City of Medicine

? City of Medicine – It’s A Bug, Not A Feature.

Executive Summary

What is a “City of Medicine?”

Healthcare is big business. In the US, healthcare represents 8% of our economy. The only other industry that compares in size is the finance industry. And c’mon, the health insurance segment of the finance industry is really just a subsidiary of healthcare anyway. When you consider that Big Pharma rolls up into the manufacturing industry and CVS and Walgreens roll up into retail, the Healthcare Industrial Complex stands alone as this country’s biggest business.

Healthcare as a business has come to the rescue of many cities whose economies would otherwise be in despair. In some cases, healthcare is the sum and total of the city’s entire identity. The most recognizable buildings in their skylines proudly display the logos of local healthcare providers. But is this really a point of pride?

This post examines the phenomenon of the City of Medicine and asks whether we should be measuring this distinction with a different yardstick.

Is it a Bug or a Feature?

If you didn’t grow up in the technology field, you may not be familiar with this common debate theme.

When I first broke into tech, I worked for a company that made graphic arts systems. One of my first assignments was on a support hotline that the company established to help engineers in the field fix problems once they ran out of ideas how to fix the problems themselves.

Sometimes these were one-off failures of the equipment and the engineer would just replace a part. Other times the problems weren’t due to failure, they were part of the design. They’d happen consistently under certain situations and all the part replacements in the world couldn’t stop them from happening.

In those instances, my role was to work with the product designers to fix their design, come up with a retrofit and distribute the retrofit so those problems would cease. Field retrofits are an expensive proposition. No designer ever wanted to be responsible for one.

Inevitably we would get in a debate as to whether the problem was a bug, in which case it would be fixed, or an “undocumented feature,” in which case my response to the field engineer and customer was “sucks to be you.”

This debate could carry on to ludicrous lengths. I once actually had to argue that smoke coming out of a printer under certain conditions was a bug and not an undocumented feature. Eventually, I won.

But will I win in the City of Medicine debate?

Meanwhile in Agrarian and Industrial America

THE City of Medicine – Durham, NC

Durham has a special place in my heart. I got my undergraduate degree there and it’s where I am completing my health coach certification.

In my undergrad days, this building defined the mighty Durham skyline.

CCB City of Medicine

Central Carolina Bank (CCB) was an old Durham institution before SunTrust bought them out. CCB got its start in 1899 when heirs of the American Tobacco Company created the bank to serve that booming industry.

Tobacco was at the center of Durham’s economy well into the 1970s. But a perfect storm of tobacco industry diversification, consolidation and vilification soon drove the companies and jobs elsewhere. By the time I got to Durham, the tobacco legacy was on its dying breath (see what I did there?). The smell of tobacco on a warm day still filled the air but downtown Durham consisted of nothing more than abandoned tobacco warehouses and boarded-up storefronts.

Recently I went back to Durham for another phase of health coach training. Reminders of the tobacco industry legacy stood firm. Duke’s alumni organization is on the American Tobacco Campus. The Hollywood-famous Durham Bulls still celebrate the legacy of the Bull Durham brand of tobacco.

Bull Durham City of medicine

The warehouses are now chic-chic condos and upscale shopping malls. Downtown Durham is alive at night. In a town where haute cuisine used to mean a run to Del Taco is now an up-and-coming foodie destination.

And this building now dominates the Durham city skyline.

DCRI City of Medicine

The Duke Clinical Research Institute is part of Duke Health and as with all things “Duke” in Durham has another founder of American Tobacco, J. B. Duke, to thank for its existence. Just around the time I first hung my hat in Durham, Duke and Durham wisely cooperated to build a healthcare superpower as a strategy to prevent the city from becoming another dying southern town.

It worked. Durham’s population has more than doubled since 1980. 8% of its people work for Duke Health. 15% of its population works for the Healthcare Industrial Complex. Their combined payroll is $1.5 billion annually. Thanks to the very same people who flooded our health systems with cancer, emphysema and heart disease, the economy booms through the treatment of cancer, emphysema and heart disease.

Durham is now officially known as The City of Medicine. But I ask you…

Is It A Bug or a Feature?

A City of Medicine – Pittsburgh, PA

This sort of reversal of fortunes is not unique to Durham. Our nation’s chronic disease epidemic bailed out other cities as well.

Pittsburgh, Pennsylvania owes its initial fortunes to the industrial revolution. Pittsburgh is best known for its industrial age legacy in the steel industry. Other industries it dominated included aluminum, glass, ships, petroleum, food, computers, cars, electronics and sandwiches that include french fries in the bun. It was world headquarters to household names like Gulf Oil, Sunbeam, Rockwell, Westinghouse, PPG and of course, US Steel.

Pittsburgh’s economy was always larger and more diversified than Durham’s and this is evident in its skyline.

Pitt skyline city of medicine

Those buildings all carry the legacy of their industrial era past with names like PPG Place and Gulf Tower. But the tallest building in Pittsburgh is the US Steel tower.

In the 1980s, America’s spiraling deindustrialization led to massive corporate departures from Pittsburgh and devastating layoffs of both blue and white collar workers. Financially distressed US Steel sold its iconic skyscraper. Although they’re still a tenant, they’re not the largest tenant. And as is custom, naming rights went to the organization that occupied the most space. Now the building looks like this.

UPMC City of Medicine

UPMC stands for University of Pittsburgh Medical Center. UPMC is the largest employer in Pittsburgh with 48,000 employees. In total, healthcare represents 10% of the jobs in the greater Pittsburgh area. That’s more jobs than its revered steel industry ever had.

Thanks to its industrial past, Pittsburgh still has some of the worst air pollution in the country. Its home county, Allegheny, has the fifteenth highest cancer risk of all counties in the country. As it relates to other measures of good health, Pittsburgh’s population is pretty much on par with the rest of the US. That means it has the same chronic disease issues as the rest of the country.

On the bright side, Pittsburgh consistently ranks as one of the most liveable cities in the world. Sure, having more bars per capita than any other city in the US helps it with that ranking. But what also helps is this awesome access to quality healthcare and the high employment it provides. But I ask you…

Is It A Bug or a Feature?

City of Medicine – Hat, AL

I know, Medicine Hat, Alberta isn’t really relevant to this post. But it does have a cool skyline.

City of Medicine Hat

Besides, it’s in Canada.

What If Instead of Celebrating Cities of Medicine We Celebrated Cities of Health?

They’re out there. There are places in America with superior access to real and fresh food, that have walkable streets, myriads of non-car dependent transportation options, cultures of physical activity and environments that help people cope with stress. Like their City of Medicine counterparts, these towns also have great healthcare, healthcare that is both interventional AND preventative.

Lists of America’s Healthiest Cities abound. They all use different criteria but the usual suspects ride to the top. For the purposes of this post, I’ll use Sperling’s which seems to be the arbiter of America’s Best Places. Northern California, DC, Seattle and Salt Lake City consistently rise to the top of these lists.

Sadly, none of them make a big hoopla over it. Their mottos are never City of Health and their websites and marketing materials rarely brag about their status on the list. Instead, they focus on the industries that overtly drive their economies. Not surprisingly, America’s Cities of Health aren’t as deeply dependent on interventional healthcare as their path to prosperity.

If suddenly there was a pill that could wipe away all chronic disease in a single dose, the cities of medicine would be looking for their next opportunity to survive.

The cities of health would continue to thrive.

That magic pill doesn’t exist. The Healthcare Industrial Complex has no incentive to create it. The next closest thing is superior access to real and fresh food, walkable streets, myriads of non-car dependent transportation options, cultures of physical activity and environments that help people cope with stress.

So for one more time, I ask you, regarding the concept of the City of Medicine,

Is It A Bug or a Feature?

Call To Action

It took me two years to figure it out but I’ve learned that all blog posts should have a so-called Call to Action to motivate readers to do something. Usually, that call is intended to help out the author by buying a product or by spreading the word about how truly amazing he or she is.

This call to action is different. Instead of asking you to do something for me, I humbly request that you do something for you and your neighbors.

If you agree that our economy is more focused on healthcare than it is on health, set an intention to do something about it. Contact your local leaders and find out what they’re doing to make your town a city of health. Hold them accountable for decisions they make that don’t promote good health or that favor some other priority over personal health. This can be a safety issue. This can be a transportation issue. It’s amazing how many day-to-day operations affect the health of your town’s citizens. Your local government needs to design good health into its systems. Because retrofitting those systems to fix the bugs is expensive. Whereas designing it in is a feature.

2 thoughts on “? City of Medicine – It’s A Bug, Not A Feature.

  1. I unfortunately must unleash my political skepticism and cynicism. Pushing our civic leaders to spend money on improving health is like pushing them to support our public infrastructure like roads and bridges. If they did and were successful, too many people would be content and take life for granted. There would be no opportunity to ask for taxes or bond issues to improve the roads or protect the health of your children. Those things would just be part of standard operating procedure and not provide for crisis management, when essential services (healthcare or DOT) are no longer a choice.

    Take the Portland, OR public schools. They have known for several years that the lead content in the drinking water in 25% of the schools has had unacceptable lead content. They studied it and decided to stop monitoring for lead because the mitigation would impact budgetary priorities the administration thought would be more visible and favorable to the voting public. They kicked the ball down the road until it became a crisis for the next administration to fix and in the process, I am sure they will become heroes for providing a safer environment for the kids.

    Bottom line: Proactive attention to positive societal expectations, is against the best interest of politicians who only want to steal credit for fixing problems and mitigating crises. They have no incentive to prevent catastrophe. Problems that never emerge are opportunities lost.

    Sad but true.

  2. Yes. Sad but true. Only because too many people opt against paying attention, holding politicians accountable and, worst of all, voting.

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