Our AB Municipal Impact strategy focuses its healthcare sector investments largely on institutions that help address disparate health outcomes in disadvantaged and historically marginalized communities. Essentially, we are looking to extend the life expectancy and quality of life for those medically underserved. As of 2016, West Virginia ranked first in the nation in the prevalence of heart attack and coronary heart disease, obesity, arthritis, as well as the rates of chronic obstructive pulmonary disease. West Virginia also ranked second in the nation in the prevalence of diabetes and rates of tobacco use. The State’s opioid-related overdose mortality rate was the highest in the nation at 43.4 per 100,000 residents, 3.2x higher than the nation and 20% higher than New Hampshire, the next closest state.
In 2018, AB evaluated the largest healthcare system in the state, consisting of 10 Hospitals and 100+ clinics. The healthcare system provided a full range of services from primary and specialized care to an academic medical center actively engaged in a wide range of outreach programs designed to serve the most vulnerable and at-risk populations. Well over 20% of the patient revenue is derived from Medicaid and services reach all but 14 of the State’s 55 counties.
Outreach programs by the Health System Included:
Comprehensive Opioid Addiction Treatment (COAT): an outpatient group-based treatment program for opioid use serving approximately 600 active participants at any given time. It is a step-based program dependent on the individual's place in recovery.
The Extension for Community Healthcare Outcomes (ECHO): the program connects rural healthcare providers with substance abuse specialists at the Health System through a knowledge-sharing network
Additionally, the rural and mountainous terrain of West Virginia presents a logistical challenge for many to reach healthcare institutions. A mobile unit expands the Health Systems cancer treatment programs to the rural communities of West Virginia. For example, the vehicle brings mammography directly to where patients live in rural communities who may otherwise not have access.
Telemedicine also provides critical on-demand expertise helping rural hospitals and physicians quickly evaluate and treat potential stroke patients. Specialists outside of these rural areas can see and interact with patients and healthcare professionals throughout the state, thereby providing patients with more timely and efficient care.
Lastly, the Health System’s Center for Diabetes and Metabolic Health Program addresses obesity and diabetes with less medication. It combines medical care with food, exercise, sleep, and stress reduction. Clinicians and staff address food insecurity, decrease sugar in healthcare settings, and support statewide collaborations to combat obesity and diabetes at the policy and grassroots level. Our integration of ESG factors and evaluation of key healthcare performance indicators led us to include this Health System in our Impact Strategy.
Another key sector in our Impact Strategy is education. A University in California we evaluated was the only Catholic university primarily for women in the western United States (and only women’s university in Los Angeles). The University is known nationally for its research on gender equality, its innovative health and science programs, and its commitment to community service. The school also serves a diverse student population with 60% of students Latinx (vs a median of 30% for all California). Supporting a lower income population–67% of first time, full-time students receive Pell grants (vs. a median of 36% for all California). Among selective private colleges nationally, the University has among the highest percent (15%) of students that come from the bottom 20% family income. The school has a track record of success moving students up the economic scale with 43% of students at the University moving up two or more income quintiles post-graduation–which makes it among the highest both in California and nationally among selective private colleges. Approximately 68% of traditional baccalaureate graduates from this University go on to earn advanced degrees. After our ESG analysis we decided to include this University in our Impact holdings.
Another educational issuer in the state of Texas where we integrated ESG issues focused on the school's "Whole Child" approach to education including guidance counseling, restorative justice and family-based social services. Daily literacy, history (including Latino and African-American history) and rigorous college preparation classes for students are held daily with an expanded school day and year. The school has invoked a Zero suspension policy for at—risk students opting to keep them in rigorous classes for achievement. Every student receives a Chromebook laptop and proficiency in two coding languages are required for graduation. Integrating these ESG factors led us to include this issuer in our portfolio.
Also inherent in our Impact strategy is to make investments toward improving the quality of life for all by enhancing and promoting civic engagement, an informed citizenry, culture, and the physical and natural sciences. A scientific and educational institute in San Francisco, CA, is a natural history museum, aquarium, planetarium and rainforest—all under one eco-friendly roof. Socially, their mission is to explore, explain, and expand environmental literacy, enhance education in the sciences, biodiversity and sustainability, as well as lower the barriers of entry regardless of socio-economics, language, or culture. The institution promotes free and reduced admission programs to ensure access for all including low-income families, subsidized student visits and Neighborhood and community Free Weekends. The institution also provides passes to moderate- to low-income neighborhood libraries that can be checked out from 72 different area libraries to ensure access to all despite socio economic status. Environmentally, the institution's facility is an award winning eco-friendly design and operations including the World’s first Double Platinum LEED-certified institution of its kind—and the largest Double Platinum building in the world including a Living Roof with 87% of the roof's surface vegetated - providing insulation reducing energy needs and transforming carbon dioxide into oxygen. The roof also includes extended solar panels for further energy efficiency. Integrating ESG factors we included this issuer on our holdings.