PROVIDENCE – A week after the election, Richard Jackson, chair of Environmental Health Sciences at UCLA, held court in Rhode Island, as part of a collaborative conversation, “Place Matters: Design for Population Health,” engineered by the Rhode Island School of Design and the Brown University School of Public Health.

Jackson’s message was direct, blunt and provocative: health was the new sustainability, and it demanded a new kind of population health analytics – a health impact assessment, a different kind of risk identification, quantifying the value of people’s health. “Put people first,” he said. “Make healthy choices easy.”

As an example, Jackson reframed the epidemic of obesity and diabetes in the U.S. It costs about $200 billion a year to treat diabetes, Jackson said, with much of the expense borne by taxpayer-funded Medicare and Medicaid. The best way to treat the disease is through access to healthier food, more exercise, and better diet choices.

The scourge of diabetes, Jackson continued, is rooted in poor policy decisions by the government – the hundreds of millions of dollars a year invested in price supports to grow corn, soy, wheat, and sugar beets.

Instead of investing in the production of high-fructose corn syrup, the government should be investing in sidewalks, in bikeways, in safe neighborhood playgrounds, Jackson said, showing a slide from Atlanta, with a pedestrian trying to cross eight busy lanes of traffic.

Jackson also touted the new sugar soda tax enacted by voters in Berkeley, Calif., aimed at reducing the effects of sugar consumption on health, as a tipping point in health policy decisions to address the diabetes and obesity crisis. The measure places a penny-per-ounce tax on most sugar-sweetened beverages, and is expected to raise more than $1 million a year, to be re-invested in public health projects.

Changing the landscape in Rhode Island
With Jackson serving as an agent provocateur, the conversation, despite its academic setting, cut to the chase: if one-quarter of all economic activity is spent on health care, what strategies will move public health, health innovation, and investments in neighborhoods in order to create a more sustainable economic future for Rhode Island?

Attempting to answer that question, following Jackson’s keynote, were: Nadine Gerdts, from the Department of Landscape Architecture at RISD, Manuel Cordero, president and founder, DownCity Design, Akilah Dulin-Keita, assistant professor of Behavioral and Social Sciences at the Brown School of Public Health, Dr. Michael Fine, director of the R.I. Department of Health, and Peter Asen, director of the Healthy Communities Office. Charlie Cannon of RISD served as moderator.

Jackson’s message – and the conversation that ensued – was the kind of freewheeling, insightful dialogue that could help to reshape the political, electoral and community landscape in Rhode Island.

If, of course, anyone beyond the auditorium walls of the Perry and Marty Granoff Center for the Creative Arts – in particular policy makers and transition team members for Gov.-elect Gina Raimondo and Mayor-elect Jorge Elorza – were paying attention. They were not in attendance.

Or, if the conversation were shared. No news media covered the event, save for ConvergenceRI and a reporter from the Brown Daily Herald.

Jackson’s pitch
Jackson, who views himself as a kind of change agent for public health and community design, interwove his personal and professional journeys. In turn, he urged the students in the audience to become change agents themselves.

His father, an Air Force veteran, who fought in the battle of Iwo Jima, died suddenly from polio after returning from World War Two; Jackson showed a slide of his father’s obit published in the local Maine newspaper.

Jackson called polio one of the scourges of infectious diseases – measles, mumps, diphtheria – that had been vanquished by investments in public health, in immunization and infrastructure.

Jackson had entered the seminary, intent on becoming a priest – until he read Thoreau’s Walden, in which he found a connection to the world around him he found missing from the dialogues of Plato, he explained.

Jackson then trained to be a doctor – but chose a career as an epidemiologist after attending to children with birth defects that appeared to be linked to environmental hazards from pesticide use.

In his career, Jackson worked for the Centers for Disease Control and Prevention in Atlanta, where he established a national asthma control program and oversaw the childhood lead poisoning prevention program.

He also led the California Health Department under Gov. Arnold Schwarzenegger.

Jackson called for the creation of “health impact assessments” as a way to invest in healthier neighborhoods, in children, in older people.

The panel responds
The members of the panel, bridging the silo between RISD and Brown, between academics and city and state officials, began the discussion as an effort to find common ground.

Asen described the problems of managing infrastructure demands within 18 square miles of Providence, and having to cope with things such as abandoned mattresses in vacant lots, as a local government, amidst the efforts to focus on initiatives to build healthier communities.

Cordero talked about the “awesome” serendipity of having the city’s Office of Sustainability being led by Providence’s former policy director, bringing with her the understanding of how sustainability connected to policy.

Cordero also spoke about the importance of “ownership” as urban landscape was redefined by a new urban garden on a vacant lot, and the pride that a middle-school student took in the project. “Guys, there was nothing here before,” Cordero said, quoting the student,” surveying the new garden.

Dulin-Keita spoke about the importance of inclusion, bringing all the stakeholders to the table, and how the design process needed to work with the community first. She also stressed how increased “safety” reduced the perception of fear.

Gerdts stressed the importance of love of place and ownership by the community, making the connection between health, environment and place. Health is about relationships, she said.

Fine, in discussing his proposal for Neighborhood Health Stations, described how the work in Central Falls had brought together many of the concepts discussed by the panel members: a community needs assessment identified what the residents wanted, the process brought everyone to the table – residents, the school department, community health centers, the local hospital.

The Neighborhood Health Station, Fine continued, featuring everything from primary care to urgent care, physical therapy, a pharmacy, a gym, behavioral health, would serve as way to re-create community – as well as reduce medical costs by 30-50 percent, by its preventive approach. “We’re not building a building, we’re building a community,” he said.

The progenitor of the first Neighborhood Health Station in Rhode Island is already in place, a collaborative school-based health clinic at Central Falls High School, which opened in late October.

Diversity, gentrification, community
The audience jumped into the conversation, asking about the structural violence of funding decisions by the R.I. General Assembly, the problems of gentrification of neighborhoods that have been reborn, the issues of diversity within an urban environment, and the economic challenges of the existing tax structure.

Jackson argued that by building a connection to community, a sense of place, the dismal 40 percent turnout in the most recent election could be reversed. The key is giving people a sense of ownership of their neighborhood, rather than just being a consumer of products.

In terms of diversity, Cordero repositioned the conversation around diversity to focus on older people in Rhode Island, and the need to include them into the conversation and the neighborhood. “What do we do with old people?” he asked rhetorically. “We ship them off.”

Fine pointed out that 25 percent of economic activity is for health care, and by spending it locally, through a Neighborhood Health Station, it leverages the economic activity for the benefit of the local community.

Gerdts stressed that design is a tool and a process, not a style.

Jackson closed with an exhortation about the need to change policies, the desire to protect the public health, safety and general welfare: “I am tired of reading environmental impact statements; I want to read a health impact assessment, detailing what happens to children and older people.”