Culture of Health Blog

When I was a full-time pediatrician, I worked at a practice in the City of Philadelphia whose primary patients were teenage mothers and their children. Most of their parents were low-income with little to no outside support. Their lives were hard. Very hard. Many of the parents (grandparents to the newborns) were forced to choose between paying rent some weeks and having enough food to feed their children and grandchildren.  

I remember in particular one mother and her infant son who came to see me after he was born. She was scared because the baby was having trouble gaining weight, due in large part to the family not being able to afford much food. His grandmother was worried; given all the research showing how critical nutrition is to developing brains, I was concerned as well. Fortunately, the practice I worked in was a collaborative one, meaning that not only did we doctors work side-by-side with nurse practitioners, but also closely with social workers. And one of our social workers immediately went to work to get this family, in which the grandmother—who was the head of the household—worked full-time, enrolled in the Supplemental Nutrition Assistance Program (SNAP).

When Dr. Rex Archer returned to his hometown of Kansas City, Missouri, to lead its health department in 1998, he was shocked by the city’s inequities. Life expectancy for white residents was 6.5 years longer than that of black residents. Gathering more data, he estimated that about half of the city’s annual deaths could be attributed to conditions in neighborhoods like segregation, poverty, violence, and a lack of education.

I also confronted stark disparities by neighborhood in my years as Philadelphia’s health commissioner, as does most every health commissioner/director across the country. It is truly unsettling to see how small differences in geography yield vast differences in health and longevity. In some places, access to healthy food, stable jobs, housing that is safe and affordable, quality education, and smoke-free environments are plentiful. In others, they are severely limited. Data can help us better understand the health disparities across our communities and provide a clearer picture of the biggest health challenges and opportunities we experience.

For some, perhaps the mere mention of segregation suggests the past, a shameful historic moment we have moved beyond. But the truth is, residential segregation, especially the separation of whites and blacks or Hispanics in the same community, continues to have lasting implications for the well-being of people of color and the health of a community.

In many U.S. counties and cities, neighborhoods with little diversity are the daily reality. When neighborhoods are segregated, so too are schools, public services, jobs and other kinds of opportunities that affect health. We know that in communities where there are more opportunities for everyone, there is better health.

The 2016 County Health Rankings released today provide a chance for every community to take a hard look at whether everyone living there has opportunity for health and well-being. The Rankings look at many interconnected factors that influence community health including education, jobs, smoking, physical inactivity and access to health care. This year, we added a new measure on residential segregation to help communities see where disparities may cluster because some neighborhoods or areas have been cut off from opportunities and investments that fuel good health. 

Hospitals have a long tradition of serving as anchor institutions within their communities—not only by providing health care, but by hiring local workers and contractors, buying locally, and building new clinical facilities.

But you probably wouldn’t think of hospitals as financial investors in their local communities. Nor might you consider them experts in managing community revitalization efforts. And yet, why not?

Hospitals as Anchor Institutions for Community Investment

Hospitals and health systems have unique assets that go far beyond their clinical offerings. These include deep community connections and relationships, the ability to make loans, expertise in real estate, finance, and project management, and significant property holdings. All of these can collectively be leveraged to benefit both the community at large and hospitals themselves.

Teaming up to reverse childhood obesity has yielded promising results—including new data that shows rates among 2-4 year olds enrolled in the federal WIC program have declined in 31 states. But the work is far from over. 

If you want to understand the texture of a large city, drive from its downtown and make your way out to the suburbs. With few exceptions, you’ll encounter pockets of poverty transitioning into mixed income neighborhoods and, finally, wealth and privilege in the suburbs.

I have lived in Philadelphia—the nation’s 5^th most-populous city and 21^st most populous county—for most of my adult life, and that is her reality. As a former public health official, I can tell you that such income gradients have a profound impact on the health of our populations.

The 2015 County Health Rankings released today are unique in their ability to arm government agencies, health care providers, community organizations, business leaders, policymakers, and the public with local data that can be applied to strengthen communities and build a true Culture of Health.