A Conversation on Community Health: Q&A with Jason Purnell

Mar 25, 2013, 11:45 AM

file Jason Purnell, Washington University in St. Louis

As research builds showing that where you live has a big impact on how healthy you are, organizations and businesses across the country are joining the dialogue on how to create healthier communities. Recently, The Atlantic and GlaxoSmithKline hosted “A Conversation on Community Health”—a series of events in U.S. cities across the country to explore what it takes, to create a healthy community. The series brought together leaders from across different sectors to forge a dialogue across different perspectives.

Jason Q. Purnell, PhD, MPH, Assistant Professor at the Brown School of Social Work and Public Health at Washington University in St. Louis, was a panelist at the St. Louis Conversation on Community Health, along with Jackie Joyner-Kersee and others. Recently, Dr. Purnell shared his vision for community health, and the critical role of broad collaboration across sectors, with NewPublicHealth.

NewPublicHealth: What's your vision of a healthy community? 

Jason Purnell: My vision for a healthy community includes the elimination of health disparities by race and ethnicity and socioeconomic status.  It involves everyone, regardless of zip code or net worth, having the resources to lead full, productive lives.  I follow the World Health Organization in its holistic focus on social, emotional, and physical well-being rather than a more narrow focus on disease prevention.  A healthy community allows everyone in its boundaries to express their full potential; it allows them to participate in the life of the community, in life itself, to the fullest extent possible.   

NPH: Your efforts have included collaboration across psychology, public health, oncology, and primary care. Similarly, the Conversation on Community Health series includes participants from across sectors. Why does public health require such broad collaboration?

Purnell: Public health requires broad collaborations because the barriers to optimal community health are complex. In order to account for the complexity inherent in individuals, families, neighborhoods, and larger communities as well as the biological, psychological, and social factors related to health, a wide array of disciplines are needed.
NPH: What do you hope will come out of this series?
Purnell: I hope this series of conversations translates into action. Many of the individuals and organizations represented in these conversations already know what the problems are. Nearly everyone mentions the social determinants of health—the extent to which where and how people live and work impacts health in myriad ways. In order to have real impact on those determinants, both coordination and adequate resources are necessarily. If these conversations lead to an increase in coordination and resources, they will have been a huge success. 
NPH: What will it take to get people to think about factors like education and livable wages as critical for a healthy life?
Purnell: Those of us who care about these issues must make the case, and I am increasingly convinced that it must be an economic case. We may persuade some people through emotional appeals to fairness or the suffering of others, but we will have the greatest impact by citing the amount of money that the public saves by preventing ill health through investments in improving the social circumstances in which people work and live. There are analyses that suggest that increasing graduation rates would save more lives than medical advances, but the public still largely thinks about health in terms of medical care. That is an information and education problem, but we have to be sophisticated about the way this information is delivered.

It is too easy, because of our prevailing culture of individualism in this country, to blame people for their social circumstances as well as their health. The common thought is that someone must have done something to deserve their circumstances. Personal responsibility has a role to play, but it is over-emphasized to the exclusion of factors that are very often outside individual control—like the accident of birth to parents with low levels of education or low incomes. Those factors have implications, not just for children but well into adulthood. We need to tell that story and include the cost to society of maintaining the status quo. And the proper investments in education or livable household incomes have mutually reinforcing benefits beyond health. They are win-win-win propositions.   

This commentary originally appeared on the RWJF New Public Health blog.