Thursday, May 9, 2019

But what is the outcome?

On Friday, May 3rd, 2019, we met at UCLA Health. "Mitch Katz Rides On" was the title for an attempt to facilitate healthy transportation programming around medical providers in Los Angeles. It is part of a larger vision of medical providers playing an active role in reducing unhealthy modes of transport. Because as you drive more, obesity becomes a problem. And the more your use actives modes (transit, cycling, walking), obesity and all its side-effects declines. Look here:





This graph gives us the big picture. It was the center of our conversation. The first installment of a good and important conversation. But what precisely was the outcome?

We understand the need for the community benefits teams to learn more about the METRO Best program which provides community based bicycle education and encouragement. We invited Indu Sanwal from the UCLA Health community benefits team, but she cancelled on the day of the meeting. We invited Cindy Levey from the Cedars Sinai community benefits team, but she had a conflict. We invited Katrina Bada from the Good Samaritan Hospital community benefits team. This hospital conducts an annual Blessing of the Bicycles, but she could not come. We invited Justin Joe from Providence, who is in charge for community benefits for a number of Providence hospitals. In his place Paul Makarewicz, Director of Mission Leadership from Santa Monica, joined us. We are very grateful for that. We invited Nancy Clifton-Hawkins from the City of Hope community benefits team, but she had a prior engagement. We invited Celia Brugman from the community benefits team at Kaiser Permanente in West LA, but she could not come, and neither could her deputy. We also invited Melissa Biel, whose firm Biel Consulting contracts with many hospitals to conduct Community Health Needs Assessments. She thought it was an important topic, but she was not available.

Mind you, we were able to make our pitch on the phone, sometimes more than once, and a very useful time on the phone it was, for which we are grateful. But when it comes to a better understanding to how healthy transportation programming could be implemented at UCLA Health, at Cedars Sinai, at Good Samaritan Hospital, at Providence, at City of Hope, at Kaiser Permanente in West LA, we were not really able to share our message and advice. What kind of format would be suitable? What kind of obstacles should we expect? How to advertise, whom to include, how to connect with related efforts. It was a important conversation to have, highlighting the need for such programming, and highlighting the need to build bridges between the domains of transportation and health, referring occasionally to the long list inspiring precedents here. And acknowledging, more than once, the work done by Prof Richard Jackson of Designing Healthy Communities, whose work has left a deep impact at UCLA and elsewhere.


Click to enlarge
From left to right: Eli Kaufman (LACBC), James Evans (UCLA Health, Sustainability), Linda Khamoushian (CALBike), Jean Armbruster (LA County Public Health, Place Program), Jimmy Tran (UCLA Transportation), Karen Miotto (UCLA Health Physician Wellness), Richard Azar (COO UCLA Health), Gustavo Friederichsen (CEO LA County Medical Association), Michael Cahn (Bicycle Academy). Not pictured: Jim Shanman (Walk 'n Rollers), Paul Makarewicz (Providence Saint Johns). Present by implication: Richard Jackson.


Yes, it was a good meeting to have. We are grateful for those who attended, and for those who had time for us on the phone. We learned that the LA County Medical Association is a strong ally for healthy communities. We argued that bike advocacy is health advocacy for everybody, not a special service to a few bicycle enthusiasts. We agreed that the Metro BEST program now offers a very special opportunity for health providers: Too good to be missed. We said that hospitals will soon come to recognize the tremendous health benefits of active transportation. In Los Angeles - where else?

The work continues. At the next round all the community benefits teams will be in attendance. Hopefully.

Friday, April 5, 2019

Hospitals addressing Automobilitis: Examples for the Future


(1992) The British Medical Association publishes "Cycling towards Health and Safety", arguing that cycling should be an integral part of the medical toolkit, as important as addressing alcohol and tobacco abuse

(1996) The American College of Surgeons issues guidelines for trauma prevention. Level I Trauma Centers must implement at least two programs that address major causes of injury in the community (Car Seat Safety etc). We are not aware of any certified hospital that has actively engaged with healthy transport or Vision Zero initiatives

(2003) The Wheeling Hospital Foundation (WV) provides a grant for a "Walk to School Day"

(2003) The CA Office of Statewide Health Planning and Development issues a recommendation that hospitals should, at a minimum, conduct one public meeting to present their community benefit plan to the public

(2003) Victoria Transport Policy Institute issues first version of "If Health Matters" with guidelines how to integrate public health objectives into transportation planning. (Frequently updated since)

Since 2008 Seattle Childrens Hospital accommodates 6000 visitors a day with only 1200 parking spots, issues only daily parking permits, and offers a wide variety of support for bicycle commuters, Certified as Bicycle Friendly Business (now Platinum) since 2009

(2008) National Center for Bicycling and Walking (bikewalk.org) receives funding from Blue Cross & Blue Shield (MN) to "remove barriers and make physical activity the easy choice"

(2008) Lancaster General Hospital (PA) sponsors Mark Fenton, host of the PBS television series 'America's Walking' as a leader of a Walkable Communities Summit (2008)

(2011) UnitedHealthcare, Children's Hospital Colorado and the USA Pro Cycling Challenge launch a Bikes for Life program which provides 1,000 bicycles to Denver-area kids. 'Bikes for Life' will promote the health benefits of cycling, helping curb the growing prevalence of childhood obesity. (Video transcript)

(2011) Centers for Disease Control issue Transportation Health Impact Assessment Toolkit which offers elaborate resources and health planning tools and highlights the health impacts of transportation

(2013) Greenville Memorial Hospital (SC) funds the position of a Project Coordinator, (School Health Bike) to implement bike programs along with other activities to promote the safe and healthy physical activity for children.

(2013) Smith and Hamann Burney publish a paper on "Transportation Demand Management Strategies at the Buffalo Niagara Medical Campus"

(2013) A group of physicians from St Michael's Hospital (Toronto) are calling for more progress on the City's bike plan: they urge councilors to consider the preventative benefits of cycling and active living in general. “Cardiovascular health, mental health, insomnia—all these things are treated with exercise…this is a public health issue, and an issue of primary care”  

(2014) Boston Medical Center lauches Prescribe-a-Bike which offers patients greatly reduced membership rates for a local bike-share system

(2014) UCLA Health issues a bicycle safety video

(2014) Kaiser Permanente (Folsom) issues Kaiser Pedal Power, a newsletter for Kaiser employees which covers Safe Routes to Schools, community planning, bicycle commuting, health tips, etc

(2015) Rady Children's Hospital El Cajon implements a Safe Routes to School Program

(2015) Good Samaritan Hospital in Los Angels conducts annual Blessing of the Bicycles (ongoing since 2003)

(2016) California Hospital Association provides information about hospital based benefit programs that improve local neighborhoods and the built environment, including transportation

(2016) Hilltop Institute highlights IRS regulation that "the health needs of a community [include] the need to prevent illness, [and] the need to address social, behavioral, and environmental factors that influence health in the community"

(2016) AARP Los Angeles becomes a sponsor for CicLAvia, a open streets event which promotes active transportation and good health through car-free streets.

(2016) Cleveland Hospitals (OH) provides sponsorship and has naming rights for Bike Share Program 

(2016) The federal Department of Transportation releases a Health in Transport Planning framework which requires transport planners to consider the health impacts of their designs

(2016) Sutter Hospital in Santa Rosa (CA) partners with MyCityBikes to support doctors and nurses cycling to work

(2016) Kaiser Permanente issues video advert to promote commuting by bicycle

(2016) American Academy of Orthopaedic Surgeons launches public service campaign to remind drivers that Cyclists Are Always Fragile

(2016) Insurance Provider HealthIQ offers 25% savings on life insurance because cyclists who ride for 3 hours a week or more have a 28% lower risk of all-cause mortality than non-cyclists

(2017) A major study in the British Medical Journal shows that initiatives that encourage active commuting can reduce risk of death and the burden of important chronic conditions. Cycling to work lowers the risk of dying early by 40 per cent, and reduces the chance of developing cancer by 45 per cent.

(2017) Gregory Hood, MD asks "Should More Doctors Ride Their Bikes to Work?" in Medscape, and his readers agree: Yes, they should

(2017) Cedars-Sinai Blog honors a staff member Juan Castillo who rides 15 miles to work but reveal their ignorance when they call him a "cycler"

(2017) American Heart Association issues a major policy statement on active transportation complete with 215 juicy footnotes presenting lots of recent research and evidence

(2017) CALTRANS calculates the savings in healthcare expenses (600M$) as expanded bike network would lead to 3,330,103,000 more hours of physical activity

(2017) Henry Ford Health System and Health Alliance Plan are title sponsors of the new MoGo bike share program

(2017) LA County Department of Public Health releases recommendations for Community Health Needs Assessments to "encourage cities to establish policies and programs that support increased walking and biking"

(2018)  Southmead NHS Hospital (UK) conducts a survey asking all visitors how they arrived at the hospital

(2018) Kaiser Permanente Baldwin Park offers safe cycling classes with ActiveSGV

(2018) Sutter Hospital Santa Rosa (CA) is certified as a Bicycle Friendly Employer by the League of American Bicyclists https://twitter.com/newhospital/status/750806700773355520

(2018) Virginia Hospital Center in Arlington uses heat map tool for healthier commutes. Hundreds learned that it would take them less than 3o minutes to ride a bike to work. The Modeify tool also found that almost all of their employees lived within a mile of a potential carpool partner.

(2018) AARP Los Angeles comments on Community Health Needs Assessments for hospitals in Los Angeles and suggests addressing healthy transportation as a community need

(2019) UCLA Fielding School hosts panel led by Richard Jackson on Transportation as a Public Health Issue

(2019) Northwestern Medicine are sponsors of the Fight for Air Ride by the Lung Association 

Sunday, March 24, 2019

Mitch Katz Rides On

The UCLA Bicycle Academy will hold a round table meeting to bring together hospital executives, community benefits managers, and bicycle advocates on 3 May 2019 at 11:00 (Ronald Reagan UCLA Medical Center, 757 Westwood Plaza, Los Angeles 90095, Conference Room 6-6234) We are natural allies, both focused on healthy communities, but we have not been speaking much to each other in the past. We are grateful to the former head of LA County Public Health department who has kindly allowed us to call this conversation "Mitch Katz Rides On". Gustavo Friederichsen of the LA County Medical Association has been the main midwife for this effort. UCLA Health kindly provided a conference room. Paul Watkins, CEO of Northridge Dignity Health and previously sustainability champion at UCLA Santa Monica hospital will join us, Linda Khamoushian from CALbike in Sacramento, Eli Kaufman from the LA County Bicycle Coalition (LACBC), Vanessa Gray from C.I.C.L.E., Jim Shanman from Walk 'n Rollers and a number of Community Benefits managers. The scope of the meeting is to learn how bicycle advocates and medical providers can work together to advance a common agenda for better health in our communities. 

"Mitch Katz Rides On" will share best practices by bicycle friendly providers, which include
  • Hospital based safe cycling education provided by certified coaches. Exciting opportunities through the Metro BEST program
  • Health providers increasing their support for active commuting choices for staff and facilitate Bicycle User Groups
  • Wayfinding for locations and appointments should no longer reproduce the notion that everybody drives in LA (include transit and bicycle access in appointment reminders)
  • Make sure leases for medical offices do not include bundled parking
  • Improved stairways in medical offices
  • Enhanced bike parking racks that carry a health message like "The Chief Medical Officer has determined that cycling and walking is good for your health"
  • Hospitals to be League certified as bicycle friendly business 
  • Community Benefits Programs which support active and healthy transportation, Safe Routes to School
  • Hospital based Blessing of the Bicycles, etc
There are a huge number of medical practitioners throughout LA who personally have discovered the pleasures of two-wheeled transport. They are waiting for the right signal from the leadership and are ready to become champions of such an agenda. 

If you want to be involved in the event, please get in touch. Bike advocacy is health advocacy. And it is urgent.

Friday, November 23, 2018

Five Forgetful Hospitals

Five Forgetful Hospitals in West Los Angeles. Major players, big names. If we don't intervene, they will forget, as before, to include healthy transportation in their program of community benefits. The process, required by the IRS, is called CHNA: Community Health Needs Assessment: It serves to confirm the non-profit status of a hospital. Currently they are working on a plan for the period 2019 - 2021.

While many doctors and all public health experts do know a whole lot about the health benefits of active modes (walking, cycling), the five forgetful hospitals are on the path to overlook the disease burden in their communities that could be lifted if people had more opportunities, and more encouragement, to leave the car at home. Prevention. Population Health. Cheap and effective.

Whence that forgetfulness? Why is it so difficult to implement public health knowledge in our local community? The stereotype that everybody drives in LA is overwhelming. The roads so crowded, the parking lots so full, the cyclists so few. Pedestrians? - Send the police to arrest them. We have been so firmly socialized into vehicular living that a special mental effort is required to recognize automobility as a health condition. But reduce driving we must, for our own well-being, and for that of our planet.

Hospitals are only in the business of curing bodies broken by too little exercise, bodies shattered by vehicles which move too fast? Prevention is none of their business? Not according to the IRS. Prevention is right up the CHNA alley. Even better, the IRS allows expenses for lobbying (like lobbying a council member for more and safer bicycle infrastructure!) Also allowed are expenses for community building activities like environmental improvements, community health improvement advocacy, leadership development and training for community members, coalition building, etc. IRS (schedule H, part II)



If that sounds like an opportunity, here are the CHNAs that currently face updating: Cedars Sinai (pdf), UCLA Ronald Reagan (pdf), UCLA Medical Center, Santa Monica (pdf), Kaiser Permanente West Los Angeles Medical Center, (pdf) (See also KP Data), Providence Saint Johns (Santa Monica) (pdf)

The CHNA process takes into account input from persons who represent the broad interests of the community served by the hospital, including those with special knowledge of , or expertise in, public health, or expertise relevant to the health needs of the community. There is a great deal of demand for healthy transportation in the Westside. Active transportation is an emerging issue that will be overlooked if stakeholders do not share their local knowledge. We need much much much more than the famous Westside Walkers who meet (drive there, of course) in a shopping mall to walk (laughter). What about a concerted effort, with local partners, aiming to offer our neighborhoods a safe way to leave the car at home and walk or ride a bike? Our hospitals must find a way to support advocates who demand healthy transport options for our neighborhoods. Doctors will be able to prescribe safe cycling training, hospital facilities will lead the way by conducting a bicycle master-plan for their premises and associated medical practices. Hospitals are quick to demand that streets must be suitable for their ambulances, now we want to hear from them that streets also need to be suitable for those neighbors who should move about without a car. Now is the time to take apart the poisonous notion that everybody drives in LA.

The current CHNA process for five forgetful hospitals is conducted by Biel Consulting. So far no public meetings have been scheduled. Which is a not a good sign. Through public meetings the hospital can build essential partnerships with community stakeholders. Failing a public meeting, the next best way to have your voice heard is to make written comments on the previous CHNA. Pick your favorite hospital and send emails to CommunityBenefit@cshs.org, smunoz@mednet.ucla.edu, CHNA-communications@kp.org, Ronald.Sorensen@providence.org. These comments count as public input and offer a privileged way to participate in the process. Now. Or wait three years for the long overdue dialogue of transportation and health.