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• Brookings: City and metro income inequality data reveal ups and downs through 2016

  

  Alan Berube, Monday, February 5, 2018

  Research has historically framed income inequality as a national issue, one best addressed through national monetary and fiscal policies that raise demand for labor and redistribute resources from the rich to the poor. Yet widening disparities across and within places in the United States, revealed in debates around wages, housing affordability, and public safety, have motivated policymakers and researchers to pay increased attention to inequality’s local dimensions.

  Now, many cities’ aggressive bids for Amazon’s second headquarters are heightening anxieties that the company’s expansion could further accelerate inequality wherever it eventually lands (as many say it has in Seattle). The debate about Amazon fits into a wider set of concerns about the tech sector’s role in contributing to income inequality, via the winner-take-all dynamics of the digital economy.

  Amid these currents, this piece updates previous Brookings Metro analysesto examine trends in household income inequality in the 100 largest U.S. metropolitan areas and their most populous central cities from 2014 to 2016. As with earlier analyses, it uses data from the U.S. Census Bureau’s American Community Survey on household income at the 95th percentile of the distribution (i.e., where only 5 percent of households earn more) and the 20th percentile of the distribution (i.e., where 20 percent of households earn less).[1] It uses the ratio between those incomes as a principal measure of inequality in cities and metro areas. Key findings include:

  Among big cities, Atlanta and Washington, D.C. exhibited the highest rates of income inequality in 2016. The top 5 percent of households in these cities earned incomes at least 18 times as high as the bottom 20 percent of households. Relatively wealthy cities including Boston, New York, and San Francisco, as well as cities struggling with high poverty such as Buffalo, Miami, New Orleans, and Providence, also registered high rates of income disparity. In general, older cities with fewer middle-class neighborhoods and larger amounts of subsidized housing tended to exhibit higher inequality. Newer, more geographically expansive cities such as Columbus, Jacksonville, and Virginia Beach, as well as those with stronger middle-class employment like Allentown and Oxnard, had among the lowest levels of income inequality.

  

  Levels of inequality in cities reflect broader income disparities in metropolitan areas. Four of the 10 cities with the highest levels of inequality are located in one of the 10 most unequal metropolitan areas (Boston, New Orleans, New York, San Francisco). Conversely, three of the cities with the lowest levels of inequality are located in one of the 10 most equal metropolitan areas (Des Moines, Lakeland, Virginia Beach). This indicates that city inequality reflects not only local housing dynamics but also wider industrial and income patterns in the regional labor market. Notably, three regions along Utah’s Wasatch Front—Salt Lake City, Provo, and Ogden—exhibit the lowest levels of income inequality among their metropolitan peers.

  More cities experienced declines in income inequality from 2014 to 2016 than saw increases. While few cities overall saw income disparities between rich and poor households change by a statistically significant margin, among those that did, declines in income inequality (eight) outnumbered increases (five). From 2014 to 2016, high-income households in 30 cities logged significant income gains, as did low-income households in 34 cities. (In only one city—Rochester—did low-income households suffer a statistically significant income decline.) The net effect reduced income disparities in Charlotte, Dallas, Jackson, Jacksonville, Kansas City, Knoxville, Louisville, and Salt Lake City, but pushed them higher in Baltimore, Detroit, Omaha, Rochester, and Washington, D.C.

  

  In contrast to the city pattern, increases in metropolitan income inequality outnumbered declines. From 2014 to 2016, 12 metropolitan areas registered a statistically significant increase in income inequality. In most of those places, high-income households enjoyed income gains while low-income households did not. In Honolulu and San Jose, top incomes rose by an estimated $60,000 in two years’ time, but did not change significantly for low earners. Only eight metro areas achieved declines in income inequality, with lower-income households posting larger income gains (in percentage terms) than higher-income households in most of those markets. Metro areas where income disparities narrowed included many of the cities—Charlotte, Dallas, Kansas City, Knoxville, and Louisville—where income inequality declined, as well as Boston, New Haven, and Salt Lake City.

  

  Some cities posted stunning increases in top incomes from 2014 to 2016. The most astonishing changes in the mid-2010s occurred among high-income households in a few cities characterized by booming technology economies. In just two years, incomes for 95th percentile households in San Francisco rose nearly $120,000. (Median home sales prices, meanwhile, increased by $250,000.) Austin and Seattle posted increases of nearly $65,000 for high-income households, while high household incomes in San Jose rose by more than $50,000. Raleigh topped all cities for 20th percentile income growth at $7,200, which was large in percentage terms (30 percent) but a far cry in absolute terms from the $35,000 increase the city posted at the 95th percentile level.

  Income trends at the top of the distribution in cities and metro areas had little relationship to trends at the bottom of the distribution from 2014 to 2016. In cities and metro areas where high-income households posted the greatest gains, low-income households didn’t fare any better or worse than those in other cities. For instance, although 20th percentile incomes in Austin, San Francisco, and Seattle rose by significant margins, they failed to increase significantly in other cities where 95th percentile incomes boomed, such as Baltimore, Denver, San Jose, and Washington, D.C. At the same time, incomes at the lower end of the distribution grew significantly in several cities—Boston, Charlotte, Louisville, Salt Lake City—where top incomes did not.

  For those concerned about the effects of high inequality in the United States generally, and in our large urban centers specifically, these city and metropolitan income trends from 2014 to 2016 present some quandaries.

  On the one hand, the trends indicate that ameliorating inequality is possible. In several places, low-income households achieved faster income gains than high-income households.

  On the other hand, even as a tighter labor market began to drive up wages in the mid-2010s, the relative gap between the rich and poor still widened in a number of cities and metro areas. And even in places where low- and high-income households made comparable progress in percentage terms, the absolute income difference between rich and poor often grew substantially. The inequality ratio did not change in San Francisco, but the distance between its 20th and 95th percentile incomes grew by an estimated $114,000.

  Moreover, at least in the short run, city and metropolitan income trends do not suggest the existence of a rising tide lifting all boats, but rather separate ebbs and flows for households at different extremes of the distribution. Even if, as Enrico Moretti and other researchers suggest, local innovation economies generate greater opportunities for workers in less-skilled industries, those opportunities may not materialize overnight, and low-income workers and families could get priced out of a city in the meantime.

  While this analysis is too brief to identify the underlying economic or policy factors that may explain those disparities, Brookings Metro’s forthcomingMetro Monitor update will shed further light on how and why economic inclusion is changing in metropolitan areas. Regardless, the distinctively local dynamics of inequality in our major urban areas reaffirm the importance of local leadership for understanding and improving access to economic opportunity for lower-income households in ways that reduce disparities over the longer term.

  Cecile Murray provided valuable research assistance for this analysis.

  Courtesy of Brookings

• NLIHC: Announces 2018 Housing Leadership Award Honorees

  NLIHC announced the honorees of the 2018 Housing Leadership Awards who will be recognized at NLIHC’s annual Leadership Awards Reception in Washington, DC on March 20, 2018.  The honorees are U.S. Senator Susan Collins (R-ME); Lisa Hasegawa, former executive director of the National Coalition for Asian and Pacific American Community Development and NLIHC board member; and Matthew Desmond, PhD, MacArthur Genius Awardee and Pulitzer Prize-winning author of Evicted: Poverty and Profit in the American City.

  Senator Collins will receive the 2018 Edward W. Brooke Housing Leadership Award for her years of leadership in Congress, unwavering commitment to addressing the needs of the lowest income people in the U.S., and steadfast support for federal affordable housing and homelessness programs. The Brooke Award is named for the late Senator Brooke (R-MA), who championed low income housing as a U.S. senator and as chairman of the NLIHC Board of Directors after he left the Senate. The Brooke award goes to an exemplary housing leader with a record of fighting for affordable housing on the national level. 

  Ms. Hasegawa will receive the 2018 Cushing Niles Dolbeare Lifetime Service Award for her years of dedication to affordable housing on behalf of the Asian American and Pacific Islander community. The Dolbeare Award, named after NLIHC’s late founder who has been referred to as the “godmother” of the affordable housing movement, goes to an individual who has demonstrated an unyielding commitment to achieving safe, decent and affordable homes for low income people over a long period of time.

  Dr. Desmond will receive the Sheila Crowley Housing Justice Award in 2018 for his groundbreaking work to elevate the need for affordable housing for the lowest income people in America. The Crowley Award, named for former NLIHC President and CEO Sheila Crowley, goes to an outstanding leader who has elevated the conversation around affordable housing for those most in need.

  Please make a Leadership Award Reception sponsorship donation honoring these outstanding leaders and supporting NLIHC’s mission of promoting socially just public policy to ensure the lowest income people in America have decent, affordable homes. To register for the 2018 Leadership Reception at which Ms. Collins, Ms. Hasegawa, and Dr. Desmond will be recognized, contact Christina Sin at csin@nlihc.org.

  Sponsorship donations can be made at: http://bit.ly/2fSOtEH  

• PBN: Names 2018 Business Women honorees

  By Rob Borkowski - April 20, 2018 6:29 am

  PROVIDENCE —  Sandra J. Pattie, president and CEO of BankNewport, has been named the 2018 Career Achiever in the 2018 Providence Business News Business Women Awards, and Kathleen Malin, vice president of technology and operations at the Rhode Island Foundation, will be honored as Outstanding Mentor at the 11th PBN Business Women Awards celebration at the Providence Marriott Downtown May 24.

  Career Achiever: Sandra J. Pattie

  Pattie began her journey to CEO with an unconventional educational background, earning her Associate degree from Rhode Island Junior College (known today as Community College of Rhode Island, while working as a teller at Coventry Credit Union (now rebranded Ocean State Credit Union). She then studied evenings as a Night Friar earning a Bachelor of Science in Accounting from Providence College. Shortly after, she joined the ‘Savings of Bank Newport’ (BankNewport).

  During the next 15 years, Pattie managed almost every area of the bank. She was promoted to chief operating officer in 2002 and to CEO in 2012. Since then, the bank has enjoyed annual growth of 16 percent.

  Outstanding Mentor: Kathleen Malin

  When Malin joined the Rhode Island Foundation in 2002, she had already spent time as director of technology at St. Andrew’s School in Barrington and before that as a network administrator and technology director at public and private schools in Rhode Island and New York.

  Malin has earned a reputation for an innate desire to give back and inspire the dreams of others. When asked about her most important career moments, her answers invariably include stories of when she has made an impact on someone else’s career.

  Fourteen other women were named either Industry Leaders or Women to Watch in six industry categories as well. The two leading award winners, as well as the 14 winners recognized by industry, will be celebrated Thursday, May 24, from noon-2 p.m., at the Providence Marriott Downtown. For information and to register to attend, visit the PBN website.

  The 2018 winners by category are:

  Creative Services Industry Leader:

  Dyana Koelsch, DK Communications, owner

  Creative Services Woman to Watch:

  Morgan Durfee, TribalVision, senior marketing manager

  Financial Services Industry Leader:

  Edythe De Marco, Merrill Lynch and  Bank of America, managing director and wealth management adviser

  Financial Services Woman to Watch:

  Jennifer Hogencamp, BlumShapiro, partner

  Healthcare Services, Industry Leader:

  Colleen Ramos,Women & Infants Hospital, Care New England, vice president of finance

  Healthcare Services Woman to Watch:

  Sara Johnson, Pro-Change Behavior Systems Inc., co-president & CEO

  Nonprofit Industry Leader:

  Suzanne Fogarty, Lincoln School, head of school

  Nonprofit Woman to Watch:

  Stephanie Frazier Grimm, The Confetti Foundation, founder

  Professional Services Industry Leader:

  Connie Tang, Princess House, president & CEO

  Professional Services Woman to Watch:

  Carolyn Belisle, Blue Cross & Blue Shield of Rhode Island, managing director, community relations

  Social Services Industry Leader:

  Barbara Fields, R.I. Housing and Mortgage Finance Corp., executive director

  Social Services Woman to Watch:

  Margaret Teller, The Children’s Workshop, president & CEO

  Technical Services Industry Leader:

  Patricia Steere, Steere Engineering Inc., president

  Technical Services Woman to Watch:

  Erin Darmetko, Amica Mutual Insurance Co.,  information systems officer

  The Achievement Honorees for 2018 are (listed alphabetically):

  Elana Carello, Elana Carello Sweaters, owner

  Jeanne Cola, LISC Rhode Island, executive director

  Norah Diedrich, Newport Art Museum, executive director

  Marita Loffredo, Phalang-Ease Mittens, founder

  Ally Maloney, Maloney Interiors LLC, owner

  Michelle Maynard, 360 Face Mind Body, owner

  Katherine Messier, Mobile Beacon, founder

  Christine Noel, Rhode Island Children’s Chorus, artistic director

  Christina Procaccianti, Green Line Apothecary LLC, owner

  Kaitlyn Roberts, Easy Entertaining Inc., owner

  Jennifer Shaheen, Technology Therapy Group, president

  Tuni Schartner, TS Consulting/TRS Strategies, owner

  This year’s presenting sponsor for the Providence Business News Business Women Awards is Webster Bank, and partner sponsors include Bryant University, Citrin Cooperman, and CVS Health Corp.

  Rob Borkowski is a PBN staff writer. Email him at Borkowski@PBN.com.

  Courtesy of Providence Business News

• ProJo: Tenants will start moving into homes at $11.2M Central Falls, Pawtucket affordable housing project

  By Christine Dunn 
  Journal Staff Writer 
  

  Posted Nov 29, 2017 at 2:13 PM

  Updated Nov 29, 2017 at 7:12 PM

  CENTRAL FALLS, R.I. — Tenants will move in Friday to the first completed building in the 46-unit Branch Blackstone affordable housing development, a renovated three-family home at 39-41 Knight St.

  The nonprofit Pawtucket Central Falls Development Corp. announced plans early last year for Branch Blackstone, which will include 29 homes in four new buildings under construction at 4-8 Branch St. in Pawtucket, by the Blackstone River. In addition, 17 affordable apartments at scattered sites in Pawtucket and Central Falls will be renovated as part of the $11.2-million project.

  In addition to 39-41 Knight St., Central Falls, the other buildings to be rehabilitated are located in Pawtucket, at 39 John St., 36 Middle St., 181 Japonica St. and 138 Woodbine St.

  According to PCF Development’s executive director, Linda Weisinger, monthly rents for the three-bedroom apartments at 39-41 Knight St. will be $776. The building was gutted and rebuilt in a modern redesign by Ed Wojcik Architects Ltd. Stand Corp. was the general contractor.

  Overall, the Branch Blackstone development will include a mix of one-, two-, three- and four-bedroom units, with rents ranging from $600 to $950 a month.

  Weisinger noted at Wednesday’s ribbon-cutting ceremony that affordable homes for working families are hard to come by in Central Falls, where 75 percent of the residents are renters. She said that, according to HousingWorks RI, the average rent for a two-bedroom apartment in Central Falls is $983, which requires an annual income of at least $39,000 to be “affordable,” that is, consuming no more than 30 percent of a household’s gross income.

  In Central Falls, 60 percent of the renters are “cost-burdened,” meaning they are spending more than 30 percent of their incomes on housing, Weisinger added.

  Nearly 100 people attended the ceremony on Wednesday morning at Knight Street. Speakers included Weisinger, Joshua Giraldo, the chief of staff for the Central Falls mayor’s office; Dylan Zelazo, chief of staff at the Pawtucket mayor’s office, State Rep. Shelby Maldonado, State Sen. Elizabeth Crowley, Thomas McColgan of TD Bank, Rhode Island Housing Executive Director Barbara Fields and Rhode Island LISC Executive Director Jeanne Cola.

  Several speakers noted that the GOP’s federal tax legislation now before Congress threatens programs that support affordable housing.

  The largest part of Branch Blackstone, located along the Blackstone River at Branch Street in Pawtucket, is a formerly contaminated site that has been remediated. PCF Development is also working with the City of Pawtucket to create a public riverfront park at the end of East Street, adjacent to the new apartments on Branch Street. The park, formerly the site of illegal trash dumping, will have seating, a walking path, shade trees and new landscaping.

  — cdunn@providencejournal.com

  (401) 277-7913

  On Twitter: @ChristineMDunn

  Courtesy of Providence Journal 

• FHLBB: 2018 Affordable Housing Program Announcement

  March 29, 2018
  
  TO: All Members and Housing Organizations
  
  I am pleased to announce that the Federal Home Loan Bank of Boston will contribute $21.3 million to the 2018 Affordable Housing and Equity Builder Programs. Of this, $18.1 million will be allocated to the AHP and $3.1 million will be allocated to the EBP.
  
  In 2018, individual AHP application limits will be $500,000 in direct subsidy and $1 million in total subsidy, including the AHP advance interest-rate subsidy.
  
  The online AHP application will be available on our website beginning on June 11 through August 2. Please note that all applications and supporting documentation must be electronically submitted to the Bank by 5:00 p.m. on Thursday, August 2, 2018. To facilitate our members’ application review, we have added a separate period for members to complete their application review and analysis. Members will have until 5:00 p.m. on Thursday, August 9, 2018 to complete this online application review.
  
  We encourage members and sponsors to start discussions early to establish a working relationship that will extend through the application submission process and beyond, should the initiative be awarded funding.
  
  

  Beginning in May, we will host multiple training sessions and webinars to help you understand the application process, and ask that you register online at fhlbboston.com/events as space is limited. The 2018 AHP Implementation Plan and the Notice of Changes, including application instructions and detailed scoring criteria and guidelines, are available on our website. Our Housing and Community Investment staff (1-888-424-3863) will be happy to answer your questions and provide technical assistance.

  Thank you for your commitment to addressing affordable housing needs across New England and the communities you serve.
  
  Sincerely,
  
  Edward A. Hjerpe III
  President and Chief Executive Officer

   

  Courtesy of Federal Home Loan Bank of Boston 
  
  

• Convergence RI: Eyes on the prize: 2018 health equity summit draws 750

  Why, then, did the ProJo ignore the gathering?

  PROVIDENCE – What does a news silo look like? The hardened boundary resulting in some events being reported while others are ignored? The visual image of an editorial wall built around those preferred narratives that are covered and promoted? 

  
  

  More often than not, the actual boundaries of a news silo can be hard to discern, similar to difficulties in recognizing the lasting stigma carried by survivors from unreported sexual assaults.

  
  

  Not last week.

  
  

  Despite the best efforts of the Republican majority in the Senate to tamp down the revelations about the alleged attempted rape committed by Supreme Court nominee Brett Kavanaugh against a university professor and research psychologist from California when they were both teenagers, the story has overflowed the riverbanks – and the swirling waters have kept rising. 

  
  

  Too many women know the relative truth from their own personal experiences with being sexual assaulted to be swayed by patronizing white male Republican Senators, such as Orrin Hatch, that somehow Christine Blasey Ford was “confused” or “mixed up.”

  
  

  News silos in action

  
  

  Closer to home, all one had to do was glimpse the front page of The Providence Journal on Friday, Sept. 21, to witness a news silo in action.

  
  

  The big front-page, above-the-fold news feature story and photo, with the all caps headline, “RISING UP,” reported on the women’s leadership conference, Realizing Inspiration and Sustaining Excellence, on the fifth floor of the Providence Convention Center, which drew a crowd of about 500 participants, according to the Journal story.

  
  

  The impressive event was certainly newsworthy of being covered, of being placed on the front page, of sending a photographer to capture images of what happened at a conference, which focused on community building and empowerment of women in the workplace and entrepreneurship, from a workplace perspective.

  
  

  But, what was missing? What was being ignored? What was not being reported on? The glaring fact was that right next door, a short football toss away on the fifth floor of the Providence Convention Center, the third annual Health Equity Summit was taking place, drawing an even larger crowd of more than 750 participants.

  
  

  The 2018 Health Equity Summit, “Building Healthy and Resilient Communities,” celebrated the belief that everyone in Rhode Island should have access to live the healthiest life in the healthiest community, according to Dr. Nicole Alexander-Scott, the director of the R.I. Department of Health, in her opening remarks.

  
  

  Alexander-Scott and the keynote speaker, Dr. Edward P. Ehlinger, framed the context of the work around health equity by the numbers: life expectancy is dropping in the U.S., the rate of infant mortality and maternal is increasing, and the reality that only 10 percent of health outcomes are determined by what happens in a doctor’s or nurse’s office, despite trillions upon trillions of dollars spent on medical care.

  
  

  The solution: to shift investment into places where health begins – in our homes, schools, jobs and communities.

  
  

  Ehlinger, who called himself a public health metaphysician, spoke about the underlying malaise – the lack of a sense of belonging and the lack of social cohesion and the need for connectedness.

  
  

  The summit highlighted the work of nine operating health equity zones in Rhode Island, which places the state as the national leader in promoting community-based solutions to health, social and economic disparities. [For those news outlets that like to cover lists about where the state ranks nationally, Rhode Island is number-one in the U.S. in health equity zones.] 

  
  

  In the unlikely case that any of the moderators [Ted Nesi, Tim White] of the first debate between the 2018 gubernatorial candidates on Thursday, Sept. 27, were to ask a question about health equity zones, where they are located geographically, and what they seek to achieve, here are the answers [none of which can be found in The Providence Journal]. 

  
  

  The nine HEZs in Rhode Island include: a citywide Providence HEZ, a citywide Pawtucket and Central Falls HEZ; a citywide Newport HEZ, an Olneyville Neighborhood HEZ in Providence; an Southside, Elmwood and West End Neighborhood HEZ in Providence; a countywide Washington County HEZ; a citywide West Warwick HEZ; a citywide Woonsocket HEZ; and a townwide Bristol HEZ. 

  
  

  Each HEZ has its own focus, based upon a community needs assessment, to achieve health equity by eliminating health disparities by using place-based, where-you-live strategies to promote healthy communities.

  
  

  The inclusive summit featured more than 50 concurrent workshops and breakout sessions, with the goal of building a shared language around community health, tackling complex, difficult topics, including: Improving neighborhood health through the built environment; supporting families with substance-exposed newborns; healthy aging and why it matters; outcomes-based funding for health equity interventions; development without displacement; and addressing disparities in cancer care among Latinos in Rhode Island.

  
  

  Before launching into an in-depth coverage of the 2018 Health Equity Summit, here are some “impertinent” questions, in the best tradition of Studs Terkel, for Providence Journal Executive Editor Alan Rosenberg to answer:

  
  

  What prevented The Providence Journal reporter and photographer from crossing the artificial boundary between the two events? [It did not stop some of the participants, who were speakers at both conferences.] Was it a lack of curiosity? Was it the constraint of the assignment? Given the recent layoffs, were there not enough reporters on hand to cover both stories? Not enough freelancers? Was it because the RISE conference had numerous large corporate sponsors, such as Shop & Stop, Care New England, Lifespan, and Blue Cross and Blue Shield of Rhode Island, Amica, Bank Rhode Island, Bank Newport, Bank America, and Cox, among others? Was it an existential choice, choosing corporations over communities, the business of health care over healthy communities?

  
  

  Was it an endorsement of the status quo, as Robert Frost once posed in his poem, “Mending Wall,” about his neighbor, whom he described as moving “in darkness, as it seems to me, not of woods only and the shade of trees,” an enduring belief in the idea that “good fences make good neighbors?”

  
  

  I’m writing as fast as I can 

  There was so much content and conversation occurring all at the same time, and so much valuable information being shared at the 2018 Health Equity Summit, it was difficult to figure out how best to the tell the story.

  Here are some snapshots:

  At the breakout session, “How Housing Works To Support Health,” which highlighted the importance of housing stability in bolstering healthy outcomes, Karen Santilli, the president of Crossroads RI, Tanja Kubas-Meyer, the executive director of the R.I. Coalition for Children and Families, Jody Shue, executive director of Age Friendly RI, and Dr. Michael Fine, the senior population health and clinical services officer at Blackstone Valley Community Health Care, discussed the lack of affordable housing options as a health disparity issue.

  Shue pointed out the demographic problem – that Rhode Island was the number-one state in the nation with the highest number of “old old” residents, people who were 85 years and older, and that 14-20 percent have mental health issues. In turn, Shue described a pilot program at Charlesgate providing clinical services for residents. Phase Two of the program is scheduled to begin shortly, which will include a full-time behavioral health specialist.

  Santilli spoke about the yearning, even among the homeless population that Crossroads serves, for a sense of community, wanting to live in the places where they have social networks.

  Fine talked about what he called the battle rhythm of housing first, primary care second, to help lives become more coherent.

  When moderator Brenda Clement, the director of Housing Works RI, posed the question about investments and resources needed to change the current dynamic, Fine replied: On one level, it was about redirecting the unnecessary amounts of money being spent on health care. The larger issue, Fine continued, was that the coordination between housing and health was “nobody’s job,” identifying the problem that too much of the work was being done in silos. “It’s nobody’s job,” Fine repeated. 

  The collisions of people and ideas, that concept often articulated as a valuable part of the innovation ecosystem, kept occurring at the summit. ConvergenceRI first bumped into Dr. Patricia Flanagan, professor and vice-chair of the Pediatrics at the Warren Alpert Medical School, chief of Clinical Affairs at Hasbro Children’s Hospital, and co-chair of PCHM-Kids, a statewide, multi-payer initiative that includes 20 practices and serves nearly half the children in Rhode Island. The point of convergence: the importance of story telling in the delivery of health care. 

  The next moment of serendipity came minutes later, when Colleen Daley Ndoye, the executive director of Project Weber/RENEW, called out to ConvergenceRI to say hello. Her community agency, a peer-based harm reduction and recovery services program for at-risk people in Rhode Island, had just been awarded a $2.5 million, five-year federal grant from SAMHSA [the Substance Abuse, Mental Health Services Administration], in partnership with The Miriam Hospital and the R.I. Public Health Institute, to focus on substance abuse treatment for high-risk HIV negative Rhode Islanders, focusing on Black and Latino men who have sex with men.  

  When had the grant been announced? ConvergenceRI asked. “It’s being announced today,” Daley Ndoye said; it is embargoed until 1 p.m., she added, looking at her watch. “Then you can write about it.” 

  Project Weber/RENEW has been one of the recovery community groups engaging with folks with fentanyl test strips, and ConvergenceRI asked her the importance of the new harm reduction tool in her agency’s work. 

  “Fentanyl test strips are such a unique and useful resource,” Daley Ndoye explained. “They can be the moment that someone decides to take charge of their own life. They can decide, at that moment, to say: I want to live; I want to see what is in these drugs; I want to educate myself.   

  Maybe they are not ready to stop using drugs, Daley Ndoye continued. “But maybe that moment of education, that moment of awareness, is a sign that that they are willing to start making small changes. Once you’re willing to start make small changes, that can snowball, so you can start making bigger changes in your life.”  

  The importance of access to fentanyl test strips, Daley Ndoye concluded, was the way in which the harm reduction tool could change the equation. “Somebody who decides to test their drugs for fentanyl might not be will to stop using, but they might use less, they might use slower, they are at lower risk for an overdose, and then they might consider, in six months time, getting into recovery, and that’s a big victory for us.” 

  Daley Ndoye also weighed in on the experience of trauma from sexual assault and sexual violence. “The way we talk with our clients, and the way our clients talk with us, they describe trauma as this,” she said. It leaves an imprint on your psyche, on your person, on who you are, and everything that you do moving forward is affected by that initial trauma, where it is in childhood, as a teenager, or as an adult.”  

  Every day in her work, she continued, “In dealing with people who are victims of trauma, and who are survivors of trauma, and with our staff, who are all trauma survivors, I think the lesson is this: things are not always logical, things don’t always make sense, it’s not always one plus one equals two.”  

  Things will come out years later, she said, as a person goes through the healing process. “We talk to people for years, and then, years later, they say, ‘This happened to me.’”  

  Keeping the health in health equity 

  A strong evidenced-based argument was put forward by the team at Clinica Esperanza/Hope Clinic that in order to achieve health equity, the needs of everyone in the community, even those left behind by the current system, must be met. 

  In a breakout session entitled “The ‘Health’ in Health Equity: How a clinic for immigrants significantly improves health outcomes through access to care and health education,” the team from the community health clinic serving Olneyville in Providence provided the evidence and outcomes to back up their position. 

  Clinica Esperanza Hope Clinic serves more than 2,000 patients a year, mainly Central and South American immigrants, 60 percent of whom speak Spanish as their primary language and 75 percent of whom report household incomes of less than $15,000 a year. 

  The focus of much of the culturally appropriate care delivered is on nutrition education, cholesterol/blood pressure/glucose checks, primary care and vaccinations. Through what is known as the “Bridging The Gap” program, which includes quarterly visits with primary care provider and participation in a health education program, patients’ use of emergency departments was reduced significantly compared with Medicaid patients.  

  One of the goals of the program is to manage chronic diseases before they become emergent or incurable, improving the quality of life and lessening the burden on local hospitals and ERs to provide charity care.  

  After the session, ConvergenceRI spoke with Dr. Annie De Groot, the founder and volunteer medical director at Clínica Esperanza, who spoke forcefully about the need to include health access as part of the process of achieving health equity.  

  “I still think we have a real problem with under-insurance and un-insurance in our communities,” she said. “If people don’t know they have diabetes, they are not going to get on a bike, or walk on a trail that everyone is building, or go to yoga classes. They just won’t know that it is very important to them.”  

  De Groot believes that access to primary health care can really make a difference in peoples’ lives. “Let’s not turn our backs on that.” 

  One of the strengths of the 2018 Health Equity Summit was that some of the underlying tensions around how scarce resources were being invested could be talked about.   

  De Groot, for instance, candidly told ConvergenceRI that relationship between Clinica Esperanza and ONE Neighborhood Builders is “fraught with tension” right now because of the spending of money on activities that are not related to connecting people to actual health care.   

  “People think that the problem [of access to health care] was fixed with Obamacare,” De Groot said. “Just like, with HIV, because now you can get treatment for HIV, we don’t have an HIV problem. Well, hello, yes we do. And, we still have a health care problem, especially for people living in Olneyville.”  

  Many people who are renting in Olneyville, De Groot continued, “They do not have access to health care.” 

  Clearly, it is a conversation, a discussion and dialogue that needs to be continued; but the differences are out in the open, and the 2018 Health Equity Summit provided an opportunity for everyone to be heard.

  Courtesy of Convergence RI