The Cognitive and Toxic Ecology of Impoverished Neighborhoods

On April 15th, 2015, Freddie Gray, a 25 year old African American man, was arrested by the Baltimore Police, hand and leg cuffed, and thrown into the police van. In the process, Freddie suffered a spinal cord injury, from which he died. Six police officers were indicted in his death.

The death of another young black man at the hands of the police pushed the community over the edge. Small protests grew larger and larger, until, in the night of Freddie’s funeral, on April 27th, they erupted into rioting and looting. After a year of similar deaths ranging from Fergusson, Missouri to Staten Island New York, Americans have been asking, why do the conditions of persistent poverty exist in such a wealthy nation?

Freddie was not destined to be a local hero- he never graduated from high school, and since then had been arrested more than a dozen times for drug possession. But the deck was stacked against Freddie from the moment that he was born.

Freddie’s mother was a heroin addict. He was raised in North Baltimore, in an impoverished neighborhood, suffused with drugs, violence and crime. He grew up with neglect and disorder, which has been shown to negatively effect a child’s cognitive development. When Freddie was a small child, he and his twin sister Fredericka were also exposed to flaking lead based paint, were tested, and found to have excessive levels in their blood. Both were classified as suffering from ADHD in school, and ultimately dropped out. Freddie turned to drugs, Fredericka was often violent. Ruth Ann Norton, the executive director of the Coalition to End Childhood Lead Poisoning, in a Washington Post article by Terrance McCoy said “A child who was poisoned with lead is seven times more likely to drop out of school and six times more likely to end up in the juvenile justice system.” (1)

A blood level over 5 micrograms of lead per deciliter of blood is likely to severely disturb a child’s cognitive development, leading to lack of executive function, emotional self regulation and an inability to pay attention. Without these skills, children often fail at school, drop out, and develop criminal records. When Freddie was 22 months old, blood tests revealed that he had 37 micrograms of lead per deciliter of blood.

“Jesus,” Dan Levy, an assistant professor of pediatrics at Johns Hopkins University who has studied the effects of lead poisoning on youths, was quoted as saying in the Washington post article when told of Gray’s levels. “The fact that Mr. Gray had these high levels of lead in all likelihood affected his ability to think and to self-regulate and profoundly affected his cognitive ability to process information. And the real tragedy of lead is that the damage it does is irreparable.” (2)

Environmental toxins negatively impact neural development, measurably degrading the intelligence of children, especially if their mothers are exposed during pregnancy. Outdoor air pollution generated by burning fossil fuels pollutes air with polycyclic aromatic hydrocarbons (PAH), methylmercury (Me Hg), sulfur, nitrogen oxides, and other toxins. These pollutants also effect adults. A study recently published the medical journal Stroke found adults who lived near highways, and were exposed to high levels of PM 2.5 particulates had a 46% greater chance of getting a stroke. Each additional 2 micrograms of PM 2.5 per cubic meter of affected the brain as though it had aged a year. (3)

Dr. Fredericka Perrera of the Mailman School of Public Health notes that the direct toxic effects of exposure to these chemicals leads to increased infant mortality, lower birth weight, deficits in lung functioning, childhood asthma, developmental disorders, intellectual disabilities, attention deficit hyperactivity disorder, and an increased risk of childhood cancers. Prenatal or early life exposure to alcohol, nicotine, and cocaine also can have what the Center on the Developing Child calls devastating and lifelong effects on the developing architecture of the brain.

There is not a great deal of work on the combined cognitive effects of toxic stress and toxic chemicals, but they cannot be good. If a child’s immune response is rendered less effective by cognitive stress, then they are likely to be more vulnerable to neurotoxins and other stresses. This toxic soup is pervasive, but to many, invisible. It is critical that we identify its components and its compounding effects.

In addition to lead, other environmental toxins such as mold, pests, pesticides, and excessive dust have been shown too adversely effect children and their families. All of these toxins may be present in any home, but they are typically concentrated in low-income homes and neighborhoods. In these poorly insulated homes, during cold winters, families often use gas-fired ovens, and stoves, for heat deeply, adding to the toxicity of the indoor air . An unpublished study indicated that the children most vulnerable to environmental toxins were more likely to have parents who suffered from the cognitive deficits of poverty – the combination of the persistent stresses of negotiating an under- resourced life, poor nutrition and environmental toxins depleted their parents’ intellectual capacity to understand the issues that were effecting them, and to develop alternative strategies. And thus their children were subject to higher levels of exposure. Freddie and Fredercka’s mother knew that her children were ingesting lead, but she could not afford to move elsewhere.

Contemporary urban life is complex, and only getting more so. Intellectual intelligence is increasingly required to figure out how to negotiate cities’ dynamic systems. Emotional and social intelligence is increasingly required to thrive in complex organizations. Children who are raised in highly stressed, environmentally toxic environments will be much less likely to succeed. And in the competitive 21st century, can a city thrive when a significant portion of its residents can’t participate in its culture and economy? Most likely not.

The riots in Baltimore revealed how deep the rifts are between prosperous and poor neighborhoods in most American cities.

Is the American Dream large enough so that every one of its children has the opportunity to live in a safe, affordable home?

(To join the movement for safe, affordable housing click on: )


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The 2014 John T. Dunlop Lecture given by Jonathan F.P. Rose: “The Entwinement of Housing, Neighborhoods and Wellbeing”

September 29, 2014


America’s Housing Challenges

America faces significant housing challenges. Harvard’s Joint Center for Housing Studies’ 2014 report notes that more than a third of American households and more than 50% of American renters pay more than a third of their income for housing costs (1) And in high cost communities, even middle income families cannot find affordable housing. In Los Angeles and Orange Counties, once a mecca of middle class homeownership, fewer than 25% of the homes on the market today are affordable to middle class buyers. (2)

Housing is the platform from which family success grows. It is typically a family’s largest cost. Over 80% of poor families pay more than a third of their income on housing and 69% pay more than half. (1) Add the cost of food, transportation, utilities, phone and internet, clothing, education and health care, and it’s hard to see how they can possibly make it all work. That’s why so many poor families double and triple up, living in over crowded conditions, or are always on the move, living wherever they can. Working lower middle class families, trying to balance two part time jobs with unreliable hours also often live in overcrowded housing, because they need the free childcare that is provided by the presence of other adults while they are out working.

Housing comes with a second cost, transportation. Poverty is increasingly a suburban phenomenon, with over 50% of America’s families now living in the suburbs, and the global poor often living in informal slums sprawling out from the edge of cities. Suburban poor working American families often spend 20-30% of their income

on auto-based transportation. To add to this burden, they often live in poorly insulated, energy inefficient homes with huge utility costs.

And those lower income families that are able to find a stable place to live, live from paycheck to paycheck. One missed paycheck or family emergency sets off a cascade of missed payments and difficult choices. If a parent misses a day to take a sick child to a clinic, they may be fired, demoted, or have their work hours per week reduced. That can put them over the financial edge, and make them unable to pay their rent.

This vulnerability effects a much larger percentage of Americans then just its poorest. A 2011 study by the National Council for Credit Counseling found that 64% of Americans have less then $1,000 in savings to deal with an emergency expense, and 30% had no savings whatsoever, other than retirement funds. (3) Savings are a critical element of a family’s economic resilience. This sense of “living on the edge” undermines their overall sense of wellbeing. The stress of just getting by is enormous.

Furthermore, affordable unsubsidized housing is often older, in very poor condition, and is being abandoned or demolished. According to the Joint Center’s 2011 report, more than 29% of the housing stock that was rented to low income families in 1999 was abandon or torn down by 2009 (4), reducing the supply of affordable housing.

But this is not just an American problem. This gap between the housing needs of the nation and the ability of the Federal Government to fund affordable housing exists in almost every country today. The World Bank estimates that globally there were 1.6 billion people in 2005 who lived in substandard housing, and 100 million homeless. (5)


Low Income Communities and Endemic and Episodic Stress:

For low and moderate-income families, the challenge of finding and keeping safe, secure, well-located places to live is very stressful.   Low-income communities are also rife with other stressors, such as crime and neighborhood violence, low-wage, low opportunity work, lack of access to health care, poor food and poor schools. These endemic stresses never go away, they are always there. The residents of these neighborhoods have fewer financial reserves, but also lower cognitive reserves. A recent study in Science indicates that the logistical demands of poverty itself impedes mental cognition by up to 13 IQ points. (6)

And although these communities are often characterized by their relative isolation, they are subject to the same global trends that are affecting every community on earth — climate change, globalization, growing income inequality, financial volatility, epidemics, the migrations of climate refugees and others. These macro trends are characterized by their volatility, adding episodic stresses to the endemic ones these neighborhoods face.

When the episodic stresses such as Hurricane Katrina, Superstorm Sandy, the fires in California, the floods in Colorado and the tornados in Missouri, or waves of foreclosure strike a community that is already saturated with endemic stresses, the community’s residents, and the social service systems that support them deeply lack the resilience to respond.


A Secure Base

Children’s Health Watch notes that “A safe, stable home is important for children’s physical and mental health today and their growth and learning abilities tomorrow.” (6) I suspect that everyone who follows the work of the Joint Center has long believed this. But over the last 20 years, advances in cognitive science have deepened our understanding of the development of the mind, and the critical relationship between cognitive health, the health of the individual, the family and the community. And we now more deeply understand the importance of a safe, stable home as a secure base.

In the 1988, British psychologist John Bowlby published “Secure Base”, in which he described the importance of a secure psychological base in the development of healthy children. Bowlby described it as “as secure base from which a child or adolescent can make sorties into the outside world and to which he can return knowing that he will be welcomed when he gets there, nourished, physically and emotionally, comforted if distressed, reassured if frightened.” (7)

The premise of this lecture is that there is a deep interdependence between the cognitive security of individuals, their families and their environment and their physical and mental health, and that these factors deeply affect their functioning in the world.

There are many contributors to a sense of security or the lack of it, but it is very clear that the endemic stresses of living in low income communities corrodes a developing child’s sense of security. Add to this the episodic stresses of large scale events that are out of the control of any individual or community, and the cognitive security needed to grow healthy children becomes frayed. These cognitive stresses have lasting, negative impacts on the child’s physical and mental health for the rest of their lives, and these impacts ripple through their communities. The best answer to mediate the cognitive diseases caused by these endemic and episodic stresses is to provide children with a secure base, and supplement it with the trauma relieving strategies.

A few years ago, a leader of a not-for-profit low-income housing development company, desperate to increase the supply of affordable housing in his community said at an Enterprise Rose Fellowship meeting “My community suffers from terrible overcrowding. We often have 13 extended family members living in a single home. Inevitably, one evening an uncle comes home drunk and rapes a young girl. Everyone in the home knows it happened, everyone feels complicit, everyone is damaged. If I can just move every single mother and her children to their own safe, green apartments, then we can begin to help them move forward with their lives.”


Adverse Childhood Experiences

The rape of a child is a horrible thing. The medical community labels it an adverse childhood experience, or ACE. ACE’s are significant negative childhood experiences that deeply affect the child’s development — they fall into three categories: abuse, neglect and household dysfunction. The include emotional abuse, physical abuse, sexual abuse, physical and emotional neglect, excessive noise at home, sudden eviction, observing one’s mother being subjected to violence, property victimization, peer victimization, exposure to community violence, socioeconomic status, parents always arguing, household substance abuse, household mental illness, parental separation or divorce, and a parent who was sent to prison. (8)

The effects of ACE’s on the health and life outcomes of the victims are significant. In 1993, Dr. Robert Anda, an epidemiologist at the Centers for Disease Control and Dr. Vincent Filetti, and internist at Kaiser Permanente in San Diego, began a decade long study of more than 17,000 people in the Kaiser system to better understand the impact of ACE’s. Approximately 75% of the population that they studied was white and had a college degree, yet 12.6% had an ACES score of four or more. ACES produce a dose/response effect, the more ACES the deeper the lifelong effects. Adults who had experienced four or more ACES as a child are twice as likely to be smokers, 12 times as likely to attempt suicide, 7 times as likely to be alcoholic and 10 times more likely to injected street drugs. (9)

A child with 4 or more ACES is also four times more likely to have intercourse by the age of 15, and 40% of the girls with 4 or more ACES become pregnant as teenagers.

There is a deep connection between a child’s ACES score and their health. As an adult, if they have experienced four ACES or more, they are 260% more likely to have Chronic Obstructive Pulmonary Disease (COPD) than someone with an ACES score of zero. They are 240% more likely to have hepatitis, 250% more likely to contract a sexually transmitted disease. Experiencing six ACES increases ones chance of getting lung cancer by 300%, and one is likely to live 13 years shorter. And the number of ACES one has experienced proportionally increases the risk of being hospitalized for an autoimmune disease such as rheumatic disease. (10) Since that initial study, there have been many population studies of the effect of ACES on children, and the results have been confirmed over and over again.

These terrible adverse childhood experiences are prevalent all over the world, but they are particularly concentrated in low-income communities.

David Bornstein, the co-founder of the Solutions Journal Network writes “Imagine if scientists discovered a substance that increased the risks of cancer, diabetes and heart, lung and liver disease for millions of people. Something that also increased one’s risk of smoking, drug abuse, suicide, teen pregnancy, sexually transmitted disease, domestic violence and depression — and simultaneously reduced the chances of succeeding in school, performing well on a job, and maintaining stable relationships? It would be comparable to hazards like lead paint, tobacco smoke and mercury. We would do everything in our power to contain it, and keep it far away from children, right?” (11)


Toxic Stress

Adverse childhood experiences cause what Dr. Jack Shonkoff, the director of Harvard’s Center on the Developing Child, labeled toxic stress.

Not all stress is toxic stress. Some stress is actually positive and advances cognitive growth. For example, if a child experiences moderate stress, such as having to read a poem to a whole school assembly, and they live in a supportive environment with protective adults, this positive stress develops coping skills, and makes the child more resilient.

There are also tolerable stresses, such as the death of a grandparent, which may be severe, but with support, the child’s mind recovers.

But toxic stress is so frequent or intense that it permanently affects the body’s stress responses.


The ACES Mechanism in the Brain

When a human encounters a threat, the brain sends messages to the hypothalamus, the part of the brain that regulates the body’s autonomic and homeostatic systems. The hypothalamus compares the threat to the memories in the hippocampus, and if the memories are bad, it releases hormones that trigger the pituitary gland to instruct the adrenal glands release two hormones — cortisol and adrenaline. This neural network is called the HPA (hypothalamus, pituitary, adrenal) axis.

Imagine that you are walking through the woods and you come across a bear. The HPA axis releases adrenaline, which quickly prepares you for fight or flight by speeding up your heart, and contracting your pupils to focus your attention. If you have to run for a long time, then your pituitary gland releases cortisol, which increases your blood pressure and blood sugar, and turns down your immune response, to enhance your long distance running ability.

Under normal circumstances, after the stress passes, the HPA relaxes and returns to normal balance. But if the stress is continuous, or if the stresses are traumatic, the HPA pathway is jarred open, and remains permanently on, even when it is not needed. Its neural patterns become fixed “grooves”.

Children who encounter adverse childhood experiences have their HPA’s wired on. They also develop smaller prefrontal frontal cortex’s, producing less robust control connections between it and the amygdala. This circuit is a key system for self-regulation, particularly the ability of people to regulate their reactions to perceived threats. And thus, children who suffer from continuous toxic stress or frequent ACES are more likely to be recessive, withdrawn, are less able to pay attention in school and to participate in activities or to make friends. In effect, until puberty, they are permanently in the flight mode. And then, after puberty, they shift into the permanent fight mode. The overactive HPA axis condition is expressed as continuous anger and anxiety. Combined with the inability to pay attention and self regulate, key functions need to perform well in school, this neurological condition leads to boys dropping out of school, joining gangs, and engaging in crime and other high risk behaviors. Girls also drop out, and seeking affection without self-control, become pregnant. And then, as resentful, stressed out, poor mothers, they pass on the condition to their children.

And this condition is inheritable. There is now ample evidence that the effects of toxic stress on young rats produces epigenetic changes that continue across generations. One of the key genes that is effected is the NR3C1 gene. (12)

Recent research has translated these rat studies to humans. Seth Pollack, at the University of Wisconsin’s Waisman Center’s Child Emotion Research Lab, recruited 50 children with a history of abuse to study their genes and discovered that their NR3C1 genes were methylated in the very same sites that the gene was methylated in highly stressed rats. (13) The Center also measured the size of children’s amygdalas and hippocampus’s, and observed that children who experienced poverty, neglect or physical abuse had smaller amygdalas and hippocampus’s than children who had not experienced these stresses. (14)

ACES is now known to cause methylation variations in genes are correlated with psychiatric disorders and medical morbidity, suggesting that ACES contribute to the vulnerability for developing psychiatric disorders. (14)

Research by Bruce McEwen, the head of the Margaret Milliken Hatch Laboratory of Neuroendocrinology at the Rockefeller University and colleagues, shows that parental care effects the epigenetic regulation of hippocampal glucocorticoid receptor expression, impacting the transmission of suicide rates. (15) Teresa Brockie found ACES causes epigenetic variations in multiple studies of Native American communities. (16)


The impact of poverty, housing instability, overcrowding and eviction on children

Overcrowding, excessive noise and transience also affect young children. Studies by Gary Evans, a research scientist in Cornell University’s Departments of Human Development and Design and Environmental Analysis, indicate that overcrowding produces a negative effect on children’s interpersonal behaviors, mental health, motivation, cognitive development, and biological measures. Overcrowding is not a function of family size in itself or even family income. Rather it is caused by the density, or number of people per room.

Parents in crowded homes are less responsive to young children, perhaps due to their own adverse childhood experiences. Evan’s research shows that parents who raise children in crowded homes speak less frequently to their children and use less complicated words. (17) And a study by Betty Hart and Todd Risley of Rice University calculated that after four years, children on welfare will have heard 30 million fewer words than children from high income families. And yet the low-income child will have heard 125,000 more words of discouragement, while the high-income child will have heard 560,000 more words of praise. (18) This too has a cognitive effect.

Parents who raise children in overcrowded homes are more likely to engage in punitive parenting, significantly increasing the level of children’s distress. This is not a function of the family’s income, rather, it is correlated with chaos and disorder in the home. Evans notes “Elementary school-aged children who live in more crowded homes display higher levels of psychological distress and they also have higher levels
of behavior difficulties in school…. Chronic overcrowding influences children’s motivation to perform tasks. Independent of household income, children aged 6-12 show declines in motivational behavior and also demonstrate a level of learned helplessness—a belief that they have no control over their situation and therefore do not attempt to change it—although they have the power to do so.” (17)

The 21st Century job markets require people not only with an increasing range of technical skills, but also the cognitive skills of attention, flexibility, and complex use of language. Children who grow up in over crowded, chaotic homes, or with abuse are most likely being condemned to a future of failure.

Housing evictions are also a driver of ACES, and the financial crisis has not helped. In Milwaukee County, between 2010 and 2013, the number of eviction cases increased by 43 percent. Evictions in Maine increased 21 percent and 11 percent in Massachusetts. (19) Matthew Desmond, a Harvard Sociologist who studied evictions in Milwaukee said “You would think that evictions is caused by job loss, but we found that eviction can actually cause you to lose your job.” (19) And once evicted, people have higher rates of depression, material hardship, hunger and lack of medical care.


Vicarious Trauma

In 2003, Diana Rose, the founding President of the Garrison Institute began a program to address the endemic stresses that New York City area domestic violence shelter social workers are subject to, and the effect of those stresses on their effectiveness and wellbeing. She, and noted meditation teacher Sharon Salzberg, founded the Contemplative Based Resilience program, to understand and help relieve the stresses that the social service workers in the system were experiencing. They began with the work of Laurie Anne Pearlman, who was then the President of the Trauma Research, Education and Training Institute, and had extensively studied vicarious trauma, or trauma transference.

Vicarious, or secondary trauma occurs when trauma passes from the traumatized population to its caregivers. This little known phenomena is one of the major causes of the burnout, stress, depression and even suicide that effects social service and medical workers who altruistically serve low income and troubled communities.

If we are going to address the epidemic of ACES and toxic stress, then, as with any epidemic, we also have to protect the service professions who come in contact with the epidemic.

The Contemplative Based Resilience project uses a four pronged approach to mediating vicarious trauma — yoga, because trauma is embodied, meditation to detoxify the mind, psychosocial education and community building. The Garrison team has gone on to apply its work with humanitarian aid workers around the world. (20)


The Solutions

In 2007, Dr. Nadine Burke Harris M.D. completed her pediatric residency at Stanford and joined the California Pacific Medical Center, a private health care network, to open a clinic in the Bayview-Hunter’s View neighborhood, one of the poorest neighborhoods in San Francisco, and one with some of the greatest health disparities. San Francisco’s Hope SF program, which is working to transform the City’s public housing, noted that between 2005-07, there was ten times more violence at Hunters View then in San Francisco as a whole. In Hope SF communities, 73% of able-bodied adults are unemployed and 53% of the project’s students are chronically absent from school.

Dr. Burke Harris was surprised by the degree of health issues her pediatric patients had, and set out to discover why. Once she learned about ACES and toxic stress, and understood them as the likely cause of the health epidemic in the Bayview-Hunters View community, she set out to find a cure.

Dr. Burke Harris’s project, now called The Center for Youth Wellness, has developed a multidisciplinary approach focused on identifying, preventing and undoing the chemical, physiological and neurodevelopmental consequences of ACES.

The Center for Youth Wellness uses a multipronged approach, working with both affected children and their parents. Its work begins with an assessment done in the clinic, home and school to determine the child’s exposure to adversity and the depth of its effects on the child’s wellbeing. The Center then educates the families on the causes and symptoms of chronic stress, and provides the families with stress reducing solutions. Children and their families are also provided psychotherapeutic treatments by the UCSF’s Child Trauma Research Program and the Early Life Stress and Pediatric Anxiety Program at the Lucile Packard Children’s Hospital.

The Center for Youth Wellness also trains its patients in mindfulness and coping skills, which help patients and their families build their cognitive resilience to manage future stressful events.

And Hope SF has initiated a program of “trauma informed” management, integrating trauma awareness and solutions into all of its public housing work.. This begins by recognizing the deleterious effects of trauma on both its residents and staff, and then figuring out how to integrate solutions at every level of the system, addressing endemic and vicarious trauma at the individual and project level.


Cognitive Ecologies

Just as the world needs a healthy natural ecology to thrive, it also needs a healthy cognitive ecology, or mental landscape of thinking, feeling and relating. If we are going to ease endemic poverty, we need to recognize that it persists in an invisible, pervasive cognitive ecology of toxic stress that deeply permeates not only families living in low income communities, but also the caregivers who are trying to support them. We should also note that although toxic stress is both concentrated and exacerbated by low socio-economic status, that it is increasing throughout all levels of society.

This cognitive ecology is the soil of civilization. The work of community development must include the creation of positive cognitive ecologies so that humans and natural systems will thrive.


Add Environmental Toxins

Environmental toxins have also been shown to negatively impact neural development, measurably degrading the intelligence of children, especially if their mothers are exposed during pregnancy. Outdoor air pollution, generated by burning fossil fuels pollutes air with polycyclic aromatic hydrocarbons (PAH), methylmercury (Me Hg), sulfur, nitrogen oxides and other toxins. Indoor toxic exposures include lead, mold, pests, pesticides, and excessive dust. All of these toxins may be present in any home, but they are typically concentrated in low-income homes and neighborhoods. For example, in low-income homes, families often open gas fired ovens and use them for heat.

Dr. Fredericka Perera of the Mailman School of Public Health notes that the direct toxic effects of exposure to these chemicals include increased infant mortality, lower birth weight, deficits in lung functioning, increased childhood asthma, developmental disorders, intellectual disabilities, attention deficit hyperactivity disorder and an increased risk of childhood cancers. (20, 21)

Prenatal or early life exposure to alcohol, nicotine, and cocaine also can have what the Center on the Developing Child call “devastating and lifelong effects on the developing architecture of the brain.” (22)


The Cognitive and Environmental Toxic Soup

The combined cognitive effects of toxic stress and toxic chemicals cannot be good. If a child’s immune response is rendered less effective by cognitive stress, then they are likely to be more vulnerable to neurotoxins and other stresses.

This toxic soup is pervasive, but to many, invisible. It is critical that we identify its components and its compounding effects.


Four Strategies to Combat Toxic Stress

Although work on toxic stress is in its early years, four strategies to relieve it have emerged. The first takes us back to housing — a safe place that is physically, psychologically and environmentally safe, non chaotic and nurturing. It is becoming increasingly clear that such housing is the ground of physical, mental and social health. E.O. Wilson, in The Social Conquest of Earth notes that all social species are also nesting species, and that a safe common nest is the ground of an altruistic society. Dr. Esther Sternberg, the Founding Director of The University of Arizona’s Institute on Place and Wellbeing, has shown how the physical environments in which we live and work can trigger the brain’s stress or relaxation responses. And Richard Louv has documented how important it is for the places that we live and work to be connected to nature.

A safe, green, calming, social, altruistic housing community is not only an essential platform for the restoration and resilience of chronically stressed families, but also for the social and health care workers who serve them. The housing stress documented by the Joint Center’s 2014 report applies to many of America’s service workers. According to the Bureau of Labor Statistics, in 2013 the median salary of home health aides was $20,820, 12% lower than the national poverty level $23,492. (23) Hospital orderlies earned a median salary of $23,990. The average domestic violence shelter worker earns $37,000 a year. Substance abuse and behavioral disorder counselors earn a median income of $40,920, and child and family social workers $43,290. These incomes are all below the 2013 median income $51,017. In high cost cities, these families, too, are housing stressed.

We are rapidly accumulating evidence that greener, healthier housing provides a significant public health benefit at very little additional cost. At this point, there is simply no reason to justify the construction of another toxic housing unit.

The second strategy is exercise. Bruce McEwen has demonstrated that exercise stimulates healthy neurogenesis. And we know that exercise is deeply connected to a community’s walkability. A study published in the Journal of Preventative Health found that children who live in smart growth neighborhoods get significantly more exercise than those who live in suburban environments designed for driving. (24) As the percentage of poor families living in the suburbs continues to increase, less exercise and social isolation become more significant issues. And walkability is an urban issue, too. A study by the New York City Department of Health and Mental Hygiene discovered that the walkability of New York’s neighborhoods vary significantly. Walkability was defined by residential density, intersection density, land use mix, subway stop density and the ratio of retail building area to retail land area. The study concluded that people living in the most walkable neighborhoods on average engaged in 100 more minutes a week of physical activity than those living in neighborhoods with low levels of walkability. This amount of exercise is significant enough to impact obesity rates. (25)

The third strategy is the development of mental quiet and space. Dr. Richie Davidson, the Founder of the Center for the Study of Healthy Minds, also at University of Wisconsin’s Waisman Center, has extensively studied the efficacy of mindfulness training on stress, and has documented positive neurological and immunological benefits from it. (26) His lab has also published research indicating that a range of contemplative practices can increase children’s self regulation, attention and pro-social behaviors such as compassion and empathy. (27) And The Garrison Institute’s CBR program has demonstrated the efficacy of meditation in alleviating the vicarious trauma of the social service section. Dr. Burke Harris told me that once she began attending the meditation classes for her patients, she discovered that the peacefulness it engendered also increased her own resilience.

Both McEwen and Davidson’s work shows that contemplative practices such as meditation can stimulate the regrowth of health brain structures in as little as eight weeks. The work of Tania Singer, the Managing Director of Social Neuroscience at the Max Planck Institute for Human Cognitive Brain Science, shows that contemplative practices increase empathy and pro-social behavior. And empathy and altruism are essential elements of healthy communities.

The fourth solution is the benefit of being part of a community that models thriving, supportive, healthy human connections. Eric Klinenberg’s study of the response of Chicago neighborhoods to the stress of heat waves indicates the importance of social networks in individual and collective resilience. In 1997, Chicago was struck by a deadly heat wave. Most of the people who died were poor and elderly. They often didn’t have air conditioning, or if they did, they couldn’t afford to turn it on. They were afraid to open their doors or windows at night, for fear of intruders. Of the ten communities with the highest death rates from the heat wave, eight were predominantly African American, and experienced high rates of crime and levels of unemployment. But oddly, three of the ten communities with the lowest death rates were also African American, poor, and had high rates of unemployment and crime.

For example, the Auburn Gresham, a poor neighborhood had a culture of altruism, carried out through church and voluntary association networks. The death rate in Auburn Gresham was only 3 per 100,000, one of the lowest rates in the city, even lower than the death rates of many prosperous, white neighborhoods on the North Side. (28) Klinenberg concluded that the differences in the rates of death correlated with the strength or weakness of the social networks in each community.

These four strategies provide the ground upon which psychosocial interventions can be most effective, transforming trauma into resilience.

Building enough safe, green, walkable, sociable affordable housing is a key first step in the creation of a safe base for families to begin to move forward with their lives. The housing must also be energy efficient, and easily connected to transit if it is going to really help reduce some of the financial stress on working families.

But a safe base of housing is not enough, the housing must be part of a safe neighborhood.


Neighborhood Effects

Social scientist Robert Sampson, now at Harvard, spent twelve years at the University of Chicago, where he organized the Project on Human Development in Chicago Neighborhoods (PHDCN) to compare the social performance of the city’s neighborhoods, and determine the key drivers of neighborhood social health and their impacts on children and adolescents. (29) Sampson compared neighborhoods with a wide range of incomes, and measures of violence. The study also tracked 6,000 randomly selected children, adolescents and young adults over seven years. The data clearly indicated that civic behavior was clearly spatially clustered, with enormous variability in the performance of neighborhoods.

The study observed that neighborhoods that had the best school performance also had the best health outcomes, the lowest crime levels and the lowest proportion of teen pregnancies. These outcomes were all inter-related. And these were persistent over time -the neighborhoods with the best outcomes remained the best, even as people moved in and out of them. Sampson concluded that neighborhoods themselves have enduring characteristics that both attract and shape the behaviors of their residents. In his groundbreaking book, Great American City: Chicago and the Enduring Neighborhood Effect, Sampson wrote “Neighborhoods are important determinants of the quantity and quality of human behavior in their own right.” (30)

Looking at the data, Sampson determined that the two most important factors that effect the quality of neighborhoods are the conditions and perception of disorder in a neighborhood, and collective efficacy, which he defines as “social cohesion combined with shared expectations for social control.” (31) These two conditions are deeply interrelated, and correlate with toxic stress.


Neighborhood Disorder

The perception of neighborhood disorder has two forms — social and physical. Physical disorder is manifested with graffiti, abandoned or poorly kept buildings, uncollected garbage and broken windows. Social disorder is reflected in openly solicited prostitution and drug dealing, public intoxication, verbal harassment, loud music and rowdy groups of adolescents. Conversely, neighborhoods that have neat, tree-lined, garbage free streets, and residents that greet each other generate a higher sense of wellbeing.

Sampson’s study correlated variations in a community’s social norms related to the orderliness of their neighborhood. Residents who agreed with statements such as “laws were made to be broken” or “it’s ok to do whatever you want as long as you don’t hurt anyone” were more cynical about their future tolerated higher levels of lawlessness, and its attendant violence. Conversely, the more orderly a neighborhood was perceived to be, the better its health and wellbeing outcomes.

Theaster Gates, an urban artist working in Chicago, asks “what happens to a neighborhood if you think that beauty is important?” (32)

And in 1965, Jim Rouse said in Chicago “we believe, because it is true, that people are affected by their environment, by space and scale, by color and texture, by nature and beauty, that they can be uplifted, made comfortable, made important.” (33)


Collective Efficacy

Sampson posited that when neighbors share expectations of social control in their neighborhood, trust each other and feel social cohesion, their neighborhoods generate much better outcomes. Neighborhoods with high levels of collective efficacy have lower levels of crime, lower rates of teen pregnancy, infant mortality and other measures of health and wellbeing. This holds true whether the neighborhood is black or white, rich or poor. Through dense personal ties, the contagion of behavior helps to facilitate collective efficacy, but they do not cause it.

Neighborhoods with high levels of social control have people who watch out for others kids, they scold teenagers for loud behavior on the streets, and they watch over each other. Reflecting on this, Alejandro Portes, a sociologist at Princeton University, expanded the definition of social capital to include not only social connections and attendant norms and trust but also “the expectations for action within collectivity” (34) ie, that the social connections and trust will produce a positive outcome for the common good.

Sampson found that collective efficacy was strongly correlated with altruism, Neighborhoods with higher levels of altruistic behaviors have better health, wellbeing and safety measures. Empowered people and neighborhoods, who feel that they can make the world a better place are healthier. It turns out that a sense of efficacy, or agency also reduces stress. And so the fourth solution, vibrant social networks help not only mediate toxic stress in children and social workers, but it also creates the ground for healing neighborhoods.

Collective efficacy is an emergent behavior of the complex adaptive system, the neighborhood. It is increased by the success of community organizations such as Parent Teacher Associations, neighborhood watches, tenant associations, community gardens and other purposeful hubs that generate associative behaviors. These associations also communicate their values back to the community. By mapping the location of all of the city’s not-for-profit groups, Sampson discovered that their density was one of the strongest predictors of collective efficacy.


The Three Degrees of Neighborhood Influence

When Sampson looked at the study’s neighborhood data on a map of Chicago, an interesting phenomena emerged. Just as people have three degrees of influence upon each other, neighborhoods also seem to have three degrees of influence on each other. If the crime rate is high in a neighborhood, it is positively linked to crime in an adjacent neighborhood. If the homicide rate in a neighborhood goes up by 40%, its direct neighbors will experience a 9% increase in homicide, and their neighbors a 3% increase. On the other hand, if the indicators of collective efficacy increases in and neighborhood by one standard deviation, the homicide rates for adjoining neighborhoods and their neighbors go down by 15%.

This means that every neighborhood of a city benefits from improving the health, safety and wellbeing of all of a city’s worst neighborhoods. And every family in a city benefits from the alleviation of the toxic stress of any child, no matter how far removed from them. And thus altruism generates a collective benefit for a city.


The Long-term Value of Paying for Solutions

The Center for Disease Control and Prevention, in a study based on 2008 data estimated the total lifetime financial costs associated with just one year of confirmed cases of child physical abuse, sexual abuse, psychological abuse and neglect range from $124 billion, to as high as $585 billion. (35) The costs were arrived at by summing short-term health care costs, long-term medical costs, child welfare costs, special education costs, criminal justice costs and productivity losses. And this is the just cost of one year of children over one lifetime, not taking into account the cognitive effects of toxic stress that pass from generation to generation. And thus, if we can invest in preventing and healing this issue now, the long-term benefit to individuals and society will be enormous.

The costs of environmental toxins are equally devastating. A literature review by Dr. Perera found that the 2008 costs of environmentally mediated diseases in US Children, including lead poisoning, prenatal methylmercury exposure, childhood cancer, asthma, intellectual disability, autism, and attention deficit hyperactivity disorder were $76.6 billion. (36)

We know enough to know that these constitute an epidemic. The system for combatting a single vector of disease, such as a flu requires the systemic integration of many public and private sector actors, from scientists, public health officials, pharmaceutical manufacturers, distributors, inoculators etc. Imagine how much more complex the fight against a multi-vector endemic disease is.

This requires that we think about community development in an entirely different way. We need to recognize that safe, green, well-located housing for populations suffering from toxic and environmental stresses are necessary, but not sufficient. We need to invest far more capital and social service funds now in the alleviation of ACES, toxic stress and vicarious trauma, to preempt unsustainable human, social and economic costs later.

To achieve this, we need a massive social impact-bonding program to bring future savings forward. It must be accompanied by trauma aware health and social services that aggressively work to sever the roots of these endemic illnesses.

The solutions that we invest in must address cognitive stress, financial stress, environmental and climate stress in an integrated way, tying together solutions to increase resilience at the individual, building, neighborhood and city scales.


Entangled Altruism is Entwinement

Quantum physics began with the study of the particle, but it quickly observed that particles were inter-related, that the condition of one particle effects the conditions of others. Quantum theory posits that each particle, alone, is in a pure state, but that in actuality, the condition of each individual particle is entangled, or woven together with every other particle. They named this quantum entanglement.

In the late 1800’s, the early psychologists posited that each person had an individual mind, with goals, wants, needs and pre-dispositions, which set our behaviors. But we have learned that we are deeply social animals, and that our behaviors are entangled with others. Our states of mind and qualities of behavior are heavily determined by the collective state of the group and context that we are part of.

Cities are systems of interwoven systems. Every aspect of a city is interconnected through a marvelous web of interdependence. As Dr. Martin Luther King said in his letter from a Birmingham Jail, “We are caught in an inescapable network of mutuality, tied in a single garment of destiny. Whatever affects one directly, affects all indirectly…” (37)

Entanglement is a physical condition of interdependence without moral direction. King’s Letter from a Birmingham Jail beseeches his readers to become moral activists, and to do so with love.

If a city adopts altruistic goals, the DNA of altruistic intentions will flow through the city’s systems, ultimately touching every bit of the city. When altruism weaves into the fabric of a city, it creates an energized and altruistic culture. It adds a moral direction to the amoral interdependence of nature’s entanglement. I call this altruistically directed interdependence entwinement.


The Entwinement of Housing and Wellbeing

Housing is a necessary ground of a stable base from which wellbeing grows. (38) But housing alone is insufficient to transform the lives of families living with toxic stress, insecurity, high levels of neighborhood disorder and low levels of collective efficacy.

We are just at the beginning of understanding the interconnection between the wellbeing of children, their families, their housing, their neighborhoods and the cities that they live in, but we do know that they are all entwined. Every step that we take to relieve the toxic causes and conditions of economic, psychological and spiritual poverty for one child improves the wellbeing of all of us. And infusing our entwined human system with pervasive altruism, informed by science, carried out with compassion, and dedicated to the wellbeing of all is the ground upon which the relief of endemic poverty will grow.

Thank you.


  2. California Dream – Not Having to Settle for Just One Bedroom: Jennifer Medina, New York Times A20 Sept 24 2014
  5. Miloon Kothari, UN Press Briefing by Special Rapporteur on the Right to Adequate Housing, November, 2005.
  6. Poverty Impedes Mental Cognition: Anandi Mani, etc Science 30 Aug 2013 Vol 341 No 6149 pp. 976-980
  8. Secure Base: Parent Child Attachment and Healthy Human Development. John Bowlby Basic Books 1988 pg 11.
  9. Improving the Adverse Childhood Study Scale-David Finkelhor,Phd.; Anne Shattuck, MA; Heather Turner, PhD; Sherry Hamby, PhD. JAMA Pediatr. 2013;167 (1):70-75 Published online Nov. 26 2012.
  11. Powerpoint: Toxic Stress: Changing the Paradigm of Clinical Practice, Nadine Burke Harris, MD, MPH, CEO Center For Youth Wellness, May 13 2014, presented at the Picower Center, MIT.
  12. Protecting Children From Toxic Stress: New York Times Opinion pages, Oct 30th 2013 David Bornstein
  20. Evictions Soar in a Hot Market, Renters Suffer. NYTimes Sept 3 2014
  22. The Impact of Climate Change on Children, Chapter 2.1: Frederica Perera UNICEF 2011
  23. Economic Cost of Pollutants: Dr. Frederica Perera
  30. Klinenberg, Eric (2002). Heat Wave: A Social Autopsy of Disaster in Chicago. Chicago, IL: Chicago University Press. ISBN0-226-44322-1.
  32. Great American City: Chicago and the Enduring Neighborhood Effect- Robert J Sampson U of Chicago Press 2012. P
  33. Ibid – 27
  34. Theaster Gates, Sept 17 2014 Talking to the NRDC Board, Chicago Arts Club
  35. Jim Rouse April 5th 1965 Chicago, Speech at The Annual Honor Awards Luncheon of the Chicago Chamber of Commerce and Industry and the Chicago Chapter of the American Institute of Architects
  36. Embeddedness and Immigration — Notes on the Social Determinants of Economic Action: Alejandro Portes and Julia Sensenbrenner- The American Journal of Sociology- May 1993 pp 1320- 1350
  38. also see:
  39. Frederica Perera: Pollutants_costs_Children
  40. Martin Luther King- Letter From a Birmingham Jail April 16th 1963




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5 Ways City Transport Systems Must Prepare for the 21st Century

Handling tomorrow’s mega-trends means rethinking today’s infrastructure.

Jonathan F.P. Rose


 Flickr user MTAPhotos

In the 21st century, cities face many forces far beyond their control: mega-trends such as dramatic shifts in population, the financial vulnerability of a globally connected economy, resources scarcity, rising income inequality, and an increase in the droughts, floods, heat waves, cold waves, sea level rise, and storm surges caused by climate change. Preparing for all these stresses won’t be easy, but a critical place to start is with urban infrastructure, an area where many U.S. cities are most vulnerable.

Infrastructure is the platform of the common good. It connects us in nested networks of systems, integrating homes, neighborhoods, cities, regions, and nations. Cities thrive with internal and external connectedness, and the backbone of this connectivity is our urban transportation systems. It’s essential that we begin now to plan, finance, and construct or renovate transportation systems that can respond to the emerging mega-trends. The following are five ways to rethink today’s infrastructure for a successful tomorrow.

Plan for an uncertain future

In 2005, New York City’s MTA began work to reconfigure the South Ferry subway station at the tip of Manhattan. The goals of the project were fine ones — to solve long standing American Disabilities Act issues, to reconfigure the platforms for longer trains, and to create better connectivity between lines. The $530 million project was completed in 2009, and as projected, significantly increased the throughput capacity and comfort of the station.

However, because of the very long planning, engineering, funding and procurement cycles, the project was set in motion before the risks of a more volatile climate and rising seas were being taken seriously by the transit community. As a result, only three years later, the rising seas of Superstorm Sandy swept across Lower Manhattan and flooded the South Ferry station with salt water, destroying much of what had just been built. The repairs are projected to cost $600 million and won’t be completed until 2016.

The lesson is not only to now plan for sea level rise and increased storm surges, its to anticipate a wider range of coming   extreme circumstances. How might agencies design for extreme heat, for energy shortages, for changing settlement patterns? City’s transit managers are now challenged to plan for an uncertain future, to estimate the range of future demands, stresses, and opportunities, plan robust, repairable, resilient and responsive systems, and then fight for the funds needed for the transformation.

Designing Robust, Repairable, Resilient and Responsive Systems

In 1989, the Loma Prieta earthquake caused the collapse of the San Francisco- Oakland Bay Bridge. The original bridge was designed to be stiff, to resist the seismic movements of the earth. But the earthquake overwhelmed that design strength and the bridge failed, a tragic example of robust but fragile infrastructure. The bridge’s replacement has been designed to be ductile, strong but also flexible enough to absorb almost any shock. Its lead engineer, Marwan Nader, writes, “The idea is to build a structure that can stretch and deform without breaking.”

Nader and his team also designed the new bridge to be easily repaired after its been stressed. . For example, the bridge’s shock absorbers can be restored in a few hours after an earthquake — its spare parts are stored under the bridge, so even if other road networks are down, the necessary parts are on site. Sensors allow for continuous monitoring of the bridge, and its structure can be adjusted for various loads and stresses. The bridge is robust, resilient, repairable, and responsive.

As cities plan and rebuild vast amounts of critical infrastructure, these principles should be applied to all infrastructure improvements.

Shifting from Lines to Networks

A century ago, when many American cities built their first streetcar and commuter rail systems, metro regions were organized around central hubs, with the lines running as spokes from suburbs to the city. But the automobile-oriented suburban revolution that followed World War II changed all of that. No longer shaped by rail lines, suburbia could sprawl in all directions. As a result, many destinations that Americans need to reach everyday can only be accessed by car.

As our regions become more layered and complex, and metro area residents want more options then just cars, our transportation systems need to function as integrated networks, not just lines. Americans marvel at the elegance of interconnected European systems, which tie together airports, long-distance high-speed rail, local rail, street cars, buses, bike systems, and walking paths. We deserve the same.

Personalizing Mass Transit

America’s transportation needs are further changing as Millennial transportation preferences shift from driving to biking, walking, and mass transit. The emergence of services like Megabus, CitiBike, Zipcar, Uber and Lyft, and their many variations, reflect a desire for a more affordable, personal, and pervasive range of transportation options.

Meanwhile, NextBus and other mobile apps are increasing the public’s access to transit information, increasing ridership and rider pleasure. These systems are more resource and financially efficient for both the manger and the users. The next step is to use the information from these apps and adjust transportation services in real-time to meet demand, just as Uber tells drivers and customers each other’s location. Just two examples are San Fransisco’s smart parking system, Stockholm’s congestion pricing system.

Changing Oversight

Resilient, responsive, and adaptable transportation technologies are rapidly evolving. Technology is not a constraint — but our rigid ways of planning, designing, building, operating, and funding transit systems can be. Too often, transport agencies are bound by rigid federal, state, and local regulations that constrain their ability to integrate with other city services and objectives, so as to more effectively respond to rapidly changing climate, economic, housing and work patterns. For example, Transit Agencies are often obligated to obtain the highest price for land near new transit extensions, rather then the most community serving uses, which may include affordable and senior housing. The HUD sustainable community planning grants began to assist communities in seeing the benefits of integrating housing, transportation and environmental goals, but they were often hampered because our cities and regions didn’t have the integrated governance systems to implement these plans.

To serve our ever-changing cities, we need to develop more flexible governance systems and operating systems to loosen the rules that rigidly bind our transportation networks to the needs of the 21st century.

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Community Resilience Centers

Community Resilience Centers – our team’s HUD Rebuild by Design proposal

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The Prosperity / Wellbeing Conundrum

Earlier this year, UNICEF released a report comparing the wellbeing of children in 29 of the world’s most advanced nations.  The report compiles data on material wellbeing, health, safety, education, behavioral factors, and living environments, in addition to subjective “life satisfaction” surveys from children themselves.  The United States landed near the bottom on almost all measures.  Our total ranking was of 26th out of 29 countries; only Lithuania, Latvia, and Romania performed worse.  Yet the United States has the 10th highest GDP per capita in the world – more than three times that of Estonia and Slovakia, which both had higher levels of child wellbeing.

The traditional economic view has been  that growth and productivity, measured by GDP, are the key markers of success and the solutions to poverty.  The UNICEF wellbeing report shows how this traditional view is incomplete.   In actuality, cities and countries with rising incomes have been confronted by the paradox of unhappy growth in which increased GDP per capita has not led to increased or widespread wellbeing.

Stanley Kuznets, the Nobel Prize winning economist who introduced the concept of GDP to the U.S. Congress in 1934, was actually the first to caution about GDP’s limitations.  Kuznets wrote: “Economic welfare cannot be adequately measured unless the personal distribution of income is known.  And no income measurement undertakes to estimate the reverse side of income, that is, the intensity and unpleasantness of effort going into the earning of income.  The welfare of a nation can, therefore, scarcely be inferred from a measurement of national income.”

Kuznets recognized that wealth and welfare are different things, and factors like inequality, social capital, and labor conditions are important in gauging the success of a society.

Thriving, Struggling and Suffering

In 2005, Gallup began polling selected residents of almost every country in the world to gauge their state of wellbeing.  Respondents are asked about their employment status, their confidence in government, the quality of their public education system, their food security, and a variety of other issues. They are also asked to describe their lives as thriving, struggling or suffering.

In the period from 2005 to 2010, the GDP in Tunisia rose by 26.1% and in Egypt rose 53.4%.  But the Gallup polls showed that increased GDP was not leading to increased happiness.  In 2005, 25% of those polled in Tunisia said they were thriving.  By 2010, that had dropped to 14%, a 44% reduction. The numbers were even worse for Egypt. In 2005, 26 % of Egyptians described themselves as thriving. By 2010 only 12% did, a 54 % drop. And in 2010, the country with the lowest reported thriving level in the entire world was Bahrain.

One of the key issues is that the prosperity generated by increased GDP has not been equitably distributed, and it has not been invested in improving the overall society’s wellbeing.  So we should have not been surprised, when, in the fall and winter of 2011/12, massive protests took place in these countries. These were places in which the GDP rose, but an increasing number of people felt that they were struggling or suffering.

There are now many systems that define and measure components of wellbeing for people, cities, and nations: Bhutan’s Gross National Happiness index, the Gallup Healthways index, and the New Economic Foundation’s Happy Planet Index, and the OECD’s Better Life Index.

The challenge for the world’s cities is to connect our knowledge of how to improve prosperity with our knowledge of how to improve wellbeing.   Measuring prosperity and wellbeing are important first steps. The next is to focus on solutions that are most likely to increase prosperity and wellbeing simultaneously.

The Answer is Urban

Unfortunately, the political turmoil of Tunisia, Egypt and Bahrain have made it very hard to initiate innovative new social strategies at the national level.  Even calmer countries, such as the United States and Italy are too gridlocked to innovate new solutions. The answer is urban.  Cities are the most likely venues for developing, testing and measuring new solutions to the prosperity/ wellbeing conundrum.

How to Make Prosperous Cities

Over the last decade, ten strategies have emerged as key drivers of the economic prosperity of cities. These are:

1. Connectivity
2. Productivity
3. Economic Diversity
4. Social Diversity
5. Knowledge and Innovation
6. Cultural flexibility
7. Trust/Security
8: Infrastructure
9. Density
10. Regional Integration

How to Make Happy Cities

There have also been significant advances in the study of wellbeing.
According to the OECD, the key drivers of wellbeing are:

1. Income/Wealth
2. Jobs and Earnings
3. Housing Conditions
4. Health Status
5. Work/ Life Balance
6. Education and Skills
7. Social Connections
8. Civic Engagement and Governance
9. Environmental Quality
10. Personal Security
11. Subjective Well Being

The Prosperity/ Wellbeing Matrix

Economic security lies at the core of every issue of wellbeing, but prosperity alone is not a sufficient cause of wellbeing.  The solution is to find the “sweet spots”: urban strategies that enhance the factors of both prosperity and wellbeing.

Cities have important tools to shape their futures: regulations, investments, incentives and leadership. When integrated, they can help advance “sweet spot” solutions.  Four such sweet spot goals stand out: 1) sufficient, well-located affordable housing; 2) easy access to multiple transit modes including public ones; 3) quality, resilient urban infrastructure; and 4)  quality public education systems, from pre-k to graduate and ongoing training. Each of these is essential for a healthy economy, creates jobs, improves wellbeing and enhances a region’s capacity to thrive.

So which cities are doing the best job of balancing prosperity and wellbeing?

While there are ample data on income, wealth, and prosperity, and a growing body of wellbeing data, there are few approaches that combine these metrics to provide an integrated assessment of a city’s performance.

My colleague Will Goodman and I began by examining prosperity and wellbeing indicators on the United States’ largest 100 metro areas, and then synthesized data to create a prosperty/wellbeing metric.  To measure metropolitan area prosperity, we used U.S. Department of Commerce Bureau of Economic Analysis 2011 data on real GDP per capita.  To measure metro area wellbeing, we used the Gallup-Healthways 2011 polling data for its U.S. Well-Being Index.  The Gallup-Healthways methodology includes survey data in six key “domains”: Life Evaluation, Emotional Health, Physical Health, Healthy Behavior, Work Environment, and Basic Access.  Gallup-Healthways combines results in each of these areas to reach a total Well-Being Index score for each metro area.

2011 Gallup-Healthways Wellbeing Score

Our prosperity/wellbeing rankings are based on a composite score that we reached by normalizing and combining GDP per capita and Well-Being Index scores for the 100 largest metros (more on methodology below).   Based on this simple analysis, the top ten prosperity/wellbeing metros are:

1    San Jose-Sunnyvale-Santa Clara, CA
2    San Francisco-Oakland-Fremont, CA
3    Washington-Arlington-Alexandria, DC-VA-MD-WV
4    Bridgeport-Stamford-Norwalk, CT
5    Lancaster, PA
6    Charlotte-Gastonia-Rock Hill, NC-SC
7    Boston-Cambridge-Quincy, MA-NH
8    Minneapolis-St. Paul-Bloomington, MN-WI
9    Honolulu, HI
10    Des Moines-West Des Moines, IA

View the full list of rankings

Looking at prosperity and wellbeing in this way produces some interesting results.  It may not be surprising that wealthy Silicon Valley and sunny Honolulu are among the top metros for GDP per capita and wellbeing.  However, Lancaster, PA, the 99th largest metro on our list, may be less obvious as a top prosperity/wellbeing location.  Lancaster ranks only 80th in terms of GDP per capita, but its #1-ranked wellbeing score is well above the other metros in the top ten.  Meanwhile the New York metro area ranks 11th in GDP per capita, but its relatively low wellbeing score (ranked 66th) drops it to #27 on the composite rankings.

It is also clear that focusing on metro areas loses some of the nuance of municipality and neighborhood dynamics.  For instance, Bridgeport-Stamford-Norwalk ranks #4 on the composite score, but those familiar with this metro area know that living conditions in Bridgeport (median household income of $34,658) are far different from Stamford (median household income of $75,454).

The Distribution of Wellbeing Matters

The relative distribution of income within a metropolitan area, and opportunities to move up the income ladder, are important elements of prosperity and wellbeing.  Research shows that societies with greater levels of inequality have less stability, worse health outcomes, and lower overall wellbeing.   We tested the impact of metro inequality on our prosperity/wellbeing rankings by incorporating each metro area’s Gini Index score (the Gini Index measures how much each area’s income distribution deviates from a perfectly equal distribution).  We used’s analysis of 2010 income data for the 100 largest metros, then normalized and added each Gini Index score to our prosperity/wellbeing composite (weighted equally with GDP per capita and the Gallup-Healthways score).  With the Gini Index included, the new top ten prosperity/wellbeing metros are:

1    San Jose-Sunnyvale-Santa Clara, CA
2    Washington-Arlington-Alexandria, DC-VA-MD-WV
3    Des Moines-West Des Moines, IA
4    Lancaster, PA
5    Honolulu, HI
6    Madison, WI
7    Salt Lake City, UT
8    Minneapolis-St. Paul-Bloomington, MN-WI
9    Ogden-Clearfield, UT
10    Seattle-Tacoma-Bellevue, WA

View the full rankings including the Gini Index

This methodology dramatically changes the ranking of metro areas like Bridgeport-Stamford-Norwalk, which dropped from #4 to #57 because of its relative income inequality – it had by far the highest Gini score, meaning it was the most unequal metro. Although Ogden-Clearfield’s GDP per capita of $29,898 ranked it 88th of the top 100 cities, because it  scores very high in wellbeing and income equality (it had the best Gini Index score),  it rose  in the  combined rankings from #46 to #9.

This analysis is just a start — I’m interested to explore how we can improve integrated measures of prosperity, wellbeing, and  equality  to guide policy decisions towards the sweet spot solutions.

One new study shows the likelihood that lower-income households can rise to middle- and upper-income levels within a given “commuting zone” (  Unfortunately, its data set did not correlate with the other data we were using, so we could not test its impact on our rankings. But it raises an interested question: is it more important to measure the distribution of income within a city, or the city’s level of access to economic opportunity and mobility?

What other economic, social, and/or environmental data should be incorporated into a comprehensive wellbeing/prosperity metric?

What are the most important common characteristics of the top metros on this list?

How do we incorporate the wellbeing of a metro region’s natural systems into this metric?

We are eager to hear your comments and thoughts.

Note on methodology:
In order to develop a composite ranking system, we normalized data sets (GDP per capita, Gallup-Healthways Wellbeing, and Gini Index scores) for the 100 largest metros so that they could be combined “apples to apples.”  This involved assigning each metro a “z-score” in each category (z-score = (score – mean score) / standard deviation of data set), which measures a given score’s standard deviations above or below the mean score in that category.  Each metro’s z-scores are then added together, and metros are ranked based on their composite scores.  For this exercise, the categories are weighted equally in the composite score.

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Resilience lessons from Katrina and Sandy

Prepare for the multiple threats of the 21st century.

One of the key failings of the Federal Government’s Homeland Security mandates is that, after 9/11, they prepared New York City for the last threat, a terrorist attack, not the next threat, climate change. Although we must prepare for sea level rise, that is not the only natural threat facing our cities. We also have to prepare them for other natural systems issues such as drought, heat, earthquakes and sunspot cycles. Cities also need to prepare for risks in human systems- degraded trust from social inequity, the contagion of diseases, massive urban migrations, cyber attacks, power outages and financial volatility. And there are rising threats from interactions between human and natural systems which are degrading and salinating water supplies, polluting air, and undermining and adding toxics into the food system. All of these threaten our cities’ viability. And there will be many more that we cannot conceive of. We are challenged with the task of planning for an uncertain future.

Planning for an Uncertain Future

The first step is to clearly define the risks to a city and their likelihood of happening. Making a list from the three catagories above- natural risks, human caused risks, and human/ natural interactions risks is a start. Normally we think of risks to systems, such as water or electrical systems. But that limits our ability to think broadly.

We cannot predict all of the outcomes of these risks.

The interactions between them are extremely complex. And each risk has implications for human, natural and economic systems. The key is to focus on solutions that have the most co- benefits and that enhancing the capacity of human and natural systems to be the most positively adaptive. Adaptive capacity is the best inoculation against uncertainty.

But there are a few risks that are very clear, and we need to begin to address them.  For example, prior to Hurricane Katrina, the insurance company FM Global guided 500 commercial clients on hurricane preparedness- as a result, these businesses experienced 85% less property damage from the hurricane then similar properties that were not well prepared.  A $2.5million of investment prevented $500 million in damages. The National Institute of Building Sciences states that every dollar spent on mitigation saves four dollars of losses.

Start Designing for more than a century of Sea Level Rise now.

Eighty per cent of the world’s GDP take place in rivers and coastal based cities. Their infrastructure was designed to function at a sea level that will dramatically change over the next century. Every single urban water, sewer, electrical and transportation system will have to be raised, or changed to accommodate new sea levels. That will take a great deal of time and investment. Cities need to start planning and investing in this work now. They also need to be designing the new dynamic, responsive systems of the future, not simply raising the static systems of the past.

Storm barriers, harbor versions of New Orlean’s levees may help in transitions, but over the long run, the risk of cities functioning below sea level or high surge levels is too high. We need to make the investments to adapt to new sea levels.

Recognize limits and establish buffer capacity

Each city faces different limits. Many are facing future water shortages, and will need to recycle more water and consume less.

They may also have to limit their growth. Others will suffer from too much water, and need to establish natural buffers and absorption areas. Others might be straining at the limits of their regions electrical generation, others may have maxed out their transportation systems, and be facing huge traffic issues. The key is to recognize that cities at the edge of any resource or impact limit are fragile- the solution is to develop a buffer to accommodate increased volatility.


Redundancy increases resilience.

Higher density cities need to develop multiple lines of defense for sea level rise- restoring natural conditions on both the water and land side, constructed barriers, elevated streets and infrastructure, and storm ready buildings.  Cities facing droughts need to combine multiple water sources with conservation strategies. Cities with more diverse energy sources will be less vulnerable to fuel shortages of any one. Redundancy is inherently in- efficient. During low risk times, the cost of developing and maintaining multiple systems seems excessive. During times of stress, they will seem essential.

Integrate Natural and Technical systems.

Much of The Netherlands has been developed on land reclaimed from the sea. With whole communities lying below sea level, it is extremely vulnerable to rising sea levels.  Rotterdam, its second largest city, and Europe’s largest port is the country’s most economically important city. Swamped by a devastating storm in 1953, Rotterdam responded by constructing hard infrastructure- dams, barriers, and seawalls.  But in the 21st century, the city’s planners began to develop the architecture of accommodation- floating buildings that can rise with storm surges.

Rotterdam is re-thinking of itself not as a city resisting water with levees, dykes and pumps, but rather, as a city living with water, integrated with the water flowing through it. Its goal is to have fully transformed itself by 2035, planting green roofs and parks to absorb and detain water, and reduce climate rising temperature.  Its new codes require building façades, garages, and ground-level spaces to be designed to be waterproof. Its power grid is being encased in waterproof underground pipes, and the entire system is being re-designed to withstand high seas and winds.

Rotterdam’s approaches include both hardened infrastructure, and also much softer natural systems, woven together.

With the movement of shipping from the heart of cities to more remote container ports, cities around the world are reconfiguring their waterfronts to serve as storm barriers, parks and bike and walking corridors. The architecture firm Weiss Manfredi recently designed a “Wandering Ecologies” park for Toronto’s Don Riverfront, creating marshlands with boardwalks for runners and cyclists. James Corner Field Operations has designed a water permeable park and walkway system on the land side of Seattle’s Elliot Bay, while enhancing salmon breeding grounds on the water side.

In 2010 New York City’s Museum of Modern Art invited a group of younger, forward thinking architects, landscape architects and planners to generate plans for New York’s future with higher sea levels. Many of the proposals in the Rising Current’s exhibit included regenerating natural edges between the land and the water, in some cases building out into the harbor, in others, eroding the land back. (Image 12) The oyster beds, barrier islands and marshy edges that protected much of Mannahatta and the Mississippi Delta are not only inexpensive ways to soften storm surges, but they naturally adapt to rising sea levels, rising with them. And, like land based parks and gardens, they have many co- benefits, including naturally cleaning urban waters of chemical and biological toxics.

The old Islamic cities were designed to provide naturally cooling breezes and shade to the summer’s heat.  The new town in Umm Al Quwain, in the United Arab Republics, designed by City Planner Peter Calthorpe updates those technologies, using shade, thermal mass and the cooling of the desert in the evening to create comfort passively.

Plan where to Retreat from Risks

New York State Governor Andrew Cuomo, describing high risk waterfront property said “ There are some parcels that mother nature owns. She may only visit every few years, but she owns the parcel, and when she comes to visit, she visits !” ( 61)


These are the areas, like the lower 9th Ward, the low lying area’s of Rotterdam and on New york City’s barrier islands that are very poor places to occupy, but if returned to their natural role, add to a city’s resilience. Each city should map its known natural risks and figure out a plan for how to retreat from them, converting them into resilience reserves.  This applies to all kinds of risks- for example, it makes no sense to keep operating nuclear power plants near known fault lines.


Lower Manhattan’s real estate and infrastructure may be worth more than a trillion dollars. It would be very costly to relocate. But it is also very concentrated, and so it may be cost effective to build a substantial sea wall around the area. But there are many coastal areas that are neither so concentrated nor so valuable. Currently, the Federal Government provides below cost insurance for home and business owners in areas that for profit insurance companies won’t insure. The government looses money every time there is a flood, paying to rebuild in high risk areas. This makes no economic or ecological sense. Even worse are voluntary buy back programs, which offer to buy back homes in high risk areas from those who are willing to sell them. This will lead to replicating the spottily resettled Lower 9th Ward.  If two third’s of the residents of the ocean facing blocks of a coastal community choose to sell, the city will still have to provide water, sewer, roads, police and fire protection to the remaining one third. And they will not be able to replace those blocks with a natural edge of dunes and wetlands which could benefit the rest of the city.

Federal and local governments should not have to bear the ongoing burden of funding the costs of a few high risk areas. Buildings in lower density higher risk locations need to be purchased at fair market value, and their residents given an opportunity to re- locate.

Retreat from the risky water’s edges should be planned over time,staged in conjunction with the rising sea levels of the coming century.

Robust, Resilient, Repairable and Responsive

In 1989, the Loma Prieta earthquake  caused the collapse of the San Francisco- Oakland Bay bridge. The original bridge was designed to be stiff, to resist the seismic movements of the earth. But when the earthquake exceeded its design strength, the bridge failed, a perfect example of being robust but fragile. The bridge’s replacement has been designed to be ductile- strong, but also flexible enough to absorb almost any shock. Its lead engineer, Marwan Nader says “The idea is to build a structure that can stretch and deform without breaking.” (59)

The bridge was also designed to be easily repaired if broken. For example, the bridge’s shock absorbers can be restored in a few hours after an earthquake.  And sensors allow the bridge to be continuously monitored, and adjusted to loads and stresses. The bridge is robust, resilient, repairable and responsive.

These principles should be applied to all infrastructure improvements.

Plan the Human Operating Systems

When Katrina struck New Orleans, the City, State and Federal operating systems failed causing and exacerbating hardships. When Superstorm Sandy struck New York City, the coordination between agencies was much more effective. Information collection was generally accurate, and shared in real time, leading to dynamic decisions. Interagency co-ordination, data sharing and planning are critical behaviors needed to increase a city’s resilience.

New York City was also willing to “fail safely.” Understanding that power lines would come down in the winds, and that the transit system would be disrupted, the subway system was closed so that it could be more rapidly restored. Teams of linesman were brought in from around the country and stood by, ready to swing into action as the storm abated.

And because the storm only damaged the City’s coastal areas, most of its leaders’ homes survived, leaving them untraumatized, and thus capable of thinking more flexibly. But the next disaster may effect the entire city, or region. City leaders need cognitive training in resilience thinking under stress.

Design for Islandization.

Battery Park City sat closest to Lower Manhattan’s water’s edge, and yet it survived the best of all. By having a power grid that was linked to the rest of the region, but separatable, it was able to disconnect from the failure that blanked out the rest of the city. As utilities  repair and replace 20th dumb century grids, they should be re-conceived of as networks of smart, interconnected micro grids- smaller, localized electric grids serving a collection of buildings or a neighborhood.  These can draw power from the larger grid, but also generate enough power from cogeneration, solar or microturbines. By adding sensing and operating intelligence, these systems can balance predict and their loads. The US Military is rapidly introducing micro- grids into its installations to increase their resilience.

The economies of cities is increasingly dependent upon internet connectivity, which, for example, ties the New York Stock Exchange to global markets. As cities and their industries move their data to the cloud, they access more robust systems- but they are are ignoring the fragility of their connection to these systems. Cyber attacks, or even worse, a cyber war could cut them off from their data and operating systems. Cities must also store their data and operating systems locally, and keep the duplicate capacity to function as data islands if necessary.

The same strategy can apply to buildings. Grid connected Solar photovoltaic systems should be able to disconnect from the larger system and provide power for building’s essential services. To do so they will need battery or other energy storage systems. Local food and water systems also help buildings or neighborhoods through disruptions. As we read in Chapter five, designing buildings for passive resilience enhance the ability of buildings to provide adequate comfort and water without requiring a significant energy supply.

We also need to design our social system’s for islandization. Chicago’s most resilient neighborhoods during its heat wave were able to self organize, separately from the larger city. Andrew Zolli’s emergent self organizing adhocracy is an essential component of a city’s resilience. When the very low income community of the Far Rockaways lost all power, food and water as a result of Sandy, the members of the Rockaways Surf club sprung into action. These were mostly Brooklyn Hipsters who had gotten together a shack by the sea as a place to gather, change and store their gear. Prior to the storm they had been viewed as odd outsiders, but after the storm, when they self organized and brought resources and visibility to the Rockaways, they were embraced. The locals described it as the hipsters becoming helpsters !

To do this effectively required the pre-existing strong ties of the surf club membership, but also the ability to rapidly form new bridging ties, as the surf club made with its public housing neighbors.

Passive Resilience

As cities and buildings become smarter they become more dependent on energy and data systems to operate. However with increase weather volatility, cyber attacks and other large scale threats, pervasive energy and data systems are more likely to go down. This requires cities and buildings to be able to function in the passive, or manual mode.

Although its currently very difficult to make dense urban buildings that can survive entirely independently from urban infrastructure, in a world of increasing weather and energy volatility, it is essential to design buildings that will perform sufficiently when the power goes out or the temperature hits extremes. They may not be the most comfortable, but they need to be livable. Their passive resilience will be enhanced by better insulation to reduce energy needs, and local generators, to keep core functions such as boilers, hallway lights and and elevators running.

One of the aftermaths  of both Hurricanes Katrina and Sandy was that oil refineries were shut down, fuel storage and pumping facilities lost power, and as a result, gas stations ran out of diesel and gasoline. Diesel fueled generators ran out of fuel, and ceased working after a few days. This raises a key element of resilience.  People, buildings, communities and cities thrive when they are connected into larger networks and systems. But they also need to be designed to function when they are disconnected, although perhaps at a less effective level. They may thrive when part of an energized, complex system, but they need to be able to survive when the system goes down.

Smart Cities also need a manual mode- a way of functioning when  automated systems fail. In manual they may be less efficient, by at least they will work. Gravity powered water supply systems such as the system that feeds New York City function even when the pumps are down.

Networks of Neighborhood Centers

Social efficacy is key generator of strong neighborhoods, and it is generated by strong not for profit and voluntary institutions. These need to be anchored in community centers such as TheArc and The Educational Alliance. Cities need to invest in a network of prepared neighborhood centers. These can be settlement houses, schools, libraries, churches or hospitals, designed to serve neighborhoods with shelter, food, water, electricity and communications when disruption comes. Their leaders should be trained to deal with the range of climate and health events that will come in an increasingly volatile era.

Resilience restores human and natural systems well being

In the beginning of this chapter we noted the interdependence of human and natural systems. We also observed that resilient strategies are evolutionarily successful when they restore their own wellbeing and increases the wellbeing of the systems that they are  interdependent with. Thus, the most valuable strategies will enhance the wellbeing of human and natural systems together. For example, greening streets and enhancing their biodiversity provides the many human and natural benefits described in chapter 5. As we will discuss in chapter 10, we need to develop measures of human and natural systems wellbeing, and measure our progress towards increasing them.

The most effective strategies will also enhance the ability of urban systems to adapt to future, unanticipated changes. They encourage positive evolution.

For societal wellbeing, solutions need to be equitably distributed.

Disasters and climate change hit the poor the hardest. They often live in the most vulnerable and most toxic neighborhoods. Lacking resources, they have the fewest options. 9/11 dislocated every resident of Lower Manhattan- the well off were inconvenienced, many moved to their second, weekend homes. The poor had to choose between homelessness and doubling up with already overcrowded relatives. Globally, the urban poor are even worse off- Dhaka, the capital of Bangladesh is a city of 7 million people, living no higher than 13 feet above sea level. As the sea levels rise, they will have no where else to go- and India is building a wall to keep them out.

After 9/11, a great deal of thought was put into protecting the New York Stock Exchange from a future loss of power- no thought was given to protecting residents of nearby public housing projects, whose elevators and heat could have operated after Sandy with just a few generators.

Low income families and communities have the least resources to deal with the stress of climate change. Columbia University professor of Clinical Psychiatry Mindy Fullilove describes low income families as living in an environment of unmitigated disaster- unmitigated trauma, health and educational deficits. With low levels of auto use and resource consumption, they have contributed the least to the causes of climate change. If we envision civilization as providing more equal opportunities and responsibilities for all, then we must plan to equalize our preparations for the coming volatility.

The degree of social inequality shown the world during Katrina was deeply disturbing. But distribution of wealth and wellbeing in New York City is also increasingly unequal. If social efficacy is a key element of a community’s wellbeing, then our rebuilding efforts must aim to increase equality of opportunity for all of a city’s residents and workers.

Does it take a disaster to rebuild our cities?

The destruction and rebuilding of Lower Manhattan and the Gulf Coast raise several questions that America, and perhaps all nations need to ask.

The first is, can we rebuild our cities without them first having to be destroyed?  Is our collective status quo bias so strong that we cannot re- imagine our cities, and make the tough political decisions to move them towards a better future while they are still functioning? Wouldn’t it be better to rebuild the decaying physical and civic parts of our cities now, without having to wait for an external destructive force?

And the second question is, if we as a nation believe that our cities are too important to be destroyed and not rebuilt, than what should we be doing to build up the planning and funding capacity for this reconstruction? Our current policy is another version of “too big to fail”. Our Federal government has been the rebuilder of last resort.

But with the increased climate change ahead, we cannot afford to respond incident by incident. We need a national strategy that integrates Federal resources and credit with State and Local initiatives, and that harness’s private capital. These resources need to begin making our cities more resilient now.

To answer these, we have to re- think the way that we plan.

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