Apr 28 2014
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Place Matters: Q&A with Brian Smedley, Joint Center for Political and Economic Studies

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Place Matters is a national initiative of the Joint Center for Political and Economic Studies, a non-profit organization based in Washington, D.C., whose mission it is to improve the lives of African Americans and other people of color through policy analysis and change. The Place Matters initiative was designed to build the capacity of local leaders around the country to identify and improve social, economic and environmental conditions that shape health. Nineteen teams are working in 27 jurisdictions.

NewPublicHealth recently spoke with seven Place Matters teams about their ongoing efforts. We will be showcasing their work in a series that begins today with a conversation with Brian Smedley, PHD, Vice President and Director of the Joint Center’s Health Policy Institute.

NPH: What are some initial steps that a community has to take when making changes in order to impact health?

Brian Smedley: Several things we believe are important, and these are principles that we employ in our Place Matters work. One is first and foremost to start with the very communities that are most affected by economic and political marginalization and that have suffered from disinvestment for years. These are often communities that have the leadership and sources of strength and resiliency to begin to tackle these problems. We believe that engaging with communities; identifying their key concerns; identifying the sources of strength and resiliency in the community; and finding out from the community what their vision is for a healthy and vibrant community are all important first steps for anyone engaged in this kind of work.

We also believe that there’s an important role for research to document the inequitable distribution of health risks and resources, and to show how that often correlates with patterns of residential segregation. We have worked with our Place Matters teams to produce what we call community health equity reports, where we document such issues as where people can buy healthy food; how close polluting industries are to neighborhoods and residential areas; sources of jobs; and neighborhoods that have high levels of poverty concentration. 

We often use maps to show the distribution of health risks and resources, but we go a step further to show their relationship to patterns of residential segregation. For example, we did a report in Baltimore where we looked at the distribution of people of color and neighborhoods that had suffered from high levels of poverty concentration for generations. We produced those maps, but then also found an old redlining map from the Federal Housing Authority from 1937 which shows areas marked in red signaling communities that could not receive, for example, home mortgage insurance or other kinds of federal programs because they were considered too risky to for those kinds of investments. Well, it just so happens that those neighborhoods that were redlined in 1937 are the very communities that, to this day, remain neighborhoods with high levels of poverty concentration and are often highly segregated.

So these patterns are not accidental. They reflect our historic patterns of discrimination as well as contemporary problems of ensuring that families have true housing choice in terms of where they seek to live. Another step that we take in this research is that we also map health outcomes such as life expectancy which we map on the basis of Census tracks or zip codes. We find that in many of the Place Matters communities there’s as much as a 25- or 30-year difference in life expectancy across different Census tracks or zip codes. And again, this often correlates with patterns of residential segregation with the communities that suffer from the highest levels of poverty concentration the most segregated, often having the lowest life expectancy—in some cases as low as 60 years—and the communities that are most advantaged in terms of wealth and income and have the lowest concentration of people of color, often have the highest health status, as much as 90 years. That’s a 30-year difference in life expectancy.

NPH: What are your outcome goals for Place Matters?

Smedley: Engaging the community, producing research to help document why place matters, as well as identifying effective policy strategies particularly in an era of limited resources at all levels of government. It’s also important that we show policymakers that there are strategies that work, so we have in our work reviewed the research literature. We’ve looked at other place-based initiatives to find practice-based evidence—what is it that is working in communities around the country to address the problems associated with segregation and the high concentration of health risks in certain neighborhoods.

NPH: Who are your partners in these efforts?

Smedley: We build multi-sector coalitions. These are not just problems for our health care systems or our public health departments. There are many stakeholders that need to be engaged. Community-based and grassroots organizations, researchers, elected officials, policymakers, leaders in the faith community and leaders in the business community—all of these sectors need to be engaged in order to build the coalitions that are necessary to build public support for policy solutions and to sustain them.

Affected communities need to be at the table, whether they’re represented by community-based or grassroots organizations or just neighborhood leadership. We need the people who have been living in communities, who understand their communities deeply. We also need to engage with academics and researchers. Often in our Place Matters work the teams are composed of not just people in community-based and grassroots organizations, but also academics and researchers who can help document some of the conditions that community members identify. And having business leaders at the table is also critically important because they have often access to the people and the resources that are necessary to help turn around the inequities.

Public health departments of course also need to be at the table, and many health departments around the country have solid experience working with communities and other partners to help foster change. And then, of course, elected officials and policymakers are important in this mix as well. Many of our Place Matters teams include local elected officials who know about the community and care a lot about these problems of health inequities.

These are the principles that we employ in Place Matters, and we think that over time these are going to be the kinds of efforts that are needed across the country to truly ensure that everybody has an opportunity for good health.

NPH: Can you give us an example of a neighborhood that’s been able to implement changes and showed success as well as an example of a neighborhood in critical need of help?

Smedley: We’ve often seen that the communities that are making the greatest strides toward ensuring equitable opportunities for good health are communities with strong leadership. So, for example, in King County in Washington State—which includes Seattle and some surrounding communities—the county government started an equity and social justice initiative, recognizing that policy decisions made in county government around such issues as resource allocation and infrastructure projects could allow the county to be more prosperous and healthy if the county considered the consequences of their decisions on existing racial and ethnic inequities and socioeconomic inequities.

So, their equity and social justice initiative quickly gained momentum and is now an equity- and social-justice ordinance in the county, requiring that the county, in all of its decision making and policy making, must consider how its decisions advance equity and social justice. And if the decisions do not advance equity and social justice, then the ordinance requires decision makers to go back to the table and figure out other strategies to ensure that no community is left behind from the kinds of decisions that they’re making.

There are many other communities where progress has been much more community based but includes many partners including county government. Some of our Place Matters teams, for example, are finding creative ways to reduce the concentration of polluting industries in highly vulnerable, high-poverty communities. There are communities that are resisting the signing of new polluting industries while trying to figure out ways to bring in more health-enhancing resources.

Some of our Place Matters teams are finding creative ways to bring more healthy and nutritious food options into communities that are overrun with fast-food stores and convenience stores, and so they’re working often with county government to, for example, create tax incentives so that grocery stores can come into a community and have the financial incentives to set up shop. Many of these grocery stores find that they’re achieving the so-called triple bottom line. Not only are they improving access to healthy foods, but they’re often a good source of jobs in the community and they find that they turn a profit, so it’s a win/win for everybody involved. And so communities that face challenges or that are still in early stages of this work we find are communities that are still struggling with the concept of understanding how social and economic and environmental forces shape health.

Tags: Built Environment and Health, Housing, Place Matters, Social Determinants of Health