Taking Urban Health Equity Seriously in 2013
Jason Corburn, PhD, MCP, is associate professor at the School Public Health & Department of City & Regional Planning, University of California, Berkeley. He is a recipient of a Robert Wood Johnson Foundation (RWJF) Investigator Award in Health Policy Research and an RWJF Health & Society Scholar. This post is part of the "Health Care in 2013" series.
The U.S. health care system must stop treating people only to send them back into the living, working and playing conditions that are making them sick in the first place. Glaring health inequities continue to persist in our metropolitan areas – differences in life expectancy, disease and disability by racial and ethnic groups and neighborhood location. Our zip codes are often a greater predictor of our likelihood of disease, disability and early death than our genetic code. We need to shift our health care system from a focus largely on cures to preventing illness and death by improving our living, working and playing environments.
2013 must be the year we all view community development and city planning as ‘preventative medicine.’
The health disparities experienced by the poor and people of color in our cities and metropolitan areas should be viewed as a form of community malpractice on the part of national, state and municipal policy-makers. For example, at least 60 years of federal housing, economic development, municipal zoning and land use decisions have failed to address racial residential segregation that is a major contributor to today’s health inequities experienced in certain urban zip codes. Re-focusing our nation’s health priorities and policies can help reverse this community malpractice.
Our health system must be re-focused to prioritize the creation of a coordinated urban health promotion strategy that will ultimately benefit all Americans by starting with improving the lives and living conditions of the poor and people of color. Leadership from Washington is necessary by, for example, reorganizing the work of HUD – Housing and Urban Development – into DUH – Department of Urban Health.
States and especially city and local governments must be resourced and rewarded to implement integrated health equity strategies that would:
1) stop focusing on treating one disease at a time, and recognize the multiple morbidities that afflict everyday living of the poor and people of color in many city neighborhoods;
2) stop regulating one pollutant or hazard at a time and recognize that the urban poor face multiple and cumulative stressors – from insecure employment and housing, to discrimination and disenfranchisement, to ‘pathogens’ like violence and poverty;
3) stop focusing only on life-styles and behavioral change – like healthy eating and exercise – and ask what policies and practices by government and industry discourage access for the poor and people of color to safe, affordable and culturally relevant nutritious food and recreation opportunities;
4) draw inspiration from the New Deal’s job-creating Civilian Conservation Corps and commit over the next ten years to training 500,000 new lay Community Health Workers (CHWs) focused on health promotion and primary prevention;
5) stop building hospitals and high-tech treatment centers and instead re-invigorate our nations’ urban community health centers and school-based health clinics, and require these centers to hire local residents and focus on health promotion, not just ambulatory care;
6) require that all federal, state and local legislation undergo a ‘health equity impact assessment,’ similar to the National Environmental Policy Act’s environmental impact assessment;
7) acknowledge that structural racism continues to permeate many urban policy and health care decisions, and an explicit racial equity approach needs to be implemented into a national Health in All Policies strategy.
Thankfully, many of the items on my ‘wish list’ are already happening, but they remain uncoordinated. The Affordable Care Act has inspired the first comprehensive National Prevention Strategy and an explicit strategy to reduce Racial and Ethnic Health Disparities. Local governments, from Boston’s Health Commission to Alameda County in the San Francisco Bay Area, to King County in Seattle, have all made racial and social justice and neighborhood-based strategies the anchors of their new approach to health equity. The White House Neighborhood revitalization initiative (NRI) also reflects this related, place-based approach to health promotion and the Obama Administration is attempting to link this program to the federal Health Center Program.
2013 must be the year we commit our health system to making urban health inequities history. Let’s all get started.