New Orleans's Choice

http://www.bostonglobe.com

Here is a video of President Barack Obama speaking at ceremony to commemorate the Ten Year Anniversary of Hurricane Katrina: https://youtu.be/pJEx-LliwbQ

Post-Katrina downtown New Orleans, Louisiana
circleofblue.org

Hello Everyone:

It is hard to believe that ten years ago this month, Hurricane Katrina struck nearly submerging the entire city of New Orleans, Louisiana.  The images of impoverished residents escaping the rising floodwaters compelled urban planners to flock to the city with dreams of "a more equitable community built on higher ground."  However, as Dante Ramos writes in his Boston Globe article, "10 years after Katrina, New Orleans abounds with hard lessons," the reality of creating this dream city went wildly off script.  Ten years later, the city is still in the same place but the big news (wait for it) is the proliferation of hipsters and yuppies.  Yuppies and hipsters aside, the story is really about the direction post-Katrina New Orleans is going in.  Does want to continue waiting for closure or fix what it can and move toward a brighter future?

Post-Katrina St. Roch Market
New Orleans, Louisiana
ocw.mit.edu

Amidst the endless and contentious rounds of post-hurricane planning sessions, one thing people on both sides of St. Claude Street could find consensus on was the need for a food store.  St. Claude is a major artery, that still has the scars of New Orleans's modern history.  During the desegregation era, working-class whites families travelled down the street, out to the suburbs.  By 2005, St. Claude street was a demarkation line between the poor, predominantly black areas that bared the brunt of the flooding and more integrated areas that were spared.

As the post-Katrina discussions continued, attention focused on St. Roch Market, "...a St. Claude Avenue landmark where working people once did their food shopping."  Mr. Ramos shares his experience of his first visit to the market twenty years ago.  He writes, "...but the city pumped $3.7 million into rehabbing the space.  Yet instead of an everyday grocery store, St. Roch reopened this spring as a gleaming, high-end gastronomic emporium..."  Instead of the every day necessities, the shelves were stock with expensive gourmet foods that seemed an anathema to the residents.

St. Roch before and after
nytimes.com

Steven Bingler, a local architect who oversaw the market's rehabilitation told Mr. Ramos,

In their minds, they wanted it restored to what it used to be, which was an authentic neighborhood market...Ironically, when you added gentrification to that formula, it didn't come back as that.

The revival of St. Roch Market is one real-life conclusion of "...the post-Katrina experiment: uplifting on some level-hipsters equal money equals growth-but anxiety-inducing on another."

Sustainable home in the Lower Ninth Ward
musicforgood.tv

Dante Ramos cites information from the New Orleans demographic research group, Data Center (http://www.dataresearchcenter.org) to point out that since the storm, "The income gap between white and black New Orleanians has widened significantly..."  Further, the child poverty is 39 percent, the same level it was before the hurricane. (Ibid)  These shocking statistics occurred despite the billions in aid and the presence of numerous non-profit organizations, including actor Brad Pitt's high profile Make It Right organization, which funded a new generation of sustainable home in the flood damage Lower Ninth Ward.  Katrina was a completely singular disaster, without a doubt.  However, when Hurricane Sandy ripped through parts of New York, it proved that down-on-their-luck Southern ports are not the only places that find themselves subjects of post-disaster urban policy experiments.  When this does happen, post-Katrina New Orleans serves as warning to planners everywhere-recovery did not make things right, it only reinforced the disparities.

Man walking past a burning house in the Seventh Ward
cnn.com

Gentrifying hipsters was the absolute least of New Orleans's worries when Hurricane Katrina made landfall on august 29, 2005.  Mr. Ramos, then an editorial columnist for the daily newspaper, recalls paddling through the streets with a colleague, taking in the

"...otherworldly beauty to the place: not just the blue sky, or the graceful live oaks trees, or the rows of brightly painted Creole homes, but also their reflection on the surface of the murky waters."  Poetic description of the aftermath of a hurricane.

Dante Ramos also recalled how the days became increasingly chaotic as residents tried to flee toward higher ground.  The images broadcast on television shocked the viewers.  "How could the victims, disproportionately poor, elderly, and African-American, have been abandon to their fate in flood-prone areas?"

Post-Katrina destruction
Photograph by Pia Z. Erhardt
latimesblogs.latimes.com

As the waters receded, a new train of thought began to form: "A stricken city built partly on drained swampland should focus its energies, and its population, on higher ground."  The Urban Land Institute declared, The city should be rebuilt in a strategic manner.  Mr. Ramos wrote an editorial, cautioning against using aid money to coax people back into low-llying areas that may not be adequately protected for years.

In a strange move by the Bring New Orleans Back Commission, assembled by then-Mayor Ray Negin, individual neighborhoods were called upon to demonstrate their viability, placing symbolic green dot-indicating potential areas for future parkland-over the low-lying Lower Ninth Ward and Broadmoor.  The hope was that there would enough federal funds to fuel large-scale relocation to higher ground.  In reality, "that was never, ever, going to happen."  This country does not have a readily available stash of cash, said Tulane University geographer Richard Campanella.  Available stash of cash that can be evenly distributed while all these folks are displaced and wondering what the next chapter of their lives is going to be, Prof. Campanella continues.

"Katrina was here"
Photograph by Richard Campanella
placesjournal.org

Other New Orleanians knew better, "the more heavy-handed the planning process, the more those in power could use it to further their own agendas."  History has confirmed this strain of thought.  When it came to public works projects-i.e. planning highways or responding to floods-civic leaders have never been shy about calling on the people to make sacrifices for the greater.  Let me clarify, people other than them.  Ironically, one of the hardest hit places was an upscale, overwhelmingly white neighborhoods.  Not a single green dot was to be found.

Eventually, the Unified New Orleans Plan, that called for the rebuilding in all the neighborhoods, was adopted.  Still, it was the same old song and dance.  "Homeowners got repair grants that reflected the pre-Katrina value of their homes-hobbling those who owned inexpensive homes but faced stiff renovation costs."  An outraged LaToya Cantrell, a Broadmoor community leader now City Council member put it succinctly, Everybody pays the same price for Sheetrock...So why in the hell-if they're building their fifteen hundred square feet and I'm building mine-why would my grant be different?

Post 119 in Gulfport, Mississippi
Katrina before and after
post_119_gulfport_ms.tripod.com

It was this precise problem resulted in a legal settlement, but there were thousands of strings attached. "Did you have clear title to a family property?  Did you haggle with insurers?" and so on.  It was enough to make someone lose their will to live. Seriously, all this nitpicking was relevant to any social justice issues, but they all conspired against the less affluent.  Even today, Ms. Cantrell observes that the majority of African-American homeowners are in limbo, completing some repairs before the money, to finish the job, ran out.  There are lessons to be learned from these troubles, Dante Ramos writes, "Superficially neutral rules for insurance and public aid can end up cheating people.  Homeowners make decisions less on abstract imperatives-move to higher ground!-than the size of the checks they receive.  If neighborhoods are to be abandoned altogether, that'll happen only over decades, not by fiat in a matter of weeks."

When you are not encumbered by unrepairable property, new economic opportunities materialize.  In parts of New Orleans that avoided serious flooding, there is a building boom in process, the very same "urban renaissance that's invigorating downtowns from Boston to Los Angeles..." is taking root in New Orleans too.  One example, is a vacant former downtown hotel that is finally being renovated.

Night Market on St. Claude/St. Roch Avenue
New Orleans, Louisiana
nolavie.com

Entire parts of the city, including St. Claude Avenue, barely changed in the years prior to Katrina have now become retail and restaurant destinations.  This was by design, the city's recovery program included the rehabilitation of several dilapidated former main streets.  What was startling, was the rapid pace, by New Orleans's slow paced standards, of private investment.  Mr. Ramos comments, "If not the pork belly in your appetizer and Sazeracs on the $12 cocktail list, you'd wonder which city you're in."

Fueling the new commercial corridors is an unexpected influx of money and innovation. New Orleans became a refuge, of sorts, for unemployed college graduates when the global financial crisis hit in 2008.  For years, Louisiana politicians bemoaned the continuous brain to Atlanta and Houston.  Prof. Richard Campanella told Mr. Ramos, New Orleans today is home to about 40,000 people who never lived in the city before Katrina-probably more than half of them young and college-educated-who've brought with them their own muscle and human capital.

Trolley car in the Garden District
New Orleans
stcharlesinn.com

 What is also noticeable different about New Orleans is its character.  The current population of New Orleans, based on the 2014 estimate, is 384,320.  (quickfacts.census.gov) Of this, 60 percent are African-America-based on the 2010 census figure.  (Ibid)  Five years before Hurricane Katrina made landfall, African-Americans accounted for 66.6 percent of the Orleans Parrish. In 2010, that number dropped to 59.6 percent.  (http://www.dataresearchcenter.org)  Essentially, the city has 97,000 fewer African-American residents than it did before the storm.  In the days immediately following the storm, community activists and civic leaders gathered around the "right to return"-the importance of bringing displaced residents back to the city.  After going through several election cycles, it became clear to the powers that be that the majority of the absent African-American residents were not coming back

Downtown New Orleans; Canal and St. Charles
commons.wikimedia.org

Flozell Daniels, the president of the Foundation for Louisiana, told Mr. Ramos "a dearth of jobs in New Orleans, coupled with a lingering bias against black applicants, keeps people from giving up opportunities elsewhere."  Those who came back to this crazy and magical place, as Mr. Daniels calls his city, have had a difficult time finding employment.  Mr. Daniels flatly told Mr. Ramos, I have not patience...for this narrative that everything is fine, that we're doing better in every area.  We're not.


Be that as it may, while New Orleans is great at making true believers out of transplants, the demographic shift inevitably alters the culture in ways that rankle the displaced residents.  Mr. Daniel says,

Some of [the new people] don't like loud jazz music in the street...Some of them move next to bars and can't understand why they're open late.  Some of the old New Orleanians are like, "Eh"..."I'm not interested.  It's not for me."

Bywater section of New Orleans
Pretty self-explanatory
forbes.com

The culture clash occasionally leads to tension between new and old residents.  For example, not long after the St. Roch Market reopened, five masked vandals, clad in black, came late at night, proceeded to break windows, splashed paint, and left the message "YUPPY=BAD" on the walls.

The real question is whether or not New Orleans is better off today than before Hurricane Katrina.  The answer depends on who you are.  Dante Ramos writes, "If you're young and aesthetically minded, the city feels far more dynamic than ever."  St. Claude Avenue, the St. Roch Market, is dotted with trendy bars and restaurants featuring a wide-ranging mix of food and entertainment.  Nearby is the casual and unpretentious Faubourg Wines.  There is an acupuncture studio and a measurable upswing in bicycle traffic.  The bursts of millennial bohemianism along the streets of the Bywater section are hard to ignore.  Catherine Markel, the owner of Faubourg said, You see people [who] look like they just walked off the set of "Portlandia."

Bywater hipsters in costume (?)
myneworleans.com

Dante Ramos writes, "If there's anything at all to the 'creative class' theory of development-the notion that artists and film producers and academics are a foundation for growth-New Orleans is due for a breakout."  The "Big Easy" business climate has built a foundation which looks very Instagram-able: no big surprise that New Orleans is showing up on national rankings for startup cities.  Even the less innovation magnet areas of the city are beginning to sprout green shoots of a 21st-century economy.  The good news is the levee system has been strengthened at a considerable expense.  However, instead of morphing into a water-retention park, Broadmoor now the site of Propeller, a social-entrepreneurship incubator and Idiya, a storefront 3-D printing and and laser-cut wood store.

The Treme Jazz Band marching through the French Quarter
framework.latimes.com

This is not the kind of recovery that New Orleans envisioned following Katrina.  It does present some different types of challenges like how to get more people into higher elevation communities where the property values are skyrocketing and how spread the new found prosperity.  Nevertheless, longtime residents believe their customs and traditions are still searching for equilibrium in post-Katrina daily life.  Ms. Markel says,

I'm just doing my thing...There are probably economists and sociologists or anthropologists who are experts and can explain what's going on.  I'm just kind of living in it.

New Orleans's current situation is not unique as other cities struggle to regain some equilibrium following great singular disasters that call for grand gestures and collective recovery efforts.  However as Dante Ramos succinctly puts it, "...but recoveries are built on how hundreds of thousands of individuals confront a fundamental choice:  You spend a decade waiting for closure to come, for justice to be done, for the heartbreak to heal completely.  Or you patch things up as much as you can, and hope the future leads to something beautiful."

Conventional

http://www.latimes.com/entertainment/arts/la-ca-cm-convention-20150802-column.html#page=1

Los Angeles Convention Center
blog.energov.com

Hello Everyone:

It seems that Los Angeles Mayor Eric J. Garcetti has grands plans for the city.  First, the latest in city's effort to become the American bidder for the 2024 Summer Olympic Games. Today, an Los Angeles Times article reported that a proposed budget for the summer games which includes funds for facilities renovations and new construction.  Second, there is the ongoing saga of the Los Angeles County Museum of Art redesign and, the proposed Frank Gehry master planned Los Angeles River. Christopher Hawthorne recently reported in his recent Times article, "L.A. Convention Center's proposed design screams 'conventional thinking,'" the venerable Los Angeles Convention Center is being eyed for renovation.  The problem, according to Mr. Hawthorne, is the proposed renovation is, well, conventional.

Rendering of proposed Los Angeles Convention Center
latimesblog.latimes.com

  Christopher Hawthorne does not mince words, "Over the last couple of years, Plan A for expanding the Los Angeles Convention Center has been slowly morphing into Plan B. Unfortunately, the proposed design for the expansion, though there's still time to improve it, doesn't deserve much than a gentleman's C." The story of how Plan A morphed into a Plan B that, at best, deserves a gentleman's C began in 2010 when Los Angeles offered to build a football stadium as part of the downtown site.

The Anschutz Entertainment Group, the

Aerial view of proposed LACC redesign
Populous and HMC, architects
archinect.com

owners of Staples Center and L.A. Live made a deal with the city of Los Angeles build an NFL stadium on a part of the sprawling convention center site.  The attraction for City Hall-a promise from AEG to pay $315-million for upgrades to the complex.  Mr. Hawthorne writes, "Though the idea was hugely complicated politically as well as architecturally, it wasn't hard to understand why the city would at least pursue it.  With visions outside money windfall dancing in civic officials's head, the thought of horrendous Sunday football traffic was a minor inconvenience.  After all, the revenue would be enough to pay for the convention center makeover.  Really, the construction of a new multi-use facility-"where luxury suites would have doubled as meeting space for conventioneers, was another story.

Los Angeles Convention Center West Hall
parkme.com

Eventually, AEG and the NFL have gone their separate ways, when the league entered into serious discussions with smaller cities: Inglewood and Carson.  Now, the dream of a football team in Downtown Los Angeles have been dashed and convention center has room to expand in, a more conventional manner, along Figueroa Street, from 10 Freeway across Pico Boulevard along the northern edge right to the front door of L.A. Live.

On February 18, 2015, the Los Angeles Bureau of Engineering announced a design competition for the expansion and renovation of the LACC. (eng.lacity.org/projects/laccexpansion)  From the field of eleven architecture firms, including AC Martin Inc. and LMN Architects; Gensler and Lehrer Architects, and the eventual winner HMC Architects and Populous.  Mr. Hawthorne notes, " Still, even without the stadium attached, this is a plum commission and a major civic project with a total budget of $470 million." The chosen design, for which the City Council will discuss in November, calls for a dramatic makeover of the West Hall, the portion of the complex nearest Staples Center and L.A. Live.  The proposed design will add a concourse spanning Pico Boulevard and redesign Gilbert Lindsay Plaza along Figueroa, named for Los Angeles's first African-America Council member.

Staples Center
aegworldwide.com

The changes are expected to increase meeting and exhibition space from 870,000 to 1.28 square-feet.  There are also plans for adding a major 1,000-room hotel along Chick Hearn Court, right where the convention center becomes L.A. Live.  According to Christopher Hawthorne, "Those basic moves address-and will go a long way toward solving-four problems that have long plagued the convention center..."  The Convention Center, opened in 1971, was designed by Charles Luckman and was later expanded by James Ingo Freed and I.M. Pei.  By comparison to other American convention centers, "...ours is seen as outdated, inflexible, undersized and served by a severely limited supply of nearby hotel rooms."  Outdated, maybe.  Inflexible, perhaps.  Undersized?  Not by Blogger's own estimation.  However, it would be nice if Populous and HMC could something about designing a more efficient on-site parking layout.

L.A. Live
aegworldwide.com

The architecture of the proposal, "as if to compensate for the sober event-management calculations around which it is organized," leans more toward the frenetic, think the Space Mountain ride at Disneyland.  Mr. Hawthorne criticizes the design gestures as "oversized and occasionally overwrought, its colors perma-bright." Blogger concurs with this opinion. From a historic preservation perspective, the proposed designed has fetishized saving one of the Freed-Pei glass entry towers, marking the corner of Figueroa and Pico, while demolishing the one near Staples.  Blogger supposes that having a landmark on an important corner makes sense in establishing a compass point, if you will.

Chick Hearn Court with statue
everystockphoto.com

A 70,000-square foot open-air ballroom would replace the current lobby and meeting rooms in the West.  Above that would be another ballroom, 100,000 square-feet, wrapped mostly in glass.  Both would offer dramatic views. Lindsay Plaza would get a much needed energy boost with colorful new paving and plants by landscape architecture firm Olin. The open space would stretch toward L.A. Live and wind its way behind Staples.  The East and West halls, would be connected by a bridge-type building spanning Pico.  Where the complex buts up against the noisy 110 Freeway, a new sound wall with thick plantings would provide updates to drivers and reduce traffic noise spilling into the convention center.

Gilbert W. Lindsay Plaza
Los Angele Convention Center
gettyimages.com

Christopher Hawthorne suggests a couple of simple changes that would seriously improve the plan: "One is to move the hotel to the Figueroa edge of the site, since what that crucial urban corridor linking USC to the heart of downtown needs is more foot traffic and a more dynamic-and also simply taller-king of urbanism."  He does observe that this ample room to build a "slender hotel while also making Lindsay Plaza a more successful open space."

One of the questions Mr. Hawthorne poses is "what the convention center owes downtown and nearby neighborhoods, architecturally or otherwise."  The cynic says since AEG, in spite of losing the NFL plan secured a five-year contract to run the convention center, has some that the complex renovations will nicely complement the L.A. Live architecture, so that traffic between the sites becomes seamless.  Blogger thinks that frenetic Pixar movie architecture of the proposed design would complement Ginza-at-night architecture of L.A. Live (Blogger's own description).

Northbound on Pico Boulevard and Figueroa Street
flickr.com

The way the process has unfolded, specifically the placement of the hotel and the way the rooftop ballroom is turned away from the Figueroa Street access toward L.A. Live, facilitates this seamless more than hinder it.  If there is any design difference between the proposed convention center design and L.A. Live in palette, there is a similarity in style, tone, and a general aversion to subtlety.  Mr. Hawthorne suggests, "...another goal should be to turn down the volume on both the architecture and landscape architecture of the winning proposal.  The architecture of the expanded West Hall, for instance could be significantly edited as the design is refined, its stack of folds thinned, its collection of bends and kinks streamlined."  Blogger concurs, the less visual clutter, the better.

Los Angeles Convention Center East Hall
lacclink.com

Christopher Hawthorne also suggests "A less caffeinated plan for Lindsay Plaza would also help a treatment of Pico that didn't suggest that the street was being removed from the city grid..."  Conventioneers may come and go but the rest of us have to look at it everyday of the week.  Further, Mr. Hawthorne also ponders the question that City Council and other with have to ask, "...whether these changes would salvage the winning plan or merely make it less disappointing."  In greater sense, results of the design competition for the Convention Center is yet another reminder that Los Angeles needs to find a way to broaden the field of firms (and design philosophies).  Mr. Hawthorne cites the example of Santa Monica, "a much smaller city, has shown far more ambition in selecting architects for civic projects, choosing not just well-known international names...but also talented local firms like Koning Eizenberg and Kevin Daly Architects." This from the man who is (was) Peter Zumthor's head cheerleader.  Blogger does not have a short memory.

McCormick Place Grand Concourse
Los Angeles Convention Center
en.wikipedia.org

Christopher Hawthorne observes, "In certain ways the flaws of the winning design aren't surprising.  Despite some talk of new approaches, like a distributed-conference model in which events are scattered among several venues in a given city, convention architecture remains hidebound."

The stakes in this case are high not just for downtown but for the entire city and county of Los Angeles.  Instead of relying on new construction, the convention center's additional square footage will be woven into and on top the existing mid-century buildings.  Mr. Hawthorne observes, "This more and more the kind of condition architects face in L.A., a site where what's required, rather than some original or boldly eye-catching state of purpose, is a sustained, strategic effort to rehabilitate, re-clad, or even redeem older buildings in a languishing or under-performing corner of the city."

Los Angeles Convention Center interior
walknridela.com

In 1989, James Ingo Freed made this statement,

Convention centers seldom make a profit in their own right...Essentially they are architectural machines designed to generate business for the city.

This is still true.  Nevertheless, as the city runs out of empty land and tries to revive its long ignored civic realm, it no longer has the luxury of considering a project of this scale as solely as a generator of tourist revenue or economic development.  Christopher Hawthorne writes, "We have to consider what it means for public space, neighborhood character and -as a horizontal city turns ambivalently more vertical-the shape and personality of the skyline as well."  The machine needs to function at a higher capacity.

When Lack Of Transportation Becomes A Barrier To Health Care

http://www.theatlantic.com/health.archive/2015/08/the-transportation-barrier/399728/

Woman riding a Greyhound bus
photograph by Shannon Stapleton/Reuters
theatlantic.com

Hello Everyone:

Fresh week, fresh things to talk about.  First, yours truly wants to express the utter shock and revulsion over the destruction of the Baalshamin Temple ruins in Palmyra, Syria. The continued wonton destruction of cultural monuments is an attack on humanity itself by those who respect neither human life or civilization.

Now for today's subject, lack of reliable transportation as a barrier to proper healthcare. It is no secret that reliable and safe transportation in suburban and low-income communities is inadequate.  The inability to find a nearby bus or train station can mean missed appointments or poor health.  In his article "The Transportation Barrier" for The Atlantic, Imran Cronk, illustrates this dilemma with his own experience as an emergency room volunteer.  One evening he encountered an older gentleman who was having vision trouble from medication and did not have bus fare.  Mr. Cronk suggested the gentleman try the admissions-and discharge desk but that was no help to the gentleman.  Mr. Cronk watched with concern, as the gentleman was having difficulty pacing the waiting room.  Finally, after his shift was over he gave the gentleman a ride home.

East Baltimore, Maryland
weblogs.baltimoresun.com

The point of Imran Cronk sharing his experience is to highlight the fact that distance can still be a barrier for poor people living in suburban and urban areas.  The irony is that despite the closer proximity to medical and dental facilities, people still have trouble with finding reliable transportation.  One problem is "Some households don't have a vehicle, or share one among multiple family members."  Underscoring this point is Gillian B. White's article, "Stranded: How America's Failing Public Transportation Increases Inequality" in The Atlantic (May 16, 2015).  Ms. White quotes Moss Kanter, a Harvard University professor and author of the book Move: Putting America's Infrastructure Back in the Lead,

Without really good public transportation, it's very difficult to deal with inequality...Access to just about everything associated with upward mobility and economic progress-jobs, quality food, and goods...healthcare, and schooling-relies on the ability to get around in an efficient way, and for an affordable price.  (http://www.theatlantic.com)

Broken window field study
Lowell, Massachusetts
boston.com

Low-income neighborhoods are acutely affected by sub-standard transportation infrastructure-"subways may not service areas on the fringes of a city, buses may be unreliable, and both are vulnerable to strikes or service suspensions.  And for those who are disable, obese, or chronically ill, riding the bus or the subway can be a difficult undertaking."

Therefore, a trip to the emergency room or doctor's office, without a way to get there and back, can mean either being stranded or missing an appointment altogether.  Mr. Cronk cites a "...2001 survey of 413 adults living at or below 125 percent of the federal poverty level in Cleveland, Ohio, published in the journal Health & Social Care in the Community, researchers found that almost one-third of respondents reported that it was 'hard' or 'very hard' to find transportation to their health care providers..." A 1997 surveyof 593 cancer patients in Texas, published in Cancer Practice revealed "...that in some cases, trouble with transportation led patients to forgo their cancer treatments.  The problem was especially prevalent among minority survey respondents; 55 percent of African America and 60 percent of Hispanic survey respondents reported that transportation was a major barrier to treatment, compared to 38 percent of white respondents."

New York City housing project
stvinc.com

Imran Cronk continues, "More recently, 2012 survey of 698 low-income patients in a New York City suburb reported that patients who rode the bus to the doctor's office were twice as likely to miss appointments as patients who drove cars."  Also, in 2013, a study published in the Journal of Community Health, titled Traveling Towards Disease: Transportation Barriers to Health Care Access http://www.ncbi.nlm.nih.gov) concluded that about "25 percent of lower-income patients have missed or rescheduled their appointments due to lack of transportation."  Further, patient who had transportation problems "also missed filling prescriptions more than twice as often as patients without that same problem."  The study authors reported, These consequences may lead to poorer management of chronic illness and thus poorer health outcomes. (Ibid)

Random corner in Watts, California
ireport.cnn.com

University of Pennsylvania professor of medicine Shreya Kangovi explains, In some situations, patients without transportation access may for a medical emergency just to be able to see a doctor.  Dr. Kangovi continues,

Mr. Jones might a disability that makes it difficult for him to use public transportation, so he has been waiting until he's really sick, short of breath, and then calling an ambulance because there is no other good way to get care.

Dr. Samina Syed, the lead author for the 2013 study told Mr. Cronk,

If a patient can't get to see their health-care team, then it's a domino effect...Missed appointments mean they can't address their questions and concerns, or update physicians on changes in their history or life circumstances.

This is a particularly worrisome situation for patients with chronic illnesses, such as diabetes, which require active care management.

Community Health Worker in South Los Angeles
myemail.constantcontact.com

While the obvious remedy to the problem is to add more public transit (bus and subway) lines, which may not be feasible, there is another approach to making sure patients get to their appointments and their prescriptions filled.  Mr. Cronk writes, "Some health-care providers are trying to less the problem by employing community health workers (CHWs), people who help patients navigate the health care system."  CHWs are usually individuals, without health-care backgrounds, who are tasked with coordinating transportation to and from office visits, encourage them to take their medications, and educate individuals on healthy lifestyles.  As of 2014, there were about 50,000 CHWs in the United States.

The implementation of CHWs shows promise of positive change in health-care access.  Imran Cronk cites a 2003 study on health disparities from the Institute of Medicine, which praised the CHW model, stating that it offer[s] promise...to increase racial and ethnic minorities' access to health care and improve their quality of care.  Research has supported this concept: a 2007 study revealed that CHWs can help hypertension patients better manage their situation and a 2014 study concluded that "patients who worked with CHWs scheduled more primary-car follow-up appointments than those who didn't."

Care Coordinator reviewing a prescription with a couple
work.chron.com

Another approach to breaking down the transportation barrier to better health-care are care coordinators.  Care coordinators, unlike CHWs, do have training in a health-related profession (social work or nursing) and are used by some hospitals and doctors.  The coordinators support groups of low-income or chronically ill patients, helping them to navigate their care strategies and schedule appointments with primary-care physicians instead of repeat visits to the emergency room.

Nevertheless, a significant number of patients, especially those with limited resources, struggle to locate reliable and affordable transportation, there are options for those who know how to find them.  Every state offers a "non-emergency medical transport benefit to Medicaid recipients, which covers a set number of rides per month and some Medicare Advantage plans also allow for a specific annual number of trips (eligibility varies according to state).  Some states enter into contracts with local companies to provide transportation; others use volunteers, or hire cabs.  Uber, Lyft are you paying attention? There is a need for reliable transportation for low-income patients.  You could provide a real service to a community who desperately needs it.  Private insurers are also taking steps to make transportation accessible for their clients, albeit through a time-consuming bureaucratic process.

Interior of a Baltimore area bus
Photography courtesy of ArchPlan Inc
archplanbaltimore.blogspot.com

The restrictions surrounding these transportation programs can be daunting and can inhibit patients from availing themselves.  Returning to the patient Mr. Cronk encountered during his shift at the ER, he writes, "The patient I encountered in the ER at midnight, for example, did not have the luxury of planning his ride home in advance.  No one who undergoes emergency hospitalization has the benefit of foresight for planning how they might leave."  Those patients who received planned care through a doctor's office or other outpatient setting may not be aware of the resources available to him or her.  The very same low-income patients, who are impacted by transportation barriers, are also likely to lack health literacy which makes it difficult for them to climb the levels of bureaucracy just to get a ride.

Dr. Shreya Kangovi explains, If you have health-literacy issues and if you don't have good access to care to begin with, you're not going to be able to fill out the application and get your provider to fill out their side of it...Barriers like that, which seem small and detailed, end up being insurmountable barriers for patients.

If it is not the lack of health literacy that prevents patients from obtaining access to transportation, it is a sense of self-consciousness.  Mr. Cronk, citing Dr. Samina Syed, writes, "Often, doctors may not even realize that their patients have problems with transportation."  Dr. Syed elaborated,

There are things patients might not tell you, or that you don't ask them, and so they just hear from the doctor that you shouldn't miss appointments, and they say 'Okay,'...But there is more to it that is beyond their control...You can provide the best care in the world...but it doesn't matter if the patient has no way to get to it.

Are We Ready To Step Into The Inner Ring?

http://www.theatlantic.com/archive/2015/08/compton-california-the-suburban/401282/

Kelly Park
Compton, California
unitedgangs.com

Hello Everyone:

Over the weekend, the N.W.A. biographical movie Straight Outta Compton made its debut; crushing its box office competition, earning a staggering $60.2 million. (http://www.forbes.com)  The title comes from N.W.A's 1988 "gangsta" rap album which put the city of Compton, California in the spotlight.  Emily Straus writes in her article "Straight Outta Suburbia" for The Atlantic, "A rap album made Compton an icon of urban decay, but the struggles of that California town are common to inner-ring suburbs.  The double-platinum album's song lyrics and music videos emphasized street and economic devastation, portraying Compton as brutal and lawless."  Compton and similar inner-ring suburbs do not fit into the suburban stereotype of happy families, living in nice single family homes in quiet, clean, crime free communities.  Indeed not.  The album cover featuring Eazy-E pointing a gun directly at the viewer contrasted against the sparkling blue California sky upends this image.

Straight Outta Compton
N.W.A. 1988
en.wikipedia.org

The movie and Dr. Dre's new album, Compton, the city has once again been thrust onto center stage.  N.W.A.'s brutally merciless vision still defines the city for many American.  In 2011 Sports Illustrated and CBS News produced a joint special report about gangs and schools only reconfirmed Compton's status as an urban jungle.  The report took its title from the album and presented students using sports participation to survive in gang-infested communities.  N.W.A. made Compton a signifier "urban decay and inner-city crime."  However, there is more to Compton's story than gangs and urban decay-"a hidden history of the 'other' suburbia."

While N.W.A's videos featured the gritty streets and back alleys, however, if you pay close attention, you can see modest-single family with front gardens that run counter to the ghetto image in most peoples's minds.  Compton is also known as the "Hub City" because of location near the exact geographic location to the geographic center of Los Angeles County. (http://www.comptoncity.org)  The area was settled in 1867 by a group of 30 families, led by Griffith Dickenson Compton.  In 1868, the settlement built a multi-purpose building which served as a schoolhouse, church, and a place for civic meetings.  The settlement took the name Compton in 1869.  On May 11, 1888 the City of Compton was officially incorporated into Los Angeles County. (Ibid)

Martin Luther King, Jr. Memorial
Compton, California
waymarking.com

Emily Straus writes, "Compton may be legally incorporated as a city, like all California municipalities, but it's actually a suburban town...But this never fit into what became the middle-class suburban model: a deep tax base, good schools, and an overwhelmingly white populace."  Rather, Compton is symbolic of inner-ring suburbs which grew up "...next central cities as single-use, residential-only subdivisions."  These types of suburbs do not have strong business districts which limit their commercial potential; they are populated with aging housing stock that diminish their attraction to higher-income earners.

Compton, like other inner-ring suburbs, like other inner-ring suburbs, was denied affordability and accessibility made them susceptible to racial turnover.  In the fifties, the city was majority white but by the 1970s, it was majority African American to majority Latino in the nineties.  The demographic shift coincided with Compton's "progressive impoverishment; by 2000, 28 percent of the town's residents lived below the poverty line, double California's 14.2 percent figure and more than twice the national 12.4 percent.  Further, the town's reputation as a "black city" inhibited any potential entrepreneurial ventures.  The cherry on top  was "The cultural associations of N.W.A and gangsta rap..." which limited any prospects for outside investment in the community.

House for sale
Compton, California
housesforsalelists.com

Emily Straus writes, "Without strong business or residential-revenue streams, Compton and similar inner-ring suburbs around the U.S. spiraled downward."  The inner ring suburbs got caught up in a vicious cycle of deindustrialization and disinvestment.  This resulted in these communities inability to maintain their infrastructure.  Desperately needed reinvestment was hard to obtain which forced Compton and like communities to resort "...to a variety of superficial, and ultimately unsuccessful solutions to their endemic problems."

Despite its nationally (in)famous reputation, Compton's situation.  Ms. Straus makes an analogy between Compton and other inner ring suburbs, including Ferguson, Missouri.  Like Compton, Ferguson also experienced racial and economic changes, "...going from 99 percent white in 1970 to over 67 percent African American in 2010.  By then, Ferguson's unemployment exceeded 13 percent, and the number of residents living in poverty had doubled in only a decade."  Further, Ferguson also experienced business disinvestment coupled with falling residential real estate values. To add insult to injury, when businesses did open shop in Ferguson, they were protected by tax exemptions, leaving the town's poor to shoulder the burden for services.

Straight Outta Compton
showbiz411.com

The story of Compton or Ferguson is emblematic of other suburban stories.  Like every town, across the United States, Compton was built with a good deal of hope and was home to waves of different ethnicities looking for better lives.  However, the reality of the place was a cold hard slap to the face of many of these ethnic groups.  Their suburban dreams slipped away, blocked by misguided housing policies, deindustrialization, disinvestment, and segregation.

Emily Straus speculates, "N.W.A put Compton on the map in 1988-too soon for most Americans to understand what they were really seeing."  After the fires of Ferguson, Straight Outta Compton is reacquainting America with Compton's ongoing struggles and hopefully focus attention on the unique plight of inner-ring suburbs.  It is not a coincidence that Straight Outta Compton opened the same week as the fiftieth anniversary of the Watts Uprising and the one year anniversary as Ferguson.  Like Compton, Watts is an inner-ring suburb that has suffered the same plight as Compton.  Emily Straus is correct when she wrote that 1988 was too soon for Americans to fully understand what they were looking at.  The good times atmosphere of the first half of the eighties still lingered.  That era of good times is long gone and hopefully, we can begin to deal with the unique challenges facing the inner-ring suburbs with greater awareness.

What Is Frank Gehry's Vision For The L.A. River?

http://www.latimes.com/local/lanow/la-me-ln-la-river-frank-gehry-20150807-story.html#page=1

Watch this Friends of the Los Angeles River video:
https://youtu.be/hcjJqBAiknw

Los Angeles River before the concrete
caltrout.org

Hello Everyone:

Today we move from the celebration versus shoe-gazing analysis of Los Angeles to more current events.  Two exciting news items from the City of Angeles: first, Mayor Eric J. Garcetti is campaign to make Los Angeles the American bidder for the 2024 Summer Olympics.  Second and relevant for today, architect Frank Gehry is working with civic officials to draft a new master plan for the Los Angeles River redevelopment.  The good part, is that it is not Peter Zumthor-so no black blobs.  The bad news, according to the comments on the social media reflect concerns about his firm's lack of landscape architecture and planning experience as well as their over-dependence on computational architectural.  Recently Peter Jamison, Martha Groves, and Dan Weikel report in their story for the Los Angeles Times, "Exclusive Architect Frank Gehry is helping L.A. with its Los Angeles River master plan, but secrecy troubles some," what Mr. Gehry's presence will bode for the future.

Bridge overlooking the L.A. River
la.curbed.com

Frank Gehry is better known for the contemporary icons Guggenheim Museum in Bilbao, Spain and the Walt Disney Concert Hall in Los Angeles,  However, since last year, Mr. Gehry has been doing under the radar work on "...what officials describe as the beginning of an overarching plan for the bridges, bike paths, walkways, and other improvements intended to revive public use of the river as it winds from the San Fernando Valley to Long Beach."

Much of the specifics of Mr. Gehry's vision still remain under wraps.  Mayor Garcetti and the L.A. River Revitalization Corp, a nonprofit organization established to coordinate a renewal effort, had not intended to announce the Santa Monica-based architect's involvement until later this month.  Nevertheless, the Times beat the Mayor and the L.A. River Revitalization Corp to the punch this past Friday; "...Garcetti said the architect is working on the project pro bono and producing a 'master plan, in the truest sense of the word.'"  Mayor Garcetti went as far as to compare the secretive master plan to the work of famed Central Park designer Frederick Law Olmsted.  To have the Olmsted of our time focusing on this, is extraordinary, said the Mayor in an unrelated City Hall press conference.

L.A. River 1895-1920
hiddenlosangeles.com

Peter Jamison, Martha Groves, and Dan Weikel observe, "Gehry's involvement marks a potential turning point in a decades-long struggle to reinvent the river and its concrete-lined banks.  But his plan is getting a cold reception from some of the activists who helped draw attention to the cause."  Their concerns include the secrecy surrounding the plan and lack of public input on a potentially broad blueprint for the river's future.  They also have sounded the alarm over the possible direction for river redevelopment could impede "...federal funding for $1.4-billion, 11-mile restoration project in northeast Los Angeles and downtown."

Those concerns came to the forefront last week when the nonprofit group, Friends of the Los Angeles River (https://folar.org) led by Lewis MacAdams, sent a letter to the River Revitalization Corp, categorically refusing to support Mr. Gehry's effort.  The letter also stated that "...the river environmental group would take in a news conference announcing the architect's plan."  A copy of the letter obtained by the Times, in which Mr. MacAdams expressed fear that the new vision and plan for the river led by Frank Gehry would undermine our efforts to receive funding from the U.S. Army Corps of Engineers and create confusion among the public and political leadership.

Lost Wetlands of Los Angeles
Photograph from Herald-Examiner Collection
kcet.org 

In an interview with the newspaper, Mr. MacAdams clarified his opposition to the project.  He told the reporters that "...his group's decision not to endorse the project stemmed partly from philosophical opposition to the sort of top-down land-use planning that led the federal government in the mid-20th century to turn a meandering river into an unsightly drainage channel."  Lewis MacAdams continued,

Last time there was a  single idea for the L.A. River it involved 3 million barrels of concrete,...To us, it's the epitome of wrong-ended planning.  It's not coming from the bottom up.  It's coming from the top down.

Frank Gehry's office did not respond to requests for comment.

Current view of the L.A. River
en.wikipedia.org

   Deputy mayor for city services Barbara Romero told the reporters, "...there would be an extensive outreach process to solicit Los Angeles County residents' thoughts as Gehry's work moves forward.  Ms. Romero also told the reporters that public comment process was to be determined and handles through the River Revitalization Corp.  She also said, "...Gehry had be studying the river in conjunction with the Revitalization Corp. since last November...his work would 'build on' the Army Corps-funded restoration project, not interfere with it."  Blogger can only imagine what the U.S. Army Corps of Engineers has in mind.  Ms. Romero bubbled, At the end of the day, the L.A. River is an infrastructure...Having someone like Frank Gehry involved elevates it.  Elevates it to what remains to be seen.

Los Angeles River and Downtown
eecue.com

The L.A. River Revitalization Corp issued a statement to the reporters saying Mr. Gehry's efforts will expand upon decades of important work that has come before...Far from complicating any other efforts, his work will complement those efforts.  The statement continues, This project will have tremendous amount of public input from the diverse talent and ideas of people across the region.  This all sounds well and good but blogger thinks it might be helpful for Mr. Gehry and River Revitalization Corp could, at least, publish some sort of teaser drawings.

Some, such as architect Kevin Mulcahy of RAC Design Build, a four year-old firm based in a riverside warehouse in Elysian Valley, were happy over Mr. Gehry's participation.  Mr. Mulcahy told the reporters, "it was an exciting resolution to the question of who would ensure that the restoration project would have a unified design as it winds through a patchwork of cities and unincorporated county land."  Keving Mulcahy said,

It ends a years-long street fight...over who might have the world-class vision and world-class capital to develop a comprehensive plan for transforming the entire river into a 51-mile-long public space.

Urban hike the L.A. River
archinect.com

The mostly arid concrete riverbed is one in a series of urban waterways targeted for redevelopments.  The best-known is the San Antonio River Walk, "which attracted more than 9 million non-resident tourists last year and million more locals."  According to Ed McMahon, senior resident fellow with the Urban Land Institute in Washington D.C., Most American cities turned their backs on the water in the 1950s, '60s, and '70s.  Today, There's hardly a city in the country that hasn't tried to reconnect with its waterfront...Some have had more success than others.

The Los Angeles River revitalization master plan was adopted by city officials in 2007 after extensive public comment.  Ms. Romero told the reporters, "Gehry's work will flesh out design elements that were left vague."  This may sound all well and fine but "in a region and state known for heavy regulatory review of large developments-especially near environmental resources-question remain about which government agencies will have a say in how Gehry's vision is implemented."  Figuring this out should be fun.

Los Angeles River through downtown in the evening
en.wikipedia.org

Los Angeles-based environmental attorney Douglas Carstens told the reporters,

It could be the city of Los Angeles with input from the federal government and local agencies or it might be a federal process with cities as the commenting agencies...They might turn this into something regional.  All of this needs to be coordinated.

Perhaps if civic officials provided more clarity about which agency was taking the lead in this project, it might ease some of the concerns over this project.  Mr. Carstens comment about the need for coordination is more of a statement of the obvious.

According to Mr. Carstens, one of the challenges is, ...to balance competing visions of the river as environmental haven-featuring abundant parkland and public access-and as the spine of major urban redevelopment, surrounded by shops and housing.  If there are differing visions, the conflicts and issues would have to be worked out...Frank Gehry might be able to do that.

Los Angeles is a park-poor city and no doubt the redevelopment of the Los Angeles River has the potential to partially remedy this situation.  Perhaps in the coming months as more information becomes available, the public will have a chance to comment on the project.  Regardless, much remains to be seen of Frank Gehry's vision for the Los Angeles River.