By Neil Peirce
How do cities reduce and control -- before they get out of hand -- the challenges they know they'll be facing?
Prevention and invention are the magic words. And increasingly imaginative cities are finding keys, with a fascinating cross-section identified in recent studies by two New York City institutions: the Center for an Urban Future and New York University's Robert F. Wagner Graduate School of Public Service.
They report that Camden, N.J., for example, has come up with an inventive "hotspotting" program to cut down on the huge expenses and inefficiency of "super-utilizers" -- patients afflicted by substance abuse or mental and chronic illnesses who make repeated visits to overcrowd hospital emergency rooms and thus drive up costs.
The Camden Coalition of Healthcare Providers seeks out patients it initially encounters anywhere from emergency room gurneys to street corners to homeless shelters. Using outreach teams of social workers, medical assistants and nurse practitioners, it works to find temporary shelter, government assistance and a permanent medical home for each of the super-utilizers. With their hospital visits dropping dramatically, the prior pattern -- 13 percent of Camden's emergency room patients consuming 80 percent of the costs -- may well be on its way to resolution.
In Chicago public schools, foreign-born and low-income parents are being offered posts as teaching assistants in elementary classrooms -- a route to workforce experience even while they receive English-language training and a modest stipend. Building new community connections, the immigrants and other challenged parents also become acquainted with -- and can better support -- their children's school curriculum.
Another innovation opportunity: efficient housing. And across North America, as populations of the elderly increase, the approach once called "mother-in-law" or "granny flats" offers a promising opportunity to keep aging parents close to their families in cities and smart suburbs.
Compact apartments mark a 180-degree turn from zoning codes of the post-World War II suburban era that favored single-family homes and often made it literally illegal to recreate the intimate, mixed-use neighborhoods of earlier times. Adding extra units on home lots has often been opposed by neighbors complaining they'll bring renters or undesirable people into communities.
But increasingly, change is in the air. Seattle first piloted an "accessory dwelling unit" (ADU) policy in 1994 and now allows one- and two-family homes to build a separate self-contained residential structure, providing it's no larger than 800 square feet and covers no more than 40 percent of the rear yard. Vancouver has pushed even more aggressively, relaxing its building code to allow detached accessory dwelling units of up to 500 square feet, plus legalizing basement conversions.
The Center for an Urban Future suggests that Brooklyn, Queens and the other New York City boroughs outside of crowded Manhattan have vast inventories of single-home lots and would be excellent terrain for ADUs. The units could help accommodate the city's projected 600,000 added residents by 2030. And for New York's expanded numbers of the elderly, the compact new housing units could provide a welcome substitute for nursing homes -- letting elders transition to a "backyard cottage" beside their own or family member's home where they can safely "age in place."
The lesson is clear: Opportunities to think ahead, plan for more livable, humane, successful cities abound.
New York City, to its credit, has been at the forefront of advanced thinking under Mayor Michael Bloomberg's leadership. He created, within his own office, a Center for Economic Opportunity (CEO) that has hatched over 50 anti-poverty programs and initiatives. One major goal has been to give the working poor varieties of programs and support to help them move up the economic ladder. Another is to create opportunities for youth who are out of school and unemployed.
A prime example of CEO programming: a set of initiatives to help thousands of low-income New Yorkers avoid debt and unscrupulous payday lenders by accessing simple and safe banking products, to lower their debts and even start to build savings.
Other CEO-launched programs have helped low-income people advance in their jobs, find jobs after imprisonment, and graduate from community college while working or raising a family. The effectiveness of each program has been tested by random trials before the programs are transferred out of the mayor's office to regular line departments.
Bottom line: New York City still has serious poverty levels, but critics among those running to succeed Bloomberg will find it a challenge to devise more ingenious sets of preventive and curative measures. And my bet is that the city's systemized effort of to discover, launch and then test out new initiatives will start spreading across the United States -- and potentially worldwide.
Neal Peirce's email address is firstname.lastname@example.org.
(c) 2013, The Washington Post Writers Group