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“LOWER ROXBURY: DEVELOPING A HEALTHIER NEIGHBORHOOD THROUGH UPSTREAM MULTI-SECTOR COLLABORATION” responds to The BUILD Health Challenge, a national awards program funded by The Kresge Foundation in partnership with The Advisory Board, the de Beaumont Foundation, and the Robert Wood Johnson Foundation. To learn more about The BUILD Health Challenge, visit buildhealthchallenge.org. The program aims to increase the number and effectiveness of hospital, community, and public health collaborations that improve health and promote health equity. Recognizing the indelible tie between individual health and community health, the program seeks to connect the dots between downstream health problems and potential upstream solutions, and to develop a comprehensive plan to implement those solutions. The BUILD Health Challenge received 319 planning award applications in Round 1. This project was one of just 8 to 15 initiatives selected to move forward to Round 2. Partnership: To address upstream solutions to health disparities in Lower Roxbury, TACC assembled a strategic partnership with organizations deeply engaged in health delivery and place-based efforts in the neighborhood: Boston Medical Center (BMC), Boston Public Health Commission (BPHC), Boston Housing Authority (BHA), and The American City Coalition (TACC). While the partners have worked side-by-side and undertaken impactful work in smaller groups, this partnership represents a new collaboration that reimagines existing inter-organizational relationships in order to catalyze and support bold, new ideas. Partners will engage in an integrated process of sustained collaboration with each other and the community through a series of convenings resulting in a comprehensive action plan targeting short- and long-term strategies to address Lower Roxbury’s health challenges. Concept: Lower Roxbury is seeing an intensifying pace of redevelopment, spurred by an increasingly dynamic real estate market. Overall, these transformational forces bring tremendous opportunity for Lower Roxbury, but also growing risk. If investment in the neighborhood can be harnessed for the good of current residents, there is an opportunity to positively impact the determinants that drive the health of the community. If, however, the rush to development leads to the displacement of residents (often to areas with less access to economic opportunity, quality education, and adequate public transportation), the opportunity will be lost. The one-year planning process creates the time to engage in a strategic dialogue that seeks to innovate through collaboration on a range of key health challenges including displacement, a pressing social problem that cannot be addressed by one organization or sector alone. We will focus multi-sector resources on limiting displacement, coupling the need for housing quality and stability with mechanisms for family upward mobility, including mobility mentoring and homeownership for current residents. The specific pathways from which real impact can be obtained require close collaboration among diverse stakeholders; a shared vision is critical to long-term impact. The planning award will provide the impetus, resources, and assistance necessary to catalyze the dialogue and partnerships required to create meaningful action, so that every resident of Lower Roxbury can benefit from the ongoing neighborhood change reshaping their community. Contact: To learn more about this project and TACC’s health-related initiatives, contact Zachary Nieder at zachary_nieder@tamcc.org or 617.822.7389.

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THE BUILD HEALTH CHALLENGE PLANNING AWARD, ROUND 1 APPLICATION SUBMITTED 1.16.15 FUNDING PARTNERS: The Kresge Foundation in partnership with The Advisory Board, the de Beaumont Foundation, and the Robert Wood Johnson Foundation AWARD AMOUNT: $75K planning in year one, eligible for $100K implementation in year two; hospitals required to match implementation funds 1:1. PROJECT PARTNERS: Boston Medical Center (BMC), Boston Public Health Commission (BPHC), Boston Housing Authority (BHA), The American City Coalition (TACC) TITLE: Lower Roxbury: Developing A Healthier Neighborhood Through Upstream Multi-Sector Collaboration 1. COMMUNITY PROFILE Describe the community to be engaged in the planning process. Include relevant demographic and health disparity data, highlighting the biggest barriers to health in your community. This planning process engages Lower Roxbury in the City of Boston, a subsection of the neighborhood of Roxbury comprised of 9,292 residents living in 3,867 households. The borders of Lower Roxbury are delineated by the following street boundaries: Tremont, Hammond, Melnea Cass, Hampden, Winthrop, Saint James, Guild, Millmont, and Highland. Lower Roxbury is home to one of the largest concentrations of extremely low-income families in the Northeast. 75% of households live in subsidized or public housing, and 47% of residents have incomes below the federal poverty line. Unemployment is double the overall rate in Boston. The neighborhood is more diverse and younger than the city or region; 60% of the population is Black/African American and 34% non-white Hispanic, while 30% of residents are under age 20. Females head 63% of households, compared to the city average of 16%. (U.S. Census) Lower Roxbury has a higher prevalence of health risk factors and conditions, as well as higher rates of many condition-specific hospitalizations, than Boston as a whole. (BRFSS, BPHC, and MDPH) It is not simply access and utilization of health care services driving these persistent disparities, but rather economic, social, and neighborhood conditions found in Lower Roxbury. Stability and quality of housing, poverty, unemployment, access to healthy food, poor public safety, stress, and other determinants underlie the health of residents. Since the mid-20th century, Lower Roxbury has seen repeated urban renewal efforts. Projects have had limited, and often detrimental, effect on the neighborhood and residents. Currently, the area is seeing an increased pace of redevelopment, spurred by an ardent civic society, policies and resources emanating from the city and state, and an increasingly dynamic real estate market. In the last six months, the Bruce C. Bolling Municipal Building, an economic anchor and new headquarters of the Boston Public Schools, was completed; the Boston Housing Authority (BHA) submitted the Whittier Choice Neighborhood Transformation Plan for the redevelopment of distressed public housing; and there is growing consensus that Lower Roxbury is well suited as a location for thousands of new units of housing proposed in Boston’s 2030 housing plan. Currently, the Boston Redevelopment Authority lists 2,022,016 sq. ft. of new development in progress in the area.

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Overall, these transformational forces bring tremendous opportunity for Lower Roxbury, but also growing risk. If investment in the neighborhood can be harnessed for the good of current residents, there is an opportunity to positively impact the determinants that drive the health of the community. If, however, the rush to development leads to the displacement of residents (often to areas with less access to economic opportunity, quality education, and public transportation), the opportunity will be lost. It is imperative to bring together a strategic partnership to take action against the displacement of vulnerable residents, so the health and economic benefits of a redeveloped Lower Roxbury accrue to those who need it most. 2. PARTNERSHIP PROFILE Describe the organizations that are partnering to address this challenge. How is each organization best positioned to address these barriers to better health? How do they plan to work together to develop a well-defined action plan? This project brings together partners deeply engaged in health delivery and place-based efforts in the target area. While we have worked side by side and undertaken impactful work in smaller groups, this strategic partnership represents a new collaboration that reimagines existing inter-organizational relationships in order to catalyze and support bold, new ideas. The following partners are applying jointly for this planning grant: Downstream Health Partners:

Hospital: Boston Medical Center (BMC). As a safety net hospital emphasizing community-based care, BMC is committed to serving vulnerable populations. BMC is the closest hospital to Lower Roxbury and heavily utilized by residents. BMC brings knowledge of direct services, aggregate data, and health education. BMC’s approach to care delivery integrates a focus on social determinants into existing programming, including Medical-Legal Partnership Services and Children’s HealthWatch.

Local Health Department: Boston Public Health Commission (BPHC). BPHC will provide insight into health disparities, existing policies, and baseline data on direct services and health behaviors. This initiative builds on BPHC’s Health Equity Campaign which centers on demonstrating the specific connections between place and health, as well as their annual Health of Boston reports.

Upstream Place-Based Partners:

Nonprofit Community-Based Organization: The American City Coalition (TACC). Since 1994, TACC has served as a catalytic leader for Lower Roxbury, publishing four community planning studies focused on strategies for redevelopment, creating targeted test fits, and contributing to BHA’s Whittier Choice Neighborhood Transformation Plan. Projects include building the capacity of groups through pre-development support and expanding citizen participation through a citizen-led initiative monitoring physical development in Lower Roxbury. TACC will soon move to new offices with space for community use in the heart of Lower Roxbury.

Government Agency: Boston Housing Authority (BHA). With 58,000 tenants, BHA is the largest landlord in Boston; new models for improving health developed here can be replicated across Boston. In October, BHA submitted the Whittier Choice Neighborhood Transformation Plan. In planning, BHA engaged residents in an extensive community outreach process that included a focus on upstream social conditions; this proposal complements that work, expanding goals across Lower Roxbury.

Additional:

Other organizations doing vital work on housing and health in Lower Roxbury will participate including a range of local CDCs, nonprofit developers, housing managers, private developers and Whittier Street Health Center, Boston Alliance for Community Health, and Healthier Roxbury.

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We will engage in an integrated process of sustained collaboration with each other and the community through a series of convenings, including: 1) Mapping organizational assets and existing place-based health initiatives, analysis of existing data; 2) Increasing the synthesis and effectiveness of shared data systems between housing and health providers; 3) Robust incorporation of physical development into needs assessment and community health improvement plans; 4) Development of comprehensive action plan targeting short- and long-term strategies to address Lower Roxbury’s health challenges. 3. ACTION PLAN How will The BUILD Health Challenge opportunity enable you to create an actionable, comprehensive plan to address the most pressing health challenges in this community? In Lower Roxbury, the built environment shapes residents’ most pressing heath challenges. To improve population health during this time of rapid physical change, we must limit the displacement of current residents so all can benefit from evolving housing and economic standards and physical improvements at the neighborhood and household levels. The specific pathways from which real impact can be obtained require close collaboration among diverse stakeholders; a shared vision is critical to long-term impact. This award provides the resources to create a common agenda for a multi-stakeholder group that shares the goal of community improvement. The award will advance the integration of clear baseline data from multiple sources and identification of viable, shared action that goes beyond traditional programmatic responses targeting health disparities and towards planning upstream interventions. Informed by the organizational assets and institutional knowledge of each stakeholder, and strengthened by access to technical assistance offered by The BUILD Health Challenge team, the action plan will encompass evidence-based policy and place-based interventions. The one-year process creates the time to engage in a strategic dialogue that seeks to innovate through collaboration on a range of key health challenges including displacement, a pressing social problem that cannot be addressed by one organization or sector alone. We will focus multi-sector resources on limiting displacement, coupling the need for housing quality and stability with mechanisms for family upward mobility, including mobility mentoring and homeownership for current residents. The action plan will include detailed steps on how each of us can deploy and strengthen our existing programs and practices to address health challenges. BMC will have increased opportunity to deliver on its commitment to community health, and incorporate the downstream impact of upstream built environment interventions into needs assessments and health improvement plans. BPHC will identify additional pathways for implementation of evidence-based policy recommendations. BHA will expand models for promoting health equity through neighborhood interventions as they undertake the large-scale rehabilitation of public housing. TACC will expand its service as an objective technical assistant, working to ensure collaboration is sustained. The BUILD Health Challenge is an opportunity to collaboratively engage with Lower Roxbury, a dynamic neighborhood where there is a narrowing opportunity to positively impact social change. The planning award will provide the impetus, resources, and assistance necessary to catalyze the dialogue and partnerships required to create meaningful action, so that every resident of Lower Roxbury can benefit from the ongoing neighborhood change reshaping their community.