Dying and Living in the Neighborhood: A Street-Level View of America's Healthcare Promise

by Prabhjot Singh

Overview

Have neighborhoods been left out of the seismic healthcare reform efforts to connect struggling Americans with the help they need?

Even as US spending on healthcare skyrockets, impoverished Americans continue to fall ill and die of preventable conditions. Although the majority of health outcomes are shaped by non-medical factors, public and private healthcare reform efforts have largely ignored the complex local circumstances that make it difficult for struggling men, women, and children to live healthier lives. In Dying and Living in the Neighborhood, Dr. Prabhjot Singh argues that we must look beyond the walls of the hospital and into the neighborhoods where patients live and die to address the troubling rise in chronic disease.

Building on his training as a physician in Harlem, Dr. Singh draws from research in sociology and economics to look at how our healthcare systems are designed and how the development of technologies like the Internet enable us to rethink strategies for assembling healthier neighborhoods. In part I, Singh presents the story of Ray, a patient whose death illuminated how he had lived, his neighborhood context, and the forces that accelerated his decline. In part II, Singh introduces nationally recognized pioneers who are acting on the local level to build critical components of a neighborhood-based health system. In the process, he encounters a movement of people and organizations with similar visions of a porous, neighborhood-embedded healthcare system. Finally, in part III he explores how civic technologies may help forge a new set of relationships among healthcare, public health, and community development.

Every rising public health leader, frontline clinician, and policymaker in the country should read this book to better understand how they can contribute to a more integrated and supportive healthcare system.

Product Details

ISBN-13:	9781421420448
Publisher:	Johns Hopkins University Press
Publication date:	09/15/2016
Edition description:	New Edition
Pages:	312
Product dimensions:	6.30(w) x 8.90(h) x 1.00(d)
Age Range:	18 Years

About the Author

Prabhjot Singh, MD, PHD, is the director of the Arnhold Institute for Global Health and chairman of the Department of Health System Design & Global Health at the Mount Sinai Health System. He is also the special advisor for design and strategy for the Peterson Center on Healthcare.

Table of Contents

Preface
Introduction
Part I
Chapter 1: Out of Many, One
Chapter 2: Heads in Beds
Chapter 3: Mending Wall
Chapter 4: Contexts of Consequence
Part II
Chapter 5: The Value of Being Connected
Chapter 6: Blessed are the Organized
Chapter 7: Coach Culture
Chapter 8: The Center Cannot Hold
Part III
Chapter 9: From Organizations to Integrators
Chapter 10: SCALE at the Speed of Relationships
Chapter 11: Total Population Health
Chapter 12: Laying the Groundwork
Acknowledgements
Index

What People are Saying About This

Risa Lavizzo-Mourey

As a physician and resident of Harlem, Prabhjot Singh understands that good health has more to do with what happens in neighborhoods than in health care institutions. In Dying and Living in the Neighborhood, Dr. Singh exposes the realities and explores the solutions in an engaging, scholarly, and personal narrative.

Ashish K. Jha

A remarkable book that bridges public health and healthcare, bringing lessons of global health to the streets of New York City. Singh is the scholar we need: data-driven, practical, but ultimately impatient. He is changing healthcare one clinic, one hospital, one neighborhood, and one city at a time.

Don Berwick

Dr. Singh weaves stories of history, policy, and economics, into a rich tapestry that provides both an incisive commentary on the challenges of health economics and public policy and a poignant glimpse of the impact on the lives of real people. An important read for anyone working to transform health care and create healthy communities.

Stuart M. Butler

This brilliant and sweeping book is a rich source of insights. Prabhjot Singh draws on extensive travel, interviews and research to rightly argue that policies and business models need to be adjusted to empower neighborhoods as partners for better community health. He is one of that small, but growing, band of physicians and policymakers who recognize that better health is much more than healthcare.

Yasmin Sultana Meah

In this sorely needed book, Singh takes a supremely unique approach, imbuing the subject of population health with a personal story to convincingly argue that healthcare needs to build from the community out to the medical sector rather than from the hospital in. Anyone in healthcare will want to read this essential book. An incredible and absolutely riveting read.

Olympia Snowe

At this time of health care transformation, Dr. Singh champions an innovative vision for a more integrated, community-centered approach to wellness.Drawing on real-world cases and experiences, he weaves a thought-provoking narrative of how the power of collaboration across multiple spheres can build a healthier America for everyone.

From the Publisher

A path-breaking book sure to redirect inquiry in the United States on how to repair our broken health care system. While economists and politicians have suggested countless ways to tinker with the overpriced and underperforming system, Singh offers a much deeper, nuanced, and humane diagnosis of the problems. This book will stir major new thinking and creative approaches towards a more effective and decent U.S. health care system.
—Jeffrey D. Sachs, bestselling author and Director, The Earth Institute, Columbia University

In this sorely needed book, Singh takes a supremely unique approach, imbuing the subject of population health with a personal story to convincingly argue that healthcare needs to build from the community out to the medical sector rather than from the hospital in. Anyone in healthcare will want to read this essential book. An incredible and absolutely riveting read.
—Yasmin Sultana Meah, MD, Icahn School of Medicine at Mount Sinai

In many nations with few resources, models linking health services to communities are well developed. Except for scattered examples, the US system is largely disconnected from neighborhoods and their problems. With penetrating analysis and compelling storytelling, Prabhjot Singh calls for connecting our system to people and their neighborhoods, almost quite literally turning it on its head.
—Drew Altman, CEO, The Henry J. Kaiser Family Foundation

As a physician and resident of Harlem, Prabhjot Singh understands that good health has more to do with what happens in neighborhoods than in health care institutions. In Dying and Living in the Neighborhood, Dr. Singh exposes the realities and explores the solutions in an engaging, scholarly, and personal narrative.
—Risa Lavizzo-Mourey, President and CEO, Robert Wood Johnson Foundation

Singh’s novel and compelling look at what really causes disease is a must-read for new physicians looking to understand sources of power and ways to leverage it in today’s paradoxical health care system.
—Elizabeth H. Bradley, Yale University, coauthor of The American Healthcare Paradox: Why Spending More Is Getting Us Less

This brilliant and sweeping book is a rich source of insights. Prabhjot Singh draws on extensive travel, interviews and research to rightly argue that policies and business models need to be adjusted to empower neighborhoods as partners for better community health. He is one of that small, but growing, band of physicians and policymakers who recognize that better health is much more than healthcare.
—Stuart M. Butler, Senior Fellow, The Brookings Institution

Unafraid of complexity, Singh persuasively argues that nothing less than health care designed by the communities it is intended to serve will set us on a path towards true population health. It is a tour de force, and left me feeling more optimistic!
—Diane Meier, MD, Director, Center to Advance Palliative Care (CAPC)

A remarkable book that bridges public health and healthcare, bringing lessons of global health to the streets of New York City. Singh is the scholar we need: data-driven, practical, but ultimately impatient. He is changing healthcare one clinic, one hospital, one neighborhood, and one city at a time.
—Ashish K. Jha, Director, Harvard Global Health Institute

At this time of health care transformation, Dr. Singh champions an innovative vision for a more integrated, community-centered approach to wellness. Drawing on real-world cases and experiences, he weaves a thought-provoking narrative of how the power of collaboration across multiple spheres can build a healthier America for everyone.
—Olympia Snowe, former Senator from Maine

Dr. Singh weaves stories of history, policy, and economics, into a rich tapestry that provides both an incisive commentary on the challenges of health economics and public policy and a poignant glimpse of the impact on the lives of real people.  An important read for anyone working to transform health care and create healthy communities.
—Don Berwick, former Administrator of the Centers for Medicare and Medicaid Services

Elizabeth H. Bradley

Singh’s novel and compelling look at what really causes disease is a must-read for new physicians looking to understand sources of power and ways to leverage it in today’s paradoxical health care system.

Jeffrey D. Sachs

A path-breaking book sure to redirect inquiry in the United States on how to repair our broken health care system. While economists and politicians have suggested countless ways to tinker with the overpriced and underperforming system, Singh offers a much deeper, nuanced, and humane diagnosis of the problems. This book will stir major new thinking and creative approaches towards a more effective and decent U.S. health care system.

Diane Meier

Unafraid of complexity, Singh persuasively argues that nothing less than health care designed by the communities it is intended to serve will set us on a path towards true population health.It is a tour de force, and left me feeling more optimistic!

Drew Altman

In many nations with few resources, models linking health services to communities are well developed. Except for scattered examples, the US system is largely disconnected from neighborhoods and their problems. With penetrating analysis and compelling storytelling, Prabhjot Singh calls for connecting our system to people and their neighborhoods, almost quite literally turning it on its head.

Editorial Reviews

. . . Singh's thesis merits discussion for anyone interested in curing a sick health care system.
—Kirkus Reviews

As Singh pulls together the moving pieces—the neighborhood, the health care sector, community organizations, and government—into a vision of how to “integrate the whole,” it seems feasible that anchoring our health to our neighborhood will bring the kind of well-being, humanity, and equity that we can afford, and that we deserve.
—Health Affairs

From the Publisher

As Singh pulls together the moving pieces—the neighborhood, the health care sector, community organizations, and government—into a vision of how to “integrate the whole,” it seems feasible that anchoring our health to our neighborhood will bring the kind of well-being, humanity, and equity that we can afford, and that we deserve.

Health Affairs

08/01/2016
As a physician and resident of Harlem, NY, Singh (director, Arnhold Inst. for Global Health, Mount Sinai Health Syst.) is uniquely positioned to offer this discussion of how "total population health" might be achieved. The author describes a process that works from the bottom up, as when in his own community he and a colleague conducted one-on-one interviews with residents in an attempt to understand how they see their own health issues and needs. That information is vital but lacking. Singh suggests that neighborhood organizations as divergent as church congregations, apartment co-ops, and store owners would all have to begin to work together and communicate effectively to see how each can have an impact on community well-being. Large entities such as the Mount Sinai Medical System would in turn learn to listen to and work with their neighbors. Such changes would require refocusing goals and redefining financial efficiency and success. Numerous organizations and individuals who are making a start in the direction Singh proposes are cited, and the difficulties made clear. VERDICT While requiring a fair amount of work to keep track of the acronyms and names, Singh's treatise offers concrete ideas for community health professionals at all levels to discuss.—Richard Maxwell, Porter Adventist Hosp. Lib., Denver

Library Journal

2016-06-30
A well-intended but imperfectly constructed argument for community-based health care by a physician-turned–medical activist.The Affordable Care Act of 2010, or Obamacare in shorthand, is a frequent target for the corporate right, offended at the thought that medicine should not be the profit center that, say, oil and copper afford. It is less often criticized by the left, which lends Singh’s (Arnhold Global Health Center, Mount Sinai) critique an interesting cry-in-the-wilderness quality. The author works from a by-now-quaint notion that the physician is the advocate for the patient and, more, that a doctor is a kind of “natural attorney for the poor.” In this advocacy, the physician must leverage existing networks not of insurers but of friends, neighbors, and family. Obesity, for instance, is a widespread problem everywhere in the United States but especially in poor neighborhoods, where nutrition is indifferent and healthy food not easily accessible. In such an instance, promoting good health practices to any effective measure involves remaking the community as much as the individual. Singh’s arguments against a health care regime “imbalanced in favor of technocrats and captains of industry” are very well-placed, as is his critique of ACA for, among other things, not including communities in health care planning or considering the neighborhood as a natural political unit; no one is better positioned to advance these arguments. Yet he is long in the diagnosis and short in the healing. While he states in many ways the basic notion that neighborhoods need to be engaged in health care, that community-based medicine needs to be made a priority, he is less cogent in advancing specific ways in which we can move toward “total population health,” as one of his chapter titles puts it, and shift medicine away from its current corporatized model. Repetitive, somewhat circular pleading weakens the case, but Singh’s thesis merits discussion for anyone interested in curing a sick health care system.

Kirkus Reviews