The stories submitted here were published as part of a regular, monthly series in Health Affairs called Leading to Health, focused on efforts to transform local health systems. In these stories, I looked at four local efforts to provide health care and health-supporting services in new ways that improve the wellbeing and health of people whose needs are often ignored or poorly served.
The first stories, told in two parts, looked at the community-based mental health system of Trieste, Italy, widely considered the best urban mental health delivery system in the world, and the decision by Los Angeles to emulate the program. Part one, “The Old Asylum is Gone,” reported from Trieste, looked at the history of the mental health revolution there, telling the story of the abolition of an infamous asylum and creation of a new system, and exploring how it now operates.
Part 2, “A New Approach to Mental Health Care, Imported from Abroad,” looked at the massive problem of homelessness and mental illness in Hollywood and Los Angeles, the inadequacy of the county’s current mental health system, and the decision to create a new system based on the Trieste model.
The third story, “Community Workers Lend Human Connection To COVID-19 Response,” looked at the power of lay people serving the communities they come from. It focused on the pioneering system of hiring, training and deploying Community Health Workers developed by the IMPaCT program at the University of Pennsylvania, and the evaluations of the program that have followed. It also looked at how people like community health worker Claude Clements of Southwest Philadelphia provided a lifeline to the people of South Philadelphia, helping them cope with the loss, fear and trauma they faced during the pandemic. The story explored the call for the creation of a large Community Health Corps, a proposal that now features in President Biden’s recovery plans.
The final article, “Forged By AIDS, Storied NYC Residence Boosts Aging In Place,” tells the little-known story of Manhattan Plaza, the massive New York City apartment complex that opened near Times Square in the late 1970s as a home for performing artists and soon became the place where more people died of AIDS than any residential building in the country. Led by an enlightened manager who was also a gay Episcopal priest and deeply committed residents, the building became a model for how a community can come together and care for its own. It has continued to do so as the building’s population has aged, becoming a naturally occurring retirement community, or NORC, where people can age in place and die in their own apartments. The story also looked at the first NORC in the country, the 2,820-unit Penn South complex in Chelsea, a mile to the south. The building pioneered the creation of services that older residents need, and the story examined the mounting evidence that these forms of housing-with-services can help older people avoid nursing homes and hospitals.