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Dying and Living in the Neighborhood

, 312 pages

1 b&w illus

August 2016



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Dying and Living in the Neighborhood

A Street-Level View of America’s Healthcare Promise


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.

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.

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

"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."

"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."

"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."

"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."

"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."

"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."

"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!"

"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."

"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."

"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."

"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."

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