Sunday, January 14, 2018

The US Housing Famine

Housing infrastructure is critical to health.  The MacArthur Foundation pulled together housing research it had sponsored to help educators, health professional and those concerned with economic mobility understand how stable access to affordable housing helped people prosper.  The report notes:
Housing is a launching pad to successful lives. High-quality housing in strong neighborhoods positions residents to capitalize on the opportunities before them. And investing in communities reaps benefits beyond the particular neighborhood in lower social, health, and economic costs city and region-wide. 
Housing is a foundational piece of the infrastructure of the nation, along with our roads and rails, energy, clean water, and safe food systems.  Our infrastructure, in general, is in a sorry state, scoring a D+ from the American Society of Civil Engineers.  In its report card on America's infrastructure, ASCE said of our bridges, which got a C+ rating:
The U.S. has 614,387 bridges, almost four in 10 of which are 50 years or older.  56,007 -- 9/1% -- of the nation's bridges were structurally deficient in 2016, and on average there were 188 million trips across a structurally deficient bridge each day... The most recent estimate puts the nation's backlog of bridge rehabilitation needs as $123 billion.  
The newspapers are full of stories of our housing crisis and all its ramifications: homelessness among veterans, the long hunt for apartments, and the threat of eviction.  This paragraph, in a story about people in their "golden years" taking in roommates, caught my attention.   
For those who are still working age, it's getting harder to pay the rent: According to a StreetEast survey, rents in the city rose twice as fast as wages between 2010 and 2017.  The lowest rents (those up to $2,300) rose 4.9 percent annually since 2010, which means someone who paid $1,500 a month in 2010 likely paid nearly $600 more for the same place in 2017.  
According to the same article, seniors make up a larger proportion of the homeless population than they did before, a related part of the growing housing crisis.  The Boston Housing Report Card analyzes the situation in that city, and in 2017 noted the following parts: decrease in housing starts, decrease in affordable housing production, increasing proportion of people paying more than 30% of income for housing (52% of renters and 36% of home owners), and an increase in foreclosures.  These combine to make a very difficult housing situation for the poor, and tight -- if not quite as difficult -- situation for those with greater income.  This is the opposite of what the MacArthur Foundation is telling us we need to create for healthy population.  

Rodrick Wallace adopted the term "housing famine" in the 1990s in relationship to the crisis of homelessness that followed the implementation of planned shrinkage policies in the mid-1970s in New York City.  This graph, from Coalition for the Homeless, show the rising numbers of homeless people in the city following on the heels of the massive destruction of low-income housing by planned shrinkage.

The famous economist, Amartya Sen, asserted, "No famine has ever taken place in the history of the world in a functioning democracy."  This leaves us to consider the options, among others: does his assertion only apply to food? is the US not in a housing famine? is the US not a functioning democracy?  I think these are important questions to answer.  In the meantime, the compilation of a national report card on housing for all should be an assignment given to some group -- how do we rate?  How can we begin to assert that housing is an essential part national infrastructure?

Thursday, January 11, 2018

Remembering Mike Smith

Dr. Michael O. Smith, legendary healer and teacher, passed away on December 24, 2017.  He was a doctor who transformed the treatment of addiction, pioneering the use of the 5-point ear detoxification protocol -- the NADA protocol -- at a time when American medicine was completely hostile to acupuncture and all things "foreign."  He once said of ear acupuncture, "It calms people enough that they can go to a Narcotics Anonymous meeting and listen."  He had a profound understanding that addiction was spiritual, psychological and physical, and he opened the doors to treating all three.

The site for this adventure was popularly known as "Lincoln Acupuncture," or "Lincoln Detox," a wonderful free-standing building that belonged to Lincoln Hospital.  Mike and colleagues had taken it over, first for methadone then for acupuncture.  They squatted the building through some freezing winters and broiling summers, gradually winning acceptance and heat.  The big room, filled with chairs, welcomed hundreds of people daily.  Upstairs, people gathered for NA and AA meetings, making twelve-step an essential adjunct to treatment.

I learned acupuncture from Mike in 1982, and became an avid proponent of the treatment.  He believed that one learned about treatment by getting treatment.  I was a young, overworked doctor and mother, and as soon as he would put a needle in me, I would fall asleep.  He said, "Sleep.  You are still learning."  He was the most comforting person

He gave life advice, too.  After my divorce, two of my children were living with my ex, seeing me for vacations.  I was distraught about this.  He was living with a similar situation.  He said, "When you see your children, think of it as a date.  Show them a wonderful time!"  Even when my children were living with me again, I kept the idea that our life together was a date -- it made it so delightful!

Mike changed American medicine, and changed me.  I dedicated my book, House of Joshua, to him.  I am so grateful to have known this courageous, inventive, and dedicated man.

Wednesday, January 10, 2018

Remember Samson and the Pillars?

One of the great films of my youth was the Cecil B. DeMille production of "Samson and Delilah."  The heart of the story is that strong man Samson reveals to seductress Delilah that the secret of his strength is in his long hair.  She cuts it off and delivers him to his enemies, who blind and torture him.  Over time, she regrets her betrayal and his hair grows back.  In the final scene, he tells her to lead him to the pillars of the building where his enemies are gathered.  He uses his great strength to push the pillars out of place and bring down the building.  To all of us raised on Bible stories, this was a very satisfying moment, and obviously it teaches us something about pillars.

I think the heads of NY Presbyterian Hospital -- despite the name -- did NOT go to Bible School and missed the pillar talk.

What's why they feel free to knock down a pillar of the Washington Heights neighborhood, Coogan's Restaurant, which has been holding the place up for decades.

For those of us who ate there, partied there, got support from there, this is an unconscionable act.  We understand the role of Coogan's in getting us through the crack era, with its street terror and violence.  We know that Coogan's always helped the neighborhood -- the 5K run, the book parties for local authors, the donations of water for our annual Hike the Heights.

Coogan's is not the place you imagine when you think of the train wreck of gentrification.  The photo in The Times shows the usual crowd, doctors, nurses, techs, administrators, business people from the hospital, enjoying lunch together.

But gentrification is not about a specific income target -- like getting poor people out of a neighborhood.  It's about maximizing profits -- the hospital wants $40,000 a month for the space, more than Coogan's can pay.  That Coogan's "pays" by caring for the neighborhood doesn't count in the math of "make more money."

And that is why we need to re-read the story of Samson.  Pillars are there for a very good reason.  This is a terrible Main Street story, because NYP got it all wrong.

Wednesday, January 3, 2018

Help for Hurricane Recovery

I just received a note from my colleague, Lourdes Rodriguez, who wrote:

These will be tough holidays for everyone affected by hurricanes Harvey, Irma and Maria and the California wildfires.  Keep folks affected in your thoughts this holiday season
Here is an op-ed on the topic of effective and JUST recovery that I co-authored with my colleague Mindy Fullilove.

Here’s how to learn more and help organizations on the ground working on recovery:
·        Centro para el Desarrollo Politico Educativo y Cultural runs social eateries (comunal meal sites)
·        Organización Boricuá de Agricultura Ecológica promotes sustainable organic farming
The end of the holiday season doesn't mean the end of the suffering, but we do tend to turn our attention to the next terrible thing.  I've been thinking about New Year's Resolutions.  So far so good on mine, but maybe I can add "once a week, remember the injured"?

Tuesday, January 2, 2018

Keep the McBride Viaduct!

Erie CPR -- Connect Plus Respect -- is fighting to save the McBride Viaduct, a bridge that connects the struggling African American community with the part of the city that lies to west.  This bridge was built over the train tracks after a child was killed.  It has been an important connector for decades, but is need of repairs.  Instead of fixing this venerable piece of infrastructure, the city has proposed that it be torn down.  This will re-create high risk for pedestrians that the bridge was built to eliminate.  Furthermore, fixing the bridge is not a more expensive proposition and has the benefit that it can create local jobs.  This repair, above all, presents an opportunity to expand job opportunities in the local area, thus pouring the repair money into the city's economy.

I had the chance to visit Erie two years ago.  I saw the Viaduct and the alternative, which is terrible.  I got to appreciate the complex disconnect in Erie, which CPR is fighting.  Erie, like many American cities, is struggling to find its way.  The McBride Viaduct becomes a metaphor for the question facing all of us: will we spend our money to further divide and endanger ourselves? Or will we look again at the possibilities that might strengthen connections while pouring money into our communities?

Erie, as I write this, is digging out from record snow and not yet thinking about the big questions that will face them as they inaugurate a new mayor.  Good luck with the snow, Erie, and save the Viaduct!