Thanks for publishing my photo in As D.C. nightlife grows, it’s becoming more of a bar town – D.C. Policy Center

2017.03.19 Ivy City, Washington, DC USA 01690
2017.03.19 Ivy City, Washington, DC USA 01690 (View on

Thanks (again) for publishing one of my photographs, DC Policy Center (@DCPolicyCenter). It was taken in Ivy City, an area of Washington, DC undergoing tremendous change (like many areas of Washington, DC). As the chart in the article shows, an emerging area like this is mostly populated with bars, as opposed to more established neighborhoods, which have a greater proportion of restaurants.

Also noting the limited impact of relaxation of liquor license moratoriums, an oft-discussed situation in Washington.

It’s another great analysis and very much related to the social determinants of health. You can see the rest of my photographs from Ivy City below. They show what growth, innovation, pride looks like.

As D.C. nightlife grows, it’s becoming more of a bar town. Restaurants still dominate D.C. nightlife, but bars are quickly growing.

Source: As D.C. nightlife grows, it’s becoming more of a bar town – D.C. Policy Center

Just Read: Bike sharing: review of evidence on impacts including health and equity

This is an evidence review of the impact of Bike sharing, which is now a generally-loved phenomenon in 800 cities with a fleet of over 900,000 bicycles, including our system in Washington, DC, Capital Bikeshare (@bikeshare). I think loved in DC both because of the application of technology to support a healthier society and availability of open data to the community to study the impacts.

From the perspective of health and equity, this is a worthwhile read. I’ve been a little bit of a student of these issues which I’ve blogged about previously: Photo Friday: What a difference open data plus 5 miles makes in understanding people’s health choices: Capital Bikeshare. It’s nice that some data is emerging.

Here are a few things I learned

  • Equity. Bike sharing is mostly utilized by white, male, affluent, more educated people. I wanted to dig into the gender differences because it is oft quoted that bike sharing is more likely to be used by women compared to bicycling. Part of this is geography in the placement of stations, part is financial hurdles to join and use systems. The equity issue is significant enough that there isn’t enough coverage in this article, just links to studies to learn more. So I’ll learn more (Thanks to Deborah Bey, PhD (@Geekyblkgirl) for providing me with lots of leads, most notably Better Bikeshare (@betterbikeshare).
  • Doesn’t replace car trips that much. From user surveys, bikeshare mostly replaces walking and public transportation. Car trip replacement was reported as 2% in London and 7% in Washington, DC. However, users surveyed about driving habits reported 29-50% less driving, based on the city. This data is from user surveys though, not direct measurement.
  • Environmental impact unclear. The vehicles used to balance bike stations throughout the day can increase motor vehicle usage. That combined with not-enough car trip replacement may increase carbon emissions.
  • Health. This is seemingly favorable, with a link to a good study which I’ll post on separately. There are higher injury rates for women which may make the health benefit less attractive. For older people, the benefits are greater because they are at higher risk for preventable illness. Unfortunately, they are the minority of bikeshare users.

Overall there is now a good basis to dig into deeper questions of (a) how good is bike sharing for communities and (b) is it good for everyone in communities as well as what changes could be made to make it a bigger win. My impression is that public perception is very favorable (who doesn’t want a bikeshare station in front of their place of work 🙂 ), and with promising analyses of health impacts for some, there is great potential.

Here’s another review of this study as well: Have You Heard About That Awesome New Bike-Share Diet? – Next City

Representing Kaiser Permanente’s Green Energy Program at the White House Summit on Climate Change and Health 6/23/15

Renewable Energy Infographic 52943Renewable Energy Infographic, source: Kaiser Permanente Share

As the title of the post says, I will be attending and speaking at the White House Summit on Climate Change and Health tomorrow: Your Health and Our Environment: How Can We Protect Both? | The White House

The event will be livestreamed at the link above.

I’m looking forward to sharing information about Kaiser Permanente’s commitment to green energy: Kaiser Permanente Share | Kaiser Permanente Makes Major Wind and Solar Energy Purchases

Details in the attached infographic. What I’ve learned being a Permanente physician is that there are things that can be done to protect our communities’ health. I’m passionate about this topic because I care about our health system’s ability to heal and not harm, for all humans. Climate change disproportionately affects vulnerable populations and is a powerful social determinant of health.

There’s a hashtag you can use to ask questions: #ActOnClimate. See you tomorrow maybe.

Just Read: S Street Rising: Crack, Murder, and Redemption in D.C.

Ironically, CBS-WUSA-Channel 9 new anchorman Bruce Johnson told me years later that a lot of the media professionals were going through the same issues that I was going through with drinks, drugs, alcohol and women. – Marion Barry, Mayor for Life

This is the story of one of those people, The Washington Post’s Ruben Castaneda (@RCastanedaWP), who was himself addicted to crack while he was covering the crack addiction of Washington, DC.

Drugs that consumed people, not the other way around

Ruben’s book, Barry’s book, and even Janet Mock’s book (see: Just Read: Redefining Realness: My Path to Womanhood – memoir of a young trans woman) portray the lives of 3 different people, in different parts of society, all touched by the cocaine and death epidemic in the late 20th Century. It’s hard to believe they didn’t know each other, they are so connected.

In Castaneda’s and Barry’s case, the very thing they were working to stop they were promoting at the same time. Is it lack of individual control, or is it greater social determinants and community conditions out of a person’s control? What happens when a community already without a strong foundation is flooded with an addictive substance? It didn’t seem to leave anyone untouched, including the President of the United States and the infamous Lafayette Park incident.

The Post had gone into overdrive after the Barry bust . Reporters were assigned to keep an eye on the disgraced mayor or his house around the clock. My colleagues downed coffee to make it through their late-night Barry watches, but when it was my turn, I took a couple of hits of crack . The irony of riding a crack high while conducting surveillance on a mayor who’d been busted for possessing the same substance was lost on me.

Castaneda, Ruben (2014-07-01). S Street Rising: Crack, Murder, and Redemption in D.C. (p. 4). Bloomsbury Publishing. Kindle Edition.

What caused the violence spiral to end? It’s unclear.

S Street slingers

Castaneda takes us through the S-Street Northwest of the 1990’s, destroyed once in the 1968 riots after the assassination of Martin Luther King, Jr., and again by drugs and murder. S Street and 7th is just 1.5 miles away from the White House and downtown Washington, DC. If you visited Washington, DC in your youth (the most common way people seem to experience it), you wouldn’t believe that just a 20 minute walk away from the majesty of our monuments are a people struggling to live. Actually, that’s still the case today, you just walk in a different direction.

The BBC did a great job putting together a show about Ruben’s work and Washington, DC, which is a good summary, as well as heartbreaking.

Since I am an afficionado of all things in the district, I took the time to visit some of the places mentioned in the book, including the most notorious open air drug markets in the city. Some of them are just blocks away from the current Kaiser Permanente Center for Total Health. One of them is adorned with a very large Kaiser Permanente billboard:

Compare the Hanover Place of today to 1984

How did it all end?

I can’t seem to find a good explanation as to how/why the drug wars as they are called ended. Was it because of increased law enforcement? Did the drugs consume enough people that the demand subsdided? Did economic development make a difference? There’s an interesting analysis here from 1999: Cracked up –

Really makes you think about social determinants of health.

The fact is that the murder rate in Washington, DC is down, but it is still significantly higher per capita than New York City, by a factor of 4 (Homicides remain steady in District, Prince George’s – The Washington Post), and we still live in something of a divided city (“New Maps of DC health data – Not yet one culture of health”).

I remember

Just as I once took a wrong turn into Janet Mock’s neighborhood in the early 90’s, I also did a student rotation in Washington, DC in 1995. It was true, walking even 2 feet east of 16th Street Northwest was like walking into a different world. It it is an interesting feeling to walk in the neighborhoods today that were the places that no one would dare go. It’s…. a feeling of respect and honor for our nation’s capital, which is hard to explain.

If you love Washington, DC, or need a reminder of where our cities came from, I highly recommend this book. There’s so many amazing stories about people brought together with little to no hope, in a place that should be overflowing with it.

Neighborhoods that are less comfortable places still exist; it is our challenge today to not wait until they are safe enough for us to spread health.

New Maps of DC health data – Not yet one culture of health

Catching up on social innovation I haven’t yet posted about…

I have complained previously about the fact that data purporting to show Washington, DC’s health status as a county is usually wrong (see: Do national numbers inaccurately represent Washington, DC’s obesity condition? | Ted Eytan, MD – Answer: YES) because DC has 8 wards within it that are not accounted for in the County Health Rankings’ of the world (@CHRankings). This makes these tools less useful in a place like our nation’s capital. What if you live here and love this city and want to make a difference?

Community Commons (@CommunityCommon) to the rescue. Earlier this year they so very nicely agreed to add Washington, DC ward boundaries to their most awesome mapping system , and some key health data points based on DC-level data. They even created a special hub “Center for Total Health” that’s invite only so I can bring community health activists to map their city, collaboratively.

Here’s the obesity map for Washington, DC:

Obesity by Ward, Washington, DC USA 51195

Here’s the smoking status map for Washington, DC by Ward:

Smoking Status by Ward, Washington, DC USA 51194

These are new; previously there was no way to understand DC’s health using an interactive system because all of the data is clumped at the county level. As you can tell from the above, if you see an obesity rate of 21 % for “Washington, DC” you’ll miss important distinctions.

Now, here’s the race / ethnicity map for Washington, DC, available by census tract:

Race/Ethnicity by Tract, US Census 2010, with Ward Boundaries  51203

Do you see a picture of different health status on the left side of the map vs the right side of the map?

Wanna play? Click on either map

The new capabilities provided by Community Commons allow us to map any sub-county level data over ward boundaries so we can understand our city better. I even created a few interactive ones that you can play with here. Just click through, you’ll need to create an account on to make any changes. Up to you.

While I was at it, I also created a map using DC-data-whiz Michael Schade’s (@mvs202) interactive Google Places map, plotting presence of what Google labels “gyms” in a 4-metro station radius of Shaw/Howard University Station:

Heat Map - Gyms in Washington DC 51193

You can see that gym businesses in the Google places database encircle Dupont Circle (14.4 % obesity rate), with a lot less presence east of Shaw/Howard University Metro (17.4 % obesity rate heading into 35 % obesity rate). These distinctions are important – people who spend their time in the western half of the city may believe they own a culture of health, but it’s only they that do.

I mention Shaw/Howard, because I recently read the excellent book S Street Rising: Crack, Murder, and Redemption in D.C. by Ruben Castaneda (@RCastanedaWP) which has stimulated tons of thinking about how a city creates and loses health. More on that later…

Yesterday, I happened upon a ribbon cutting ceremony by our Mayor (@MayorVinceGray) (who has done incredible things for human rights) in that neighborhood. I asked a bystander if she was here during the riots that destroyed this part of the city in 1968. She said, she was, and it was a scary and sad time. I believe her.

Photos: S Street, 1968 and 2014 – next to Shaw/Howard Street Metro

She told me that her friends told her she should have taken photos of the before and after, because so much had changed. I responded that there were still plenty of photos to take – even though the buildings look new, there’s plenty of “before” to be found, the maps show it.

Thanks a ton, again, to Community Commons for being responsive/interested/supportive and no negative vibes meant to County Health Rankings – we are all friends and the two resources go together in the most useful way. Sometimes you have to go to the places that no one else goes to find and create innovation in health. That’s what social innovators do 🙂 .

If you’d like to do some DC mapping, drop me a line/comment/tweet and I’ll invite you to the hub on Community Commons.


Just Read: Redefining Realness: My Path to Womanhood – memoir of a young trans woman

There have been a lot of great reviews of this bestseller published, mine is a read from the perspective of a physician, trans* ally, supportive of equitable health care for all.

As the title says, this is a memoir of a young woman, Janet Mock (@JanetMock) formerly a staff editor at, now (today) starting her own show at MSNBC – “Shift” (@ShiftMSNBC). I wanted to learn about the journey of a trans woman, and also to celebrate what we call “positive exemplars” – the people who change perception of what a ____ (name your population) is supposed to be. 

“Oh. This is a story of a woman growing up.”

That’s what I said to myself when I finished the book.

Clearly people are going to be interested in the portion of Janet’s life that is about transition, and she does a nice job throughout to convey important information about the social, medical, scientific millieu of being a transgender person. However, she tells the story of a young woman raised in challenging environments, in Honolulu, Dallas, and Oakland:

…plugging people into the “transition” narrative (which I have been subjected to) erases the nuance of experience, the murkiness of identity, and the undeniable influence of race, class, and gender. It’s no coincidence that the genre of memoir from trans people has been dominated by those with access, mainly white trans men and women, and these types of disparities greeted me head-on when I stepped forward publicly.

I was specifically taken by her description of growing up in Oakland, California, when the crack epidemic hit. It describes a drug that consumed people, not the other way around, and is so similar and impressive to a story told a continent away, in Ruben Castaneda’s (@RCastanedaWP) “S Street Rising,” about Washington, DC.

When we talk today about “social determinants of health” and individual behavior, there’s something here that seems a bit beyond what an individual family or person can control:

“How much you pay Charlie?” the man asked John. I had to stop everything inside of me from saying that Dad did not get paid to tend to John’s car. He was no one’s employee; he did it because he was John’s friend and he loved the Caddy as if it were his own. “He loves that car, man,” John said, calming my defenses. I knew he knew my father and appreciated his work. “But,” John continued , “I feel sorry for him, you know. He’s a crackhead. I give him twenty bucks here, another there.” I turned my head toward Dad, who was polishing away at a rim. Beads of sweat ran from his hairline to the lines of his forehead as he bobbed his head to a tune only he could hear. In one instant, Dad was . . . a crackhead.


I vividly remember the routine sight of a baby girl wearing a soiled diaper, playing with an equally dirty doll on her lawn. No parent or sibling in sight. She would just cry and cry and cry. No one asked, “Where’s her mama?” Her wailing became the background vocals to our double-Dutch anthems , kind of like the barely heard baby yelps in Aaliyah’s song “Are You That Somebody?” In addition to the baby girl, I saw stray dogs and crack vials on my way to school. But crack’s reach went beyond those vials we skipped over. When Maddy’s mom, who would beg the boys on the corner for “some stuff,” passed away of AIDS complications, I hugged my friend good-bye: Maddy and Aisha moved to San José to begin a better life with their mother’s sister.

I did a little research on the crack epidemic as part of this – it’s not clear exactly how it ended. Maybe through the actions of people like Janet’s father who moved away from Oakland, or Ruben Castaneda, who was hospitalized by his employer, the Washington Post, it just stopped tearing through people.

I think this woman’s (Janet’s) is important because it’s not about the loving middle class parents who recognize differences and from whence viral videos come from:

To be frank, these stories are best-case scenarios, situations I hope become the norm for every young trans person in our society. But race and class are not usually discussed in these positive media portraits…

Being a woman

There’s a helpful discussion about what it means to be a woman, a trans woman. I have seen people make comments that people who are trans somehow have a responsibility to identify themselves as such.

It is not a woman’s duty to disclose that she’s trans to every person she meets. This is not safe for a myriad of reasons. We must shift the burden of coming out from trans women, and accusing them of hiding or lying, and focus on why it is unsafe for women to be trans.

I agree. In the scope of human relations, why is it important to know someone’s sex at birth, or their sexual orientation before puberty for that matter (which is a different issue than gender, to be clear)? Why not appreciate people for what they are today? It’s hard enough for any person to do that for themselves, we don’t need to make it more difficult.

Getting Health Care

khun krap, Miss Janet,” he thanked me in Thai, reaching for my hands. “I want to thank you for trusting me to help you in this next step of your life. It’s a blessing that I get to make people like you more happy.

It’s amazing to think that an important part of the LGBT population needs to to go Thailand to be treated with compassion by the medical profession. It’s what they call in some circles “reverse innovation” – that the best ideas don’t start in the United States.

Considering the world she grew up in, she seems incredibly fortunate to have found an endocrinologist in Hawaii that listened and prescribed her hormones.

Not all trans people come of age in supportive middle- and upper-middle-class homes, where parents have resources and access to knowledgeable and affordable health care that can cover expensive hormone-blocking medications and necessary surgeries. These best-case scenarios are not the reality for most trans people, regardless of age.

The other thing this population is also forced into is sex work, not by choice, but by poverty, not just to pay for excluded medical care, but to manage a society that discriminates in employment. Janet openly discusses this part of her life. And then, at some point she transitions from a girl to a woman, with an academic degree, a profession, and the ability to achieve her life goals through optimal health. Just like every woman should.

A world away, except that it isn’t

We can read these stories and say to ourselves, “wow, so far away from my experience,” except this distance is based on choices we make.

I reflect on the fact that while Janet’s community was being devastated by crack cocaine, I was receiving an A+ education just a few miles away, at UC Berkeley, in Public Health. The Oakland freeways at the time were a little confusing to me, and a few times I took a wrong turn and probably drove through Janet’s neighborhood in a confused an anxious state, as I looked at the streets on either side of me. The same was true of my existence the following year in Washington, DC – just a few blocks away from neighborhoods spiraling out of control with deadly violence (I’ll post on that next week).

We can say that was a long time ago, except that those parallel worlds still exist today, wherever we are. We have a responsibility to know that they exist, and work to make them less hostile, or we’ll just say in another 20 years, “I had no idea that was going on a few miles away.”

From that perspective I’m grateful for the Janet Mock’s, the Ruby Corado’s (@CasaRubyDC) , and all the people I share a city and community with who are willing to teach so that the people who will come after them will have better lives. Because that’s what Janet says, it’s what Ruby says as well – “you know, I can take this, but the kids coming out deserve better.” They do. 

I was fortunate to see Janet Mock live when she was in Washington, DC when the book was published. She appeared at the Martin Luther King, Jr. Library, with an audience sitting under a mural of MLK’s legacy including the signs of people during the 1968 Memphis sanitation workers strike that said “I AM a Man.”

How appropriate for Janet Mock to be speaking to us about being a woman, then 🙂 . Photos from that event below. Thanks again for changing the way we think about women and providing a helpful resource for people to improve their compassion skills.

Health is more than about medicine, as taught to us by…ApplePay

My first transaction. Just a pair of vanilla cones, easily walked off / not to worry.

The day ApplePay was released to the world, I happened to be with a few close friends from the Innovation Learning Network (@HealthcareILN), in Charlotte, NC. Okay, I actually crashed their dinner – it was with people from Kaiser Permanente Colorado (@KPColorado), Robert Wood Johnson Foundation (@RWJF), HealthPartners (@HealthPartners), Nordstrom (@Nordstrom), and our world famous Innovation Consultancy (@KPInnovation) – who wouldn’t want to crash?

What they probably all remember is the drumbeat of my request to find an establishment where I could try ApplePay for the first time. My first transaction ultimately happened in Washington, DC a few days later, which is probably a better place for me to enjoy such a milestone anyway 🙂 .

I remember Tim Cook introducing ApplePay on September 9, 2014 – in my mind it was presented as mostly convenience and ease – the end of the wallet as we knew it – with a little bit of security added on. I wanted to try it just because of the cool factor, because at some level I am an innovator (shh, don’t tell, I try and portray myself as early majority).

What completely caught me off guard was what happened next.

When one, then two major retailers abruptly disabled support not just for ApplePay, but all contactless payment systems over the weekend, security took center stage. And in the process fairly large banks of good will began to experience significant withdrawals…

I have posted about the bank of good will concept previously: Using social media to build up the Bank of Good Will – Businessweek | Ted Eytan, MD, which is otherwise called “Using your peacetime wisely” to build a trusted following in advance of times of crisis.

In this case one of the companies has built a sizable amount of good will based on the decision to discontinue selling tobacco, and a nice rebrand (@CVSHealth @CVS_Extra). Now, watching the twittersphere light up shows what I’d call a significant erosion of that good will, and interestingly, around the issue of “health” in the broad sense.

If you do search of comments directed at @CVS_Extra today (click here to see a realtime search of tweets directed their way), you’ll see a slight reduction in the simmer, with tweets alternating between carved pumpkins and mild to moderate what I’d call “unhappiness” about the decision to shut off contactless payments for all people, even though they’ve been working in stores for several years now. Obviously turning something off that people once had is worse than never having it in the first place.

Looking at the unhappiness though, shows that people are discounting the health rebrand based on a perceived threat to the health of their financial transactions. In other words, they are making a link between their community’s physical health (improved by making tobacco less available) and their personal financial health (degraded, by making secure transactions less available). You can see it in the tweets, several of which I’ve favorited to demonstrate this.

Link to selected tweets connecting financial health and physical health in the era of ApplePay

As I look deeper there are actually people who appear to have joined Twitter just to make their opinion known. And people who don’t even own the required equipment (Apple iPhone 6) who are unhappy.

The issue of security, as explained by Tim Cook, is that the contactless mechanism of ApplePay keeps information held by the consumer, in the consumer’s hands (or their mobile device) and does not transmit it to the retailer – a one time token is created for the purpose of the purchase. The old-fashioned swipe-your-card method transmits a credit card number to the retailer with all the challenges that ensue from that approach (including free credit monitoring, which most Americans, including myself, now have as a result…).

I’m not going to get into the why the retailers made the decision they did and why a competing system is causing grief (plenty online about that), just thought it’s useful to point out this connection from a health perspective.

Health is about wellbeing and security in all forms, including physical, spiritual, financial, that allow people to achieve their life goals.

As I am fascinatedly watching through the lens of ApplePay and the theatre that is social media, consumers are making it known in 2014 that promoting health means promoting all of it. I assume I’m not the only person seeing this (because I’m not that smart and my ideas aren’t that unique) – let me know your observations in the comments…

Just Read: In DC, there’s up to a 14 year life expectancy gap between blacks and whites that hasn’t changed in 15 years

The life expectancy of a black male in Washington, DC as of 2009 is the same as a man in North Korea as of 2012. For a white male, the life expectancy is higher than Israel, lower than Switzerland.

Sources: World Health Organization; Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82. View Life Expectancy World and DC – Male – 46576 on

The life expectancy of black females in Washington, DC as of 2009 is in between The Russian Federation and Syria or Iran as of 2012. It’s higher than North Korea, which is 73 years. For white females in Washington, DC, it’s just below the highest life expectancy in the world, Japan.

Sources: World Health Organization; Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82. View Life Expectancy World and DC – Female – 46577 on


This article caught my eye because of my recent trip to Anacostia, in Washington DC’s Ward 8, where health disparities are extremely tangible (underscore): The People of Washington, DC’s Anacostia are Building a Culture of Health | Ted Eytan, MD

They are not just tangible in Anacostia, they’re visible on my walk to work through the city, where I pass through about 8 years of life expectancy. Just do a search of “#activetransportation” on my Twitter feed to see photos of what this looks like; it’s obvious.

This paper, published in this month’s Health Affairs (Harper S, MacLehose RF, Kaufman JS. Trends In The Black-White Life Expectancy Gap Among US States, 1990-2009. Health Aff. (Millwood). 2014;33(8):1375–82) is an analysis of the disparity in life expectancy between whites and blacks in all 50 states and the District of Columbia, using census data.

It confirms what I see on my walk to work, and adds another piece of data that I don’t see, which is that this disparity has continued, unchanged, for the last 15 years:

The estimated state-specific racial gap in life expectancy among males in 1990 ranged from 14.4 years (95% CI: 13.3, 15.4) in the District of Columbia to 0.0 years (95% CI: −5.2, 5.3)

For females, the District of Columbia and New Hampshire also had the largest (10.4 years; 95% CI: 9.5, 11.2) and smallest (1.2 years; 95% CI: −3.9, 6.2) gaps, respectively, in 1990. In 2009, despite overall improvement at the national level, the enormous racial gap in the District of Columbia remained almost completely unchanged for both males (+0.4 years; 95% CI: −1.1, 1.8) and females (+0.2 years; 95% CI: −1.1, 1.6). Life expectancy there remained dramatically more unequal than in every other state.

And then if you compare the change in life expectancy for women (men show the same trend), it’s been constantly disparate since 1990.

And then there was New York

New York State has shown a different trajectory, as you can see from this chart. There has been a massive upgrade in life expectancy for black men and women compared to their white counterparts, narrowing the gap the greatest.

The largest decrease in the gap for males occurred in New York (−5.6 years; 95% CI: −6.0, −5.1), largely because of a dramatic increase in black life expectancy, from 63.9 years to 75.4 years. This was a gain of 11.5 years; the national average gain was 6.5 years.

I’ve written about this previously (New Yorkers Living Longer Than Ever, Outpacing National Trend, a look at the data | Ted Eytan, MD). It’s real. And since I’ve written about it, a review of what happened in New York has been published just this year (Preston SH, Elo IT. Anatomy of a Municipal Triumph: New York City’s Upsurge in Life Expectancy. Popul. Dev. Rev. 2013). A lot of New York’s success has come from identification and treatment of HIV, as well as the same for drug and alcohol related injury/death. It’s worth a read for sure.

Our cities are changing, we just need to make the change happen for all

A few more really important DC datapoints:

  1. Population in 1950: 802,178
  2. Population in 1990: 606,900, 70 % black
  3. Population in 2010: 601,723, 50 % black
  4. Population in 2013: 646,449

In this map you can see where the black and white population live. The green color represents black residents, the blue represents white residents:

You can grab and manipulate this map yourself at the continually awesome (@CommunityCommon)

I cross the “dividing line” in the middle when I walk to work. Ward 8 (Anacostia) is in the lower right. Every other map you could draw, from bikeshare rentals to income to education is going to show the same disparity. With this visual, it’s not hard to tell why an “enormous” disparity still exists between black and white people.

I still see proclamations of Washington, DC as the “third thinnest” state, which badly misrepresents the huge disparities here and harms our ability to understand the health of our community.

Why this is not good

There is good news, which is that life expectancy for both black and white men and women has increased in Washington, DC (by 4+ years for both black and white women, by 8+ years for black and white men).

A significant inequality still exists and that’s a problem. This means that the opportunity of black men and women to achieve their life goals starting with a long life is blunted compared to white men and women.

Diversity brings with it a torrent of innovation. If this trend does not change, we’ll learn less every day, and enjoy our community and the world a lot less. And why would we want to do that?

We share our community with incredible leaders who don’t support the status quo:

I’m with Ruby. We are going to change everything 🙂 .

Permission to reproduce the images courtesy Health Affairs (@Health_Affairs)

The People of Washington, DC’s Anacostia are Building a Culture of Health

The last time I was in Anacostia, Ward 8 of Washington, DC, was almost exactly 2 years ago (!) when I walked with Kait Roe (@Fuse_Kait) and Pierre Vigilance, MD (@PierreVigilance) (see: My #walkwithadoc and patient, exploring the determinants of health in Washington, DC Ward 8 | Ted Eytan, MD). Well actually, I was *near* Anacostia when I walked the future 11th Street bridge (@DCBridgePark) (Photo Friday: Walk With a Doc over a future, beautiful park over water, in Washington, DC, USA | Ted Eytan, MD).

On the ride back to much-less-obese Ward 2 in 2012, I remember asking Pierre about the determinants of the social determinants of health in Ward 8. If people didn’t want to die any earlier in Ward 8 than in Ward 2, how did they want to live? There was so much in the media about dog parks, bike lanes, and food deserts at the time, what was the answer?

It’s now 2 years later, and this time, I didn’t go to Anacostia to go see Anacostia, I was invited, along with my friend Lane (@tlanehudson), to meet Khadijah Tribble (@tribbleme), who is a person who lives in Anacostia. We chatted in the brand newish NURISH Anacostia (@NurishAnacostia) cafe, one of only 3 sit down restaurants in the Ward, one of which has a sign on the door that says, “Please have your shirts on.”

Khadijah used to be over 300 pounds. She’s now at 208 and she let us know that she’s working to create a culture of health in Anacostia, because when she looked for one, it wasn’t there.

“Culture of Health” were her exact words – she said she picked the phrase up from the Robert Wood Johnson Foundation’s newest initiative. Hey I know some people that know a little something about that @RWJF :).

The Maps

Thanks to the still awesome Community Commons platform (@CommunityCommon) I ran some maps of Washington, DC with data on food access, poverty, and high school education. Poverty plus high school education gives you a vulnerability index.

It doesn’t matter which map you look at, you can tell which parts of the city are most in need. The Northwest part of Washington, DC is the least obese, has the greatest income gradient, lowest poverty rate, highest educational attainment, highest access to healthy food. The Southeast part of the city, across the river, where Ward 8 is, the opposite:

The county level obesity data is not useful, as you can tell, and actually tends toward being harmful, because it implies that Washington, DC is in the top quartile of obesity status and that there isn’t a problem. I’ve explored this in a previous blog post – you have to look at sub-county level data (Do national numbers inaccurately represent Washington, DC’s obesity condition? what electronic and personal health records can do to help | Ted Eytan, MD). There is a problem. There are impressive disparities in this city.

I ran a comparison of San Francisco, CA on the food access data, which shows that even the less vulnerable parts of Washington, DC are more challenged in food access than in San Francisco.

The Walk

Khadijah took us on a walk down Martin Luther King, Jr. Ave SE, past “The other U Street” (Southeast, we inhabit U Street NW, which a generation ago was strikingly deprived itself). We passed the largest chair ever made (“The Big Chair”), rededicated as a sign of hope for this community in 2006. The convenience store that I visited in 2012 didn’t seem to be open this time.

I took photos. See if these images are the signs of a healthy community:

I was so lucky that I got to meet The Advoc8te (@TheAdvoc8te), fellow blog writer of the I’ve-been-following Congress Heights on the Rise Blog. She’s in the photo with myself and Khadijah. It was a cool moment for me 🙂 . I also got to meet Dr. Lisa Fitzpatrick (@askdrfitz), who’s currently enrolled at the Harvard Kennedy School mid-summer program.

The Culture (of Health)

Lisa and Khadijah are part of (founded?) The Community Wellness Collective (@comemovenlearn) which is based at the Anacostia Arts Center (@AnacostiaArts), where NURISH is also housed. So where I left Ward 8 2 years ago with a lot of questions, this time I left with a lot of ideas, that are not from me. Those are the best kinds of ideas.

As Khadijah explained, there isn’t yet a sense of “comfort” for women in the community who want to exercise. A lot of messaging (and the assumptions that go along with them) are not appropriate for this audience. Here’s a great example of that: How Low-Income Commuters View Cycling – CityLab. People don’t know how to use health services well, and they don’t know how to shop healthy within their immediate environment, based on what’s available. These add up to challenges that need to be solved at many different levels, because as the data shows, there are large disparities.

The Community Wellness Collective is working toward this, with exercise classes and food instruction. I hope to attend some of these, because all I know is that I don’t know about what’s needed.

Our Cities are Changing

The new Ward 8 7-11 looks a whole lot like this Ward 2 7-11 from 2012, and that’s a healthy thing View on

I just noticed this post on CHOTR: Congress Heights on the Rise: Anacostia welcomes it’s 1st national retailer to the neighborhood!, which is about the first 7-11 opening up in Ward 8. And guess what. The photographs of the Ward 8 7-11 show a similarity to the photographs I took of the Ward 2 7-11 in 2012, right down to the fresh fruits and vegetables..

She writes:

As we were exiting I noticed that several discount stores on Good Hope Rd had undertaken a little upgrade of their own. The shop directly across from 7-11 was sporting some freshly cleaned windows (possibly a first in the 6 years I’ve been in the neighborhood) and a newly organized window display. It seems consumers aren’t the only ones taking notice of the new kid on the block. 😉 Here is to hoping the upgrades continue.

I came to Anacostia for the same reason my generation came to health care – we are not satisfied with the status quo, we love the places that we live in, and we’re here to change everything. Yes, here is to hoping the upgrades continue, because, to quote community leader Ruby Corado (@CasaRubyDC):

Doctors Like Bridges, Especially This One

I got to visit with Scott Kratz (@ScottKratz) , Edmund Fleet and fellow supporters of the Washington, DC Bridge Park (@DCBridgePark) yesterday, in one of Washington’s first allergy free days this season yesterday.

The Park continues to accumulate fans, including the best design teams in the world: Washington Post: Designers compete to build D.C. version of High Line park.

Doctors like bridges. Especially ones with parks, that connect communities and produce health. The fact that it’s in DC is just icing on the kale 🙂 .

DCBridgePark (DCBridgePark) on Twitter