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In DC, access to medical care really depends on where you live

We know that emergency vehicles take longer to get to DC residents who live east of the Anacostia River, but how does where people live in DC affect their access to non-emergency medical care? Fewer clinics, pharmacies, and vaccine locations east of the Anacostia River means access to non-emergency medical care is more difficult there as well.


Photo by Jared Hansen on Flickr.

Health clinics

Let's say you come down with the flu. Your first stop may be a clinic. Since 2010 many urgent care clinics, like MedStar PromptCare, and retail clinics, like CVS Minute Clinic, have opened across DC. These walk-in clinics provide immediate care for injuries and illnesses that don't require an emergency room visit, such as your flu-like symptoms, but also infections, sprains, and minor wounds.


DC's eight wards. Image from the DC Office of Planning.

Retail clinics are staffed by nurses with a more limited range of services, while urgent care clinics have doctors who can provide more complex treatment, like stitches.

DC is split up geographically into eight wards, each of which has a representative on the DC Council.

No urgent care or retail clinics have opened in Wards 4 or 8 since 2010, and nearly 70% of all DC's clinics are in Wards 2 and 3.


All graphs by the author.

This gap is partially filled by community health centers. Community health centers receive federal funding to provide primary care to underserved populations. One such clinic, Unity Health Care, operates a community health centers in all wards except 2, 3, and 4, with varying degrees of walk-in services.

Pharmacies

Once you've been diagnosed by a clinic with the flu, your next trip is probably to the pharmacy. This may be more difficult east of the Anacostia; Wards 7 and 8 have the fewest pharmacies of any ward. Combined, they have a total of 18 pharmacies. This is less than Wards 2, 3, and 6 individually, and equal to the number of pharmacies in Ward 1.

Places to get vaccines

Hopefully you won't get the flu at all because you thought ahead and received a flu shot—and you were able to actually get the shot. Vaccine locations are another area of disparate care across the District.

There are fewer vaccine locations east of the Anacostia, including both Wards 7 and 8, than any other individual Ward.

For this post, I got pharmacy locations through a FOIA request to the DC Department of Health; I didn't include pharmacies located in hospitals. Vaccine and clinic data came from the DC Open Data portal, as well as www.urgentcarelocations.com. I verified the data through internet searches and phone calls. You can find complete code for this on my github page.

Sustainability


A more accessible Anacostia Park would mean a healthier community

Anacostia Park is part more than 1,200 acres of parks and wetlands that sit along the Anacostia River. It's not in great shape, but there are people working to turn it around. If they succeed, residents are set to reap the health and social benefits that come with quality parks.


The waterfront trail running through Anacostia Park. All photos by the author unless otherwise noted.

Overshadowed by the Washington Monument on the National Mall, the Anacostia Waterfront, which the National Parks Service and District government manage together, is one of Washington's most undervalued landmarks.

Originally planned nearly 100 years ago, the waterfront was designed under the McMillan Plan to be a grand public park running along the river, featuring promenades, islands, and bathing lagoons.


Image from the Anacostia Waterfront Trust.

Over the ensuing century, however, Anacostia Park was neglected and underused. Despite all that it has to offer, Anacostia Park never achieved the kind of recognition from tourists or regular use from residents that places like Rock Creek and Meridian Hill do.

Part of the problem is that much of the park is bounded is by the Anacostia River on one side and a busy highway on the other, limiting access by public transportation and connection to the rest of the city.

Parks can help address public health issues in Anacostia

Communities east of the Anacostia River are plagued with elevated rates of asthma, diabetes, and heart disease, so much so that there's clearly an expanding the gulf between these underserved areas and the rest of the District. According to the city's most recent assessment, residents of Ward 8 have the highest rates of obesity and are the least likely to exercise of anyone in the city.

The health woes people in Anacostia face persist despite the fact that many people live within a mile of Anacostia Park or Waterfront Trail.


The Anacostia Waterfront trail has an aast and west branch along both sides of the river, and runs for a total of 15 miles.

There's proof that the active lifestyle parks encourage mean lower obesity rates and high blood pressure rates as well as fewer doctor's visits and fewer annual medical costs. Further benefits include lower levels of cholesterol and respiratory diseases, enhanced survival after a heart attack, faster recovery from surgery, fewer medical complaints, and reduced stress.

Recognizing what Anacostia Park can do for residents as well as how much it's been ignored, recent administrations—starting with Anthony Williams, who was in office from 1999 until 2007—have championed the park and waterfront, slowly shifting investment across the river. In the past decade, new playgrounds have gone up, and 15 miles of new trails have formed the nucleus of the Anacostia Waterfront Trail.

Both what's coming to the Waterfront and what's already there make for tremendous opportunity to serve community health needs in Wards 7 and 8.


Anacostia park lacks the public transportation options that other places have. This is the only bikeshare station located along the eastern branch of the Waterfront Trail.

New programing is a great tool for increasing park attendance. Last year, the National Park Service hosted the first annual Anacostia River Festival to promote "the history, ecology, and communities along its riverbanks." The inaugural event was an opportunity for the community and local politicians to come out in support of the Park and another is in the works for this upcoming spring.

Here's how DC can connect Anacostia Park to its community

For progress to continue, interest in Anacostia Park has to go beyond these periodic events and promising proposals. The easiest way to support active use is making sure people know about all that Anacostia Park has to offer.

According to the American Planning Association, for a park to increase physical activity it needs to be accessible, close to where people live, and have good lighting, toilets, and drinking water, and attractive scenery. Today, Anacostia Park has some of these things, but others are sorely lacking.


This is the south-eastern tip of Anacostia Park and Waterfront Trail, seen from across the river at Yards Park.

The first thing that would get more people using Anacostia Park would be creating convenient points of access. Creative infrastructure and programs could be replicated in Anacostia Park based on what other cities have used to successfully boost attendance and forge a connection with the community.

In Chicago, The Garfield Park Conservatory Alliance helped community members create a "Quality of Life Plan," identifying top issues facing the community in order to craft policies that the park to meet the most pressing needs. Since 2005, the initiative has facilitated coordination between local employers, provided employment for 84 local youth, and mobilized over 10,000 residents to support a number of projects.

In New York, a collaboration between the Prospect Park Alliance, the Brooklyn Botanic Garden, and the Brooklyn Academy of Science and the Environment (BASE) High School resulted in a curriculum based on the physical and educational resources of the Botanic Garden. Such a partnership could be replicated between the National Arboretum, Park Service, and City if the interest and collective will are demonstrated.

Fortunately, creating new ways to access the park and things to do once people are there does not require large sums of money because Anacostia Park doesn't need to be built or set aside. What it does demand, however, is public and private support as well as a willingness to incorporate the communities these changes are meant to benefit into the planning process.

To foster dialogue between the community and other stakeholders, The Anacostia Waterfront Trust has recently partnered with 13 other organizations to form the Anacostia Park and Community Collaborative.

While still taking shape, the APCC is designed to engage with nearby residents in order to promote active use and develop long term plans. Efforts like these can help ensure that the many projects and initiatives intended to help residents of the Anacostia Waterfront actually serve their purpose.

Other parks are blossoming nearby

Work is ongoing to create an additional 13 miles of trails connecting the park to other sites along the Waterfront, including the Kenilworth Aquatic Gardens, Yards Park, and the National Arboretum.

Another example of a Waterfront project that can do a lot for its community is the 11th Street Bridge Park. The project will include an education center, outdoor performance spaces, and urban agriculture, and when it's finished, it will be a link Wards 6, 7, and 8.


Image from the 11th Street Bridge Park design team.

Sustainability


People are healthier, wealthier, and happier when cars don't come first

It'd be pretty tough to read through everything on our list of the best planning books. But if you have 16 minutes, author Jeff Speck shares the basic arguments of his book Walkable City in this TED talk.

Speck's argument for walkable cities appeals to what just about everyone wants: more money, better health, and a cleaner environment.

In cities that require more driving, residents spend far more of their income on transportation. Physical inactivity, which suburban design encourages, has grave health consequences. And the farther away households are from cities, where it's easier to share resources, the more carbon dioxide they produce.

Speck acknowledges that it's hard to challenge people's established ways of life. But at the same time, there's good reason to think we'd all be happier if we didn't view car travel as the norm or spaced out living as what's best.

"I'd argue that the same thing that makes you sustainable gives you a higher quality of life," he says. "And that's living in a walkable neighborhood."

Bicycling


Bikeshare and better health go together

Besides having a useful mode of travel, Capital Bikeshare members report getting more exercise after joining, a survey found. But governments can do more to help low-income communities, where obesity is often greatest, take advantage of Capital Bikeshare.


Photo by DDOTDC on Flickr.

Graduate students at George Washington University conducted the survey in partnership with Capital Bikeshare officials from DC and Arlington. Officials released it and another general survey of CaBi members this morning. The GWU survey collected responses from 2,830 members and asked about their exercise before and after joining Capital Bikeshare.

Between the before and after time periods, members are more likely to exercise at least 3 hours a week. 53% said they got at least 3 hours a week of exercise before, which rose to 60% after. Also, more members (66%) report having very good or excellent health, compared to 59% at the time they joined.

Also, the report says, "Over 30 percent of respondents indicated they had lost weight since joining, 60 percent reported no change, and 6 percent reported weight gain."

However, most members are not particularly joining for health reasons, but for transportation reasons. The report says that 71% said "get around more easily, faster, shorter time" as a "very important" main reason for joining, versus only 27% saying the same for "exercise, fitness."

How can health benefits go to those who need them most?

Many communities with the greatest health challenges are not taking strong advantage of Capital Bikeshare. Almost 97% of respondents in the survey have a bachelor's degree or higher. Members are predominantly younger, less likely to be poor, and slightly more male than the general population.

Most significantly, only about 3% of respondents were African-American, versus about half of DC and a quarter of the region. Wards 7 and 8, which face obstacles of greater poverty, larger hills, and poor bicycle connections to the rest of the city, have only 0.8% and 0.4% of Capital Bikeshare members, respectively.

This is far from a new issue. Darren Buck wrote a graduate paper about how other North American bike sharing systems are reaching out to underrepresented groups. Today's GWU report suggests Capital Bikeshare pursue sponsorships from health insurance companies and state and local health agencies to fund outreach programs, do further studies on why some communities don't join Capital Bikeshare, and other research.

It would also be interesting to find out more about how the lower usage by lower-income and minority residents corresponds to factors, like geography, which nobody can control. In areas that already enjoy mixed-use growth, like Columbia Heights, are residents from underrepresented groups more likely to join Capital Bikeshare than elsewhere in the city? If so, that could point to ways to make the most impact on health in a shorter period of time and with fewer resources.

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