JUDY WOODRUFF: Now, can a midsize city rebuild itself in such a way that it promotes healthier living at a time of economic distress? That question is very much on the minds of citizens on one Texas community.
NewsHour health correspondent Betty Ann Bowser has the story.
BETTY ANN BOWSER: Galveston Island, Texas, is one of those American coastal cities that gets clobbered by hurricanes. In fact, there have been 11 in a little over 100 years.
The last big one, Hurricane Ike, hit in 2008. And three years later, you don't have to look very far to see the havoc it created. So, once again, Galveston is rebuilding, but this time around, some residents want to do it in a way no city has tried before. They want to make Galveston a healthier place to live.
Longtime resident Betty Massey is the current head of the island's rebuilding committee. In the days after Ike, she said she had an ‘aha' moment.
BETTY MASSEY, Recovery Committee: It wasn't good enough to just go back the way we were. That wasn't -- that wasn't what we wanted to do. We wanted to have some vision for our community.
BETTY ANN BOWSER: Massey's vision is a city that builds structures that encourage exercise and make it easier for residents to get healthy food.
Those lofty goals have been endorsed by the Centers for Disease Control, the Institute of Medicine, and a growing body of evidence that shows things like bike paths, sidewalks and grocery stores can make a difference in health outcomes.
Some island residents think all that's just a bunch of talk, but not Betty Massey.
BETTY MASSEY: It's no more pie in the sky to rebuild a community with a healthier infrastructure than it is the hardscape. It's no more pie in the sky to do that than it is for a town like Galveston to build higher, to stronger wind codes, to more wind- and flood-resistant buildings. Let's build a community that is also more resilient, more sustainable.
BETTY ANN BOWSER: Lexi Nolen is director of the Center to Eliminate Health Disparities at the University of Texas Medical Branch in Galveston.
JOHN PROCHASKA, University of Texas Medical Branch: Well, what this map outlines is every place that you can buy food on the island, so restaurants, even bars.
BETTY ANN BOWSER: She and her colleagues are using a computer-generated mapping system to identify unhealthy areas of the city.
LEXI NOLEN, University of Texas Medical Branch: We have identified a number of indicators that are related to community health. What is it in a neighborhood that helps to make that community healthier or less healthy?
One indicator, for instance, is access to healthy foods. We know that when people have access to nutritious foods, affordable foods, that they tend to have better diets.
BETTY ANN BOWSER: Nolen has spent a lot of time focusing on neighborhoods like this one and what she thinks it needs.
LEXI NOLEN: A park for kids, a recreation center, a senior center, elderly adults need a place to come together, congregate, have fun, stay physically active. We need places where people have opportunities to work. Economic development is a critical component of creating a healthy neighborhood.
BETTY ANN BOWSER: One of the island's business leaders has no problem with building healthy neighborhoods, but Jeff Sjostrom, who runs Galveston's Economic Development Partnership, says a lot of businesspeople are concerned about where they fit into the picture.
JEFF SJOSTROM, Galveston Economic Development Partnership: I think businesses in general are concerned about the overall economy, period. There are a lot of challenges that we have confronted as a community over the last two or three years, from natural disasters and hurricanes. So at the end of the day, everybody wants to know: Where's the money? Who's going to pay for it? Who's going to be responsible for it?
BETTY ANN BOWSER: In parts of the country where community leaders have brought grocery stores into food desert areas, they have relied on millions of dollars from public/private partnerships to lure food companies into neighborhoods.
In Galveston, no such partnerships exist, and there is no funding to even develop a plan for grocery stores or transportation upgrades. And there are other problems. Texas A&M Marine scientist Sam Brody, who's studied barrier islands like Galveston, says the sandbar the city sits on is constantly moving, and with its vulnerability to hurricanes, all this rebuilding with health in mind could be washed away the next time a major storm comes through.
SAM BRODY, Texas A&M University: But a barrier island is a moving target. So think about trying to develop a sustainable, resilient community for generations on a moving target. That's extremely difficult to do. And then with -- throw in politics, economics, the national economy, and some very important strategic and historic assets the island holds, you create a storm of its own.
BETTY ANN BOWSER: But some residents say, no matter how difficult, change must come. In some neighborhoods, there are no supermarkets, only mom-and-pop convenience stores that sell junk food and liquor at inflated prices.
Earl Williams lives in one of these areas. He's spent all 44 years of his life here. And even though he loves it, he admits living here is tough. For a loaf of bread, Williams can walk to the corner convenience store, but getting fresh groceries? That's something else. Since the Williams do not have a car and there are no direct bus lines, we volunteered to pay for a cab and asked to follow along on the six-and-a-half mile drive to the nearest grocery store.
EARL WILLIAMS, resident of Galveston, Texas: My cab fare is normally around -- it's close to around $15 total. That's one way, going there, and then $15 coming back. So every time I go, that's $30 that I'm spending on a cab just to go and get food for the house. And that's not including putting food up and all of that stuff.
So if we leave in the morning time at 9:00, we would get back home probably around 2:30 or 3:00 p.m., something like that. It takes up half the day.
BETTY ANN BOWSER: By the time all of that's done, Williams' food allowance is shot. So he would be thrilled to see a new grocery store close by.
EARL WILLIAMS: Oh, I would love that. I would love it. Then I wouldn't have to spend -- I wouldn't -- instead of spending money on cabs, I could buy more food.
BETTY ANN BOWSER: Nurse practitioner Kate Fiandt thinks access to a good grocery store would go a long way to improving the health of her patients at a health clinic funded by the university in a low-income area.
KATE FIANDT, UTMB School of Nursing: They are working poor with major health problems, diabetes -- 30-plus percent are diabetic; 50 percent have hypertension, very chronic, very -- very ill, the sickest population I have ever seen in primary care.
If we can invest money in keeping these people healthier, not healthy necessarily, but healthier, better lifestyles, more active, better control of their diabetes, less likely to get diabetes, better control of their blood pressure, then they are not going to become more ill. So, just on a very pragmatic level, it's a -- you get a return on your investment
BETTY ANN BOWSER: Economist and school board member Norman Pappous isn't so sure about that. He sees significant obstacles to making people healthier, especially in low-income areas.
NORMAN PAPPOUS, economist: I think they are barking up the wrong tree. When they basically want to come in and create a utopia on a few square blocks of downtown Galveston, that is something that they are hoping is going to work, and they are using our tax money to do it. I think there is a high probability it's wasted money....
BETTY ANN BOWSER: And Pappous has even more doubts about current plans to build mixed-income housing on the same lots where public housing once stood before Ike.
NORMAN PAPPOUS: They are not areas of high opportunity and they are areas of heavy concentration of unemployment and poverty.
BETTY ANN BOWSER: UTMB's Lexi Nolen knows there are big challenges ahead, as she tries to convince city leaders to adopt a new mind-set about rebuilding.
LEXI NOLEN: What we are asking is that they look into what the health implications of their decisions are and take that into account when they make a decision.
It's reasonable to say that health is not -- a health decision is not going to win the day every single time. There are lots of other reasons why we make the decisions that we do. Sometimes, they are economic. Sometimes, they are political. But what we do expect is that that information be considered in the mix.
BETTY ANN BOWSER: What eventually happens here will be determined by a number of different government agencies, with the Galveston City Council ultimately calling most of the shots. But however it turns out, health policy people will be watching. No city has ever tried such big ideas before.