What a Real Estate Lawyer Taught Me About Child Health

October 2026

For more than 25 years as a pediatric surgeon, I measured success one child and one procedure at a time. I still believe deeply in that work. But over time, I came to understand what the operating room cannot fix: most of what makes a child healthy happens outside the walls of a hospital.

About 85% of health is not connected to medical care. It is housing. Food on the table. A good school. Freedom from violence. At Nemours Children’s, we are in the business of creating health, not just treating disease. To achieve that goal, we are partnering with the people building health in places clinicians don’t usually look.

That is the idea behind Leadership Dialogues, a new series from our Well Beyond Medicine podcast. I am joining host Carol Vassar to talk with national leaders in child health, policy, and community change about the ideas and partnerships shaping healthier futures for children.

Our first guest is Carol Naughton, CEO of Purpose Built Communities, a national nonprofit that helps to drive resident-centered neighborhood transformation and upward mobility. I spent time with Carol and her network at their national conference recently, and I came away with one conviction: if we want healthier children, we must have healthier neighborhoods. Listen to the episode.

A Lawyer Who Discovered She Was in the Health Business

Carol started her career as a commercial real estate attorney. By her own account, it never lit her up. She left private practice for the Atlanta Housing Authority, where she put those real estate skills to work reinventing public housing as mixed-income communities that no longer isolated families by income.

One moment in our conversation stood out: Carol admitted that for years, she didn’t think Purpose Built was in the health business at all. It developed housing, schools, and YMCAs. Then, former Atlanta Mayor Shirley Franklin, who served on the Robert Wood Johnson Foundation Commission to Build a Healthier America, started dropping the commission’s reports on her desk. She recalls Franklin’s implication: You’re not working in housing, you’re in the business of health outcomes here.

I agree and would go further: anyone working on housing, schools, or jobs is in the health business, whether they call it that or not.

What Surrounds Us Shapes Us

Early in her career, Carol held the common misconception that families living in poverty were there because of their own choices. Working alongside those families changed her mind. The obstacles they faced, from substandard housing to struggling schools to high crime, were not individual failings. They were conditions. And many of those conditions were created through deliberate choices, such as redlining. These policies, as Carol puts it, have “long, sticky tails.”

That is not an easy truth. It is also a hopeful one. Conditions built by one policy can be remedied by another.

Purpose Built’s model brings mixed-income housing, a cradle-to-college education pipeline, economic vitality, and community health and wellness together in a single neighborhood. And it starts with residents. They already know what they want for their community. Too often, no one has asked, or no one stayed long enough to help them get there.

Earning the Right to Lead

At Nemours, we believe children’s health systems can and should be the quarterback of child health in their communities. Carol pushed on that idea in a way I appreciated.

Nobody invites you to be the quarterback, she said. You earn it, through authentic relationships and by recognizing that the people who live in a neighborhood hold many of the answers. The question is not only what you can do. It is how you do it: with a community, or to it.

That is a lesson for every health system, including Nemours. It is one we see in practice through our partners at REACH Riverside in Wilmington, Delaware, one of Purpose Built’s network members. Learn more about our partnership with REACH Riverside.

Excellence Over Scale

In health care, too often we measure success by what we build: more beds, more scanners, more procedures. Purpose Built measures itself by how people are doing in the neighborhoods it serves. Are kids ready for kindergarten? Are they graduating from high school? Are families stably housed?

Those near-term measures matter because the big outcomes, economic mobility and better health, take longer than any budget or election cycle. You need wins along the way to earn the chance at the big ones.

The overall need is sobering. Carol estimates about 5,000 neighborhoods across the country could benefit from this kind of transformation. Purpose Built works in about 60 today.

Why This Matters for Children

At Nemours, our approach to Whole Child Health rests on three ideas: understand what health is, pay for health, and start with children. We spend trillions trying to change the course of adult disease. We could spend pennies in childhood and have a far greater impact.

Carol’s work shows what “understand what health is” looks like on the ground. Her closing thought has stayed with me. Most people don’t want to live in a society built on disadvantage. When we make both the moral case and the economic case for broadening opportunity, everybody wins, whether you live in that neighborhood or across town.

Listen to the Full Conversation

Our first Leadership Dialogues episode, The Zip Code Effect on Child Health, is available now.

Next in the series, I talk with Kody Kinsley, former North Carolina Secretary of Health and Human Services, about expanding Medicaid, treating food, housing, and transportation as drivers of health, and what North Carolina’s Healthy Opportunities initiative can teach the rest of us about investing upstream.