Health

When a steady paycheck is good medicine

LOS ANGELES — Growing up in the Baldwin Village section of Los Angeles, Charles Slay roamed the streets as a member of the Bloods. The neighborhood was forlorn and devoid of commercial life, making it easy ground for ambush — especially a ragged patch of dirt alongside a major thoroughfare.

“I used to rob people there,” he said.

But three years ago, when construction workers began transforming the vacant lot into a gleaming campus of medical offices, there was Slay, donning work boots and coveralls. He had spent 27 years behind bars for a gang-related murder. On this day, he was employed as an apprentice electrician.

“I never in my life used a power tool,” he said. “The only tool I used was a gun. Now, I’m driving forklifts.”

His evolution from convict to tradesman had been spurred by an initiative within the American medical industry to broaden the idea of how to keep a community healthy. A coalition of nonprofit health care providers is investing in the notion that ample paychecks, stable housing and nutritious food are no less critical to well-being than doctors, medical equipment and pharmacies.

Forty-one nonprofit medical systems across the United States, plus four government providers, have formed the coalition, the Healthcare Anchor Network, with the mission of doing more business with local companies in the communities they serve. Most are concentrated in major American cities, from Chicago to Los Angeles.

The American health network is part of a global movement through which activists are pressuring companies to target spending toward improving local fortunes, rather than contracting with distant corporations. Such initiatives are being driven by anger over the workings of global capitalism — how it has produced unprecedented riches for some while leaving hundreds of millions of people coping with economic insecurity.

Collectively, these systems spend more than $50 billion a year on a range of services — from construction to catering to laundry. Traditionally, they have directed much of that money to huge, national corporations that distribute their profits to shareholders around the world. The basic goal among the participants in the Healthcare Anchor Network is to shift their spending to local companies, keeping the wealth close by. Kaiser Permanente, which erected the new medical center near Baldwin Village, is one of the largest medical systems in the network.

The In Chan Kaajal Park, a rehabbed parking lot that will be the future front porch of a Mission Economic Development Agency housing project, in San Franciscoa. A coalition of nonprofit health care providers is investing in the notion that ample paychecks, stable housing and nutritious food are no less critical to well-being than doctors, medical equipment and pharmacies. (Cayce Clifford / The New York Times)

The health systems are also directing their reserve funds toward so-called impact investments — loans to nonprofits that buy homes to spare low-income people from eviction; capital for minority-owned businesses; child care for the working poor.

This initiative was behind Kaiser’s decision to reserve a third of the construction jobs at its new campus for people who lived nearby. Among them were 70 former prison inmates employed as plumbers, carpenters and electricians.

“You have individuals building homes rather than doing home invasions,” said John Harriel, a former gang member turned tradesman who has helped Kaiser recruit previously incarcerated people at the construction site.

Backlash to Inequality

The idea that turned into the Healthcare Anchor Network began with a man named Ted Howard, who co-founded the Democracy Collaborative, an advocacy and research institution that experiments with fresh ways to attack economic inequality.

A decade ago, in the midst of the Great Recession, Howard used his hometown, Cleveland, as a laboratory for a new approach toward recovering from factory closings and joblessness. He started three cooperative companies in low-income neighborhoods, including a laundry service that gained a contract to wash linens at the Cleveland Clinic, a world-renowned health care provider.

The laundry hired people from surrounding communities. It won the contract on competitive terms, with an important guarantee: It paid workers better than rival national chains. It could deliver on that promise because it was a cooperative. It merely had to break even rather than enrich shareholders with dividends.

“These are businesses,” said Howard. Unless they produce returns, “you lose all the social benefits. We think it’s really important to open up the imagination to successful models.”

The approach is especially tailored to the United States, where efforts to increase support for government programs confront a strong American aversion to taxes. Rather than wring hands over the difficulty of prying money from Congress for social programs, he pressured deep-pocketed companies to spend, and invest, locally.

“Our epiphany is that one answer to the supposed scarcity of funds is that the money is right there in the community now,” Howard said. “It’s in institutions that are locked in place.”

His success in Cleveland has captured attention far beyond the American Rust Belt, sending Howard around the world to evangelize. He found adherents in northwest England, where political leaders in the city of Preston were wrestling with years of national austerity that had decimated local government services.

Drawing on Howard’s counsel, the city government, Lancashire County, the police department and a pair of local universities joined forces and directed their spending toward local companies.

“We had the double whammy of austerity and also an economy that wasn’t working for people,” said Matthew Brown, leader of the Preston Council. “We took inspiration from Ted.”

Beyond the Hospital Walls

In the United States, health care has become especially fertile ground for Howard’s approach, in part because of the passage of the Affordable Care Act, better known as Obamacare, which aimed to expand medical coverage to the tens of millions of people lacking access.

The program requires that nonprofit hospitals annually assess the health needs of their communities in a broad context — including job markets and the availability of affordable housing — while coming up with ways to improve local life. Given that 56% of community hospitals in the United States are nonprofit, this amounted to a significant potential alteration of American health care.

Kaiser, which operates nonprofit hospitals and provides health care for more than 12 million people, was already conducting such assessments under California regulations. Obamacare, passed nearly a decade ago, extended the obligation nationwide.

“It brought a discipline to the industry so that we all had to think about this,” said Bernard Tyson, Kaiser’s chief executive officer, during an interview at the company’s headquarters in Oakland, California. “It forced the industry to think outside its own box.”

The Democracy Collaborative convened the first participants in what would become the Healthcare Anchor Network in Washington in December 2016. In the years since, it has sought to coax medical companies to formalize and expand financial commitments that are now voluntary and vaguely defined — more like an accepted social compact than a firm obligation.

The logic is driven by large numbers: Hospitals and health care providers across the United States collectively spend more than $780 billion a year, control investment portfolios worth some $400 billion and employ more than 5.6 million people. Even a minor shift in how they manage their money, contract for services or hire workers will have an impact on the U.S. economy.

“We encourage a pledge of 1% of assets as a starting point,” said David Zuckerman, coordinator for the health care network. “This conversation is moving very fast and moving in a very powerful way. These institutions are just being exposed to this idea.”

Over the past two years, members have pledged more than $300 million toward local investments, with Kaiser alone promising two-thirds of those funds.

The company has taken its cue from volumes of literature attesting to the fact that poverty is lethal. People who experience homelessness have shorter life expectancies than the rest of the population. People without jobs do not eat as well as those who are fully employed. Financial stress can breed other ills, including substance abuse. Health care costs have risen so rapidly that many Americans fret about how to pay their bills.

“One in four Americans are having to make a choice between ‘Do I buy milk today?’ or ‘Do I pay my copay to get my prescription?’” said Bechara Choucair, Kaiser’s chief community health officer, citing a recent company survey.

For health care companies, improved community fortunes help the bottom line. More jobs mean more people in stable homes, lowering the cost of care when they need hospitalization. It means more people can afford medical plans, which spreads health care costs across larger populations.

That reasoning prompted Dignity Health, another health care provider that joined the anchor network, to deliver a $1 million loan to La Cocina, a San Francisco nonprofit that helps women of color start catering and restaurant businesses. Since its inception in 2005, the organization has produced 55 now self-sufficient businesses. Two of its graduates have been finalists for the prestigious James Beard Award.

La Cocina is using Dignity’s money to turn a shuttered post office in San Francisco’s Tenderloin district — an area rife with open-air drug sales — into a food court offering the dishes of program graduates. Geared to working poor people, the food court will provide a daily $5 special.

Among the chefs featured is Dilsa Lugo, a Mexican immigrant. Sixteen years ago, a pregnant Lugo carried a lunch of home-cooked tamales to the construction site where her husband was working. The property owner tried them, loved them and demanded to buy them. Lugo honed her skills in La Cocina’s commercial kitchen in the Mission District, where volunteers helped her secure funding.

“If I was by myself, I would have been afraid,” Lugo said. “I didn’t know how to start.”

Dilsa Lugo at her Los Cilantros restaurant, which employs nine people, in Berkeley, Calif. (Cayce Clifford / The New York Times)
Dilsa Lugo at her Los Cilantros restaurant, which employs nine people, in Berkeley, Calif. (Cayce Clifford / The New York Times)

Today, her Los Cilantros restaurant in Berkeley employs nine people. She earns more than her husband.

Dignity has also funded another local nonprofit, the Mission Economic Development Agency, which aims to blunt the displacement of low-income, predominantly Latino families. It has purchased 23 buildings in recent years, keeping existing tenants in place at subsidized rents, while maintaining fruit and vegetable merchants and bakeries in ground-floor commercial spaces.

“We’re looking for ways that we can address health care issues beyond the hospital walls,” said Pablo Bravo, Dignity’s vice president of community health.

A building on Mission Street that the Mission Economic Development Agency will redevelop as a family housing, art community space and early-learning center, in San Francisco. (Cayce Clifford / The New York Times)
A building on Mission Street that the Mission Economic Development Agency will redevelop as a family housing, art community space and early-learning center, in San Francisco. (Cayce Clifford / The New York Times)

Creating Local Jobs

This was the thinking as Kaiser Permanente began preparations for its new medical campus serving the neighborhoods of Crenshaw and Baldwin Hills in America’s second-largest city.

The need for the facility was obvious. The company’s closest hospital was a 25-minute drive away, before factoring in Los Angeles’ traffic. Many people in the neighborhood lacked cars. They relied on a patchy bus service that could take an hour to reach the facility.

But beyond the demand for doctors’ offices, a pharmacy and a laboratory, the community had other needs. Among the 278,000 area residents, 93% were black or Hispanic and nearly 30% were officially poor. A similar percentage had not completed high school. Former gang members languished in housing projects with no means of supporting themselves.

In 2015, Kaiser held meetings to ask residents what they wanted. Their testimony shaped the blueprint: The hospital would offer Wi-Fi and comfortable workspaces, enabling low-income residents to send out online job applications. The complex would include green space, exercise equipment and a farmers market.

But the primary demand was the most basic — paychecks. “The No. 1 thing people wanted was jobs,” recalls Jodie Lesh, who then oversaw Kaiser’s construction projects in Southern California.

Kaiser required its contractor to reserve 30% of all jobs for people living within 5 miles of the site. It set aside $24 million of the $90 million construction costs for women- and minority-owned businesses.

The Kaiser Permanente medical center, that serves the neighborhoods of Crenshaw and Baldwin Hills, in Los Angeles. Forty-one nonprofit medical systems across the United States, plus four government providers, have formed the coalition, the Healthcare Anchor Network, with the mission of doing more business with local companies in the communities they serve. (Elizabeth Weinberg / The New York Times)
The Kaiser Permanente medical center, that serves the neighborhoods of Crenshaw and Baldwin Hills, in Los Angeles. Forty-one nonprofit medical systems across the United States, plus four government providers, have formed the coalition, the Healthcare Anchor Network, with the mission of doing more business with local companies in the communities they serve. (Elizabeth Weinberg / The New York Times)

At first, Kaiser stumbled. It held a job fair and hardly anyone came.

Then Lesh met John Harriel, an electrician and a conspicuous character known as Big John.

Raised in the neighborhood, Harriel, 49, was a former member of the Bloods and the son of a single mother bedeviled by addiction. He had spent more than five years in prison for dealing drugs. He used that time to gain his high school equivalency diploma.

John Harriel, a former gang member turned tradesman who works for a community nonprofit which prepares former inmates for careers, outside the Kaiser Permanente Baldwin Hills Crenshaw Medical Offices in Los Angeles. (Elizabeth Weinberg / The New York Times)
John Harriel, a former gang member turned tradesman who works for a community nonprofit which prepares former inmates for careers, outside the Kaiser Permanente Baldwin Hills Crenshaw Medical Offices in Los Angeles. (Elizabeth Weinberg / The New York Times)

Once out, Harriel trained as an electrician apprentice and eventually rose to supervisor. He works with a community nonprofit, 2nd CALL (for Second Chance at Loving Life), which prepares former inmates for careers.

About 600,000 people are released from prison every year in the United States. The unemployment rate among formerly incarcerated people is about 27%, according to the Prison Policy Initiative, a research and advocacy group.

Harriel sees those numbers as indicators of hidden promise. People released from prison are so eager for a career, and so fearful they may never get the opportunity, that they will work harder than the next person to master a trade. Starting over means feeling special pressure to show up on time, do the job the right way and stay out of trouble, he said.

“The world is looking at us,” Harriel said. “You’d rather be two hours early than two minutes late.”

Still, employers are reluctant to hire convicted murderers, robbers and drug dealers, Harriel acknowledges. That is where he and his organization come in. They offer job training and courses in anger management, trauma counseling and financial literacy. They teach black and Latino former gang members to look their white supervisors in the eye — something that could provoke violence in prison. Those who sign up for training must complete it, and then demonstrate their skills and dedication, before he will provide a recommendation to an employer.

“If someone is screwing around,” he said, “I will be the first to say they should be fired.”

From Guns to Tape Measures

Physically imposing and blunt, Harriel is reflexively skeptical of outsiders’ promises to rescue his community. He is impatient with corporate-sponsored happy talk. As a child, he drew discipline at his elementary school for scoffing at the notion of Santa Claus.

“I said, ‘Let me get this straight,’” he recalls. “‘There’s this fat white guy riding around in the sky delivering presents down the chimney? I don’t see any chimneys in the projects.’ I said: ‘That’s a lie. You’re telling us a lie.’”

His neighborhood had suffered through more aborted promises of redevelopment schemes than he could recall. What was different this time?

Kaiser’s cluelessness about its job fair was not a hopeful sign. “They didn’t know where to go. They didn’t go inside the belly of the beast right there,” Harriel said, pointing to a cluster of apartments. “They went to the library. They went to some church. I said, ‘That’s not where the suspects hang out.’”

He went into gang communities and knocked on doors. At the next job fair, several hundred people descended. Dozens were hired, including Slay, the ex-Blood.

Charles Slay, who now works in construction after spending 27 years behind bars for a gang-related murder, in Inglewood, Calif. Slay’s evolution from convict to tradesman had been spurred by an initiative within the American medical industry to broaden the idea of how to keep a community healthy. (Elizabeth Weinberg / The New York Times)
Charles Slay, who now works in construction after spending 27 years behind bars for a gang-related murder, in Inglewood, Calif. Slay’s evolution from convict to tradesman had been spurred by an initiative within the American medical industry to broaden the idea of how to keep a community healthy. (Elizabeth Weinberg / The New York Times)

Slay grew up in South Central Los Angeles. His mother died when he was 10, leaving him with his father, who cadged work as a mechanic. He wanted to join the Boy Scouts, he recalls, but he lacked the $16 fee. Jobs in the neighborhood were scarce and good jobs nonexistent. People flipped burgers and bagged groceries, pursuits with no route out of poverty.

“The only people getting respect were the people coming out of the penitentiary,” Slay said.

By 14, he was living in itinerant hotels, smoking angel dust and robbing stores with the Bloods. By 21, he was behind bars for killing a man of the same age from a rival gang.

In prison, he attended a class about the impact of gang violence on victims and their families and listened to a woman who had seen her daughter raped.

“She was talking to us about forgiveness,” Slay said. “I had never seen compassion and forgiveness. My approach had been: ‘I’m in a gang. I got you before you got me.’”

He earned his high school equivalency diploma and then studied sociology.

“I started thinking about the people that I robbed,” he said. “I started thinking about the magnitude of my actions. How did I go from a little boy that my mother loved to a man willing to take another man’s life? I started thinking about some of the things that I was lacking. I said, ‘If I ever get a chance to get home, I will relish it.’”

The chance came when he was 48 years old.

Back on the outside, he was euphoric at first. He moved in with his aunt and attended Alcoholics Anonymous. Then, grim realities took over. He applied to be a truck driver, but the conditions of his parole barred him from driving more than 50 miles from home. He got a job unloading ships at a port. It paid $9 an hour with no health care.

Then Slay met Big John, who saw him as a potential electrician. He finished life skills classes and was sent to a contractor as an apprentice, alternating seven weeks of work with a week of training.

Five years later, he is part of a crew handling the electrical work at a new stadium for the Los Angeles Rams football team.

He earns $39 an hour — enough to buy a car, help his 86-year-old aunt with rent, buy groceries and give presents to his eight grandchildren. He pays for a health care policy from Kaiser.

”I’ve been through several lives within my time,” he said. “I feel like I’ve been around the world twice, and it’s amazing that I’m a productive member of society, the backbone of my family.”

 


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