area.

Please list at least two major barriers/challenges you anticipate. What is your strategy for ensuring a successful implementation?

• Building an integrated Network:

The sustainability of this project relies upon the integration of each service, program, and engagement. As we have articulated, many services and organizations already exist but are inaccessible and isolated. Our task will be to facilitate partnerships amongst the stakeholders, from larger institutions to local property owners and community groups. The consistent challenge we anticipate will be creating and maintaining these connections. We have already confronted this challenge in our initial development phase. Partnering with USC, we have received a grant to improve access to nutritional foods through the creation of a LH farmers’ market. Restrictions on the grantee zone nearly prevented an collaboration with LA Prep Kitchen, an innovative development with the mission of providing nutritional food to seniors, while training transitional members of the population. Falling less than ½ mile outside the grant zone, we almost missed an opportunity to leverage proximity to existing transportation and a partnership with the other development focusing on access to nutrition in the area. While we successfully appealed the grantee zone, we realized that each component must interconnect to sustain partnerships.

• Ensuring Self-Sustaining Revenue to Maintain and Scale Services: While we are depending on institutional and foundational support for this initiative, future sustainability will rely upon generating revenue. We anticipate that initial investments in the infrastructure and major components (community hub and transportation network) will allow us to create resources while maintaining accessibility to the community. This model depends upon a baseline capacity of users that will lower the price point while maintaining service. Commissioning a transportation study will allow us to determine a price point of service that accommodates the users and the scale of the network. We also expect compensation from various entities such as the Business Improvement District and LACUSC for facilitating access to their services. The community hub will also collect rent while lowering the market entry of its tenants. As the network adds services and routes, operations will depend on a constant revenue stream. To confront the primary challenge of revenue generation, it is important that our initial investments build a sound foundation for future growth.

What resources does your project need?

  • Network/relationship support
  • Money (financial capital)
  • Volunteers/staff (human capital)
  • Publicity/awareness (social capital)
  • Infrastructure (building/space/vehicles, etc.)