UNNATURAL CAUSES is inequality making us sick? HEALTH EQUITY research topics and resources to learn more
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Housing / Neighborhoods

Background: In the United States, street address and zip code are surprisingly good predictors of health. Why? Because the social, economic, and physical environments in which we live powerfully shape our life chances and wellbeing - for better and worse.

Where we live is not simply a matter of personal preference. It has a profound impact on financial security, school quality, job opportunities, safety, as well as access to goods and services. Unfortunately, racial segregation and past housing and loan discrimination have helped create inequities in neighborhood quality and the distribution of wealth and health.

Among other things, communities with lower income and educational levels tend to have higher rates of asthma, obesity, diabetes, heart disease, and child poverty. They are also more likely to have substandard housing, underfunded schools, poor access to grocery stores and supermarkets, and to be located near toxic industries and other sources of pollution.

On the other hand, well-off neighborhoods include many resources that help protect and sustain individual and group health: safe streets, well-maintained public spaces, good schools, libraries and other amenities, community programs, clean air, and good access to jobs and healthy food options.

Several overlapping factors play an important role in shaping health directly and indirectly:

Physical environment. Built space, infrastructure, and environmental quality all have a direct impact on our wellbeing. Old, substandard housing is more likely to have peeling paint, exposing families to dangerous lead levels, as well as pests and mold, which increase the risk of infectious disease and respiratory ailments like asthma. Geographic access to jobs, services and safe places to exercise and play shapes behaviors, choices and economic opportunities. Proximity to polluting industries, waste, freeways, and other hazards affects the air we breathe, the water we drink and the land we live on. Noise pollution also affects our anxiety and stress levels, which increase our risk for chronic illness.

Economic environment. Wealth, employment and economic mobility are important to foster good health, now and in the future. High housing costs threaten food and financial security, while concentrated poverty and a lack of good jobs lead to crime and disinvestment. On the flip side, home ownership brings financial security; attracts public and private investment in businesses, schools and infrastructure; and also promotes neighborhood cohesion - all of which are beneficial to health. Job training and access to good jobs with benefits, decent pay and career ladders help families avoid falling into financial disaster and reduces their risk for premature death and chronic disease.

Social environment. Communities that have strong social networks and foster social inclusion are healthier. Isolation and lack of support not only contribute to illness, they disempower individuals and communities. Neighborhoods where residents gather and help one another can foster belonging, affirmation and increased civic participation. They also have a bigger voice: organized groups can better advocate for their needs, reduce crime and increase safety, and bring health-promoting resources and services into their environment.

Resources and services. Our access to grocery stores and supermarkets, reliable transportation, clean parks, safe streets, community programs and institutional services reflect larger structural patterns of opportunity and advantage in society. Nevertheless, they impact our ability to make healthy choices, to gain skills and knowledge, to get adequate health care, fire protection and police protection, to avoid injury and live relatively unencumbered by fear, and fundamentally, to ensure that our basic needs are met and that we have a future to look forward to.

Together, these elements determine our health in subtle and obvious ways. Ensuring that every community is the healthiest it can be requires community organizing, political will, and public investment. Strategies to revitalize neglected areas, clean up environmental hazards, improve schools and foster economic development and wealth are critical they but must include and respond to the needs of residents, who more often than not are painfully aware of what is wanting in their communities.

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Image Thumbnail Environmental Justice Resource Center E-mail to a friend

The Environmental Justice Resource Center (EJRC) at Clark Atlanta University was formed in 1994 to serve as a research, policy, and information clearinghouse on issues related to environmental justice, race and the environment, civil rights and human rights, facility siting, land use planning, brownfields, transportation equity, suburban sprawl and smart growth, energy, global climate change, and climate justice. The overall goal of the center is to assist, support, train, and educate people of color, students, professionals, and grassroots community leaders with the goal of facilitating their inclusion into mainstream decision-making.

Image Thumbnail Equitable Development Toolkit E-mail to a friend
A toolkit from PolicyLink

Equitable development is an approach to creating healthy, vibrant, communities of opportunity. Equitable outcomes come about when smart, intentional strategies are put in place to ensure that low-income communities and communities of color participate in and benefit from decisions that shape their neighborhoods and regions. This online toolkit includes 28 tools to reverse patterns of segregation and disinvestment, prevent displacement, and promote equitable revitalization.

Image Thumbnail Fair Growth 2020: A Tale of Four Futures E-mail to a friend
ARTICLE by Lance Freeman, House Facts & Findings, 2000

What will America look like in 2020, given the steady decline of our central cities and our unchecked suburban expansion? In this 2000 article, author Lance Freeman looks at four possible scenarios for the future, and their implications for urban sprawl and social equity.

Image Thumbnail Foreclosed: State of the Dream 2008 E-mail to a friend
REPORT, United for a Fair Economy, January 2008

In this year's report for Martin Luther King, Jr. Day, United for a Fair Economy found that the subprime lending crisis is causing the greatest loss of wealth to people of color in modern US history. They also estimate the difference in losses due to racial bias. The report details how and why the damage occurred, and offers solutions for what can be done.

Image Thumbnail Forum #1: Healthy Communities (pdf) E-mail to a friend

Dolores Acevedo-Garcia, Meizhu Lui, Makani Themba-Nixon, and Jack Shonkoff answer questions from Web site visitors about neighborhoods, community organizations, labor, family, and early childhood.

Image Thumbnail Getting Under the Skin: Using Knowledge about Health Inequities to Spur Action E-mail to a friend
RESEARCH-IN-ACTION BRIEF, Charles Hamilton Houston Institute for Race and Justice, Harvard Law School, 2009

"This brief has two purposes. The first is to translate knowledge from the so-called “social determinants of health” arena into a useable form. The second purpose is to explore how to best use this knowledge to lobby for, and create policy and programming changes on the ground in, communities of concentrated disadvantage."

Image Thumbnail Healing the Hurt: Trauma-Informed Approaches to the Health of Boys and Young Men of Color E-mail to a friend
The California Endowment

 The project is founded on the understanding that trauma and adversity have a direct impact on health. The authors also understand that African-American and Latino young men are disproportionately affected by various forms of trauma and adversity including violence, poverty, incarceration, lack of access to health care, marginalization and low social status.

The project has two main goals:
  • To identify, analyze and synthesize existing knowledge about the health status of boys and men of color across disciplines, and interpret it through the lens of trauma.
  • To identify promising trauma-informed models and approaches to addressing the health needs of boys and young men of color.

Image Thumbnail Health Education Resources for ESL Educators E-mail to a friend

KQED has developed lesson plans for use with ESL/ ESOL student, using clips from UNNATURAL CAUSES and other media to broaden students' understanding of factors affecting health.

Lessons using the series:
Stress: The Bigger Picture (Not Just a Paycheck / When the Bough Breaks)
This Place Matters: The Impact of Neighborhood on Health (Place Matters and online video)
Living in the United States: Is It Good for Our Health? (Becoming American / In Sickness and In Wealth)
Food Pyramids: What We Eat and Who We Are (Becoming American)

Other lesson plans explore health literacy, the social contexts of drug and alcohol addiction, stress management, and cultural differences in medical practice.

Image Thumbnail Health Inequities in British Columbia (pdf) E-mail to a friend
DISCUSSION PAPER, Health Officers Council of British Columbia, November 2008

This report and recommendations from the health officers of British Columbia provides one of the clearest and easiest to understand documents on health equity produced thus far. The first half defines terms, sets a health equity framework, and makes policy recommendations that are widely applicable. The second half focuses on outcomes specific to British Columbia.

Image Thumbnail Health Inequities in the Bay Area E-mail to a friend
REPORT from the Bay Area Regional Health Inequities Initiative (BARHII)

This report is an attempt to show how the various forces discussed in UNNATURAL CAUSES influence health in the nine-county California Bay Area, and to suggest the kinds of policy initiatives and activities that will be crucial for both reducing the disparities among populations and improving our health overall.

Image Thumbnail Health Justice Report Card E-mail to a friend
DATA TOOL from the Praxis Project

This tool is designed to help community based organizations, public health advocates and practitioners to look at how their county is doing along a range of issues related to the health and well being of communities. For each indicator, there are links to tools and resources to support organizing, advocacy and policy development toward that end.

Image Thumbnail Health Leadership: Action Steps DVD E-mail to a friend
PRESENTATION available from Blue Cross and Blue Shield of Minnesota Foundation

The 2007 Blue Cross Foundation Leadership Award Program and Luncheon featured a keynote by Dr. Anthony Iton, director of the Alameda County (California) public health department, on how race, class, wealth, education, geography and employment affect health status.

Also includes presentations from Atum Azzahir, co-founder, president and executive director of the Powderhorn Phillips Cultural Wellness Center in Minneapolis, and remarks by Marsha Shotley, foundation president; the new Minnesota Health Commissioner, Dr. Sanne Magnan; and Blue Cross and Blue Shield of Minnesota President Colleen Reitan.

Image Thumbnail Health Policy Institute of the Joint Center for Political and Economic Studies E-mail to a friend

With the mission to ignite a Fair Health movement that gives people of color the inalienable right to equal opportunity for healthy lives, this pioneering program of the Joint Center for Political and Economic Studies undertakes research, publications, activities, and projects designed to accelerate progress beyond listing and analyzing a litany of health disparities. Rather, they are directed toward collective strategies that will produce real change—and real opportunities for health.

See also: HPI Place Matters

Image Thumbnail Healthy Development Measuring Tool E-mail to a friend

Developed by the San Francisco Department of Public Health, this tool is a comprehensive evaluation metric to consider health needs in urban development plans and projects. The Tool encompasses a community-based vision for planning and uses public health to explicitly connect physical and environmental planning to a wider set of social interests.

Image Thumbnail Healthy Homes and Early Learning: Addressing Social Determinants of Health in Seattle and King County (pdf) E-mail to a friend
PRESENTATION SLIDES from Jim Krieger, Public Health - Seattle & King County / University of Washington

The slides from a presentation by Jim Krieger, one of the experts featured in Place Matters, Episode 3 of UNNATURAL CAUSES. Krieger discusses how the High Point project sought to address various social determinants of health by building healthier homes and neighborhoods. The second half of the presentation discusses early childhood development and the need to provide early education.

Image Thumbnail Hidden Wounds of Violence (PDF) E-mail to a friend
NEWS ARTICLE, Chicago Tribune, April 28, 2008

A clear and compelling article about the "secondary" negative health effects that violence has on children.

Image Thumbnail High Point, Seattle E-mail to a friend

Information on the High Point Community in Seattle, featured in Place Matters, Episode 5 of UNNATURAL CAUSES

Image Thumbnail Housing as the Best Cure E-mail to a friend
INTERVIEW by Donna Kimura, Affordable Housing Finance, Sept 2008

In this interview, pediatrician Megan Sandel of Boston Medical Center explains the positive health effects of good, affordable housing, comparing it to a vaccination that helps keep children healthy and prevent disease.

Image Thumbnail Infill Development, Housing Costs, and Public Health (pdf) E-mail to a friend
EDITORIAL by Rajiv Bhatia, Director of the San Francisco Department of Public Health’s Occupational and Environmental Health Section

While acknowledging the great potentials of infill development to curb sprawl and revitalize city centers, Bhatia calls attention to the great need for decision-makers to consider the needs of existing residents. Among other things, he recommends a Health Impact Assessment (HIA) for affected communities during the planning process.

Image Thumbnail Interdisciplinary Consortium on Urban Planning and Public Health (ICUPPH) E-mail to a friend
WEB SITE by the Harvard Center for Society and Health

ICUPPH brings together academics, practitioners, students, and community members focused on urban planning and public health to help advance the state of each practice through collaboration. ICUPPH members bring expertise and experience in myriad areas, including but not limited to environmental justice, food systems, healthful affordable housing, residential segregation, urban air quality, and obesity and the built environment. ICUPPH's activities fall into four main tracks: education, outreach, and research/consulting.  ICUPPH is advised in its work by faculty members from the Harvard School of Public Health, the School of Architecture and Planning at MIT, Tufts University (the Department of Environmental Policy and Planning), and the Boston University School of Public Health.

Image Thumbnail International Making Cities Livable E-mail to a friend

The International Making Cities Livable Conferences were founded in 1985, and are held biannually in the United States and Europe. They are unique in enabling city officials, architects, planners, developers, community leaders, behavioral scientists, artists and others responsible for the livability of their cities to exchange experiences, ideas and expertise.

Image Thumbnail Introduction to Environmental Justice E-mail to a friend
TRAINING CURRICULUM from the Asian Pacific Environmental Network (APEN)

APEN has nearly 15 years of experience working with low-income Asian immigrant and refugee populations from the Laotian and Chinese in Oakland and Richmond, California, including elders, youth and women. Our organizing and advocacy manual documents APEN's leadership methodologies so that others may use it to organize their communities. This initial curriculum book focuses on healthy homes education tools tailored for API community-based organizations and their leadership.

Image Thumbnail Jack Shonkoff Interview (mp3) E-mail to a friend
PODCAST, Web-exclusive content from UNNATURAL CAUSES

In this original interview, Dr. Jack Shonkoff, director of the Center on the Developing Child at Harvard University, discusses the importance of early childhood experiences on life-long health, learning, and success. He describes the effect of toxic stress on brain development, and asserts that we have a moral and economic incentive to provide the best environments for all children or pay the price later in the form of reduced productivity and the burden of chronic disease.


Image Thumbnail KIDS COUNT Data Center E-mail to a friend
DATABASE created by The Annie E. Casey Foundation

A database system that contains state- and city-level data for over 100 measures of child well-being. This easy-to-use, powerful online database allows you to generate custom reports for a geographic area (Profiles) or to compare areas on a topic (Ranking, Maps, and Line Graphs).

Image Thumbnail Life and Death From Unnatural Causes: Health and Social Inequity in Alameda County E-mail to a friend
REPORT from Alameda County Public Health Department, California

This report takes an in-depth look at health inequities and underlying social inequities in Alameda County based on local data. Part One describes the nature and magnitude of health inequities in the county. Part Two describes social inequities and proposes policies to address social inequities-the root causes of health inequities. Sections include: segregation, income and employment, education, housing, transportation, air quality, food access and liquor stores, physical activity and neighborhood conditions, criminal justice, access to health care and social relationships and community capacity.

Also see Alameda County Public Health Department Director Dr. Tony Iton's comment on press coverage of the study.

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