Improving Community Health and Building Community Wealth in the Bay Area

Oakland at golden hour from the LHS vista, Berkeley CA (David Parks/Flickr)

Hospitals, schools, universities, and municipal governments have the potential to improve public and environmental health and to strengthen the economic vitality of their communities. As anchor institutions, they are rooted in place, holding significant investments in real estate and social capital, are among the largest employers in their communities, and are often explicitly oriented toward supporting community health in alignment with their missions.

What if, in addition to providing important public services, they worked with the community to leverage their considerable assets and purchasing power to target the social determinants of health with a focus on increasing job opportunities, improving health outcomes, and fostering community resilience?

A multi-sector community-based partnership, comprised of representatives from key anchor institutions in the health and education sectors, non-profit organizations, lenders, foundations, community leaders, and cities and counties in the San Francisco Bay Area of Northern California has set out to answer this question. The partnership is called Anchors for Resilient Communities (ARC) and is being co-coordinated by Health Care Without Harm and the Emerald Cities Collaborative, a national non-profit with a focus on creating sustainable, just and inclusive, local economies.

Despite a booming, tech-fueled economy in San Francisco, income and health inequities in Bay Area communities are prevalent and on the rise. In 2015, PolicyLink created an Equity Profile for the region. In 1979, the Bay Area ranked 45th of the largest 150 regions when it came to income inequality. By 2013, the region was 14th. With these economic disparities come related health inequities. Since the 1960’s in East Bay communities, the life expectancy gap by race has widened considerably from less than two years to nearly six. National economic inequality has grown rapidly during this period as well, a development that the Ford Foundation has taken to calling the “defining challenge of our time.”

Poverty and environmental health account for over 40% of health problems in the East Bay Corridor. (CalEnviroScreen)

At the outset of the project, ARC collaborated with the Democracy Collaborative to complete an extensive assessment of both the procurement needs of anchors and the existing resources and capacity in the communities of Oakland and Richmond. The assessment, which included over 200 stakeholder interviews, led to recommended priorities for opportunities: 1) a vibrant, localized food system and economy, 2) clean energy / green building, and 3) green businesses.

The key to creating a resilient community, according to the assessment, is local green businesses which promote sustainability and provide jobs. In California, the “clean” economy now employs over 300,000 workers and is the fastest growing sector of the state’s economy. Local business is a proven impetus for growing community wealth. According to the American Independent Business Alliance, 48% of revenue from local businesses gets redistributed in the community compared to only 13% of revenue from chain businesses.

The assessment also quantified the collective procurement spending of anchor institutions in the East Bay Corridor at $6.8 billion dollars per year. The effect on the local economy, if even a small percentage of procurement shifted over time to locally owned businesses, products, and services, could be profound.

Robust, Regional, and Resilient Food Systems

Fostering healthy regional food systems, according to the assessment, was a realistic and attainable strategy to help improve community health outcomes and build community wealth in the Bay Area based on factors including the existing agricultural productivity of the region and the vibrant urban good food and food justice movements.

“Health Care Without Harm envisions health care’s role in building a robust, regional food system through a combination of procurement and investments — a potentially powerful combination” says Lucia Sayre, the Western Region Director for Health Care Without Harm’s Healthy Food in Health Care program. “To localize the food economy, we need to look at the possible interventions which exist all along the continuum of what we call the food system.”

“This is an opportunity to go beyond addressing acute food insecurity,” she continues, “to building processing and distribution infrastructure, increasing sustainable food production in the region, and funding initiatives to modify land use and preserve agricultural land, all of which are critical steps in our approach to mitigate climate change as well.”

Many major institutions want to support a regional food economy through their purchasing, however this goal can be challenging for a number of reasons, primarily due to a lack of infrastructure: garnering enough supply, replacing conventionally-grown products with sustainable alternatives, processing whole foods to the institutions’ specifications and needs, etc.

Hundreds of institutions are striving to support a regional food economies, many successfully, but with the right community agriculture infrastructure in place, it could be much less challenging.

Anchors for Resilient Communities sets the table for conversation between anchors and community around using community benefits, purchasing power, and other assets to invest in building the infrastructure needed to solve these challenges. One initiative already in development is a regional food system project called My-Cultiver.

Part food hub, part aquaponic greenhouse, and part meal production and distribution center, My-Cultiver aims to produce 200,000 ready-to-eat meals per a day to distribute to institutions such as hospitals, schools and universities, and will be locating the core of its operations in the communities of the East Bay. The collaborative is led by FoodService Partners which has been providing meals for Kaiser Permanente’s Northern California facilities for over 17 years. These meals will be comprised almost entirely of fresh, seasonal, locally produced sustainable ingredients and will be delivered ready-to-eat to institutions all over the region.

My-Cultiver organizational chart (Sally Wally)

In partnership with ARC, My-Cultiver is primed to create jobs for residents, foster a cooperative ownership model, increase the capacity of small community-owned food businesses to scale up to the institutional market, and support existing urban and regional food production.

“My-Cultiver represents an ideal food provider — offering the kinds of food and meals that our hospitals have been committed to sourcing and serving through Healthier Hospitals and the Healthy Food in Health Care Pledge,” says Sayre. “It is these types of collaboratives and infrastructure that are needed to increase the availability of the quality food the hospitals have committed to purchasing such as poultry raised without routine antibiotics and local, sustainably grown-produce.”

Institution Supported Agriculture

The community-based, vertical integration of production, preparation, and distribution is critical to the success of this plan — whether the food is produced in My-Cultiver’s aquaponic greenhouses or aggregated from local food producers both in the city and in the surrounding 250-mile foodshed. To produce the volume of food needed to meet institutional demand, both urban and regional food producers need support in the form of planned purchases and other investment.

The story of a strawberry from aquaponic greenhouse to plate (My-Cultiver, Sarah Wally)

Traditionally farmers have had to take a risk at the beginning of the growing season. They plant what they think they can sell and hope that enough can be sold to cover their costs. Community supported agriculture and a growing market for local foods is helping to absorb some of that risk but institutional buying agreements take this support to a whole new level.

“It’s a complete shift in what’s happening in local farming,” says Sarah Wally, the managing director of My-Cultiver.

“We already know our customers and clients and we know how many millions of pounds of local food products we are going to be need on an annual basis.” She continues, “Our chefs, dietitians and nutritionists are creating those menus three months in advance — we can easily go to our farmers and can pre-plan the carrots, the beets, the potatoes, the onions…from vegetables, proteins, fruits, to finished products. The farmer doesn’t have to wait until the harvest has ended, we’re pre-contracting all the way down the line.”

In addition to food production and meal preparation, My-Cultiver, seeks to be a community center for education and innovation. The 20,000 square-foot “Edu-tainment Center” will host classrooms, exhibits and hands-on demonstrations teaching visitors about agricultural science, nutrition and sustainability. Vocational training and practical knowledge lessons in growing and cooking and everything in between will be offered creating jobs and nurturing careers. My-Cultiver intends to incubate new food businesses by partnering with food entrepreneurs in order to continually increase ingredient options and to support community economic growth. Wally envisions My-Cultiver becoming an “anchor business.”

What’s Next?

Lauren Poor, the California Community Food Systems Specialist for Health Care Without Harm, is working with ARC coordinators on an evaluation plan to measure the health, environmental and economic impacts of ARC-supported projects in Bay Area communities. With this evaluation framework, anchors will be able to identify how their procurement and investments in businesses like My-Cultiver can meet both their goals for increasing sustainable food procurement and for improving community health outcomes. Another potential role for the anchors at the table is to lend their expertise in evaluation, data collection and research from their community benefit work to this process.

FoodService Partners Tour. Pictured from left to right, Angelo Bizarro (FoodService Partners) Tara Marchant (Emerald Cities Collaborative), Courtney Crenshaw, Lauren Poor, Lucia Sayre, Jack Henderson (Health Care Without Harm), Sarah Wally (My-Cultiver)

Through its research, work and planning process, the Anchors for Resilient Communities project has shown that it takes a community to manifest community resilience and the health sector is an integral member.

“Health Care Without Harm is expanding from our original mission of ‘Do No Harm’ to one of building community systems that heal and helping to define what the health sector’s role is at this table,” says Sayre, “It’s a much more proactive role, going beyond preventing harm to fostering health.”