Healthy Communities Conference Ron Sims 1. As I was saying about my good friend, Dr. David Fleming, I think that,

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1 1 As I was saying about my good friend, Dr. David Fleming, I think that, not only was he doing incredible work on the community development side. But I should also point out that he was a part of a team, a group of people that changed King County s health care system. We made a decision as a health care provider that our insurance company would actually encourage wellness. Rather than wait for people to be ill. And that we would build into the whole series of wellness strategies. And it has worked spectacularly well. And that we d also change the health care system, which people said we couldn t do. And they made a decision to do. Delivery based upon performance and practice. And then rate them publicly. And that is also working very well. So thank you for your leadership. But I want to take to you about some work that his group did that was spectacular for us on the community development side. We had done through our demographers, and then through our health care professionals, a look [?] and saying what can we say about health care in King County? And remember, it s the eighth richest county in the United States after backing out [?] billionaires, because we have so many. You put them into our mean [?] data and they just blew it. So we extracted them. And we were still the eighth richest. I mean, you have to take out Bill Gates. And you gotta take out Paul Allen. You gotta take out the Microsoft. They just kind of blow data. And what we found is that we were able, in looking at equity issues, to predict health care outcomes by zip codes. Now, we could tell you morbidity rates by zip code. We could tell you the long-term earnings of children by zip

2 2 code. We could tell you what you were going to die of by, actually, morbidity rates. What illnesses you would get by zip code, even the treatment you were likely to get by zip code. And for us, it was pretty stunning because we thought we were doing all things well. We thought we were perfect. That there was no way in the world that our land use policies would allow for a community, just because it existed, to have a disparate and a significant disparity in health care outcomes, but they did. Previously to that, we had done a Lutack [?] study, which was the first in the nation, where we actually looked at transportation policy. What does a commuter, what are their health conditions likely to be? People who take public transportation, what were their health conditions likely to be? And we modified, basically, our comprehensive land use plan to reflect the need to discourage sprawl. And to encourage what we call more density based upon the Lutack study that said that densities resulted in healthier people. Sprawl resulted in unhealthy people. But going back to the issue of how we develop. When you go to thirty thousand feet and you look down on King County, what you would see is that design matters. The nature of a home and the nature of a neighborhood. When people tell me about encouraging people to walk, that is great when you ve got wide sidewalks. It is great when you have good site lines. It is great when you have a park within a quarter mile of your home. It is great when the house faces [?] are lit. It is great when you have a supermarket nearby. All those things are really important. But in most urban neighborhoods they don t exist. So telling a person who is seventy years

3 3 old, if you go out and take a walk you can deal with your type 2 diabetes. They re going to say, I don t feel safe. And decide whether [?] it can work for me. It s too close to this street. There s no room on it. There are no good site lines. So, from what we re doing in HUD is, I ve taken what Dr. Fleming taught me. And I brought it back here and simply said, you know, there are two significant factors right now that are affecting health care outcomes in America. One is your personal habits. And the other is nature of the home and neighborhood you live in. And if we had continued to allow the growing rate of type 2 diabetes, excuse me, obesity among children. And that hits into early onset of type 2 diabetes. Our health care system is not formulated to handle it. It ll break it. So, to us, on the HUD side, we are being very, very aggressive about saying we really got to think about neighborhood design. And houses in terms of what would be a health outcome. So, we re a development agency, very much thanks to Mr. Briggs here, who s insisted that we work with other agencies which has been absolutely delightful. But our goal is to say why don t we integrate transportation systems. Why don t we integrate parks? Good schools? Why aren t we talking as a federal government in a, we call, one voice. I was the elected head of King County, and the federal government never spoke in one voice, ever, on anything [laughter]. So what is nice now, under President Obama s administration, is we re getting coherent. We re getting coherence. And you ll see that in the sustainability grants that are coming out. Because in the sustainability grants, we are saying how are you going to grow

4 4 on the transportation side, the housing side, health side. Your parks and your schools. And we want them to think regionally. We re also saying we ll be going through a process called a Consolidated Plan. Anybody we see has [?] a community development block grant has to do a Consolidated Plan. And in the Consolidated Plan, we re going to ask the same questions. How are you growing? And what is the impact of it? It directs both what the federal government will do in terms of funding. It will direct what happens when you get community development block grant. But one of the issues in it that we re going to make really clear, is we want health resolution. We want zip codes to ultimately be an address, but not a life determinant. And we can t sit passively by and allow it. So, we re directing a lot of our attention toward the development of, we call it, comprehensive neighborhoods, smart neighborhoods. Sustainable neighborhoods, livable neighborhoods. Neighborhoods that have diversity. Neighborhoods that end disparities. All those things that are lofty ideals, but we re saying can no longer be ideals. They have to be things that are going to happen in this country as a matter of course and development. And that s where our money is going. That s where our focus is going. But underneath all that is health care. We have some other initiatives. We have one called the Transformation of Rental Assistance. People say why do you feel so strongly about that. I say, because we want to empower poor people. Why? Because if we give them a voucher, because we have four point six million people, families, on rental assistance in this

5 5 country. And we have said if you give them money, you ll give them choice. And their choice is to move into a better neighborhood, or to [...?...] do that, and attract new investment. We re saying that the only way to break the cycle, I call the chains of poverty, to attack it, and to do it smartly, is to give people choice. And that s what we re trying to do. Now, we re having a hard time explaining that to people. But nonetheless, HUD is striving [?] to basically saying we can no longer allow neighborhoods that win, and neighborhoods that lose. We can no longer have neighborhoods that we call good neighborhoods. And neighborhoods that are bad neighborhoods. Every neighborhood should work for every one of its residents. Whether they re children, whether they re adults, or whether they re seniors. So we have not, you know, we re not standing away from the issues of what constitutes a healthy neighborhood. It is not just whether people feel good about their neighborhood. It is actually whether they physically are going to be better off in that neighborhood. It is whether children are going to have a chance to get the same levels of education in that neighborhood. Are we going to design their homes smartly? Are we going to design the sidewalks smartly? Their parking smartly. The services they get, smartly. All those things have to be focused on what we call the ultimate thing, which is to making sure that they walk out with strong physical well-being. So, like I said, I gotta thank the county for its incredible work. And Dr. Fleming s shop [?]. And all the people who orchestrated that, there were a number. This tool that we have is predictive [?] anywhere in the country,

6 6 anywhere. Portland just applied it to a six county area and got the same data the ones in King County got. So they can predict by zip code, disparities and health care outcomes in Portland. And PBS did it for Modesto, California. So we re no longer debating whether or not we have tools that measure it. What we re doing in HUD is saying no more discussion because everybody likes to talk. And everybody likes to meet. And they ll talk, and they ll meet. But the losers will be the people in those neighborhoods. And we re saying, you know, no more. No more. Just, no more. So, like I said, we re tied together. I do need to thank Xavier though, because he s going to be very modest up here, and I can t let him do that. The nice thing is to be able to have brains like David Fleming, and early in my life when I was a county executive. And then have a person who gets it from O and B [?]. Because I can tell you that the real issue is, we ve gotta get past debate. Everybody wants more and more studies. I mean, you can t go into a poor neighborhood and say I m going to study you one more time. You can t say that. They ll say, wow, you ve been studying us for generations. I mean, what do you need to know? What do you need to know before you act? And so we have moved to an action stage. And people can say, is that perfect? I don t care if it s not perfect. I mean, good works if it saves lives. Good works if it creates futures. Good works if people perceive their neighborhoods to be healthier and safer. And so we ve moved more to action elements in our work. And what is exciting about that is, yet, is it an experiment? And the answer is it s a wonderful experiment. The goal, in our

7 7 opinion, is achievable. So, whether it s working with the developers, or working with cities. Working with philanthropic groups, or working with counties, or states, HUD is driving an agenda. And it simply says zip coded will be an address, not a life determinant. And they ll be no bad zip codes. Thank you. [Applause] [END OF TRANSCRIPT]