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11
Apr
2017

Do You Stand for Health Equity?

By ,

McKinney & Associates is proud to share the work of Brian Smedley, PhD, and Carla Gullatt, Executive Director and Deputy Director of the National Collaborative for Health Equity. During National Minority Health Month, they talked to McKinney & Associates about the leading causes of health inequity and shared evidence-based solutions that animate the growing field. View our CommPassions newsletter here.


Carla Gullatt, Executive Director and Deputy Director of the National Collaborative for Health Equity
Carla Gullatt, Executive Director and Deputy Director of the National Collaborative for Health Equity

What drives health inequity?

Health inequities are the result of a complex interplay of factors, but among the most important are factors outside of health care.

A large and growing body of research demonstrates that the spaces and places where people live, work, study and play have powerful direct and indirect influences on health status. And because of persistent segregation in schools, workplaces, and communities, many people of color are more likely than whites to occupy spaces that are less conducive to good health.

At the same time, too many of these neighborhoods lack access to health-enhancing resources, such as safe places to play and exercise. Even healthcare providers, hospitals, and clinics are harder to find in these neighborhoods.

People of color disproportionately live, work, and play in unhealthy communities, and therefore differences in neighborhood characteristics are a major factor that explain the poorer health of many minority groups relative to national averages.

Segregation is associated with poorer health because it concentrates poverty, thereby excluding and isolating people of color from mainstream resources necessary for economic mobility, such as good schools, good jobs, and access to banks and capital for business development. African Americans, Hispanics, and American Indians are substantially more likely to live in high-poverty neighborhoods than white non-Hispanics. Today one in four African Americans, one in six Hispanics, and one in eight American Indians in metropolitan America lives in a census tract in which 30 percent or more of the population is in poverty. These rates starkly contrast with the estimated one in 25 non-Hispanic whites who live in one of these tracts. But the high proportion of people of color in high-poverty communities is not solely the result of well-documented class differences: even middle- and higher-income minorities are disproportionately in neighborhoods with high poverty.

People of color are more likely to live in high-poverty neighborhoods because of a host of historic and contemporary factors that facilitate segregation, such as the ripple effects of Jim Crow segregation, “redlining”—the now-banned but persistent practice of disinvestment and economic discrimination against communities of color—and contemporary discrimination such as steering of minority potential home-buyers or renters away from majority white communities.

Why is health maintenance such a challenge in communities of color?

Community conditions can overwhelm even the most persistent and determined efforts of individuals to take steps to improve their health. Neighborhoods characterized by high levels of segregation are disproportionately burdened by health risks, such as environmental degradation often brought about by a high density of polluting industries. It’s harder to eat right in these communities because there are fewer grocery stores offering fresh fruits and vegetables. These same communities typically have poorer quality housing and transportation options, and are hit hardest by the home-mortgage lending crisis, which crushed wealth opportunities and disproportionately affected communities of color. Many of these neighborhoods also experience high rates of crime and violence, which affect even those who are not directly victimized, as a result of stress and an inability to exercise or play outside.

Talk about how history relates to this issue.

People of color are more likely to live in high-poverty neighborhoods because of a host of historic and contemporary factors that facilitate segregation, such as the ripple effects of Jim Crow segregation, “redlining”—the now-banned but persistent practice of disinvestment and economic discrimination against communities of color—and contemporary discrimination such as steering of minority potential home-buyers or renters away from majority white communities.

Brian Smedley, PhD
Brian Smedley, PhD

How can we fix this?

A combination of place-based and people-based investment are needed to help advance equity and opportunity. Place-based investments seek to reduce the concentration of health risks in vulnerable communities, while increasing access to health-enhancing resources. For example: we know that access to parks and recreational facilities is associated with lower body mass index among children and increased physical activity among adults.

We know that access to parks and recreational facilities is associated with lower body mass index among children and increased physical activity among adults. Families and children who live in lower-income communities and communities with higher proportions of Black, Latino or other racial and ethnic populations at high risk for obesity have significantly less access to recreational facilities than those in higher-income or predominately White communities.

Leading public health organizations, such as the Centers for Disease Control and Prevention and the American Heart Association, recommend using Joint Use Agreements (JUAs) to increase access to school properties.6, 7 A JUA is a formal agreement between two government agencies that sets forth the terms for shared use of public property or facilities. Healthy People 2020 objectives call for increasing “the proportion of the Nation’s public and private schools that provide access to their physical activity spaces and facilities for all persons outside of normal schools hours (that is, before and after the school day, on weekends and during summer and other vacations).”

People-based strategies acknowledge that we must help inoculate people from health risks where they are, or help them find healthier places. We know, for example, that investments in high-quality early childhood education can help children in low-income families, or those growing up in high-poverty neighborhoods, to enter school ready to learn and succeed. These benefits last well into adulthood: longitudinal studies show that children expose to high-quality pre-school programs have better educational, occupational, and health outcomes as adults. By some estimates, early childhood education programs save $17 for every dollar invested in them.

Other people-based strategies can help families to find safer, healthier environments, particularly for children. Where possible, existing housing mobility programs should be enhanced to help people who want to move out of distressed communities and into communities with lower poverty and better opportunity structures. Federal housing programs, such as the Section 8 voucher programs, could be strengthened to increase access among beneficiaries to housing in low-poverty communities, and federal research on the outcomes of housing assistance programs should be expanded. And a recent study finds that these families also have lower rates of obesity and diabetes than a randomly-assigned control group of families who also sought housing assistance but did not move out of distressed communities. These programs are promising and suggest that the nation can finally accelerate steps toward desegregation.

How did you become engaged in this work?

We “incubated” our work over many years at the Joint Center for Political and Economic Studies, a think tank in Washington, DC focused on addressing the needs of communities of color, before spinning off as the National Collaborative for Health Equity, whose mission is to equip leaders with the tools and catalyze the partnerships necessary to advance health equity movements. And we bring many years of prior experience to our work, including at settings such as the Institute of Medicine (now the National Academy of Medicine). Beyond that, we bring our personal experiences and passion as people of color who grew up during the heyday of the Civil Rights era, and seek to spark a new era of justice and equity for all people!

View our CommPassions newsletter here.