Transit oriented development puts health care next door

November 15, 2012

By Ted Trautman
California Health Report

Increased mobility can lead to better health: reliable transportation allows patients to cast a wider net when choosing physicians and gives them more flexibility in scheduling appointments, which can often mean earlier treatment. So when Oakland’s Unity Council opened 47 apartments, including ten reserved for low-income tenants, alongside Fruitvale’s BART station in 2004, the people who moved in had greater access to healthcare than many Oaklanders, simply by virtue of their proximity to BART.

Antoinette Howard was one of the first to move into Fruitvale’s “transit village,” as urban planners refer to mixed-use developments near transit hubs. Although Howard works from home and shares a car with her husband, she says her teenaged sons have come to rely on BART’s trains and AC Transit’s buses much as they would a trusted relative.

“If me and my husband can’t give the boys a ride somewhere, we’ll just say, ‘Take Uncle BART,’” Howard explained, adding that she and her family refer to AC Transit as ‘Aunt Clara.’ “My son has braces. He goes in every month and gets them tightened, so he gets a ride from Uncle BART, gets off at 19th, and he’s at the dentist. I don’t have to worry about him.”

Transit villages are the brick-and-mortar manifestations of a planning philosophy called transit-oriented development, and they’re popping up all around the Bay Area. Fruitvale is one of twelve transit-oriented projects either completed, in progress, or planned in the BART system alone. The Metropolitan Transportation Commission, which oversees the Bay Area’s many transit agencies, counts as many more projects near ferry terminals, Amtrak and Caltrain lines, and major bus routes, from Santa Rosa to Richmond to San Jose.

Developments like the one at Fruitvale are designed to encourage the high-density living found naturally in most cities’ downtowns, along with a decreased reliance on cars. When successful, as Fruitvale Village is generally regarded to be, transit-oriented development provides transportation and convenient shopping to residents, a steady flow of customers to commercial tenants, and incentives to walk and bicycle.

Transit villages, almost by definition, promote health in the very basic sense that they encourage exercise and put their residents within range of off-site healthcare facilities. But Fruitvale goes much farther: besides the restaurants, a jeweler, a convenience store and a smattering of other retail businesses, Fruitvale’s commercial tenants include an impressive array of healthcare providers on-site.

The village’s largest healthcare provider – and arguably its anchor tenant – is La Clinica de la Raza, a three-story, low-cost clinic primarily serving the uninsured. With a dozen physicians on staff, the clinic is able to accommodate an average of 270 patients a day – about three-quarters of whom are Latino, reflecting the high Mexican-American population in Fruitvale whom La Clinica was originally founded to serve. Seventy-eight percent of the clinic’s patients fall under the federal poverty line.

La Clinica boasts specialized services like dentistry and optometry but, curiously, the diversity among Fruitvale Village’s residents allows the development to sustain a second optometry office less than a block away.

“I don’t think we are affecting in any way La Clinica’s operations, or reducing their patient load,” said Dr. Payam Irani, who owns and operates Fruitvale Optometry in the transit village’s central courtyard. “They have a different system. A lot of their patients go there because they have almost free service, depending on their income. People who can go wherever they want to, sometimes they come to us. I think there is a need for both.”

Irani says his practice was one of the first businesses to open at Fruitvale Village, before it was clear that the development would attract residents or customers.

“At the time it was a big risk,” he said in his office recently. “But from the beginning, once we opened, I kept thinking, ‘This is the right place.’ And also I came here precisely because it’s an underserved community.”

Despite its reputation and resources, La Clinica’s focus on low-income and uninsured patients makes it a less than perfect fit for the village’s middle class residents’ and neighbors’ healthcare needs.

Even Antoinette Howard and her family, who qualified for an income-based discount on their rent at Fruitvale Village, have the resources to search more widely for their medical care. Howard’s sons see an orthodontist in Downtown Oakland, and her own doctor’s office is farther north, in the Temescal neighborhood of Oakland – both locations are BART-accessible.

Howard says her husband avoids La Clinica for more practical reasons:

“He’s like, ‘I don’t want to go to the doctor where I live,’” Howard paraphrased. “‘If something’s wrong, I don’t want everybody to know my business.’”

“He’s really finicky like that,” Howard added with a laugh.

But for those who prefer to find healthcare as close to come as possible, Fruitvale Village offers an impressive selection to its residents and the surrounding, predominantly Latino community. Just like La Clinica, Dr. Irani maintains a Spanish-speaking staff, in recognition of the community’s demographics. Even Irani, a 40-year-old Baha’i who grew up in Iran, speaks Spanish fluently (which he learned as a teenage refugee in Argentina).

“You can’t function here if you don’t speak Spanish,” Irani observed. “More than half of our phone calls are purely Spanish-speaking, which is why I need Spanish-speakers on the phone and here with me.”

While many aspects of Fruitvale Village have been copied by similar developments around the country, few transit villages have duplicated its approach to healthcare. This is due in part to the priorities of the Unity Council, which developed and owns Fruitvale Village. While most transit villages are developed by a coalition of private firms, from its inception Fruitvale has followed the uniquely singular leadership of the non-profit council and its outreach goals.

Oakland’s next big transit-oriented development – the MacArthur Transit Village in the Temescal neighborhood in 2021 – is more typical in that its development is steered by several companies, with a firm called BRIDGE Housing taking a leadership role. The MacArthur transit village is not expected to include any healthcare facilities on-site, despite being several times larger than Fruitvale. And MacArthur might use a clinic more than many transit villages, as it will stand unusually close to the freeway and potentially present more respiratory health issues for residents.

Antoinette Howard is happy with her apartment in Fruitvale, but said she’d be theoretically open to living in MacArthur’s village when it opens, despite the absence of on-site healthcare facilities.

“I mean, that’s a real luxury we have here in Fruitvale, to have a clinic like that,” Howard said. “But it’s not the only good thing about living here.”

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