In addition, these experiences have prompted the Johnson Foundation to join with our distinguished senior colleague in housing and community development-the Ford Foundation-as well as the Pew Charitable Trusts, in funding an important new national intermediary, modeled after the Local Initiatives Support Corporation, The Corporation for Supportive Housing (CSH). With $10 million from the three foundations, CSH has embarked upon an ambitious program of special housing development for homeless people with mental illnesses, AIDS, and other disabilities. CSH is working, at this point, in New York City, the San Francisco Bay area and Chicago. IV Because of the interests of this Committee, I've discussed our housing-related initiatives at some length. I'd now like to discuss-in much less detail-two of our active and replicable programs that also operate beyond this foundation's traditional health delivery base, and one that operated within it. A. "Fighting Back" is a five year program to which the Robert Wood Johnson Foundation is committing some $40 million in an effort to allow American communities to fight drug and alcohol abuse. When we just announced this program in early 1989, we received proposals from over 300 individual towns or neighborhoods of large metropolitan areas with populations between 100,000 and 250,000. This tremendous response was later accommodated, in part, by the Federal Government by its 1990 Community Partnership Program (from the Office of Substance Abuse Prevention, Department of Health and Human Services), which has made $42 million available to some 95 communities around the country. In January of this year we released $18 million to 13 communities that had competed for our funds in order to create homegrown, single community-wide systems of drug and alcohol prevention, early identification, treatment and after-care. These communities are: Columbia, South Carolina Kansas City, Missouri Little Rock, Arkansas Milwaukee, Wisconsin New Haven, Connecticut Newark, New Jersey. Oakland, California Santa Barbara, California Washington, D.C. Worcester, Massachusetts Each one of these towns is now implementing a single, coordinated plan to control the demand for illegal drugs and alcohol. And each plan unifies the services and skills of such diverse sectors as local business, schools, churches, health providers, social services and law enforcement agencies. I am proud to tell you, senators, that every one of our granteetowns had to overcome such common obstacles as: • Lack of community leadership to set priorities and to determine local norms about substance abuse, as well as, Inadequate public awareness of the enormous social costs of drug abuse, including diminished productivity; increased demands on the health care system as well as the law enforcement, judicial and correction systems; drug-related violence; and the undermining of local educational and social welfare programs. Will "Fighting Back" work? We do not yet know. But this much I can report even at this early stage. The "Fighting Back" program has engendered a spirit not only in the 13 communities that were awarded Johnson grants, but also among the towns and neighborhoods that applied and failed to make the cut. That spirit reveals itself as a conviction, a new conviction that in fact we the leaders and members of this local community-can reduce the demand for these substances, we can fight back, we can make a difference. I'd like for my foundation to take credit for that "can-do" spirit, but the truth is that we willingly share it with a vast array of once very skeptical mayors, councilmen, pastors, police chiefs, city editors, agency heads and hospital administrators throughout this country. It will be a few more years before I can return here to report on whether or not that spirit and this complex model were enough to reduce the initiation of drug and alcohol use among children and adolescents, and to reduce incidence of drug-related deaths and injuries and, of course, the crime rates related to drugs and alcohol. But I urge you to watch this experimental model closely. It may very well prove adaptable to other and larger metropolitan center, where the need for creative responses to deadly threats increases daily. B. Another of our programs of likely interest to this committee, is the Robert Wood Johnson Foundation's School-Based Adolescent Health Care Program. This $17 million initiative, launched in 1986, established comprehensive health service centers in 24 high schools located almost exclusively in low income, inner city neighborhoods. Among those cities are: Birmingham Los Angeles Santa Clara Denver Miami Baton Rouge New Orleans Detroit St. Paul Newark New York, and, Many of the 40,000 enrolled students are uninsured and unable to obtain health care, and all of them are subject to the consequences of low immunization rates, poor nutrition, mental and emotional stress, teenage sexual activity, alcohol and drug abuse and violence. These clinics have proved to be both medically effective and cost effective. They also proved to be acceptable to students and, under our program, to parents as well. We think that our School-Based Adolescent Health Care Program is poised for replication and expansion, and we will welcome the opportunity to share an objective evaluation of it with you as soon as that is completed. C. The third program I will summarize is a research effort testing whether special interventions for low birthweight children and their families could reduce their development and health problems. As you know, inner city children, especially those of African American heritage, have a much higher risk of premature birth and low birthweight. These children require intensive services in the hospital and face an uncertain future once discharged. In 1990 the Journal of the American Medical Association reported the results of a $33.6 million study showing that a set of interventions-home visits to support the mothers of these children and to teach them parenting skills, child development centers between the ages of 12 to 36 months, and regular parent support and education groups-did make a difference. Compared with children in a control group, those receiving the special services had significantly higher IQ scores at age 36 months and their mothers reported significantly fewer behavior problems.3 Because of these exciting results, the Center for Disease Control, and the Robert Wood Johnson Foundation have recently announced a partnership to extend this program to 10 cities in the United States. Examples of other programs recently developed by the Foundation include efforts to increase the numbers of minority students entering the careers of medicine and nursing, to stimulate community-based systems to increase immunization rates against reemerging childhood diseases such as measles, and to help prisoners combat their drug addiction problems when they reenter society. Even as we formulate new programs in response to health and health care needs, especially of our urban centers, we know we must apply-or try to apply the lessons learned from our closed or current grant programs. Some of those lessons include working with: • Increasingly besieged and beleaguered local officials who seem incapable of looking beyond today's crises in order to plan a response to tomorrow's. • More and more state and local agencies-designed to work with the poor-being rendered impotent by budget cuts and the general fiscal woes of the 1990. • A widespreading contempt for elected and appointed public_officials, which serves to burn them out as well as to frustrate those who might otherwise rely on political promises concerning local services. • An astonishing lack of integration and coordination among categorical programs serving the same clients at the local level. • A rising tide of ethnic rivalry and racial tension as well as new suspicions that separate neighborhoods and bar effective action at the grassroots. 3 The Infant Health and Development Program, enhancing the Outcomes of Low-Birth-Weight, Premature Infants: a multi-site, randomized trial. Journal of the American Medical Association 1990; 263:3035-3042. • A leadership crisis at the local level, affecting both voluntary and elected officials who seem to have lost confidences in their own ability to make a difference. Gentlemen, I hope I've taken practical advantage of the opportunity given me to present a sketch of what problems and opportunities we see from our health care window on the inner cities of the United States. V. Mr. Chairman, your invitation to today's hearing ended where I will now close-with a request to review extant federal, state and local policies that might have hindered or prevented our efforts. I could cite for you examples of waivers we've sought and failed to get for certain grantees, or the inhibiting effects of this legislation or that regulation. But those are irritants, not impediments. The thing that discourages health care reform in our urban centers especially, as well as in the country at large, is-I believe— a growing, profoundly discouraging conviction that government is unable to summon the will to face the strong and competing special interest groups of providers and the recipients of health care services each of which is today convinced that reform, change and improvement of our system of care should begin somewhere else. That perception of a lack of will at the top is surely beyond the scope of my Foundation or of any philanthropy in general to deal with. But it is within the scope of this and other committees of congress and agencies of government. I salute you for taking this first step to address that perception. STATEMENT OF FRANKLIN A. THOMAS PRESIDENT, THE FORD FOUNDATION SEPTEMBER 17, 1992 Senator Riegle, and other members of this committee. I am pleased to have the opportunity to present my thoughts on the current condition of our cities and how we can address their problems and build on their strengths. You are addressing one of the fundamental domestic issues facing America: how to ensure that our cities regain the economic vitality that has enabled them to offer hope and opportunity to all who seek to better themselves. Cities have long been the heart of the Nation's economic, cultural, and intellectual life. Throughout our history, cities have been the first port of call for new immigrants seeking freedom and opportunity. Cities, more than anywhere else in America, are home to the rich diversity of peoples who give meaning to the very notion and image of the United States. They have provided the jobs that are the first rung on the ladder of upward mobility. Their strength has been integral to America's prosperity as it evolved from a Ñation largely dependent on agriculture to the world's largest industrial economy. Nowhere in the annals of civilization is there a record of a Nation that prospered while its cities were neglected and died. I find it difficult to believe that America will continue to be a strong and prosperous Nation if our cities are not restored to vitality. Today, however, economic and political forces are draining the life blood of our cities. Although they retain much of what has made them great, they are increasingly burdened with economic and social ills that are, for the most part, not of their own creation or within their control. Most of these troubles are well known. Among those most frequently cited are growing unemployment and poverty, the proliferation of drugs, seemingly rampant crime, the spread of AIDS, decaying infrastructure, and a widespread sense of alienation and frustration. Regrettably, much of the current political dialog tends to gloss over the causes of these problems as well as possible solutions and, instead, dwells on simplifications that divide the Nation along economic, political, and racial lines. I commend you Senator Riegle and the committee for taking on such a challenging and critical undertaking. Solving the problems of America's cities and their residents must become a top priority for our Nation, and I hope that this hearing will contribute to a serious, sustained search for such solutions. The recent tragedy of Los Angeles, what it tells us about America, and what it may signal for our Nation if we cannot find ways to arrest the social and economic decline of our cities, makes your task all the more important. It is time to think anew about long-term national strategies to promote urban revitalization. As we approach our urban problems, we should keep in mind that we are not simply helping less fortunate people, we are investing in the human capital from which our prosperity flows, renewing our cities as centers of commerce and industry, and rebuilding our competitive strength in the world economy. Let me begin by describing a framework for improving our cities, then detailing some specific strategies. This framework is consistent with the findings of a Foundation-sponsored examination of the U.S. social welfare system which was conducted in the mid-1980's by an independent panel of citizens representing business, labor, civic and civil rights communities. The report, entitled The Common Good, and a companion video were widely distributed and continue to be used as a centerpiece for debate and discussion about American values and social problems. The framework must recognize four points: 1. Whatever programs are developed, they should mobilize people to improve their circumstances and contribute to their communities. To do so effectively, programs must incorporate the experience and opinions of people who live in cities. One way to do that is to work closely with people who lead the many community-based nonprofit organizations working to improve inner-city communities. 2. I urge that you build on the many successful existing programs in health, child care, youth development, and community rebuilding. There are myriad organizations that have succeeded despite the limited resources of the past decade. They are ready and able to expand as part of broader, nationwide efforts. |