Archives for the month of: February, 2010

Recently I had the opportunity to interview center city expert Jamie Licko to glean her thoughts on the future of downtowns. Jamie is the founder and president of Denver based consulting firm Centro.

Jamie Licko

1. By all accounts there has been a resurgence of interest in downtowns as places to work, live and play? What sorts of factors are driving this?

I think there are a couple of trends driving this, one financial and one demographic. On the financial side, the recession was a wake up call to Americans that living big isn’t sustainable. Sprawl, big houses, big cars, big commutes… these things all costs big money. Center city living provides an alternative to this. If you live in or around downtown, you have access to amenities and resources that are extraordinary, but that can be reached on foot, by bike, by bus, by streetcar, by lightrail. It’s a more sustainable form of living, economically and in many other ways too. As we all learn to downsize and live within our means, city center life gives us a chance to still have all that we want and need, but in a more sustainable way.

The other trend is simply demographics. We now know that baby boomers are taking to downtown life… they like the active, social lifestyles that downtowns allow. To the Boomer generation, downtowns provide a social return to the past. There is activity and life and people on the streets. There is easy access to activities and goods. I think the other trend driving the downtown and urban neighborhood resurgence is the Millenial or Gen Y generation. They are nearly equal in number to the Boomers and they are ushering in a new way of thinking that is conducive to what downtowns offer. These individuals are global thinkers. They’ve been raised in a multi-cultural society and have had access to the world via technology since the day they were born. They think big and dream big. And they don’t follow the rules. They are creating their own ventures, dreaming their own dreams, starting companies and driving brands. Perhaps most importantly, they crave authenticity. This is a group that shuns, and will continue to, big box retail, sprawl, suburbia, and anything mass produced. They look for places that are real, and gritty, and have a story to tell. In our cities, only our downtowns and urban neighborhoods can truly serve these needs.

2. Despite the social and cultural amenities offered in many of our nations center cities, many residents in outlying suburban area seems reticent about venturing into urban core to enjoy its advantages. What sorts of misconception come into play here and how can they be overcome?

You know, I do a lot of research and surveys and forums as part of my work, and regardless of where you are working (big city or small town) there is always a group of people who say they will never come downtown voluntarily. And their reasons are very consistent: they see cities as dirty and crime-ridden and a parking nightmare. Their perception is that the hassles downtowns offer aren’t worth what’s there. And to be honest, these people rarely know what tremendous value our downtowns boast. So there are a couple thoughts I have to this question. First, there is always going to be a core group of people who will never be convinced of downtown’s value. For a variety of reasons, downtown just doesn’t offer what that group of folks needs and wants. And that’s okay. I, for example, love cities and downtowns and could never imagine living in suburbia. And many in suburbia feel the same about cities and downtowns. That part is sociological and perhaps psychological too. I think getting people to our cities means we have to tell the story of our downtowns. We have to invite people into our downtowns. We have to give them compelling reasons to come. We have to serve a variety of markets and make sure our downtowns are designed for people of all demographics. This is one place where I think downtown management organizations such as Business Improvement Districts (BIDs) have really excelled. While there are always lots of issues to address in a city, sometimes the biggest is perception. If you can use marketing, public relations and perhaps more than anything else special events to break down those perception barriers, it’s the first step to getting people there and overcoming those perceptions.

The second challenge is delivering on an experience once they arrive. Our cities need to be user friendly. They need extraordinary signage, accessible parking (and a friendly customer service experience), they need a strong visual landscape (flowers, trees, colorful banners and art) and they need a place people perceive as clean and safe (no litter, great lighting, etc.). You can’t change everybody’s mind, but if we want to change habits, we need to make a compelling case for them to come, and then we need to make them feel welcome once they arrive.

3. The Business Improvement District (BID) concept is a popular one among many downtown leaders? What sorts of advantages are there for cities in establishing a BID, particularly with their efforts to rebound amid tough economic times?

Well, in my response to the last question, I speak to the merits of a BID in their strength as a placemaking organization. BIDs have fundamentally changed our downtowns in that as somewhat of a microcosm of the city they can take downtown to the next level. Their autonomy and flexibility make them an extraordinary tool. Perhaps even more important is that because they are funded by downtown stakeholders who want to see a return on investment, they inherently unite disparate groups and ownership entities in an effort to work towards common goals. But I mentioned the BIDs flexibility and I think this is an important point. While BIDs really were created initially as clean, safe and marketing funding and management tools, increasingly they have ventured into the economic and community development realm. Many BIDs now have economic development and research arms within their organization, for example, that keep comprehensive tabs on downtown data (development, sales, vacancies, pedestrian traffic, etc.) and package that information as a powerful sales and incentive tool for helping development and business occur downtown. But BIDs are also venturing into retail development efforts too, offering programs to incentivize the growth of local, independent retail in the city core. Increasingly BIDs are just one arm of a multi-faceted downtown organization that has lots of tools and resources it can bring to bear. One area that is growing and is expected to grow is in the creation of community development corporations (CDCs) that can help facilitate development of otherwise difficult projects, both by acquiring land and property and by offering start up loans and incentives to small businesses.

4. Can you identify a few cities that are uniquely poised to create prosperous, sustainable urban cores over the next ten years? What are they doing differently from cities that are languishing?

I personally think all cities are going to have to rethink the way they do things to stay competitive in the next decade. We’ve come a long way in the last 10-20 years in making our cities cleaner, safer more welcoming places. But the emerging Millenial generation (and the generation behind it) are going to demand more. We need to be careful of gentrification, we need to make sure the local, indepedent businesses can afford to stay in our downtowns, we need to start integrating technology into everything we do (on this front, I think IBM’s Smart Cities initiative is critically important for all of us to get on board with) and we need to make sure we keep our cities “authentic” places. We need to guard against cities that offer the same chain stores on every corner. Our downtown leaders need to hold on to what is unique and real about the places they serve, and not veer from the path of sticking to authenticity. Cities who do these things, who invest in themselves and the things that make them real and unique, will succeed. You know who I actually think may become a leading community in doing things differently? Detroit. The city built on the automobile is in such dire straights that they are having to completely rethink how they do everything. I encourage you to read Time’s Detroit blog. They’ve purchased a houses in Detroit and have reporters living there telling some great stories. Not only are the people of Detroit looking at new ways to survive and thrive, but young people, smart young people, from all over the world are going there to try their hand at doing something out of the box in a place they can afford to do it. I think we need to keep on our eye on Detroit. I think we’ll see big things out of it. I’ve always believed that those places and people in the most dire of situations are the ones that end up being our leaders. They have to fight harder, and in that fight they generally have to find new and innovative ways to do things to succeed.

5. So what is the driving force behind your passion for cities? And what sort of contributions do you hope to offer to the  center city movement?

I grew up on an Iowa farm in a small town of 250 people. I was the sixth generation of my family to be born in this town. For six generations, my family had been involved in building a community they believed in. My earliest relatives were responsible for everything from platting the land, building bridges, running the post office and working for the railroad when it came through town. For a majority of the time I was growing up, my dad served as a council member and eventually as mayor. I was taught early to take pride in the “place” that I called home. I was taught to respect the land, and the environment and the amenities we were blessed to have. I was also taught that it takes lots of people working together, bringing to bear their unique talents, to make a place better. Without people and place, my childhood and my life today would be much different, I believe. The line between where I come from and where I am is not necessarily a straight one. My family rarely visited big cities when I was growing up and I never took great interest in them at a younger age. But somewhere along the line my belief in people and my passion in place led me to downtown. Perhaps its that I saw in a city’s downtown a microcosm of what I experienced growing up. Individuals, families trying to building something better, greater, different, unique and doing so in a way that respected the history of where the community began. I saw, in my downtown work, the power of uniting people. I traveled – the country and the world – and began to gain a tremendous appreciation of the city center as the space that defines a place. The Piazza San Marco in Venice is no different than Main Street in my small Iowa town. Both serve a need as gathering space, as the heart of the community, for the community they serve.

My hope and goal in this work is that we never forget this core purpose of our downtowns. That we never forgo the goal of creating authentic and gritty and real places that serve as the heart of the community. That we remember that building great places isn’t about bricks and concrete, it’s about people. Our cities are our heart and our history. If we want to hold onto this (and I feel that, perhaps more than ever, it’s critical that we as humans do) we must fight for it. And we must continue to grow and evolve to meet the needs of both young and old, men and women, people of all races. That means bringing people together, listening, working together and building accessible, meaningful and real places.

“Urban living is the most sustainable way to live.”

Andres Duany

In the wake of lower paying jobs and higher out-of-pocket expenses, sadly many of us are discovering that our lifestyle expectations are now unsustainable. I attribute this trend to an unprecedented structural shift in our nation’s core economic system—one that requires us to recalibrate our standard of living. With soaring energy costs, increasing fuel expenses, pricey real estate and environmental concerns taking hold, many people seek to capitalize on the advantages of dense urban living—high mobility areas that allow them to cut their living expenses by living and working in close proximity.

In light of these economic shifts we should take a hard look at the benefits of urban density in terms of creating a new model for cost-conscious living. A major catalyst for my thinking in this area comes from a report, which found that Bay Area residents spend an average of $41,420 annually on transportation and housing, amounting to 59% of the area’s median household income. Even more remarkable, 3/5 of all Bay Area residents live in communities unaffordable to households earning less than $80,000 annually.

The key finding from this report, however, is that the combined costs of housing and transportation are lowest in the most densely populated sections of the region, namely in Alameda and San Francisco counties. This speaks to a concept called “location efficiency,” which is defined as the proximity of housing to transportation nodes, jobs, and retail centers. This so-called clustering demonstrates that urban density has an essential role in supporting a lower cost of living in our nation’s metropolitan regions.

Housing in the Urban Core of Sacramento

Bucking the suburban migratory pattern, early adapters to this economic shift choose to live in urban centers where cost-of-living advantages and conveniences abound. This very topic was the focus of a recent conversation I had with a friend in Boston, who builds her lifestyle around the area’s walkable grid. She touts the city’s compactness, which allows easy access to her job at Harvard University as well to local amenities in neighboring communities and downtown. And while being without a car has its disadvantages at times, she is quick to point out the cost-effectiveness, particularly in a city rich with mobility options.

As my Boston friend attests, the core concept of urban density is “walkability,” which seeks to promote maximum accessibility in cities and communities. Designed efficiently walkable environs connect people with transportation centers, arts and entertainment venues, coffeehouses, libraries and other local and regional amenities in a manner that promotes cost-effective living. There is also evidence to suggest a correlation between more walkable neighborhoods and property values, thereby boosting homeowner return on investment.

It is this sort of economical thinking that companies like Zipcar and uHaul hope to capitalize on by offering cost-conscious solutions to urban dwellers. Both offer hourly, shared car membership services as an alternative to ownership. If you consider the additional cost of interest on a financed car, insurance and parking, let alone regular maintenance and fuel, these membership services can result in substantial savings for the infrequent driver.

uHauls New uCarShare Program is Growing in Popularity in Cities such as Portland, OR

Another economic trend is the number of grocery stores popping up in urban centers, a welcome development for urbanites who for years have lamented the lack of stores offering quality, reasonably priced food options. Cities such as San Diego, Milwaukee, and St Louis have all been at the forefront of the movement to offer urban style grocery retailers to their growing central city base.

Flexible office space options for telecommuters and entrepreneurs represent another emerging development to meet growing needs for cost effective, convenient workspaces. These coworking environments appeal to developers, writers and other independent creative sorts seeking to collaborate with like-minded people in a non-traditional office setting. Work settings like these appear to be most popular in areas such as Denver, San Francisco, New York and Toronto where there are dense clusters of professionals that thrive on idea incubation and social connection.

In the end, though, the biggest prize for those who embrace urban living are the wealth of opportunities for civic connection and community. As our nations cities make significant strides in repurposing their urban core, growing numbers of people are discovering of the cultural, social, and leisure advantages that density rich living affords. And you can’t put a price tag on that.

Michael Scott is an urban writer and researcher based in Folsom, California. He can be reached at

The U.S. health care system is poised to undergo seismic changes for the foreseeable future. More concerning are the staggering implications for our nations communities as the realities of this conflagration begin to take shape.

Today’s health care system is overburdened by crowded emergency rooms, overworked medical professionals, and dwindling resources to pay for it all a clearly unsustainable scenario. The American Hospital Association reports that more than 35 million patients are admitted to the hospital each year. More alarming is the estimated 118 million that are treated in emergency departments for ailments that could be handled easily by primary care physicians. Urban hospitals have been particularly hard hit, with more than 65% of facilities reporting at or over capacity.

Discussions of health reform are ubiquitous these days.  Our media airways are choked with sound bites of congressional proposals, harsh partisan rhetoric and “death panels pulling the plug on grandma.” Even advanced health policy thinkers are overwhelmed by the barrage of opinions and discourse on the topic.

Questions abound on how to fix such a massive, complicated issue. Much of the challenge centers on addressing the vast demographic differences that exist in the U.S. today: cultural, lifestyle, gender, socioeconomic, and myriad other factors have to be taken into consideration.

For true transformation to occur, a “New Geography of Health Care” must involve a sea-change in three fundamental areas of reform: access, quality, and cost. Let’s take an in-depth look at the challenges as well as the opportunities associated with each of these areas.


Talk of reform is wonderful fodder for the airways, but if the government successfully overhauls the system, over 47 million more Americans will be accessing our health care system on a regular basis. How will an already overwhelmed system be able to accommodate a massive influx of patient visits by people who have delayed doctor visits due to lack of coverage? The root of this problem lies with our medical schools, which are not producing a sufficient number of graduates to meet this burgeoning need. Data from the American Academy of Family Physicians indicate that to keep up with the demand for primary care doctors, over the next decade the U.S. will need to add another 40,000 physicians to the existing 100,000. Rural areas will be particularly hard hit since these regions historically have fewer doctors to begin with.

An even larger issue impacting health care access is the question of undocumented immigrants. Currently, momentum seems tilted toward preventing them from securing public or private health insurance. If this opinion becomes part of the enacted reform legislation, our communities will be faced with a nightmarish public health scenario; namely, how will undocumented immigrants receive care while they are still here in the U.S.? Short of mass deportations, we are still left with the issue, leading some to advocate that the President must address immigration policy before health care policy.

Absent some miraculous policy shifts, what we are likely to see in the short term is a further socioeconomic divide in how health care is delivered. The poor and indigent will continue to use emergency departments and community health centers as a refuge of last resort, swelling the capacity of these health providers beyond the resources they need to meet demand. This trend will be particularly acute in states like California, Texas, and Arizona, which have large undocumented populations.

Those with financial resources will have more options for accessing a health provider. Suburban areas in particular will see a meteoric rise in boutique private physician practices, known as concierge medicine. Under this model, patients pay a flat monthly rate for 24/7 access to a primary care provider combined with catastrophic medical coverage and a health savings account, the latter being used for any out-of-pocket health care expenses. Many of these patients will also have access to home visits a throwback to the days when doctor’s made house calls.


The cost of care in America is a hot topic of debate these days. However geographic disparities in health care value are often overlooked. Michael Porter, a Harvard professor and author of the book Redefining Health Care: Creating Value-Based Competition on Results, has long stated that this value proposition should be the emphasis of any reform effort. Porter argues that significant improvements in the value of health care require a fundamental restructuring of our health care delivery model, not incremental improvements. He claims that valuebased provider competition for patients and referrals will be the main driver of meaningful health system change.

Evidence suggests that geographic distinctions in health care are beginning to take shape. The recently released 2009-10 Data Advantage Health Value Index study analyzing more than 4,500 general acute care hospitals nationwide found that America’s best hospital value is often in smaller towns, particularly those in midwestern states. Further, this care was predominantly provided by communitybased hospitals close to home. Topranked hospitals were found in geographically diverse locales such as Dotham, AL, Clarksburg, WV, Holland, MI, and WinstonSalem, NC. The topfive states for hospitals delivering high value were North Dakota, Iowa, Montana, South Dakota, and Maine.


According to a Kaiser Family Foundation study, premiums for family health coverage have more than doubled since 1999 from $5,791 in 1999 to $13, 375 in 2009. Employer-sponsored plans have seen their employee-paid premium amounts increase by 128%.

Viewed through a geographical lens, Kaiser reports that Utah has the lowest per capita health care costs in the nation, with residents spending $3,972, just a little more than Canada’s $3,912 and slightly less than France’s $4,056. Compare this with the U.S. average of $7,026. President Obama along with many health reform advocates often cite Salt Lake City-based Intermountain Healthcare as a model for costeffective, quality medical care. The secret to success for the largest healthcare system in the western region is a concept known as evidencebased medicine, where doctors make liberal use of scientific evidence regarding the effectiveness of treatments.

As cost concern debates continue, Federally Qualified Health Centers (FQHCs) will assume a more prominent role in our nations communities. The umbrella term for community health centers, public health centers, and tribal health facilities, these safety net providers capture a high percentage of underserved populations who would otherwise not have access to care. Thousands of FQHCs exist today and are the health delivery option of choice for millions of Americans. According to the National Association of Community Health Centers, between $9.9 billion and $17.6 billion in health savings a year are attributed to health center support in directing patients toward preventive and nonemergency room services.

A likely catalyst to reframe the health-care cost conversation is medical tourism. Also known as global medicine and health tourism, it refers to the popular practice of patients traveling across international borders to access health care at costs 50%-70% less than in the U.S. These expenses are often inclusive of airfare and hotel for both the patient and their families.

Procedures that are often performed by Americantrained, board-certified physicians include knee and hip replacements, cardiac surgery, dental surgery, and cosmetic surgeries, among others. Despite some concerns about regulatory and legal oversight issues, medical tourism continues to grow in popularity among Americans who otherwise not be able to afford the cost of care at their local provider.

It is no secret that commercial health insurers are jumping on this bandwagon, as domestic health care cost continue to climb unabated. The topfour commercial health insurers in the U.S. are pursuing pilot programs to determine the efficacy of overseas health care. Several small insurers as well as brokers are introducing travel options for growing numbers of employers many of whom are facing premium increases of 9% or more annually, according to the international consultancy PricewaterhouseCoopers.

Rogue initiatives like medical tourism certainly hold promise for spurring health care affordability. But encouraging Americans to take greater responsibility for their own health behaviors is the likely elixir for reining in costs.

Whats Next

It’s anyone’s guess as to where health reform is headed. A discussion to watch is state and regional differences in how health care services are being managed and delivered. It portends messy politics though in achieving comprehensive health reform.

Michael Scott is the president of Visions for Downtown America, Inc, an economic development firm supporting the growth and sustainability of downtown central-cities. He can be reached at

“People don’t compete for available resources. They create the resources.”

Ayn Rand

Many of our nations urban centers are in an economic mess these days. And admittedly my libertarian tendencies have been in full gear of late, pondering scenarios on how to revive our moribund cities.

It has become abundantly clear to many Americans that the economic stimulus package ushered in with the historic presidency of Barack Obama has yet to reap any sort of traction to date. Communities across our great land are struggling mightily as unemployment continues its unabated climb, residential and commercial real estate properties are in free fall and metropolitan infrastructure crumbles. Particularly sad are all of the talented people who potential contributions are being underutilized amid skiddish job prospects and their own personal financial struggles.

Enter “Conscious Capitalism”—a concept rapidly gaining credence in the corporate world as a fresh approach to socially conscious community building. Championed by John Mackey, the mercurial CEO and co-founder of Whole Foods Market, it espouses some intriguing concepts that may serve as a catalyst for metropolitan renewal efforts.

The core premise of Conscious Capitalism is the alignment of business enterprise around a deeper mission or purpose—versus simply the maximization of profits. Contrary to the philosophy of many cities and communities where the incessant need to generate tax revenues is the central operating principle, Conscious Capitalism, if applied to community development aims, would seek a deeper understanding of community members values around happiness and achievement. Moreover, individual stakeholders would be given a voice as well as the freedom to create without undue incumbrances. If successfully repurposed to metropolitan causes, even our nations most distressed urban areas would become catalysts of private capital investment and economic growth, turning these anemic urban environments into flourishing, vibrant and sustainable communities.

Another fundamental element of Conscious Capitalism is its emphasis on managing a community for the benefit of all. Here the goal is to uplift others, particularly those who have been traditionally marginalized, so that they become self reliant creators of opportunity.

One promising spinoff of this movement, known as Community Capitalism, has been used to spur long-term economic growth in Kalamazoo, Michigan. Predicated on a disruptive approach transcending traditional notions of economic development, Community Capitalism espouses five tenets that must function simultaneously in order for a community to be economically viable—investments, place, capital, infrastructure and education. Says Ron Kitchens, Chief Executive Officer of Southwest Michigan First, and author of Community Capitalism: Lessons from Kalamazoo and Beyond: “Our model is about putting together philanthropy, business and government to do what each does well.

So what are the potential returns for cities that embrace this mindset? For starters, cities and communities can apply Conscious Capitalism as a guiding principle for attracting new entrepreneurs and emerging businesses, boosting area economic development. It also holds the potential of spurring private sector collaboration with non-profits, community groups, organized labor, and other stakeholder groups, thereby harnessing long term community potential.

An example of a city where a spirit of conscious capitalism is in full bloom is in Denver, Colorado where mayor John Hickenlooper has evoked his own brand of servant leadership in the nations 24th most populous city. During his keynote address at an annual breakfast recently hosted by the Downtown Sacramento Partnership, Hickenlooper championed the virtues of public/private and city/suburban synergy as an elixir to the divisive bickering common in many cities and regions. He also talked about the valuable insights he gained prior to his mayoral stint as an entrepreneur running a brewpub in the city’s LoDo District—experiences that proved valuable to him in promoting a spirit collaboration for metropolitan Denver. As a result of the city’s forward-thinking philosophy, recently named Denver as one of its the top ten cities in the nation to live and launch a new business.

Storm Cunningham, CEO of Resolution Fund, LLC in Washington D.C. which helps communities ignite rapid, resilient renewal for their economy, natural resources, and quality of life says that Conscious Capitalism certainly represents a potential alternative to the traditional siloed approach of relying on the city planning or economic development departments to do it all. However, Cunningham does not advise cities to throw caution to the wind in terms of revitalization models that comprise nothing but a grab-bag of key subject areas, with no underlying process.” Says Cunningham—“Conscious Capitalism if applied to cities and communities may accomplish good things, but it should never be confused with a true revitalization effort, which emphasizes a process orientation versus a bunch of activities.”

Michael Scott is the president of Visions for Downtown America, Inc, an economic development firm supporting the growth and sustainability of downtown central-cities. He can be reached at