Philanthropist Christy Brown and Mayor Greg Fischer are among the authors of new research paper published today by the journal Health Affairs that examines the policy and partnership elements of AIR Louisville.
In the April issue, “AIR Louisville: Addressing Asthma with Technology, Crowdsourcing, Cross-Sector Collaboration and Policy” explains how partnerships were built and sustained during the three-year project. In addition to helping individuals get control of their asthma symptoms, data from the project helped doctors understand triggers and gave city leaders a fresh perspective on how to reduce the burden of asthma.
“Cities exist to provide citizens the opportunity to reach their full human potential — no matter their race, gender, sexual orientation, or ZIP code”, said Fischer. “No city can do this alone, which is why we’re committed to working with citizens, businesses, and nonprofits to undertake innovative projects like AIR Louisville that can positively impact the lives of citizens.”
Brown’s and Fischer’s contributions to the project were recognized along with the many community partners that supported the asthma project. The AIR Louisville Collaborative credited in the research paper included Andrew Renda, Humana, Jim Sublett, MD, Family Allergy and Asthma, Grace Simrall, Louisville Metro, and Sarah Moyer, MD, Louisville Metro Health Department as well as 16 other contributors. This group of individuals represents the broad network of local partners that made AIR Louisville possible. Veronica Combs, Institute for Healthy Air Water and Soil, and Meredith Barrett, Propeller Health, were the main authors of the paper.
“The City’s Department of Civic Innovation was a vital partner in this work that brought together employers, doctors, advocacy groups, philanthropists and citizens to focus on asthma,” Combs said. “Convening these diverse groups encourage fresh partnerships and new ideas about how to use data to improve quality of life.”
Funded by the Robert Wood Johnson Foundation, this digital health project was the first time that a city was used as the organizing principle for a digital health project. The AIR Louisville team recruited 1,100 participants and 11 community partners – including 7 employers. During the three-year project, the team collected 250,000 data points about rescue inhaler use. Each participant used a sensor that added a time and location stamp to the medication use. This allowed the project team to add more than 1 million environmental data points to the analysis.
The project’s final report identified neighborhoods with the highest asthma risk. The team also used the findings to recommend new city policies during the ongoing update of Louisville’s Comprehensive Plan. One recommendation was to increase the tree replacement requirement when trees are cut down during land development. Another suggestion was to designate truck routes through the city to protect residential areas from traffic pollution.
The Institute received a $28,000 grant from the city’s Department of Sustainability to plant trees. We will be working with Trees Louisville to select a location that has a high risk for asthma attacks as well as low tree canopy. The planting project will be completed later this year.
This analysis highlights the places in Jefferson County that have multiple environmental challenges: high heat, flooding issues, and low tree canopy. Planting more trees can address all of these issues.
The Rubbertown Community Advisory Committee uses these ground rules at its monthly meetings to ensure productive conversations.
Over the last three years, I have talked about asthma, air pollution, and digital health to at least 50 different groups. Most recently I shared the Institute’s work at the February meeting of the St. Margaret Mary Elementary school board. Next month I’ll be talking with the Building Industry Association of Greater Louisville. I also have attended scientific and medical presentations and public meetings. One frequent problem that pops up subject matter experts talk with a general audience is communication. Typically a technical expert and a citizen don’t have a shared language. Each group has to make an effort to connect and actually converse.
In February, I spoke at the monthly meeting of the Rubbertown Community Advisory Committee. The group works to develop mutual trust between chemical companies and residents and to provide two-way communication on community and industry concerns. The table tent in the picture above sets the ground rules for the conversations at these meetings. These rules address many of the problems I have experienced at conversations between average citizens and scientists, researchers and engineers. In my experience, people in both groups are well-meaning, capable and engaged. Researchers and technical experts care about doing a thorough and thoughtful job when analyzing environmental conditions and related health risks. Community residents have thoughtful questions about complex topics and completely justified concerns about their homes and their health.
The breakdown comes when the two groups meet without clear ground rules like the ones the Rubbertown CAC uses. When scientists use technical language or jargon, this shuts down the conversation. It’s easy to get intimidated when you don’t understand a word and just as easy to slip into acronym shorthand when you use it all day with colleagues.
I know the rules work because I saw several of them in action. The bold rules in the list below are the ones that people in the meeting used to clarify a point or gently remind a technical expert about how to interact with people who are not scientists.
- Silence your pager and cell phone
- Minimize side conversations
- Stay on task
- Translate acronyms and jargon
- Trust the process
- Agree to disagree agreeably
- Remember that no idea is silly
- Be unafraid to ask questions
- Share the air (don’t dominate the conversation)
- Separate the idea from the person
In my experience, subject matter experts and scientists would find it easier to connect with residents if they remember #5, #7 and #10.
Meetings in general would be better if everyone followed the first three rules.
This is what Beargrass Creek looked like on March 5 at the Frankfort Avenue bridge just north of Mellwood Avenue.
As I looked out at the gray skies last Thursday, I read Southerly
, a newsletter by Lyndsay Gilpin. This weekly newsletter focuses on “ecology and culture in the American South, exploring the complicated relationship between Southern communities and their environment.” It’s very good – I highly recommend you subscribe
In the latest issue, Lyndsay writes about encountering sewage in two parts of town – a park and a bar – after the recent heavy rains:
While strolling in Louisville’s Cherokee Park on a dreary, rainy day last week, my friend, Anna, stopped to look at a soggy piece of white paper hanging from a tree branch. “Is that toilet paper?” she asked.
I nodded slowly in disbelief. We walked a little farther, where we discovered a giant, stagnant pile of trash under a bridge along Beargrass Creek. There were basketballs, footballs, bottles, paper, hundreds of styrofoam cups and to-go containers. More litter was strewn along the banks of the creek and in the trees. Brown water soaked the grass under our shoes. The air was humid, clammy, and smelled of raw sewage.
The day after we walked around the park, Anna and I went to a jazz club in downtown Louisville located a couple of blocks from the Ohio River. Halfway through the set, water rose from the drain, covering the floors in several inches of murky water.
On the same day, WFPL reported that the Metro Council delayed a vote on allowing MSD to increase rates to update our Civil War era infrastructure:
MSD is again seeking to raise rates to cover expenses for what it says are necessary infrastructure upgrades. The measure has failed passage in Metro Council in the past, most recently last year.
MSD has spent some $700 million on projects for the federal consent decree to reduce sewage overflows into the Ohio River. The deadline for that project is 2024. MSD is not able to do much beyond consent decree work with its current budget, MSD executive director Tony Parrott said.
MSD estimates that the higher rate would add about $10 to the average bill, which goes out every two months.
On Sunday after breakfast at The Silver Dollar, I drove over Beargrass Creek going north on Frankfort Avenue just after Mellwood. The water was a murky teal. The stream looked like a settling pool or water holding tank that you usually see in a water processing facility. I guess that is what our natural waterways have become – free range sewage processing plants. The intersection of the two news stories from the previous week – sewage everywhere but no will to fix it – popped back into my mind.
You don’t have to live on River Road or in West Point to feel the effects of our city’s overwhelmed sewer system. It’s hard to imagine that the combination of news stories (four billion gallons of stormwater and raw sewage into the Ohio River and Beargrass Creek over the last five days) and first-hand experiences with sewage (toilet paper in the park) isn’t enough to generate sufficient will in the Metro Council to give MSD the ability to solve the problem. As Mr. Parrott said last fall, the rate hike requests aren’t going away.
Last year was a busy one for the Institute. We hosted 14 events, gave 11 national presentations about our work and 10 local presentations. We completed the AIR Louisville project with 251,379 data points about asthma medication use and 1.4 million related environmental data points. We published report cards for the asthma project and Green for Good. This study tested the idea that a greener neighborhood is a healthier one.
In October we launched Green Heart, a project that builds on Green for Good by expanding the idea to a neighborhood level. On October 26, we had speakers at the Kentucky African American Heritage Center, tours of the neighborhood and a dinner to celebrate. This project is a collaboration that includes the University of Louisville, Hyphae Design Lab, Washington University in St. Louisville, the Institute, and The Nature Conservancy. The five-year project will test the hypothesis that a greener neighborhood is a healthier one. Lauren Anderson of t*he Institute has taken the lead on community outreach. She has met with leaders in the south Louisville neighborhood where the study will take place. Lauren completed 30 engagement meetings in 2017 and has more on the schedule for 2018. The Institute also hired Jennifer Nunn, a resident of the Green Heart neighborhood. She is offering feedback on the project to the leadership team and connecting with residents in the neighborhood.
Lauren Anderson of the Institute describes community engagement plans for the Green Heart Project.
We did a lot more policy work in 2017 than in previous years. This included:
- Public comment on proposed VA Hospital site
- Public comment and collaboration with local groups on ASRC modification request
- Education campaign on expansion of indoor smoking ban
Also in 2017, city government leaders worked on an update to the Comprehensive Plan. Based on data from AIR Louisville, we proposed 2 new policies:
- Increase the requirement to replace tree canopy during development from 15% to 45%. Under the current rule, developers are required to replace only 15% of the trees chopped down during construction projects. As trees provide so many benefits to humans – cooling our homes, removing pollution from the air, absorbing storm water, and increasing home values – it makes sense to preserve as many trees as we can and to replace any we cut down.
- Use Green infrastructure to improve air quality. Cities should use land use and development policies to protect vulnerable populations from air pollution from cars. Development policy should require facilities serving vulnerable populations be at least 500 feet from high traffic roadways. Vulnerable populations include children under 18 and adults over 65. Facilities serving vulnerable populations include daycares, schools, universities, nursing homes, and hospitals. This recommendation comes from the American Planning Association’s Metrics for Planning Healthy Communities.
In 2017, we worked with City Lab to host Louisville in Harmony. The goal of this event was to define the next phase of the cross-sector collaboration that powered AIR Louisville. Now that the three-year community asthma project is complete, how can we take the energy and analysis from that work and direct it at a new project to improve the health of everyone in Louisville? At this event, we heard from Health Ambassadors who had developed their own unique collaborations across companies, organizations and individuals. The group then took on three challenges found in many Louisville neighborhoods:
- After-school activities for kids
- Economic development
- Air pollution
We are finishing a report on the event and will be identifying next steps for one of these challenges by the end of Q1.
Ambassadors Nasra Hussein and Sadia Abdirahman at the Spring Reception
The Ambassadors for Health in All Policies program is another unique collaboration that we launched in 2017.
These 56 community leaders
represent businesses, schools and philanthropic organizations around the city. There are students, doctors, entrepreneurs, artists and poets among the Ambassadors. There are three types of Ambassadors: students, business leaders and community leaders. These individuals understand the interconnections and interdependence among the many factors that influence human health. Each Ambassador is working in at least one of the eight areas of health represented the Circle of Health and Harmony. Our 2017 events stretched all the way around the Circle also.
- Break Up Summit
- Air Policy Summit
- Reception for Spring 2017 Ambassadors for Health In All Policies
- AIR Louisville Provider Lunch
- Air Walk with artist Dominique Paul
- AIR Louisville Report Release
- Ambassador Networking Breakfast
- Well Building Workshop
- Ambassador Networking Lunch
- Health in All Policies Training for Ambassadors
- Reception for Autumn 2017 Ambassadors for Health In All Policies
- Green Heart Launch
- CEO Diabetes Roundtable with Louisville Health Advisory Board
- Louisville in Harmony: The Power of Collaboration
In addition to getting the word out in Louisville about our work, the Institute team traveled around the country to share our research and citizen science projects with other interested groups.
- Sharing Knowledge to Build a Culture of Health, Louisville, KY
- MATRC 2017 Telehealth Summit, Leesburg, VA
- Health Impact Assessment Training, Dale Hollow, KY
- Asthma and Air Pollution Summit, Pittsburgh, PA
- ACO & Payer Leadership Summit, Los Angeles, CA
- Root Cause Conference, Louisville, KY
- Meeting of the Minds, Cleveland, OH
- American Public Health Association 2017 Conference, Atlanta, GA
- EPA Region 4 staff, Atlanta, GA
- Nemacolin International Asthma Conference, Farmingham, PA
- Past Forward 2017, Chicago, IL
Along with our partners, we are thrilled to announce the launch of our most important work to date. The Green Heart Project is a five-year collaboration with scientists and residents to precisely define the power of nature to project human health.
Click here to read more about our work.