Cuba

By J. Mac Holladay, President, CEO, and Founder

I returned last week from a week in Cuba. After spending two days in Havana, the Washington & Lee Alumni College group sailed around the western edge of the island and proceeded to the Isle of Youth, the largest of the Canarreos Archipelago. After visiting the capitol, Nueva Gerona, we traveled on to Cayo Largo, Trinidad, and Cienfuegos. We then drove across the mid-section of Cuba to the Havana airport to catch our one hour and thirty minute non-stop Delta flight back to Atlanta. 

My impressions are too numerous to recount in this short piece, but I do want convey both some facts and thoughts. There were many surprises for me. Here are a few comparison facts to consider:

1) The voting age there is 16 versus our 18.

2) In the hospital, there is a 24% less chance of infant death than in the United States. 4.7 of 1000 babies die in Cuba before age of one, while 6.17 die in the US.

3) While there remain some critical questions about Cuba’s 1980’s HIV program, last year there were only 100 HIV deaths in Cuba. Click here for an in-depth 2012 NYT article about the program.

4) Cuba is having 26% fewer children than in the US. Annual births there are 9.90 per 1000, while in the US it is 13.4.

5) The per capita expense on health care is 93.7% less than in the US. The total public and private expenses per person in Cuba reach $558 versus $8995 in the US. 

6) The inflation rate there is 5.5% versus 2.1% here.

7) The National Parliament has 45% female members versus 22% in our Congress. 

8) Private ownership of fire arms is forbidden. In fact, only the National Police have weapons, the local police have only night sticks. 

Our visit was both “people to people” and educational. Two Washington and Lee professors presented lectures about Cuban history, Castro, and the life and culture there. The lack of new equipment from cars to tractors to trucks was evident everywhere. In many places, horses (many of them under great stress) were pulling carts and doing hard work. While much of the country appears very capable of agricultural production, only sugar cane and tobacco were evident. Yes, there were some “classic cars” somehow beautifully restored, but many more vehicles are barely working with engines and parts from any and everywhere. 

Both Trinidad and Cienfuegos have been declared UNESCO World Heritage Sites. I sincerely hope that all of central Havana can receive the same designation. There are literally hundreds of beautiful buildings in Havana that have not been touched since the 1950’s. The opportunity for historic restoration projects is almost unlimited. 

Recently, the government has allowed entrepreneurs to thrive and keep the vast majority of their profits. While the country is not part of the international banking community, small business is growing. What is badly needed is massive foreign direct investment in major industry sectors still under full governmental control. There is no doubt that the now nearly 60 year old US embargo has crippled the Cuban economy. 

The educational and medical systems were far more advanced than I thought they would be. The deep commitment to the arts including music, dance, and graphic arts were evident in all the schools we visited. The health care system begins at the neighborhood level and continues through excellent hospitals and research and development. Both education and health care are free at all levels. 

With a population of over 11 million, this 792 mile long island nation has amazing economic opportunity for the future. Many believe that the changes now underway are unstoppable, and that once Raoul Castro is gone as president a new era will begin, perhaps with the United States as a full partner.

Webinar: Partnering with Your Local Healthcare Industry to Drive Economic Impact

By Ranada Robinson, Senior Research Associate.

I recently participated in an IEDC webinar entitled Partnering with Your Local Healthcare Industry to Drive Economic Impact. The two speakers, Steven Standley (University Hospitals, Cleveland, Ohio) and J. Eric Mathis (Williamson Redevelopment Authority, West Virginia), provided information on the innovative approaches their communities have been involved with spurring economic development from healthcare anchors. In many communities, hospitals are major economic drivers in terms of employment and investment, and it was interesting to hear how these communities are working as partners with their hospitals to create community-wide improvements.

Steven Standley briefly discussed Vision 2010. This $1.2 billion expansion effort by University Hospitals included a construction program which introduced a new project labor agreement with construction trades – a model for inclusion with goals for the percentage of contracts and employment relating to racial, gender, residency as well as apprenticeships for inner city vocational high school students on the projects – and a local vendor development strategy.

He then talked about the Greater University Circle Initiative. The leading anchor institutions in the community were rallied by the Cleveland Foundation to support this multi-faceted initiative. University Hospitals, Cleveland Clinic, Veteran’s Affairs Medical Center, Case Western Reserve University, and Cleveland Museum of Art together provided investments of over $3 billion. Here are examples of the projects this initiative has successfully implemented:

• Focus on Neighborhoods at Risk – The initiative has programs focused on revitalizing struggling neighborhoods, with an aim of retaining and attracting talent. Working with community development corporations, development projects for nine neighborhoods in the City of Cleveland were identified.
• Creation of Evergreen Cooperatives – This initiative works to provide living wage jobs in low-income neighborhoods in the area. Several workers even have criminal records that previously made it difficult for them to find quality jobs. There are three for-profit companies operated within the cooperative: Evergreen Cooperative Laundry, Evergreen Energy Solutions, and Green City Growers Cooperative. All three are sustainable businesses with green business practices.
• Creation of New Bridge Cleveland Center for Arts and Technology – This facility retrains area adults to become phlebotomists and pharmacy technicians and after graduation, they are hired at the University Hospitals or other area healthcare employers. The facility operates other programs as well, such as an after school arts program for high school students.

J. Eric Mathis discussed the components of the Central Appalachian Sustainable Economies (CASE), noting that this effort, designed and implemented in the “Heart of the Billion Dollar Coal Field,” required a serious, tough conversation regarding renewable energy vs. coal. Within this conversation, partners around the table were able to find synergies with the coal industry. The six components of CASE are healthy communities, food systems, sustainable tourism, integrative education, sustainable building, and energy optimization. Built into all six components are innovation and entrepreneurship, through programs such as the JOBS Project, which connects rural landowners with federal and state incentives for the development of renewable energy projects that will create quality jobs, and Smart Clusters, which emphasizes sustainable development in at-risk counties of Central Appalachia.

• The healthy communities component is centered around diabetes prevention and increasing access to walkable, bikeable trails. Through the Williamson Walkable Communities Program, community groups and businesses in the downtown area compete for the most miles walked in order to encourage healthy living.
• A closely related component is food systems, which encompasses increasing the number of farmers markets, organic farms, and farm to school connections. One key initiative to this component is the Regional Food Systems Project. Currently, there is a pilot organic farm located on a reclaimed mine site. In addition, community gardening is a priority – an example of community collaboration is the Williamson Community Garden, a partnership between CASE, Williamson Redevelopment Authority, Wildwood Garden Club, Americorps NCCC, and local volunteers, that includes a greenhouse and 24 individually raised beds.
• The sustainable tourism component links back to the bikeable community along with other outdoor recreation, such as hiking and all-terrain vehicles), a tourism corridor, and historical tours. The famed Hatfield and McCoy feud has been depicted in a film released on History Channel, and the Hatfield and McCoy Trails now have its first stacked loop mountain bike trails.
• The integrated education component focuses on high schools, community and technical colleges, and universities. CASE has partnered with global leader – Global Service Learning – to establish an integrated education program that links Wayne County with local educational centers. This component directly confronts generational poverty through basic skills training like balancing a checkbook and healthy eating.
• Sustainable building focuses on leadership in energy and environmental design, Living Building Challenge certification, deconstruction, and community revitalization. The Williamson Health and Wellness Clinic provides integrated, one-stop health services at low or no cost. Its facilities have undergone several energy efficiency upgrades, including the installation of the largest renewable energy system in the southern coalfields on its rooftop.
• The energy optimization component includes utility-scale, municipal, commercial, and residential energy. Williamson, WV has a local energy action plan, which aims to reduce energy expenses for the city’s five public buildings. One of the goals of West Virginia Sustainable Communities is to provide citizens with sustainability education opportunities.

Health and wellness is not an island that sits away from economic development. Healthcare institutions and initiatives have a very influential place in planning and development. When leaders from various constituencies within a community sit at the table to collaborate so many initiatives that can have a huge impact on residents can be achieved.

Health Care, Medical Schools, and Economic Development

By Ranada Robinson, Senior Research Associate.  

Over the last couple of years, health care has become a major area of interest for me—not just because of ObamaCare and all of its controversy but for many personal reasons: a new child, aging parents, an aunt with early-onset Alzheimer’s, and another aunt with cancer. These life events plus the constant reminder that there are impending doctor and nurse shortages through articles such as this New York Times article and reports such as this study published recently by the Association of American Medical Colleges only reinforces to me the importance of including health care in conversations about economic development.

In weighing the competitiveness of client communities, we here at Market Street evaluate data indicators that quantify health care access, such as doctors per capita and percent of citizens who are uninsured. Health care from the demand perspective is not always clearly tied to economic development, but think about it—health outcomes affect worker productivity as well as infrastructure needs. Communities have to have healthy people to keep moving forward.

Here are three clients who are working diligently to increase health care access and meet future demand by increasing the number of homegrown doctors they produce.

Jackson, MS: The University of Mississippi Medical Center is expanding its medical school, located in my hometown of Jackson, MS with a new $63 million building that will allow for an additional 30 to 40 students per class. Mississippi Governor Phil Bryant and University of Mississippi Chancellor Dan Jones broke ground on the building earlier this month. 

Austin, TX: Slated to open in 2016, plans for a research-intensive medical school affiliated with the University of Texas at Austin and a teaching hospital are underway after voters approved a property tax increase in November. The new tax will also supplement the activities of Central Health, an entity that provides a health care safety net for the underserved, as well as go toward medical school patient services.

Joplin, MO: Still in the trenches of their quest for a medical school, Joplin stakeholders have built a strong case for locating a medical school in the region and pitched it to an unnamed university this month. Joplin, an interesting place to watch as it has overcome the odds to restore what a 2011 tornado took from them, already has a strong health care foundation, and a medical school would be a welcome and fruitful addition. 

Health care needs will continue to grow over the coming years—is your community prepared?

Where are the uninsured?

By Jonathan Miller, Project Associate. 

The recent ruling from the Supreme Court upholding the individual mandate to purchase health care insurance is a defining moment for the future of care in America. As Stephanie Allen wrote earlier this week (Economic Development Rx) regarding the effect of the ruling on economic development, “Whatever else the health care bill is or may do, its aim is to make the people in communities across America healthier. And, a healthier community is a more vibrant and more productive one.” So, the question becomes, where are the communities that stand to gain the most from the individual mandate?

The following is a ranked list of the top 20 American cities that have the highest concentrations of uninsured people (the U.S. average is set to 1.0, so a value of 2.35 indicates that there are 2.35 times more uninsured people in the metro than in the U.S. as a whole). The table also contains the percent of uninsured and the percent of uninsured children (under the age of 18).

American Cities with Highest Concentrations of Uninsured Persons, 2010


Source: U.S. Census Bureau, American Community Survey

The list of cities is dominated by those in Sunbelt states, reaching from South Carolina all the way to New Mexico. Yakima, Washington is outside of the Sunbelt geography, but is in the part of Washington that is actually sundrenched (I should know, I grew up in Seattle).

The presence of 12 Texas cities on the list is intriguing as the productivity gains that could accrue in these cities - think healthy workers are less likely to use sick days and be stuck with crushing medical debt - have not been the rhetorical focus of Texas lawmakers (Gov. Rick Perry called the law a “stomach punch to the American economy”).

Whether you are for or against the health care reform and the individual mandate, there should be consensus that many cities and regions have much to gain, regardless of political ideology.

Economic Development Rx

By Stephanie Allen, Project Assistant.

Friday, the Supreme Court decided to uphold the health-care law. In the last few days, there have been a slew of articles about what it will mean—what it will mean for people’s lives, for health insurance companies, health insurance brokers, for hospitals, doctors, nurses, etc. But, what will it mean for economic development?

Well, first of all, if the projections are right, it means we’re going to need a lot more doctors, nurses, and other medical professionals. Considering the current shortages, and the short time frame for implementing the law, it means every community, even those who aren’t directly targeting the health care sector, will need to focus on attracting (and even “growing”) more health care professionals. In most communities, health care is a huge economic driver and despite bad economic times the health care industry continues to hire.

So, there’s the direct effect of creating jobs, which is always a goal of economic development, but there are other, maybe less thought about, effects too.

As economic development continues to broaden its scope to include more and more community development efforts, we economic developers become increasingly concerned with quality of life. Because, after all, it isn’t just money we want it’s a vibrant community full of happy, healthy, gainfully employed people. Whatever else the health care bill is or may do, its aim is to make the people in communities across America healthier. And, a healthier community is a more vibrant and more productive one (see Christa’s 2009 blog post, “An apple a day keeps unemployment away”).

There’s another part of this law, though, that may make local economic developers wary. While medical professionals seem mostly positive about the law being upheld, small business owners are, well, mixed. Starting in 2014, small businesses with 50 or more employees will have to provide medical coverage for employees. Business lobbyists worry that this will be a disincentive for hiring and growth on the part of small business owners, effectively stunting the growth potential of America’s entrepreneurs.

As economic development professionals, we’re used to seeing the good possibilities with the bad when it comes to public policies. This law could bring increased prosperity or disaster. It could mean so many different things for our economic future. At this stage, it’s pretty unclear what its long-term effects will be, but that’s where economic development comes in.

It’s our job to make plans in the face of uncertainty that attempt to increase the chances of prosperity and decrease the chances of disaster. So, now we’ve got to get to planning. 

Live from L.A.: The annual ACCE Convention

By Kathy Young, Director of Operations.

Last week I traveled with Market Street's CEO, Mac Holladay and our Directors of Projects and Research (Alex Pearlstein and Ellen Cutter) to attend the 2011 American Chamber of Commerce Executives (ACCE) annual convention.  Market Street serves as the  national economic development sponsor for ACCE and so our team was also there as a presenter and exhibitor. The convention provided an excellent opportunity for us to visit with old friends and former clients, and meet new friends. We were also able to congratulate ACCE's newest "CCEs" (Certified Chamber Executives) during our annual breakfast on Saturday morning. Jim Page at the Decatur-Morgan County Chamber and Ruth Littlefield, at the Tulsa Metro Chamber were among the new CCEs, representing two Market Street client Chambers. Congratulations to all the new CCEs and award winners!

While there were a wide range of interesting workshop and forum sessions, two of my favorites (and I admit a certain bias) featured Mac and Ellen. Ellen's session focused on "the Baby Boomer Economy."  Ellen framed a number of issues and presented a wide variety of information to session attendees, reflecting all the while that though the Great Recession has hurt Boomers' 401k plans, the generation remains the country’s economic driver.  Ellen's presentation explored demographic trends, growth industries, and workforce implications facing the nation and every community now that more and more boomers reach retirement age.

While there is a tremendous amount of information in the presentation, the value that Ellen brought to the session was the ability make the data, charts, and complex trends incredibly relevant for Chamber executives. It's not just about the numbers, it's about the story - in this case, the story of how we're changing, and what the practical implications of those changes are today, and in the years to come. To view Ellen's full presentation, click here. In the days to come, we'll be adding Mac's presentation as well, so stay tuned!