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 Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health (pdf) E-mail to a friend
WORKBOOK - Centers for Disease Control and Prevention, 2008

This workbook is for community-based organizations seeking to affect the social determinants of health through community-based participatory approaches and nontraditional partnerships. Along with an introduction to the concepts of health equity, the workbook presents case studies of communities working at both small and large scales. The authors then provide guidelines for developing your own initiative, from creating partnerships to identifying your approach to assessing and maintaining your progress.

Image Thumbnail RACE - The Power of an Illusion E-mail to a friend
DOCUMENTARY SERIES produced by California Newsreel, 2003

What is this thing we call 'race'? Where did the idea come from? What are the patterns of human variation? And if race isn't biological, what is it? How do our social institutions 'make' race? Used widely in classrooms and community spaces, This acclaimed three-part series compels viewers to scrutinize some of their most fundamental beliefs.

Also see the extensive companion Web site, with games, interactivities, and additional information.

This film is part of the Structural Racism sub-category of California Newsreel's African American Perspectives Collection.

Image Thumbnail Racial Residential Segregation: A Fundamental Cause of Racial Disparities in Health (pdf) E-mail to a friend
SCHOLARLY ARTICLE by David R. Williams and Chiquita Collins, Public Health Reports, 2001

The authors review evidence that suggests that segregation is a primary cause of racial differences in socioeconomic status (SES) by determining access to education and employment opportunities. SES in turn remains a fundamental cause of racial differences in health. Segregation also creates conditions inimical to health in the social and physical environment. The authors conclude that effective efforts to eliminate racial disparities in health must seriously confront segregation and its pervasive consequences.

Image Thumbnail Realizing the Vision for a Healthy California (pdf) E-mail to a friend
POLICY BRIEF from Strategic Alliance, 2009

The Strategic Alliance for Healthy Food and Activity Environments has developed recommendations for taking advantage of opportunities from the American Recovery and Reinvestment Act of 2009 to improve the health and safety of all Californians.

Image Thumbnail Rebuilding Neighborhoods, Restoring Health E-mail to a friend
 Alameda County Public Health Department and Causa Justa ::Just Cause

This report examines the many pathways by which foreclosures are taking a toll on individual and community health.  The consequences of the foreclosure crisis spreading most rapidly in low-income communities of color extend well beyond individual families being forced to leave their homes.  Neighborhoods pockmarked by vacant housing are struggling with increased crime and violence.  Social bonds are broken as families leave the neighborhood, leaving the entire community less prepared to deal with problems.  School stability is threatened as families are forced to move out.  The report highlights the health impacts of foreclosure and offers strategies to reduce or eliminate foreclosure's negative health outcomes.

Image Thumbnail Recommendations for the Prevention and Wellness Funds (pdf) E-mail to a friend
POLICY MEMO from PolicyLink and Prevention Institute, April 2009

This memo offers recommendations for targeting Prevention and Wellness recovery funds to maximize the health and equity benefits in the Recovery Act of spring 2009. It makes the case that prioritizing disease prevention – particularly among the most impacted communities – is imperative to strengthening the nation. It makes specific recommendations for using funds to
- Build upon and leverage existing prevention initiatives;
- Promote equity by targeting America’s low-income communities and communities of color;
- Target multi-disciplinary strategies focused on environmental change;
- Develop the health workforce to effectively shape and implement prevention efforts; and
- Advance a vision of healthy people, healthy places.

Image Thumbnail Reducing Inequities in Health and Safety through Prevention (pdf) E-mail to a friend
POLICY MEMO from Prevention Institute and the Health Policy Institute of the Joint Center for Political and Economic Studies, January 23, 2009

Advancing health equity to ensure all Americans have the opportunity to lead healthy lives should be a priority. We have an opportunity to do so in a way that alleviates pressure on the health system and saves money. This memo was developed in January '09 to provide background and recommendations for developing a comprehensive, prevention-oriented strategy for acheiving health equity.

Image Thumbnail Remembering the Marshall Islands E-mail to a friend
ARTICLE by Jane Goodall, Rick Asselta, June 30, 2006

Opinion piece commemorating anniversary of Bravo detonation, 60 years after the commencement of U.S. nuclear testing in the South Pacific, urging us to remember the health effects of nuclear testing on the residents of the Marshall Islands.

Image Thumbnail Research: Green areas lower health inequities between rich, poor E-mail to a friend
NEWS ARTICLE, USA Today, Nov 11, 2008

Health inequalities between rich and poor people are much lower in areas that have lots of green space, such as parks, forests and playing fields, a large British study finds.

Image Thumbnail Richmond California Struggles for Clean Air E-mail to a friend

Community activist Torm Nompraseurt leads a "toxic tour" of Richmond, California where high levels of industrial pollution are wreaking havoc on the health and wellbeing of residents.

Image Thumbnail Ron Sims: The King County Equity and Social Justice Initiative E-mail to a friend
TRANSCRIPT of a speech by Rom Sims, King County Executive, March 2008

In a speech for the CDC Health Transformation Lecture Series, Mr. Sims explains how his office has made health equity central to its work - across sectors and in partnership with communities, business, and local agencies - and makes the case for the CDC to use its considerable influence and reach to promote and support health equity nationally.

Image Thumbnail Seattle Healthy Homes Project - Healthy Homes II Asthma Project E-mail to a friend
WEBSITE by the King County Asthma Forum

Includes tools for community health worker programs, resources, and references to academic studies on the project.

Image Thumbnail Selected Additional Resources on Health and Place E-mail to a friend

This handout describes several key resources that may be useful for audiences interested in learning more about the connections between population health and the built / physical, social, economic, and service environment.

Image Thumbnail Sick People or Sick Societies? E-mail to a friend
RADIO SHOW, CBC, "The Best of Ideas Podcast" 2008

Journalist Jill Eisen explores the importance of the social determinants of health from a Canadian perspective. The program devotes considers the importance of looking at "upstream" causes of health and presents possible policies for intervention on different levels.
Part One: S. Leonard Syme, Richard Glazier, Carol Shively, and Michael Marmot explain the concepts behind social determinants of health, present evidence for how stress contribute to "modern" diseases, and elaborate the moral and practical obligations we have to demand action.
Part Two: Dennis Raphael, Richard Glazier, and Clyde Hertzman discuss the obesity and diabetes epidemics and early childhood development. Raphael makes an interesting commentary as to why governments continuously fail to address social threats to health.

Image Thumbnail Smart Growth Online E-mail to a friend

In 1996, the U.S. Environmental Protection Agency joined with several non-profit and government organizations to form the Smart Growth Network (SGN). The Network was formed in response to increasing community concerns about the need for new ways to grow that boost the economy, protect the environment, and enhance community vitality.  The Network's partners include environmental groups, historic preservation organizations, professional organizations, developers, real estate interests; local and state government entities.

Image Thumbnail Social change and health in Sweden - 250 years of politics and practice E-mail to a friend
BOOK by Jan Sundin and Sam Willner, Swedish National Institute of Public Health, 2008

This thorough text examines the history of public health in Sweden, with particular attention to the emergence of the welfare state in the past century. Say the authors, "Historical lessons cannot be transferred uncritically from one country to another. However, differences and similarities in appropriate contexts can increase our understanding of relations between health and society. We hope that this book will be useful for policy comparisons and in the training of public health policy-makers, researchers, administrators and practitioners."

Full pdf available online, 5 MB.

Image Thumbnail South Los Angeles Health Equity Scorecard (pdf) E-mail to a friend
REPORT by A Park, N Watson, and L Galloway-Gilliam, Community Health Councils, Inc., December 2008

To assess the extent to which inequities in the healthcare and physical resource environments determine and shape the health of the South LA community, Community Health Councils collaborated with the Coalition for Health and Justice in a year-long study examining the healthcare and physical environment resources in the area. The resulting Scorecard takes into account multiple public and private policies that influence the resident health through investment—or lack of investment—in economic, education, housing, and healthcare systems. The Scorecard also identifies incremental steps by which South LA can be helped to achieve health equity.

Image Thumbnail Still Toxic After All These Years: Air Quality and Environmental Justice in the San Francisco Bay Area (pdf) E-mail to a friend
REPORT by the Center for Justice, Tolerance, & Community, UC Santa Cruz

From West Oakland's diesel-choked neighborhoods to San Francisco's traffic-snarled Mission District to the fenceline communities abutting Richmond's refineries, poor and minority residents of the San Francisco Bay Area get more than their share of exposure to air pollution and environmental hazards, this report finds.

Image Thumbnail Strategic Actions for a Just Economy E-mail to a friend

SAJE is an economic justice, community development, and popular education center that has been building economic power for working class people in Los Angeles since 1996. Over the past eleven years, SAJE's winning combination of community organizing, coalition-building, and grassroots policy has gained significant benefits for the community. Accomplishments include creating the nation's first welfare-to-work bank account and, through the Figueroa Corridor Coalition for Economic Justice, negotiating the nation's most comprehensive community benefits agreement.

Image Thumbnail Strategic Alliance for Healthy Food and Activity Environments E-mail to a friend

The Strategic Alliance is a coalition of nutrition and physical activity advocates in California, working to shift the debate on nutrition and physical activity away from a primary focus on personal responsibility and individual choice to one that examines corporate and government practices and the role of the environment in shaping eating and activity behaviors. The Alliance's goal is to benefit the health and wellness of all California residents by promoting environmental solutions and institutional and government policies and practices that support healthy eating and activity.

Image Thumbnail Strategic Review of Health Inequalities in England Post 2010 E-mail to a friend

Professor Sir Michael Marmot has been asked by the British government to Chair an independent Review to propose the most effective strategies for reducing health inequalities in England from 2010. This review is a response to the recommendation of the WHO Commission on Social Determinants of Health that national governments develop and implement strategies and policies suited to their particular national context aimed at improving health equity.

Image Thumbnail The Beloved Community E-mail to a friend
DOCUMENTARY distributed by California Newsreel, 2006

Sarnia, a Great Lakes oil town that is the nerve center of Canada's petrochemical industry, once enjoyed the highest standard of living in the country, but now the bill has come due, in compromised environmental and community health.

This film is part of California Newsreel's Health and Social Justice Collection.

Image Thumbnail The biggest asthma trigger of them all? New studies indicate how poverty itself Is inflammatory E-mail to a friend
 Edith Chen, Ph.D at the Psychobiological Determinants of Health Lab at the University of British Columbia

Scientists such as Edith Chen, Ph.D, have found evidence that the very experience of poverty and the stress it induces might itself be an asthma “trigger.” Dr. Chen co-founded the Psychobiological Determinants of Health Lab at the University of British Columbia to better understand the pathways by which class gets under the skin and influences our heath.  Rather than focus on how material pollutants, like soot, disrupt our physiology Chen and her colleagues are investigating how ‘social pollutants’ – that is, toxic social environments can become embedded in our bodies and increase susceptibility to disease. 

Image Thumbnail The Biology of Disadvantage: Socioeconomic Status and Health E-mail to a friend
JOURNAL Nancy E. Adler  and Judith Stewart, eds. Annals of the New York Academy of Science

How does socioeconomic status get under the skin? This book summarizes the decade of research by the MacArthur Foundation Research Network on Socioeconomic Status and Health “exploring the pathways and mechanisms that contribute to the gradient relationship between socioeconomic status and health.”

PDFs of each article are available online.  You may also purchase a complete copy of the journal.

Image Thumbnail The Built Environment: Designing Communities to Promote Physical Activity in Children E-mail to a friend
POLICY STATEMENT from the American Academy of Pediatrics

This first-ever policy statement on health and place from the AAP argues that pediatricians working with community partners should participate in establishing communities designed for activity and health.

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