“Housing policy is health policy. Educational policy is health policy. Antiviolence policy is health policy. Neighborhood improvement policies are health policies,” says David Williams in Unnatural Causes.
Last week my professional life converged on “health equity”—a more empowering and assertive approach to understanding the differences in health status we see across social groups. It’s a necessary response to those who would throw up their hands and overemphasize biology and behavior as major explanatory factors.
“People tended to attribute health differences to behaviors, genes or nature and inevitability: “That’s just the way things are.” True, some outcomes are random or result from accidents of nature or individual pathology.
But health equity concerns those differences in population health that can be traced to unequal economic and social conditions and are systemic and avoidable – and thus inherently unjust and unfair.” What is Health Equity? (Excerpted from “Unnatural Causes” toolkit).
At its core, the health equity frame recognizes complex and simple links between many social ills. This alternate framing moves discussions of the social determinants of health towards actionable, creative, and innovative strategies for change. We can hack away at the inherently unjust and unfair by forging connections across disciplines and interests, while putting historically disenfranchised communities in the driver’s seat. We need community members and experts in labor, education, housing, transportation, urban planning, social policy, and public health to form teams seldom seen outside of the DC Universe.
Keeping it local and focused, organizations, communities, and academic disciplines have successfully bridged differences in language, theory, and perspective that encourage silos and alienate communities. The programs below are just a few examples of how our understanding of health disparities has informed our understanding of how to achieve health equity.
The South Bronx Greenway: Public Health, Urban Planning, and Environmental Justice
Released in November 2006, the South Bronx Greenway is one of the primary goals of a comprehensive planning process for the South Bronx that began with the Hunts Point Vision Plan, issued in March 2005.
The proposed Greenway will vastly improve access to the waterfront, provide much-needed recreational opportunities, improve transportation safety, and enhance the network of bike and pedestrian paths on the South Bronx peninsula while providing opportunities for compatible economic development. More info. Even more info.
Building Green to Combat Asthma: Public Health and Housing
One of the Sonoma County Asthma Coalition’s first big wins came in 2005 with the passage of a County Board of Supervisors Resolution highlighting the links between indoor air quality and asthma and calling upon the Department of Health to educate both property owners and tenants on improving poor indoor air quality. Building off this momentum, the coalition successfully advocated with Burbank Housing Development Corporation, the largest low-income housing developer in the county, to implement three new green building practices — improved ventilation systems in units, use of no- or low-volatile organic compound indoor paints, and landscaping with low-allergen plants. Burbank Housing continues these healthier practices in all new developments. More info.
Citywide Colon Cancer Coalition: Public Health, Hospital administration, Community Members, and Foundations
According to a presentation by the Department of Health and Mental Hygiene, NY, New York City was successful in eliminating disparities on colorectal cancer screening through community interventions such as direct colonoscopy referral systems, a system which ensures that the primary care provider follows up a colonoscopy referral directly with a colonoscopy center. The Department of Health and Mental Hygiene also established a task force and a clear policy goal to increase numbers of people getting screened, and eliminate disparities. Recent numbers in New York City show screening rates up by 66 percent, indicating the progress of this intervention. Outside organizations also deserve credit for this progress, including the American Cancer Society which covered 2,000 colonoscopies through this program. More info.
UnnaturalCauses.org. What is Health Equity?
Whitehead M. The concepts and principles of equity in health. Int J Health Serv 1992;22:429–445. (first published with the same title from: Copenhagen: World Health Organisation Regional Office for Europe, 1990 (EUR/ICP/RPD 414).)
CDC. Promoting Equity in Health: A Resource to Help Communities Address the Social Determinants of Health.