Public Health Advances

finding public health in unexpected places

Shrinking Santa Monica

In Measure LV, Santa Monica voters will decide whether to sharply restrict the height of future buildings. While the supporters of LV are coy about it, there is no way to vertically shrink Santa Monica without building fewer homes. And that has costs.


Read Center for Health Advancement Co-Director Dr. Zimmerman’s recent guest post in the Santa Monica Daily Press.

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Trump’s Missing Tax Dollars Are a Missed Opportunity

Trump took a loss of $916 million dollars in 1995: this we know. He may have avoided paying income tax for the next 18 years: this we suspect. Pundits are focused on what Trump did or didn’t pay, took or didn’t take, gave or didn’t give. I want to know: where might his tax money have gone?


At the Center for Health Advancement at UCLA, which I co-direct with Dr. Jonathan Fielding, we look at how to make tax dollars work harder. We use economic modeling to estimate the human impact on health, education, and crime of various programs and policies that have been shown in rigorous academic studies to actually work. When I hear about nearly a billion dollars gone missing from the US Treasury, I know what could have been done with that money.


Start with Philadelphia, where decades of economic misfortune in many parts of the city have made it impossible to adequately maintain an aging housing stock, and where, partly as a result, one in every four children has asthma. A one-time investment of $81 million dollars would allow the City’s Public Health Department to expand its successful home remediation to homes of all 40,000 children in the city with asthma. The program deals with physical problems like mold or ancient carpeting and trains kids and parents to better manage their asthma. Extending this program to all children with asthma would prevent an estimated 80,000 trips to emergency department and 19,000 hospitalizations. And because asthma is one of the main impediments to school attendance, this program would prevent 342,000 missed school-days every year.


In San Antonio, Trump’s missing taxes could have fully funded an innovative program that makes physical education fun. This program provides rock-climbing equipment and a movable climbing wall, yoga instruction, Frisbee golf, scarf-juggling, and other creative and engaging ways to teach kids about keeping their bodies active. It also trains PE teachers and others to ensure that kids really get something out of their time. Had $44 million of Trump’s taxes gone here, the investment could expand this program to all K-5 public-school students in Bexar county for 18 years. Nearly a million children would experience a new PE, and the benefits would be enormous. Over the ensuing 25 years, the program would prevent over 2,000 cases of diabetes and over 3,000 cases of heart disease. An estimated 258 lives would be saved as a result of this investment. Even more surprising, because getting kids’ blood moving is good for their brains, the program would also increase test scores, by about 11% for reading and 12% for math.


Another great use of Trump’s missing tax dollars would be functional family therapy, a program that works with juvenile offenders and their families to improve relationships and help overcome adolescent behavior problems. Delivering this proven intervention to all juvenile offenders in Houston for 18 years would cost an estimated $70 million, and would not only prevent an over 10,000 crimes, but would also help turn life around for these kids. We’ve estimated that this program would, over 18 years, prevent 3,762 kids from becoming addicted to drugs or alcohol, and would help 774 to graduate from high school when they otherwise would not.


Another program Trump’s dollars might have supported would have an even greater impact on education, albeit at greater cost. The high-school mentoring program called Talent Search could be offered to all of the roughly 90,000 students in tenth grade in the Los Angeles Unified School District for two years for a cost of $630 million. This program has been proven to raise the rates of high-school graduation by 11 percentage points, about half of what’s required to bring the District up to 100% graduation.


Together, all these investments together would cost just $826 million—10% less than Trump’s missing taxes. They would, if implemented, bring in $4.7 billion dollars in net new tax revenue or reduced expenses for incarceration and income-support, for a government return on investment of $4.7 for every $1 spent. Trump’s missing tax dollars wouldn’t simply help American’s health and well-being, they would make the U.S. money. This makes paying taxes smart.


There is no direct connection from Trump’s tax avoidance to the starvation of public programs. If the Treasury had taken in an extra $50 million every year, Congress might not have chosen to spend an extra $50 million each year. Yet ultimately, the numbers do have to add up. And although the causality is not direct, there is benefit to dwelling on the $916 million that Trump did not pay and the 258 lives that were not saved, the 9,882 crimes that were not prevented, and the 20,000 high-schoolers who did not graduate.


When Donald Trump says that he is just being smart by avoiding income taxes, he is thinking only of his business, and only of himself. This makes him greedy, but it also makes him, from the perspective of the American collective, a terrible investor.


All told, Trump’s missing millions don’t only include the dollars he didn’t direct to the U.S. Treasury, but the millions of children he didn’t aid, health problems he didn’t help solve, adolescents he didn’t work to keep out of prison, schools he didn’t keep open, and families he didn’t nurture. Think of his missing dollars as millions of lost opportunities.

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CHA Director Dr. Fielding on Lowering Prices for Lifesaving Drugs

Center for Health Advancement Director, Dr. Jonathan Fielding, addresses the exorbitant increase in drug prices and suggests several solutions in a recent U.S. News & World Report. Americans pay more for common medicines than most other countries, forcing millions of U.S. consumers to forego filling a doctor’s prescription or to lower their dosage to make the medicine last longer. Failure to take a prescribed medicine or reducing the amount costs $300 billion in extra medical expenses and contributes to 125,000 deaths a year. Read on for Dr. Fielding’s common-sense fixes to make drugs affordable.

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Nothing Stops a Bullet Like a Job

The short-term benefit is money in their pockets. The long-term benefits are improved educational, employment and health outcomes and reduced drug/alcohol use, arrest rates for violent crime and incarceration. Summer jobs for youth do more than save kids from boredom during their time off from school.


After generally trending downward since 1989, the labor force participation rate for youth started to climb a bit in 2010 and has since been around about 60%. Despite recent increases in the number of summer jobs for young adults, the demand is still higher than the supply.. This past February, the Department of Labor announced $20 million in grants to expand the summer jobs programs into career pathways for youth. These efforts build on other programs meant for low-income at-risk youth, such as the My Brother’s Keeper initiative.


There are a number of summer jobs programs around the country, including in such cities as Chicago, New York City and Los Angeles. Programs are also available in rural areas as well, such as in Minnesota. These programs target youth between ages 14 to 24 years. Youth in L.A. are provided with work experience for 6 weeks, paid $10.50 an hour and work approximately a total of 120 hours (20 hours a week). The employers pay the teens their salary, but they are reimbursed with federal and state funding. But, summer job programs provide much more than a paycheck, especially for low-income, at-risk teens, who can benefit from the program in a myriad of ways.


The National Bureau of Economic Research researched the outcomes associated with the New York City Summer Youth Employment Program, which is the largest employment program in the country. The researchers looked at three years of program participant data, tax records, incarceration data and death records. They found that program participation results in increases in average earnings and the probability of employment in the year of program participation. Participation also decreased the probability of incarceration by a 10 percent reduction relative to the baseline incarceration rate and decreased the probability of mortality by a 20 percent reduction relative to the baseline mortality rate. That’s impressive for a relatively inexpensive program!


In Chicago, a randomized control trial from 2014 found that participation in a program called One Summer Plus reduced violent crime arrests by 43% over a 16-month period compared to the control group. Participants were high school students from disadvantaged neighborhoods in Chicago, worked for 8 weeks for 25 hours a week and were paid minimum wage of $8.25 per hour. The youth were assigned job mentors (about 10 mentees per mentor). Half the participants worked 15-hour weeks and received 10 hours of social-emotional learning. However, interestingly, there was not a difference between the group that received the therapy and those that didn’t, suggesting that students working longer hours also acquired some of the same social-emotional skills on the job or that the therapy was ineffective. However, we know from our own analysis that cognitive behavioral therapy for juveniles, which this study based its therapy off of, helps to reduce arrests. Regardless, the program had a lasting impact, reducing arrests for violent crimes even up to a year after the program ended. A notable theory from their findings was that prevention of violence, by offering summer jobs while teens were still in school, rather than remediation, when they’re already out of school and struggling in the labor market, can improve outcomes more effectively, with less intensive treatment.


These programs can also help with outcomes that are more difficult to quantify, but are still important, such as building self-confidence, communication skills to interact with strangers, and learning which aspects of a job they like and dislike to inform a future career.


Despite the many benefits, the documentation required for such programs can be enough to cause some teens to give up before they start. Especially for the most at-need ones, who may lack home stability and the support necessary to help locate and obtain their social security card, working papers, proof of family income and other necessary documents. If the summer jobs programs can work with these particular youth, the employment programs would be likely to reach a targeted niche of the most at-risk kids.


The summer youth employment programs that target at-risk kids not only helps them and their families financially, but extends beyond that to prevent arrests and improve educational and health outcomes. It’s one of those ‘Win-Win’ interventions that have benefits for multiple sectors and stakeholders.

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Using College Food Waste to Feed Food Insecure Students

Approximately 19% of University of California students go hungry at times due to limited resources and an additional 23% lack steady access to a variety of quality, nutritious food. Yet, college campuses are one of the biggest food wasters. College campuses throw away about 22 million pounds of uneaten food each year. That’s a lost opportunity to feed students that are food-insecure.


Food insecurity is not typically associated with college students, but with increased tuition and living costs, many students struggle to get by as they work toward a better future for themselves. About one in ten California State University college students are homeless and more than double that do not have a consistent source of nutritious food.


Food waste is a massive problem. Half of all food produce in America is thrown away because it doesn’t meet our standards of perfection. We want to see only blemish-free vegetables and fruits, but that’s not the way food naturally grows. Food also gets thrown away because it’s uneaten and our standards don’t allow food to be saved for the next day. Cafeterias especially struggle because they have to prepare enough food to feed everyone, but they can’t always predict the exact number of students that will stop in.


There are a number of organizations that work to connect unused food to the people that need it to help decrease food waste and malnutrition. Imperfect, a service delivery start-up, provides customers with deeply discounted “ugly” produce that would otherwise be thrown away. A small box of 10-14 pounds of produce costs $12. The EatBy app helps households reduce their own waste and claims to save families an average of $700 a year. Food Loss & Waste Protocol has a mission to develop an internationally accepted standard to quantify the amount of food removed from the food supply chain. With more accurate information, they hope entities can take steps to decrease food waste.


A number of California campuses also have programs to reduce the amount of discarded food scraps. The Food Recovery Network is a student-run movement against food waste at college campuses. Started at University of Maryland-College Park in 2011, it now has 191 chapters nationwide and has recovered 1,418,630 pounds of food. In response to the recognized need for food for some students, the UCLA Food Closet was started to provide students who are experiencing financial hardship with food. What started as leftover food from on-campus events has morphed into a pantry with donations from staff and other students. The program has received national news coverage and is inspiring other college campuses to create similar programs. Today, about 40-50 students visit the food closet each day to get food and toiletries, which they can do anonymously. Fresno State similarly developed a ‘cupboard’ that provides leftover food from catered events. A mobile app immediately notifies students when food is available.


An innovative idea to reduce food waste among college cafeterias is to go trayless and offer smaller plate sizes. Students often load up their trays with more food than they end up eating. The remaining food goes in the trash. Without a tray, they are less likely to get additional plates of food that they won’t eat. A number of universities have opted to go trayless to reduce food and water waste. One study found that trayless dining reduced food waste by 25% to 30% per person. Additionally, 288,288 gallons of water were conserved, which together saved an estimated annual amount of $57,000. Reducing food waste also saves costs for college campuses. A study estimated that it costs the campus $1.60 for every pound of food removal. Perhaps more important than cost, connecting students with edible food waste allows these students to have access to consistent meals. Access helps them worry less about where they’ll get their next meal from, and concentrate more on their studies. Additionally, better nutrition helps them concentrate in and outside the classroom, which is likely to improve their success rate in college.


When food is wasted in college cafeterias that serve the very people who might need it, it’s a no brainer to develop food closets and other similar initiatives.

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