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.

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.

Community Health Needs Assessment (CHNA)

Every three years, hospitals need to submit a CHNA to the IRS to secure their status as a tax-exempt organisation. Community health benefits listed in the CHNA can take many forms. They should be based on statistical data, but also on community input to identify emerging issues. The CHNA for the Ronald Reagan UCLA Medical Center (2016) often reminds us of an in-house questionnaire which includes the question: "Is this work a community benefit?" Adding up all the "Yes" answers in a large organization, you invariably end up with a very long list. These activities are then arranged in priority areas, but even at that level it lacks the overarching coherence of a well designed community intervention. The result is one grand confusion of initiatives and programs. It is hard to make out the encompassing vision for the community.

In the following we outline a new area of community benefits which is currently missing. Healthy transportation initiatives will have a positive effect on many of the health needs listed. They impact the community as a whole. They comprehensively address separately listed health needs such as diabetes, heart disease, cancer, obesity, mental health, etc. The empirical evidence for the effectiveness of such interventions is not in doubt. We hope the hospital will consider these suggestions and include support for healthy transportation as an overarching community benefit in the next CHNA.

1) UCLA Health Bikeway Corridor: This innovative project provides a comprehensive plan for a bike route between the hospitals in Westwood and Santa Monica. It is currently managed by UCLA Transportation. The implementation itself is not funded. It represents a tangible community benefit by supporting safe infrastructure for healthy modes. It is part of the evolving issue of healthy transportation and sustainability which has received much attention recently. UCLA Health should associate its brand with this admirable project. I would also have a role in educating the community about the health benefits of active modes. As the pathway nears its implementation phase, UCLA Health should take full ownership of this project, provide funding and help present its advantages to stakeholders in the community. It should lobby local agencies for it. IRC 501(h) allows lobbying expenses. Bicycle infrastructure is a evidence-based community health intervention <link>.

2) Additional Interviews, Community Meetings, Partnerships: Prioritizing local needs is partly based on interviews with community stakeholders. The list of stakeholders is impressive but is biased by the leadership roles of those included. Do they live in the community? How are these selected? What kind of expertise do they have? Is the selection biased because it fails to include persons who commute by bicycle?
A well facilitated stakeholder meeting provides much better insight into community needs. A series of interviews lacks transparency and dialogue, whereas a series of meetings can lead to local partnerships which are the best way to implement community benefits. The next CHNA should include such meetings for stakeholders. The following stakeholder groups should be consulted in future CHNAs.

• The Healthy Campus Initiative at UCLA is a very valuable interlocutor, both for their expertise, but also for the community connections they have developed. It seems negligent to exclude these local experts from this process 
• The list does not include researchers from the Fielding School of Public Health who have worked on population health. It seems negligent to exclude these local experts from this process 
• Community groups advocating for healthy and sustainable transportation in the community (Calbike, Los Angeles County Bicycle Coalition, UCLA Bicycle Academy, Better Bike Beverly Hills, Santa Monica Spoke, losangeleswalks.org, etc)
• Neighborhood groups or councils (The new NWWNC, midcityneighbors.org, etc)
• Youth groups and educational stakeholders, especially the Saferoutespartnership.org which advocates for safe ways to get kids to school without a car
• The AARP has taken very progressive positions on transport policy and health for the elderly recently. They support Ciclavia events in Los Angeles and have a clear view of the transportation needs of those who can no longer drive a car (Stephanie Ramirez sramirez@aarp.org)
• DPP Diabetes Prevention is an important aspect of population health and its voice should not be missing here

3) Modeling Best Practice: UCLA Health should make community involvement a central part of its mission, not a triennial statistical exercise. This will require some input from the leadership. Spisso has repeatedly spoken about the importance of community health. She says that health is not only about repairing a broken organ, it is about healthy practices and healthy contexts. Establishing healthy practices in and around the hospital and the medical offices in the community can transform the UCLA Health into a local leader, but the leadership needs to think "outside the bed". The NHS in the UK has developed some guidelines as to how a health provider should do business in the community: Bicycle parking is better than valet car parking. Inviting stairs are better than elevators. Bike parking and transit information is absent from all UCLA Health webpages that contain way-finding info.

4) UCLA Health and its Communities. Recently the UCLA Vice Chancellor has conducted a discussion about a revised mission statement for the campus. During this process, UCLA Health has remained largely silent or MIA. Does the hospital have a vision for community involvement? Perhaps it could be of interest to the leadership that Part II of IRS Schedule H (Form 990) allows expenses for community building activities like environmental improvements, community health improvement advocacy, leadership development and training for community members, coalition building, etc

Healthy transportation programs are a perfect fit with the UCOP 2025 Carbon Neutrality Initiative. In order to see results in this area, leadership is needed, work needs to be done, relationships with community stakeholders need to be developed, advocacy needs to be prepared, and effects need to be evaluated. In short: UCLA Health needs to actively dismantle the stereotype that everybody drives in LA. The process of converting car parking into bicycle parking will position UCLA Health at the vanguard of population health and sustainability in California. Which is exactly where you want to be.

Lawyers to the Rescue

In our discussion with UCLA Health we were told that the difficulties of renting and improving medical office space that would be bicycle perfect (bicycle parking, showers, no bundled parking to allow parking cash out) goes back to the lease template provided by the University of California, Office of the President.

So we wrote to the UCOP Real Estate Services with some suggestions how to turn the lease template into a path towards better transport choices. We look forward to their response!

Dear Allen Meacham, 

The UCLA Bicycle Academy is concerned that leases used for UC premises have insufficient regard to sustainability issues. We are especially concerned that UCLA Health affiliated medical offices operate without adequate facilities that would support healthy modes of transport. This leads to a system-wide dissonance: The mode of transport most often recommended by doctors is very poorly served at the very premises where these doctors see patients. We were advised that the UCOP lease template prevented better accommodation of healthy and sustainable modes. 

Your colleague Julie Wong shared the standard lease template for leases where the UC Regents are the tenant. (Rev. 12/2016 4821-2942-8779 v. 3)

This templates includes only references to petrol burning vehicles (cars). From this exclusive focus a direct line can be drawn to the deplorable state of bicycle provision at premises used by UCLA Health (and on other campuses)

We would like you to make the following changes to the template

• 1. 1. 2. (Premises) ... loading and unloading areas, visitor parking areas,  - add: loading and unloading areas, visitor parking areas, shower facilities for bicycle commuters ... (LEED certification considers such facilities a necessity)

• 11.1.e.(xxiv): any other parking facilities associated with the Building  - add: any other parking facilities for cars or bicycles associated with the Building,  (it is important to be clear and explicit about transport options)

• 11.1.e.(xxiv): utilities, insurance of any form, real   - add: utilities, vehicle charging points, shower facilities for bicycle commuters, insurance of any form, real  (it is important to be clear and explicit about vehicle types and required facilities)

• Addendum 4, #2: Tenant Improvements must satisfy the Campus Fire Marshall, State Building Code and Federal Americans with Disabilities Act.  Add: Bicycle parking must be designed according to the bicycle parking guidelines of the APBP  (Where bicycle facilities are present, they invariably fail to meet the standards set by APBP and become an embarrassment in the eyes of bicycle user) 

In addition, the UCOP leases should NEVER include bundled parking. Bundled parking is a sure way to remove incentives, for the entire duration of the lease, for users and organisations to reduce car use. Bundled parking effectively removes the ability to offer financial incentives for modes other than cars (Parking Cash Out). From the point of view of the sustainable transportation advocate, bundled parking is the prime source of unsustainable and unhealthy transportation choices. From the environmental point of view, it is a very bad idea. It should never be part of a UCOP lease. (Remove first Option in Addendum 1, or strongly discourage it)

In a perfect world, the current template could well encompass sustainable and healthy modes of transportation. But experience shows that without explicit reference to these modes, administrators have consistently overlooked these issues. As it stands, the template enables and encourages administrators contract for facilities where EVERYBODY DRIVES. As amended, the template would better project the interest of UCOP in supporting and planning for sustainable and healthy forms of transportation. The amended template would also lead to lease negotiations that act in the best interests of those campus members (and the public) who would prefer to get around without a car. It is crucial that such improvements are planned in the early stages, because adding such facilities at a later stage is a very burdensome and complicated process.

We believe making such changes to the UCOP lease template could well qualify for an Higher Education Energy Efficiency and Sustainability Best Practice Award issued by CHESC, for instance in the new Large-scale Planning category

Sincerely

-- 

Dr Michael Cahn

Secretary, UCLA Bicycle Academy 

Transportation Wellness Task Force

When we made the case for an active transportation policy to the UC Regents Health Services Committee, there was no opportunity for a dialogue. That is why we are very grateful that UCLA Health offered us the opportunity for such a dialogue. UCLA Health already has a No Smoking Policy, it serves antibiotic free meat, and it has recently been named LGBTQ Healthcare Equality Leader. Perhaps our medical provider should also consider its role in the (healthy or not) transport choices its staff and patients are making every day? What would President Johnese Spisso, Richard Azar (General Services), and Joe Earnest (Media Relations) think?

We very much looked forward to this meeting. The lack of conversation over many years leads to a great deal of urgency: The more you have the conversation only in your own head, the more you are disappointed about the lack of results.

"These are all good ideas." "You will not find many doctors who would oppose such initiatives." But is there a constituency that could move things ahead? "Perhaps we could look into a certification as a bicycle friendly employer." "The staircases are really difficult because of building standards and fire regulations." "The leases which govern parking cash out and bike parking improvements come from UCOP, the Office of the President." "Perhaps we could do some bike commuter courses for staff, or something in the Vital Signs magazine." I like the idea of a UCLA Health branded bike rack said the President, perhaps we can do it like a wrap, and we shook hands on that (Full list here). In the end, it is about an institutional attitude, and that needs time. But health impacts and climate impacts don't wait for us to make up our minds. Urgency? And how!

Thirty minutes with the leadership of a national "Best in the West" health care institution is one big deal. We recognize this and we appreciate it. On the other hand, the institution has no plan how to increase cycling among staff and clients, it has no plan how to improve bicycle facilities at all its locations, it does not assess the health effects of all this driving. UCLA Health has a community relations department, but it does not get involved in local planning discussions, does not remind Caltrans and METRO that the I-405 widening has discouraged more people to ride a bike to UCLA Health destinations. It is mum about a the slow death of a Great Streets Initiative for Westwood Blvd that would have included a much needed bikelane to our Medical Plaza, torpedoed by homeowners in Holby Hills and LA city council-member Paul Koretz. But a health system that prides itself on its local connection - "See you in the Neighborhood" - can ill afford to remain quiet when neighborhoods fail to safely accommodate the modes of transport doctors recommend most often.

Supporting healthy and sustainable modes is not about privileges for a few determined and reckless bike riders: It is about inviting the entire community to consider that car-centric policies and organizations have made us unwell. And that a health provider must not unwittingly lend support to the false notion that everybody drives in LA. A first class health system at a world class university should really be a leader on the bike-path towards healthy communities. It would be good to establish a formal forum in which active transportation advocates and public health experts can help the UCLA Health to address the unhealthy car bias of the organization. We would call it the Transportation Wellness Task Force.

Transportation Wellness Task Force.
(Draft Remit) 
The purpose of the task force is enhance transportation wellness for staff, patients and the communities where UCLA Health operates. It provides a comprehensive perspective on the health implications of transport choices - for the individual, the enterprise and for the community.

The purpose of the task force is

• to integrate the public health research into the daily practice of a large medical institution
• to provide recommendations to the leadership for programs and investments which improve transportation wellness for staff, patients and the community
• to identify facilities improvements that would encourage more to use healthy modes
• to identify areas where improved messaging can increase the visibility and attractiveness of healthy modes
• to identify perverse incentives and address their impact on transport choices
• to share its recommendations with related institutions in the UC Health system 
• to pursue certification of these efforts and to educate the public 
• to support the collection of trip data for staff and patients for scholarly analysis, including a quantitative study the health benefits delivered over a longer period, to engage campus expertise from urban planning and public health, and to contribute to a discussion of transportation wellness in the academic community
• to make its insights available in the context of local and regional transport planning, and to provide community facilitation to increase availability of healthy options in the communities where UCLA Health operates 

The members of the task force represent the following areas of expertise:

• Public health 
• Population health, diabetes prevention 
• UCLA Transportation Planning
• UCLA Health - Marketing 
• UCLA Health - Sustainability
• UCLA Health - Community Relations 

Two members of the committee use a bicycle for their commute. The task force produces an annual report.

The following have supported the establishment of such a task force: