Academic Medical Centers And Urban Redevelopment

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{a view over Forest Park Southeast of the Washington University Medical Center and Barnes-Jewish Hospital – image from Google Earth}

The great thing about being interested in our urban environment is that you can find interesting and relevant news and information just about anywhere. And so it was as I briefly glanced as my wife’s copy of The New Physician on the way to the recycling bin. The title story? “Won’t You Be My Neighbor?: Academic medical centers try to fulfill their critical community role.” And wouldn’t you know it, Washington University Medical Center and Dr. Kenneth Ludmerer get a mention.

Academic medical centers are busy developing the medicine of the future. But how are they treating their im-mediate neighborhoods?
The New Physician, September 2009
by Steve Woo Volume 58, Issue 6

On a humid July day, the community surrounding Johns Hopkins Hospital is pocked with abandoned homes, missing windows and other distressing signs of neglect and poverty.

Yet in the midst of this East Baltimore neighborhood resides the luminous buildings of a prosperous hospital rated best in the nation for the past nine years by U.S. News & World Report, and considered one of the best in the world.

The community, however, is in the midst of a $1.8 billion project, in which Johns Hopkins is one of many part-ners. A new biotechnology park is being built, and dilapidated dwellings are being replaced with new homes in an area where there was a 70 percent property vacancy rate.

While the central mission of academic medical centers is to train future doctors and perform scientific re-search—which often lead to medical breakthroughs—teaching hospitals historically have had social responsi-bilities to their communities.

This includes charity care, improving neighborhood infrastructure and working with community organizations to improve the lives of residents. Physicians-in-training also benefit by learning about community-based medicine through these alliances.

….

At academic medical centers in impoverished urban areas, such as Hopkins, it is an attempt to bridge the stark gap between hospitals composed of affluent doctors and communities of underprivileged minorities.

Relationships still face difficulties over real estate, respect for communities, expansions into neighborhoods, and issues of the centers’ nonprofit status causing loss of local tax revenue.

Hopkins has found success offering a variety of community programs, including a job recruitment program that aims to employ even those with felony convictions. Another program offers to pay half the college tuition for children of any hospital employee, says Pamela Paulk, vice president for human resources at Johns Hopkins Hospital and who works with these community programs.

Announced in 2001, the aim of the 88 acre project is to bring biotech businesses to the area and rehabilitate the neighborhood. The project is headed by East Baltimore Development Inc. (EBDI), a nonprofit formed in 2003 that includes partnerships with the city, the state of Maryland, Johns Hopkins, the Anne E. Casey Foun-dation, a commercial developer, and others.

Some community groups such as the Save Middle East [Baltimore] Action Committee (SMEAC), created to oppose the project, have been vocal critics. They opposed acquisition of homes through eminent domain to move residents, even if some did not want to leave. SMEAC has considered the project unjust and an example of affluent entities exerting power over those with less.

“We are not going into their neighborhood; they are coming into ours,” says Donald Gresham, president of SMEAC, of the developers. “This project has not been fair.”

In a commissioned study by one project partner, nine out of 10 former residents said they were satisfied with the arrangement, says Sheila Young, EBDI’s vice president of development and communications.

Homeowners were paid $165,000 on average for dwellings often worth as little as $25,000, Young says. They also have a “right of return,” where they would be helped financially to resettle in the neighborhood’s new housing if they so choose.

Relations with SMEAC and the developers remain difficult, but Young believes it is good to have the organiza-tion’s input on the changes.

“I think of them as a partner and I think they have made this project better, and I think they are sincere about making sure that we do right by the neighborhood,” Young says.

….

In the early 1990s, Columbia wanted to build its own biotech center with laboratories and space for biotech companies. But occupying that space was the Audubon Ballroom, where civil rights activist Malcolm X was assassinated in 1965. The university, along with the city of New York and the state, wanted to demolish the building, which stood across the street from the hospital and was vacant for several years.

The community fought to save the property, and the university worked with neighborhood groups to restore the building, most visibly its ornate façade. The university now shares the space with community organizations.

But the community still considers Columbia University as an “800-pound gorilla,” Meyer says. Between the hospital and the community, there is a “big power differential there, and there is the financial disparity there.”

Meyer and two other authors detailed the historical relationships and perceptions between the groups, and the ways they have improved in a 2005 article in Academic Medicine. They wrote, “Initially, the university faculty was perceived as the ‘Ivory Tower,’ arrogant and all-knowing, as our community liaison reported. There was mistrust of the university’s intentions, the community seeing itself historically as being poorly served or having its members exploited as subjects of research.”

The article went on to say that the faculty doubted the community’s understanding of how medicine was practiced, and changing perceptions was critical to improving children’s health.

….

The intent to care
All in all, academic medical centers generally want to improve communities, says Dr. Kenneth Ludmerer, au-thor of Time to Heal, a book presenting the history of American medical education from the beginning of the 20th century.

Ludmerer, a professor at Washington University in St. Louis School of Medicine who focuses on the history of medicine, himself graduated from Johns Hopkins University School of Medicine. He devoted part of a chapter in his book to the contentious relationship between Hopkins and its community in the 1960s and early 1970s. In an interview, he recognized Hopkins’ recent efforts to improve the relationship.

“In general, the great majority of academic medical centers want to do the right thing,” he says. Of Hopkins, “their heart is definitely in the right place.”

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