Rochester Unnatural Causes in Sickness and In Wealth Video Questions Who did the Whitehall study look at (describe the participants they studied) and what

Rochester Unnatural Causes in Sickness and In Wealth Video Questions Who did the Whitehall study look at (describe the participants they studied) and what did they find was the connection between health and employment grade?What is the wealth-health gradient?What stories from Jim Taylor’s life illustrate how wealth, power, and status translate into better health?What did the monkey research study teach us about the connections between power, subordination, and health?Discuss how stress impacted the health of the dominant versus subordinate monkeys.Why would changes that promote greater equity (equality) translate into population health improvements?What are some of the chronic stressors mentioned in the film that affect our health? (list 5)Discuss how societal forces create and reinforce the stressors you listed above?What additional set of stressors might racism impose? Introduction To
Social Determinants
of Health
What do we mean when we say
social determinants of health?
?
Social determinants are social factors within our
environment that play a large role in determining
our health. Social factors are those that are
?
Social factors include:
? Race/Racism
? Access
to resources such as health care
? Social Class/Income
? Education
Health Disparities
What are Health Disparities?
? Health disparities are differences in health
between two or more groups of people.
? Those groups can be determined by many
different demographics, such as:
?
? Income
? Gender
? Geographic
location
? Race, Ethnicity
? Age
What Leads to Health Disparities?
Health disparities are often confused with
social determinants.
? It is important to keep in mind that social
determinants are the environmental risk
factors that often lead to health disparities
or differences in health.
? These health disparities are often the
cause of years of social injustice, misstreatment or lack of education.
?
Statistics
?
What are statistics?
? It
is important to remember that statistics
identify risk factors within communities; this
does not mean that someone is determined to
get a particular disease, but they may be at
risk.
?
What do they mean?
Health Disparities
?
There are large disparities in health
outcomes between White Americans and
minorities in many different areas including:
? Infant
mortality and low birth weight (LBW)
? Diabetes
? Cardiovascular disease (heart, blood pressure)
? Cancers such as prostate and breast cancer
? HIV and other sexually transmitted diseases
Female Age-Adjusted Mortality Rates per 100,000 Persons by
Race/Ethnicity for 4 Health Focus Areas
Source: Slide taken from the CDC website
Drug Overdose by Race and Ethnicity
Why do these disparities exist
Racism/Unfair treatment for example, job
placement.
? Stress/lack of social support
? Living conditions/working conditions
? Income
? Unequal opportunities
How do these
? Lack of resources
?
? Health
?
insurance
Education
factors influence
health?
How factors influence us from early
on
Macrosystem
Mesosystem
Microsystem
Lets take a closer look.
?
Activity: First figure out what social factors
are having an effect on each individuals
health health, then place them on the
diagram.
Your Role as A CHW
?
Reduce the burdens on individuals by
connecting them to resources
Unnatural Causes-In Sickness and in Wealth
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Unnatural Causes-Place Matters
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Why Place Matters:
Building a Movement for Healthy Communities
PolicyLink is a national research and action institute
advancing economic and social equity by
Lifting Up What Works.®
Design by: Leslie Yang
COVER PHOTOS COURTESY OF (from left to right, top to bottom): ©iStockphoto.com (Danny Warren), ©iStockphoto.com (konstantin32), ©iStockphoto.com (Thania Navarro), Harlem Children’s Zone, ©iStockphoto.com (Christopher Hudson), ©iStockphoto.
com (Justin Horrocks), p.37: ©iStockphoto.com (kajetan), ©iStockphoto.com (Inger Anne Hulbækdal), Youth UpRising.
PHOTOS COURTESY OF: p.16: Harlem Children’s Zone; p.26: ©iStockphoto.com (Justin Horrocks); p.27: ©iStockphoto.com (konstantin32); p.28: ©iStockphoto.com (Kerry Muzzey); p.29: ©iStockphoto.com (Tomas Levstek); p.32: Blue Cross & Blue Shield of
Minnesota Foundation; p.33: ©iStockphoto.com (Hannamariah photography); p.34: Youth UpRising; p.37: ©iStockphoto.com
(kajetan); p.38: ©iStockphoto.com (Thania Navarro); p.39: ©iStockphoto.com (Danny Warren); p.41: ©iStockphoto.com (Daniel
Rodriguez), p.42: ©iStockphoto.com (Cameron Whitman); p.45: ©iStockphoto.com (Christopher Hudson); p.46: ©iStockphoto.
com (Inger Anne Hulbækdal); p.47: ©iStockphoto.com (Brandon Laufenberg); p.48: ©iStockphoto.com (Michael Braun); p.57:
©iStockphoto.com (Pathathai Chungyam); p.58 iStockphoto (Bonnie Jacobs).
Why Place Matters:
Building a Movement for Healthy Communities
Judith Bell
President
Victor Rubin
Vice President for Research
All Rights Reserved.
Copyright © 2007.
PolicyLink
2
Why Place Matters: Building a Movement for Healthy Communities
PolicyLink
Table of Contents
Case Studies
4
Preface
5
Executive Summary
6
Introduction
13
I. Class, Race, Ethnicity, and Health
a. Socioeconomic Status (SES) and Health
b. Race, Ethnicity, and Health
c. The Health of Immigrants
18
18
19
20
II. A Framework for Healthy Communities
a. Economic Environment
b. Social Environment
c. Physical Environment
d. Service Environment
22
24
30
36
44
III. Themes from the Case Studies: Lessons Learned
49
IV. Recommendations: Moving Into the Future
51
Notes
62
3
PolicyLink
Case Studies
4
Harlem Children’s Zone: Focusing on 100 Blocks and One Child at a Time
16
Moving to Opportunity
25
Health Impact Assessment in San Francisco: A Tool to Build Healthier Communities
26
Metro Denver Health and Wellness Commission: A Broad Coalition to Address Health
in Schools, Worksites, and Communities
27
Using Food Stamps to Buy Fresh Produce at a Local Flea Market
28
Fresno Works for Better Health: A Partnership to Improve Health Through Economic
and Leadership Development
29
Kids Make A Stand in Shasta County
32
The Blue Cross and Blue Shield of Minnesota Foundation: Grantmaking to Address
Community Conditions That Impact Health
33
Youth UpRising: A Center for Youth Leadership and Community Transformation
34
Looking at Transportation Planning Through a Health Lens
37
The Greening of Los Angeles: Improving Health Through a Movement for Urban Parks
38
Keeping Housing Away from Freeways and Toxic Polluters
39
City of Richmond: Considering Health in the General Plan
41
Improving Health by Improving Homes: Research and Advocacy in Three Cities
42
Kaiser Permanente: A Health System Looking Beyond Health Care
45
Colonias in California’s Central Valley: Working for Basic Infrastructure
46
Data + Community Collaboration = Policy Change
47
Community Coalition: Promoting Healthy Neighborhoods
Through Leadership Development and Community Involvement
48
Unnatural Causes
53
Moving the Golden State towards Health: The Governor’s (and Advocates’)
Vision for a Healthy California
55
The Bay Area Regional Health Inequities Initiative (BARHII)
57
Reading, Writing, Arithmetic, and Health: Lessons Learned from
School Efforts to Combat Obesity
58
Why Place Matters: Building a Movement for Healthy Communities
PolicyLink
Preface
PolicyLink and The California Endowment have
long recognized that place matters. Our work
is informed and driven by the recognition that
neighborhood environmental factors—from local
economic opportunities, to social interactions with
neighbors, to the physical environment, to services
such as local grocery stores where people can
buy nutritious food—all affect individual health.
We’re extremely enthusiastic about the growing
movement that’s developing place-based solutions
to place-based problems.
We know that residents of low-income communities
and communities of color suffer disproportionately
from negative environmental factors: poor air quality
as a result of over-exposure to toxins such as diesel
exhaust from highways and bus depots, poorly
maintained homes with mold, lack of healthy food
options, and the lack of clean, safe open spaces
such as parks and playgrounds. Social, economic
and service components—lack of access to good
jobs, inadequate healthcare and other crucial
services, and fractured social networks—also present
obstacles. As detrimental as these are, we know
that, unfortunately, they represent only a few of the
factors that cripple far too many neighborhoods and
the people who live in them. Understandably, there’s
much work to be done.
We believe that an equitable approach to building
healthy communities requires a number of diverse
tactics from multiple stakeholders. Collaboration
across a broad range of sectors and groups, including
the private sector, is necessary to create the type
of healthy communities we want for ourselves and
our neighbors. And the experience and voices of
community members—particularly people of color—
must be an integral part of discussions and strategic
thinking around sustainable change.
We’re not alone in our belief. The organizations
and coalitions profiled in this report—many led by
visionary leaders—demonstrate that environmental
factors, which strengthen and enliven communities,
can be created and replicated to benefit everyone.
No one approach works for all communities, each is
particular to the place and the people they are meant
to serve, and the goals they want to achieve.
Why Place Matters offers examples of promising
practices from across the country, with many
concentrated in communities throughout California.
Some groups are working with planners to develop
strategies for improving residents’ transportation
options; some are joining with city governments
to create plans for neighborhood economic
revitalization; some are linking healthcare services to
prevention, and others are working with the private
sector to better serve their communities’ social and
service needs. We trust each of them will illuminate
the connection between people and place in new
ways, facilitate collaboration and the exchange of
ideas, encourage cross-sector partnerships, and
stimulate action.
We appreciate the participation of everyone who
shared with us those best practices that are working
well in communities, near and far. It is our hope
that these successful strategies will be used by
advocates and policymakers, government and
business, researchers and educators, city planners and
community builders, and all others who want to be a
part of the movement to build healthy communities.
This report benefited significantly from research
and writing by Diana Bianco, a health care policy
consultant. The PolicyLink Center for Health and
Place team—Mildred Thompson, Rebecca Flournoy,
Glenda Johnson, Mary Lee, Rajni Banthia, Iman Mills,
and Erika Bernabei—contributed throughout, from
the initial conceptualization to final editing. The
California Endowment was represented by Marion
Standish who provided overall vision and oversight,
and George Flores who added useful comments and
editing suggestions. Paulette Robinson, consultant,
provided excellent editing support. We thank them
all for their dedication and hard work.
Robert K. Ross
President
The California Endowment
Angela Glover Blackwell
Founder and CEO
PolicyLink
Preface
5
PolicyLink
Executive Summary
Driven by the knowledge that where
you live determines how you live, a new
movement is building. It is spearheaded
by local leaders and anchored by the belief
that a broad array of communities and
interests must be engaged. Advocating for
equitable policies and practices to establish
healthy communities, this movement draws
from a broad framework, incorporating a
community’s physical, social, economic, and
service environments. Traditional single-issue
boundaries are being broken, forging new
connections and alliances across diverse
sectors. Efforts are underway to influence and
change environmental factors so communities
can thrive.
The leadership of this movement is
appearing in many parts of society. Public
health officials, planning officials, and
educators are studying a neighborhood’s
physical or “built” environment—the safety
of its streets and parks, the condition
of housing and schools, the location of
businesses, and patterns of regional growth
and change—as indicators of residents’
health. Community leaders, elected
officials, and organizations are realizing
that a high degree of civic participation
and strong social support systems inform
people’s sense of safety and belonging
and influences their health. Business and
community leaders and government officials
are linking a neighborhood’s economic
health—for example, the presence of, or
connection to, jobs paying living wages,
a thriving commercial sector that employs
local residents with neighborhood-serving
businesses—to individual health and wellbeing. Local organizations are linking
the presence of culturally-grounded,
neighborhood-level services to the
6
Why Place Matters: Building a Movement for Healthy Communities
physical and emotional health of residents,
understanding that every service from the
effective delivery of medical care to the use of
recreational programs has health implications.
The framework described in this report
provides a way to understand the relationship
between community conditions and health,
analyzes the connections among all of the
environmental factors that contribute to
a healthy community, and identifies both
protective and negative environmental effects
on community health. Why Place Matters
builds on the growing movement to improve
the health of individuals through a focus on
community and illustrates how organizations
and groups are employing effective “placebased” strategies throughout California and
the country.
I. Class, Race, Ethnicity,
and Health
American neighborhoods are often
segregated by race and income.
Communities of color and low-income
communities are plagued overwhelmingly
by high crime rates, under-funded schools,
insufficient services, poor transportation
and housing options, and other harmful
attributes that compromise individual and
community health. Segregation limits
residents’ access to full-service grocery
stores; safe, walkable streets; and a healthy
environment. In fact, polluting businesses and
factories are located much more frequently
in communities of color, which means a
less healthy neighborhood with more air
and soil contamination. Communities of
color—African Americans, Latinos, and some
Asian Americans—suffer disproportionately
PolicyLink
from certain health problems—diabetes, high
blood pressure, obesity, and asthma.
Since so many American communities are
informally but thoroughly segregated by race
as well as income, health disparities are both
a health and a place-based issue, one where
improving community conditions could make
a real difference in health outcomes. When
policies and practices are put into place that
improve the physical, economic, social, and
service condition of communities, the lives of
those within the communities also improve.
II. A Framework for Healthy
Communities
Place matters.
Individual health is compromised when
residents fear walking outdoors in the
evening and won’t allow their children to go
outside during the day, after school, or on
weekends. A child’s health suffers when he
or she must sit in shoddy school buildings
in need of repair, without nutritious
meals or an opportunity for physical
activity. Children’s and families’ health are
impacted when their neighborhood lacks
a decent grocery store with fresh fruits
and vegetables for sale. Families suffer
when there is little access to economic
opportunities. Residents suffer in high crime
areas because crime influences the quality
and availability of services and economic
opportunities; it impacts whether businesses
will locate in the neighborhood, or whether
others will come to the neighborhood to
patronize local businesses or attend social or
cultural events. Neighborhoods across the
country are afflicted with risk factors that
have profound implications for community
and individual health.
By contrast, many protective factors help
build and sustain community and individual
health. Safe, well-maintained parks can
promote physical activity and public spaces
for neighborhood gatherings. Access to
healthy food can reduce obesity and related
diseases such as hypertension and heart
disease. Clean air quality can reduce asthma
in adults and children. Reliable and safe
public transportation can provide residents
with the necessary mobility to get to jobs
and schools. There are myriad ways that a
neighborhood’s protective factors positively
impact individual health.
This report’s case studies highlight examples
of groups working to increase and fortify
protective factors—in economic, social,
physical, and service environments—
throughout California and the country. The
case studies show how the experience and
voice of community members are critical
for successful place-based strategies. Many
of the efforts profiled represent innovative
partnerships and new alliances for change.
These collaborations are influencing
policymakers—in the public, business, and
nonprofit sectors—producing real change
in communities and states. Many of the
efforts also involve people of color in
leadership positions, building the capacity
of local leaders to advocate for policy
change, showcasing the need for a focus on
equitable outcomes.
The specific factors that are most important
and the strategic approaches for enabling
healthy communities vary, but there are
some time-tested truths that these case
studies confirm: local residents have
significant insight into what problems are
most critical to address, what community
strengths can be used to improve health and
community conditions, and what strategies
and solutions will be most effective. Local
leaders, connected with those at the regional
and state levels, will create the power and
momentum to pull the ultimate levers for
sustainable change at the local, state, and
national levels.
Executive Summary
7
PolicyLink
A. Economic Environment
A solid economic environment entails
commercial investment, a focus on providing
jobs that take people out of poverty,
businesses that provide healthy food options
to all residents, and a path that moves people
to opportunity. The presence of thriving
diverse businesses is a protective factor that
helps build financially secure and healthy
neighborhoods. New business development
tends to draw additional activity as others
seek to capitalize on existing economic
vitality, providing an opportunity to hire
local residents, creating increased individual
income and available disposable income.
Coalitions, such as Fresno Works for Better
Health, have been creating innovative
programs to improve job quality, in terms of
wages, benefits, and career ladders; to tailor
training to the needs of local residents; and
to ensure that residents of one community
can have practical access to jobs throughout
their metropolitan area. Within their
neighborhood’s retail sector, residents of lowincome neighborhoods typically face a paucity
of healthy food options. However, there are
now many examples of organizations and
coalitions working to improve healthy food
access. One is Kaiser Permanente, which
has established farmers’ markets across the
state; another is Fresno Metro Ministry, which
worked with the California Department
of Social Services, the U.S. Department of
Agriculture, and the California Nutrition
Network to ensure that low-income residents
could use their food stamps to buy nutritious
food at a local flea market.
B. Social Environment
Strong social networks that bring neighbors
together—whether to advocate for change,
cultivate a community garden, or provide
services—can strengthen community ties
and empower individuals to be advocates
for themselves and change agents for their
neighborhoods.
8
Why Place Matters: Building a Movement for Healthy Communities
When diverse people come together for
a common goal, it increases the potential
for meeting their objectives and also offers
opportunity for bridging differences.
Knowledge, skills, and connections—to
jobs, services, and civic l…
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