Culture of Health Blog

Editor’s Note: To commemorate the 50^thAnniversary of the Fair Housing Act this month, we are republishing a post that originally appeared in 2016. Be sure to also check out the 2018 County Health Rankings which provide updated information on the impact of segregation as a fundamental cause of health disparities. 

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. 

Nearly six months ago three catastrophic hurricanes devastated parts of the United States and her territories, and the lives of millions of people in America. Although they were all Category 4+ storms, the impact and aftermath have been markedly different. While the recovery is ongoing, many communities in Texas and Florida are finally returning to normal life: schools are open, transportation systems are running, and homes are being rebuilt. By stark contrast, in parts of Puerto Rico, people are still struggling to survive without clean water and electricity.

What accounts for these differences in recovery? There is plenty of conjecture: people point to the level of damage inflicted, soundness of infrastructure, the condition of the local economy, as well as institutionalized discrimination.

Disasters also come in many forms—natural disasters, to be sure, but also chronic poverty, broad lack of access to health care, and other hardships a community faces. When these adverse factors co-exist, recovery is exponentially harder.

One of my earliest and most vivid childhood memories is watching from my bedroom window as my city burned in the riots that erupted after Dr. Martin Luther King Jr.’s assassination 50 years ago.  

The next afternoon, my mother brought me to the playground at my school in Southeast Washington, D.C., which somehow was untouched. As she pushed me in a swing, she asked if I understood what had happened the day before and who Dr. King was.

“Yes,” I said. “He was working to make things better for Negroes like you.”

My mother, whose skin is several tones darker than mine, stared at me in surprise. Somehow, even at 4 years old, I had learned to observe differences in complexion.

That is particularly interesting to me now, as I eventually came to believe that “race” is a social construct.

Of course racism and discrimination exist. They are deeply embedded in America’s history and culture—but so too is the struggle against them.

Atlantic City, New Jersey, is a colorful place with a storied past. Today, its casinos, beaches and boardwalk make it a natural tourist destination, with a transportation infrastructure that puts it within easy reach of millions of people. The many languages spoken in the city are a testament to its vibrant diversity.  

Despite its long-standing status as a tourist destination, the city has not always enjoyed a stellar reputation. Crime rates exceed national averages (although they’ve fallen over the past few years), and unemployment is nearly double the national rate. Gambling hasn’t brought much luck to a place that sits in a county ranked 17^th in health outcomes among New Jersey’s 21 counties, according to 2017 County Health Rankings data.

“I fell asleep on the bus and usually wasn’t really awake until after first period ended,” says Andrew Schatzman, whose school day in Northern Virginia’s Fairfax County ("Fairfax") used to begin with a 6:30 a.m. pickup time. When district leaders moved the high school start time to 8:10 a.m., it made a big difference in his life. “He’s still a teenager, so nothing is easy, but now he’s ready to go,” says Andrew’s mom, Liz. “I’m awake enough to do what I have to do in first period,” adds Andrew.

Thanks to this change Andrew starts the school day rested and ready to learn, but millions of U.S. students do not share that experience.

Nearly half (46%) of the U.S. high schools that begin classes before 8 a.m. are filled with teenagers who have not received the 8+ hours of sleep that young people need. As adolescent brains develop, sleep patterns change. It’s a normal, natural occurring physiological milestone. Sleep researchers call it the development of an evening-type circadian phase preference. The rest of us call it becoming a night owl.

Regardless of the terminology, the result is the same: teenagers stay up late. They do not fall asleep sooner if school starts earlier. Instead, they get sleep-deprived.

New research shows that seniors who participate in the SNAP program are much less likely to be admitted to nursing homes and hospitals, demonstrating the power of investing in social services to reduce health care costs and improve health outcomes.

Dinnertime is stressful for Ruiyi Li, a married mother of two who lives in San Francisco’s Chinatown.

She has to wait in line for almost an hour to use a communal kitchen in the building where her family rents a single room for $400 a month.

Then there’s the problem of how to eat the meal. The family’s tight dwelling is slightly wider and longer than the size of a double bed, with no space for a table. Li, her husband, son and daughter must sit one next to the other on the edge of the lower half of a bunk bed, balancing bowls in their laps.

“Dinner is quick and fast,” Li says using the dialect spoken in her southern Chinese hometown of Toishan. “It doesn’t even feel like the family is eating together.”

My change leadership journey was ignited by a spark of dissatisfaction when I was about 7 or 8 years old, growing up on the small island of Dominica. I walked into a doctor’s office with my mother, brother, and younger sister. My mother called the doctor from the phone in the lobby, and in minutes, we were whisked right into the consulting room, bypassing about two dozen other patients who looked tired and sick.

I imagined that these other families had driven for hours in a truck on dusty, potholed roads to get to this office in Roseau. They waited hours for medical care, only to be forced to wait longer to accommodate the needs of my family. That moment, jumping that line, felt awful. Right then, I decided to become a doctor so that I could make things better for people living in poverty.

The Columbia Gorge Region where I live is a vast rural area larger than Connecticut but with a population of only 75,000. While many people here are doing well, others live in poverty, or have to drive long distances to get to a doctor’s office. In this land of fruit orchards, one in five people regularly run out of food.

Mandi Rae Pope was once one of those people. A few years ago, during a difficult pregnancy at the end of her husband’s graduate studies, Pope says she was “counting pennies out of a Mason jar to pay for gas.” She struggled with migraines, and they were getting worse. In the midst of all that, our local Women, Infants, and Children nutrition program gave her a prescription for Veggie Rx, a program we started to provide free fresh fruits and vegetables to people struggling with food insecurity. This was a top concern that community members had identified. By using Veggie Rx, Mandi Rae was able to provide fruit to her toddler son, and the more nutritious diet also helped tame her migraines. Grateful for the help, she wanted to pay if forward and expressed an interest in promoting the program.

My passion for public health was ignited early on in my career in nursing, serving children and families in St. Louis’ Head Start program. I quickly realized that the health of the individuals for whom I cared depended on a complex mix of factors—including personal choices, the opportunities they had available to them (or not), and the resources within their communities. And my time in St. Louis set me on a career path in nursing that has shown me just how integral a role nurses can play in the health of not just their individual patients, but the broader population.

• View related RWJF analysis and perspectives on Nurses, Nursing and Population Health
  

Nurses have always played a key role in improving our nation’s health and well-being. We see people—not just at different stages of their lives, but also in all of the different places our patients live—using nursing skills and expertise to care for them in many different ways.