Panel Discussion Highlights with:
David Erickson, Federal Reserve Bank of San Francisco
Mark Pinsky, Opportunity Finance Network
Robert McNulty, Partners for Livable Communities
James Marks, Robert Wood Johnson Foundation
Rachel Schneider, Center for Financial Services Innovation
Nicole Smith, Georgetown University
David Erickson: I just want to very quickly talk about this issue of collaboration. This was a big theme that came out of a book that we just recently published called Investing in What Works for America's Communities (and I think there are some copies out on the table here), but we looked at some of these examples of these sorts of collaboration examples across the country—things like the Harlem Children's Zone, Purpose Built Community in Atlanta, Neighborhood Centers Inc. in Houston, Magnolia Place in Los Angeles—all of them very interesting because they were place-based, they were cross-sector, it wasn't just education; it wasn't just housing; it wasn't just health; it was all of those things at once.
Mark Pinsky: One of the things that makes this conversation different than, I think, the research papers and the discussion that are organized around them is that our mandate is really to think broadly, rather than (and everybody brings a lot of depth to this panel, as do all of you), but really to try and make connections, sort of, horizontally, if you will, and across our fields, and we'll spend a fair amount of time having that discussion today as best we can.
Nicole Smith: If the jobs are there, then what's the point of this particular education to get the job, and if you don't have the education then you are not going to be able to get the job. So it is a little bit of a chicken-and-egg story here. Education continues to be the ultimate arbiter of economic opportunity in this country of chosen education and workforce over the welfare state.
James Marks: What we came to realize...what I came to realize was, in fact, we in health had been too narrow in what we think of as important for improving the human condition, and in fact that's what we are both about—community development and health. The classic definition of health is a complete state of physical, mental, and social well-being, and we have been focusing on reparative work largely on the physical side.
Robert McNulty: I think it's time for a new outreach. The best tool that I've heard and I would really urge that you use it is Part 24 of the Comptroller of the Currency on public welfare investments.
Pinsky: Let's talk about health care and let's talk about social determinants of health to start. So a little perspective (speaking to Nicole Smith).You had mentioned that nursing jobs are a major growth area, health care jobs...you know, when you get into fiscal policy now, major concentration of fiscal policy is clearly around health care and health care related, whether it's Medicare, even Social Security, but certainly the health care reform. And so can you talk a little bit about, as a fiscal policy, how do we leverage that; how do we make that work?
Smith: For a long time we have been stopping our gap with foreign-born workers in health care. You hear all these off-comments, especially the former mayor of D.C. when he said, "Well, how come we don't have more African-American nurses in D.C. that are working?" The issue here is, "What's the entry-level education requirement?" For a lot of these registered nursing programs, it's a bachelor's degree.
Marks: Health, education, and poverty are not separate issues. They are deeply, fundamentally, closely linked in that trying to work on one is not going to succeed without recognizing that there is a lot to connect together. We know that how our communities are constructed foster certain things of health or inhibit them, and we've got to do more in that. And the debate between personal responsibility and societal responsibility is the wrong debate. It's how to bring those together.
McNulty: Reimagine your traditional resources, be it the faith institutions, the libraries, the museums, the community colleges, and have them play a role in some combined way on public health. It is going to really pay dividends.
Rachel Schneider: Individual households' finances are intimately related with their neighbors and their communities, and I think that we need to think about community financial health, we also need to think about individual family health. There is something actually kind of in between, which is "me and my neighbors" or "me and my extended network."
Marks: We're looking at marrying the social factors into the medical system. So there are two programs: medical legal partnership that uses lawyers. A physician can say, "This person needs help with their housing or their utilities," and the lawyers will help figure out what they're able to get.
Smith: We focused a lot talking about health care as one of the fastest-growing occupational clusters, but so is STEM (science, technology, engineering, and mathematics). And STEM, although it's growing quickly, is really one of the hardest educational clusters to get anyone interested in.
McNulty: In a sense, it's a metaphor of "the worst of times, it's the best of times." People rarely collaborate with new players in times of plenty. Today, everyone is anxious to find a player to collaborate with.
Schneider: There are moments when an idea that's been percolating somehow takes hold, right? When enough information has come out, enough people have thought something's right that all of a sudden it's a zeitgeist and we all get it, and I think that certainly feels like it's become the case around health care, for example. It's hard to not think about the challenges we have as a country related to health.
This interconnectedness that we're seeking across the types of work we do is really challenging, and you have to think a lot about partnership formation and the challenges of partnership formation. And so if you think about an increasingly interconnected world, but it's not necessarily in person. There is just a whole separate set of dynamics that we have to be prepared for as we work with each other, as our communities try and work with each other.
Marks: Public health often was about managing the programs they had responsibility for. We need to elevate that so that they're the voice for the health of the public and help make the connections elsewhere in their community.
But I see the issue of empathy as a serious one for us as a nation and one that perhaps explains why we invest less in social sector programs than other countries because that issue of connectedness and recognition of shared fate, rather than "I am in charge of my fate only in if I can get ahead and it is at the expense of someone else, that's OK." That, I think, is something we have got to overcome a bit as a nation.
Schneider: The challenge is that people want to collaborate and are most likely to collaborate in the moment of crisis, but if they haven't collaborated in advance it takes too long to create the partnership in order to successfully work together. Right? And so, I think another answer to your question is to play the long game around collaboration. To know that you've got to build the relationships in your community before you need them.
Pinsky: Humility, discipline, and brutal honesty is what makes an organization resilient, and you've got to do it everyday. It only takes a couple of days to slip and fall from that. I don't know if that's really responsive to the question, but I wanted to get it out there.
Marks: Resilience in a community is going to be built up by having the relationships and the connections. So Rachel said you need to start to work to come together even if you don't have a crisis yet. And if you don't have a crisis that's when you have the chance to build your "empathy cushion" (to pick up on Dennis Lockhart's comment about "financial cushion"), especially for communities that don't have a lot of resources. Then when the crisis hits, you can draw it down to help you get through that crisis.