Americans today live shorter, sicker lives than people in most other developed countries.
A new report from the National Academies of Sciences, Engineering, and Medicine contends that social inequities that lead to problems like poverty, a lack of jobs, inadequate housing and discrimination are to blame for the nation’s poor health and warns that unless these gaps are closed, the United States will pay the price in the form of lost lives, wasted potential and squandered resources. As an example, racial health disparities alone are projected to cost health insurers some $337 billion between 2009 and 2018.
Communities in Action: Pathways to Health Equity is the result of a yearlong analysis by a National Academies committee of national experts in public health, health care, civil rights, social science, education, research and business. The report, commissioned by the Robert Wood Johnson Foundation as part of a $10 million, five-year grant, focuses on promising community-based solutions to mitigate inequities.
“I think the most powerful part of the report addresses what communities can do themselves. By providing many examples across the nation, we wanted to show community action is possible. Positive outcomes are possible,” said Hortensia Amaro, dean’s professor of social work and preventive medicine at the USC Suzanne Dworak-Peck School of Social Work, USC associate vice provost for community research initiatives, and member of the committee and the National Academy of Medicine.
Leveraging community assets
Health starts where one lives, learns, works and plays. Research consistently indicates people’s zip code may have as much to do with their health as their genetic code. Opportunities to lead a long and healthy life can vary dramatically by neighborhood.
Many factors can influence health differences among neighborhoods — opportunities for education and jobs; safe and affordable housing; availability of nutritious food and places for physical activity; clean air; and access to health care, child care and social services.
“These are all reflective of how much we, as a society, invest in communities. The choices people make depend on the choices available to them. The role of government is to make healthy choices the easiest choices and to structure opportunity for success equitably,” Amaro said.
Understanding what creates or limits the opportunity for health is essential to understanding what creates disparate health outcomes and what needs to be done to prevent them.
“In their personal lives, Americans understand how important the community where they live is, but as a country, when we think about what creates health, we don’t connect it. Instead, when asked to think about health, Americans tend to think about health care. This report articulates the concept of social determinants in a way that people understand. We’ve highlighted the role communities can play and how communities are coming up with solutions,” said Amaro, who also authored the 2015 State of the Neighborhood Report, another study that used social determinants of health to note inequities in the communities surrounding USC’s University Park and Health Sciences campuses in Los Angeles.
One of the success stories recognized in the report is the Magnolia Community Initiative, a pioneering effort that galvanized residents and organizational partners in a low-income area of Los Angeles to reimagine how resource providers, communities and parents can collaborate to strengthen families and prepare children to succeed. This groundbreaking model for large-scale community change has helped 35,000 vulnerable children break all records of success in their education, health milestones, the nurturing they receive from their family and the economic stability of their family.
“A major part of their effort is focused on building relationships between neighbors, building leadership among community residents to engage in efforts that improve community conditions, build social capital and social cohesion in their community. Those are key elements for community action and agency,” Amaro said.
Anchors in the community
Another important recommendation Amaro noted was emphasizing the role of anchor institutions, such as universities, hospitals and businesses, in expanding opportunities to improve health equity in their communities.
“While universities often have community service programs that help individuals, the anchor institution approach seeks to improve underlying conditions that affect all residents in their immediately surrounding area. It uses the economic engine of the organization to bring capital into the community with the goal of uplifting the community’s economic conditions,” she said. “The key strategies used in this approach designate a percentage of expenditures related to procurement, contracts, services and employment for local residents and businesses.”
She points to the Cleveland Model, which leveraged public, private and philanthropic funds to launch a cooperative initiative — a cluster of worker co-op businesses developed to do business with universities and hospitals — with the goal of spurring economic development and building democratized wealth and cooperative business ownership in low-income neighborhoods.
The anchors have become more responsive to communities’ needs by prioritizing local hiring, setting more inclusive and locally targeted procurement policies, increasing local job training and helping neighbors realize their entrepreneurial goals. In turn, the worker cooperative has kick-started a laundry service, a solar energy company and a hydroponic vegetable farm.
Charting a course
Health equity is fundamental to community well-being, economic vitality and social vibrancy.
Thriving communities provide opportunities for people to live healthy lives. Unsafe communities that provide poor educational and economic opportunities and offer weak infrastructure can make them sick. However, such realities are not destiny, and communities across the country have shown their resilience and ability to be agents of social change.
“We can and must do better to provide equitable opportunities for those who don’t currently benefit from opportunity and conditions that create health,” Amaro said. “Communities hold the greatest promise in creating change because they have the most at stake. They know the problems and strategies needed to create equitable conditions so everyone, no matter who they are, can participate more fully in society and live healthy, productive lives.”