Why Cities Must Keep Equity a Central Focus in Building a Culture of Health

“Economic development is integral to having a healthy community. If we can address the economic issues in our neighborhoods, we can help people live healthier lifestyles.” – Mayor Mark Holland, Kansas City, Kansas

Seeking to achieve health equity is the best way to ensure the health of all residents within your city. (Getty Images)

Access to high-performing schools, good jobs, affordable housing, viable transit options, and healthy food can predict both how long and how well people live. Seeking to achieve health equity is the best way to ensure the health of all residents within a city. (Getty Images)

This post was co-authored by Alyia Gaskins and Stephanie Boarden.

Where you live determines your health as well as your proximity to opportunity. However, deep patterns of discrimination, racial segregation, and decades of federal, state and local policies have dictated where people live and the opportunities to which they have access. Despite advances in public health and improved economic prosperity, poor health outcomes disproportionately affect low-income communities and communities of color.

“We all need to understand that racial disparities exist in every important aspect of life. From infant mortality to life expectancy, race has the power to predict and even determine success. And that presents society and local leaders with some unique challenges. Local government leaders are well positioned to make the policy, institutional, and structural changes necessary to reduce disparities and advance equity.”
– Leon T. Andrews, director of the National League of Cities’ Race, Equity, And Leadership (REAL) initiative

We cannot ignore how historical, systemic and structural racism has also shaped our nation’s cities and towns, resulting in disparities in education, housing, employment and health. Low-income communities and communities of color are still feeling the impacts of those decades-old decisions today. For these communities, the lack of key resources and services results in poor and costlier health outcomes, which are referred to as health inequities. Simply put, race and place matter when it comes to health and well-being.

In addition to having serious health consequences for individuals and families, health inequities negatively impact the economic competitiveness and vitality of cities through lost potential and productivity.

  • In 2000, the infant mortality among African Americans occurred at a rate of 14.1 deaths per 1,000 live births, which is more than twice the national average of 6.9 deaths per 1,000 live births that same year
  • Children who experience hunger are more likely to be in poor health and have behavioral and emotional problems in schools. Additionally, children experiencing hunger are more likely to repeat a grade and require special education services
  • Researchers estimate that childhood lead exposure in homes costs society over $50 billion per year due to lost economic productivity resulting from reduced cognitive potential
This graphic shows the average life expectancy by county in the Washington, D.C. metro area.

A graphic showing the average life expectancy by county in the Washington, D.C. metro area. (Robert Wood Johnson Foundation)

Now more than ever, municipal leaders have a responsibility to lead the way in partnering with communities to reimagine, design, and plan healthy places for residents to live, learn, work, and thrive. “Economic development is integral to having a healthy community. If we can address the economic issues in our neighborhoods, we can help people live healthier lifestyles,” says Mayor Mark Holland, Unified Government of Wyandotte County, Kansas City, Kansas.

The following steps can help local leaders address racial and ethnic health inequities and create healthier, more inclusive and prosperous cities:

  1. Increase the understanding of the systemic and historical policies that have exacerbated health disparities in your community by providing trainings for staff and local decision makers
  2. Collect and analyze neighborhood-level data on social, economic, and environmental factors such as race and ethnicity, crime, housing, small business development, and transportation to better understand the distribution of the social determinants of health across your city
  3. Invest in health promoting resources and services such as parks, early childhood programs, workforce development, and training programs that have direct and indirect benefits for health
  4. Create multi-sector partnerships that include public health and non-health stakeholders, community leaders, residents, and anchor institutions to advance health equity. For example, under the Affordable Care Act (ACA), health plans and hospitals are looking beyond their walls to identify opportunities to address the most pressing needs of their communities

To do this efficiently and effectively, it’s essential that residents be engaged in meaningful and authentic ways – especially those who are experiencing the poorest health outcomes – to inform the policymaking process from design to implementation. Only by including the voices and the stories of those most affected by health inequities can we advance policies, programs, and practices that promote health and advance equity.

This is the second blog post in our new Culture of Health series. Look for the next post in November. If you’re interested in learning more, check out the recording of our October 27 webinar, A Level Playing Field.

About the authors:

Alyia Gaskins is a Senior Associate for Health and Community Wellness at NLC’s Institute for Youth, Education, and Families. Follow Alyia on Twitter at @a_gaskins412.

 

Stephanie Boarden is an Associate Director at PolicyLink.