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Health Care Innovation, From the Outside In

By David Sandman, President and CEO, New York State Health Foundation
Published in the Huffington Post on October 26, 2016

If you’re on a mission to improve people’s health and to make our health care system better, change can seem too slow and incremental. Other industries—especially those with a big tech component—evolve quickly. The ways we travel, shop, consume media, and communicate with friends and family are different today than just a few years ago. Yet, the pace of change in health care can feel stuck in a low gear. Claims of innovation and disruption abound, but they often turn out to be more hype and marketing than really big changes.

If we want to shake up health care, maybe we need to look outside of traditional health care and public health settings to find more of those big ideas. When we at the New York State Health Foundation decided to bet on potentially game-changing ideas and organizations to improve health over the next 10 years, it turned out that many of the most innovative approaches came from other than the usual suspects. The winners of the “Emerging Innovator” awards include a settlement house, an urban farm, and a film-making program for veterans. They’re focused on issues as diverse as food access, criminal justice reform, affordable housing, and post-traumatic stress. The winners, to my surprise at least, didn’t include physician groups, health insurers, hospitals, drug companies, and other entities that make up the mainstream fabric of the health care system.

All of the winning organizations are using novel approaches designed to transform the health of New Yorkers over the next 10 years.

  • The Center for Active Design is a young, rapidly growing organization that uses design to foster healthy and engaged communities. Its mission is to transform design and development practice, ensuring equitable access to vibrant public and private spaces that support healthy communities in New York and beyond. The Center provides research, resources, and technical assistance to developers, designers, and communities to enhance the health impacts of their projects, including affordable housing developments, hospitals, and worksites. In 10 years, the Center envisions that health will be a fundamental priority in all design projects.
  • The Center for Law and Justice, a community-based organization in Albany’s South End, focuses on issues related to the interactions among health care, poverty, race, and criminal justice. The Center’s HEAL initiative focuses on Health, Education, Advocacy, and LEAD—Law Enforcement Assisted Diversion—to improve community health, work with law enforcement to divert low-level offenders to health and social service providers rather than the criminal justice system, and educate residents about disease prevention and treatment. It pushes for substance use to be treated as a health issue rather than as an intolerable crime. This comprehensive approach—addressing the underlying health and social issues that are wrapped up in substance use and low-level criminal activity—is what has the potential to be truly transformative.
  • If you know Lenox Hill Neighborhood House, you may be scratching your head, wondering how a 122-year-old settlement house qualifies as an “emerging” innovator. But it has in the last few years started a program that serves 400,000 fresh, healthy, locally-sourced meals each year to nonprofit institutions like senior centers, a homeless shelter, Head Start and universal pre-K programs, and a day program for older adults living with dementia. Last year, Lenox Hill introduced a new Teaching Kitchen, a nuts-and-bolts food business course to help nonprofit food service directors, chefs, nutritionists, and kitchen staff increase their clients’ access to fresh, healthy, local food. It has already trained organizations that serve 1.5 million meals annually, and aims to take that work to scale and reach 500 nonprofits that serve 40 million meals each year to low-income New Yorkers.
  • The Patton Veterans Project uses video production and storytelling to help veterans and military families cope with post-traumatic stress. The team develops and runs workshops that give veterans the chance to learn about film-making and create short films about their service experience. The program enables veterans to connect with one another, make sense of their traumatic experiences, become more open to seeking care, and substantially reduce their post-traumatic stress symptoms. The film-making process encourages collaboration, reduces stigma, and builds hope and a new sense of community among participants. In addition, the completed films serve as tools to help educate non-veterans about the challenges associated with trauma, transition, and other struggles that New York’s estimated 85,000 returning Iraq and Afghanistan veterans face.
  • Finally, Soul Fire Farm Institute was founded by a family living in inner-city Albany that found it was easier to acquire weapons and drugs in their neighborhood than it was to get healthy food. Committed to providing good food for their neighbors, they purchased land, started to farm, and began focusing on reducing disparities in food access. Soul Fire provides direct food distribution weekly to 80 families living in food deserts. It also works to increase the number of farmers—particularly black and Latino farmers—in New York State and nationally. It has trained more than 1,500 young people and adults in farming practices, and is the only minority-led farm in the area that offers comprehensive training and support for new minority farmers. By training farmers, Soul Fire is supporting the community in providing for its own healthy food needs and advancing food sovereignty.


I’m enthusiastic about all of these organizations, even though I stopped looking for silver bullets some time ago. I know that some new ideas won’t work out, or others may not achieve the scale required to make a widespread difference. And of course, we also need to invest in programs, organizations, and ideas that are tested and well-established. There are so many known improvements in health care that haven’t spread and scaled for a variety of reasons, but that could make a huge difference. Investing in those interventions—versus being tempted by shiny new things—is a good strategy too.

But we need to look beyond ourselves for exciting ideas that do more than tinker around the edges. If we keep trying the same old ideas, working with the same old partners, we’ll be stuck with our same old approach to health. Industries rarely disrupt themselves; it wasn’t travel agents, for example, who came up with Expedia and Orbitz. It wasn’t the big three networks who gave us streaming on-demand news and entertainment. Likewise, real innovation in health care may come from outside of health care. We should welcome it.

Follow David Sandman on Twitter: www.twitter.com/davidsandman1