Health Equity and the Role for Community Development
August 16, 2016 | Douglas Jutte, MD, MPH and Colby Dailey, MPP, Build Healthy Places Network | This post first appeared on the Build Healthy Places Network blog.
As our nation struggles with what is fair and just, and for whom, the urgent call for equity rings loudly. In philanthropy, equity is high on the agenda among major players, for example, the Ford Foundation, Kresge, Kellogg, the California Endowment, and many others. The Robert Wood Johnson Foundation’s new push for a Culture of Health places health equity central to its goals.
Similarly, in public health we’ve seen health equity named as this year’s theme for the National Association of City and County Health Officials (NACCHO) and as a guiding priority for the American Public Health Association (APHA). This year’s Association of State and Territorial Health Officials (ASTHO) President’s Challenge is to “Advance Health Equity and Optimal Health for All.” And in the Community Development sector the Opportunity Finance Network (OFN) frames equity like this: “We believe in opportunity for all. CDFIs—Community Development Financial Institutions—align capital with justice. We invest in opportunities and transform lives and places for disinvested people.”
So why do we believe that equity is fundamentally at the intersection of community development and health? Let’s start with some definitions.
“Equity” means fairness. No matter your race, ethnicity, ability, gender, or sexual identity, having an equal opportunity to achieve the American Dream is an intrinsic value in our United States. “Health equity” means a fair and equal opportunity to achieve the long and healthy life we all aspire to live. What stands in the way? For some of us, there are hurdles too high to jump even when personal motivation is strong. Barriers such as lack of access to good jobs, quality education, affordable housing, a safe environment—all are determinants of health.
This brings us to our sweet spot at PHI's Build Healthy Places Network: working at the intersection of community development and health. Because the determinants of good health are also the determinants of living a happy, productive, and successful life, and all people should have the opportunity for both.
So let’s talk about the flip side for a moment—the lack of opportunity to achieve a healthy and rewarding life. One root cause of this is poverty. And addressing poverty is the focus of community development work and investments. But too often, many Americans face a double-whammy. Not just poverty, but poverty plus sustained, systemic discrimination. Poverty combined with discrimination has even greater adverse effects on the health and well being of people across race, ethnicity, gender and sexual identity. As evidence, a new report from The Prevention Institute describes how discrimination has exacerbated the impact of poverty to create a vicious cycle of denied opportunity and poor health.
Poverty + discrimination is complex and intractable. But we believe that greater collaboration, utilizing the strengths of different sectors to maximize impact, can overcome it. By joining forces—across community development, health, and finance—we have the power as a nation to reverse the inequities experienced by millions of Americans. Evidence for this is now playing out across America—collaboration not just to improve buildings but even more so to revitalize places where people live. In other words, advancing a health + equity approach.
For example, consider these health + equity community development efforts:
- The Mariposa Project in Denver, CO: a holistic, transit-oriented affordable housing development led by the Denver Housing Authority where both community-level improvements and individual health outcomes are evaluated and measured—showing success in both.
- The Brandywine Center: A new community hub in Coatesville, PA that provides the area’s first federally qualified health center, affordable housing, and a behavioral health center to a low-income pocket of an otherwise wealthy county.
- Health and Literacy Center in South Philadelphia: a collaboration between Children’s Hospital of Philadelphia and the City as unexpected partners working together to bring a neglected neighborhood both improved access to health care and health promoting recreation and literacy opportunities.
- The Vita Health & Wellness District in Stamford, CT: a partnership between the housing authority and hospital to turn an impoverished inner city area into a mixed-income community with expanded neighborhood services centered around a sustainable urban farm—all while preserving every unit of public housing.
- Rolling Hills Apartments in Minneapolis-St. Paul: Twin Cities LISC, a local CDFI, is working with local organizations and city agencies to create new quality affordable housing with improved healthcare access, including the building of a nearby Federally Qualified Health Center.
- The San Pablo Area Revitalization Collaborative (SPARC): EBALDC, an Oakland-based CDC, has incorporated health into its strategic plan to revitalize one of the most impoverished sectors of the city, successfully preserving the historic California Hotel as affordable housing and bringing a grocery store to this long abandoned neighborhood.
- The ReFresh Project in New Orleans: A local CDC partnered with residents, multiple local organizations, and Tulane University to turn the largest post-Katrina derelict property into a community facility that co-locates a grocery store in a food desert with a university teaching kitchen, youth development catering training center, and community offices.
It’s clear that there is no easy path forward—no one way to address poverty + discrimination or the barriers to fairness that impede achieving a good and healthy life. But by working alongside communities, community development and health professionals can interrupt the cycle, create opportunity, and transform high-poverty places into communities where all people can live rewarding and healthy lives.
Douglas Jutte, MD, MPH and Colby Dailey, MPP are the directors at PHI's Build Healthy Places Network.