| By Jonathan Heller |
This blog post was first published by the Detroit Wayne County Health Authority on Feb 9, 2015.
Too many babies are dying in Detroit – just as in my town, Oakland, California. Too many people are dying earlier than they should be. Heart disease rates are soaring. None of these facts are in dispute. But when we ask why or what can we do, we get some different answers.
Some say we need to improve the health care system. But while health care is important, it does not address the reasons people are getting sick. Most of us go to the doctor’s office when we are already sick.
Others attribute it to personal behaviors, saying that if people ate better and exercised more, their health would be better. That’s true, but if we examine why people don’t have healthy behaviors, we quickly find that healthy options are limited – particularly for those living in low-income communities. Healthy food is scarce. Parks aren’t safe. Streets aren’t walk-able. Good jobs are scarce, so stable housing in neighborhoods with high performing schools remains only a dream.
At the root of all of these, however, is a tragic reality: The most important reason health outcomes in Detroit are so bad is that we have created public policies that mean parents can’t get good jobs, our kids go to inadequate schools, and many members of our communities are isolated from opportunity. We have created policies that mean kids don’t have the healthy food, stable housing, and good education they need to thrive. They live under constant stress because these policies have resulted in difficult family conditions and community violence. The way they live each day is simply not conducive to good health.
The good news is that change is possible. There are many things those of us working in health can do. We can use our individual and collective voices to advocate for policies that get at these core issues – policies that promote full employment and higher wages, integrated communities with affordable housing, and a strong educational system. And we can use the resources our organizations have to address these underlying determinants of health.And we should do all this recognizing that the communities suffering from poor health outcomes bring their own expertise that should be respected.
Because we are all in this to improve people’s health, we must use the power and resources we have to work for that change. For example:
- Public health professionals and organizations can contribute data and research that connect the dots between public policy and health outcomes.
- Non-profit hospitals can include an analysis of the determinants of health in their community health needs assessments and use their charitable community benefits dollars to address the root causes of disease instead of,or at least in addition to, treating the symptoms of public policy.
- Medical professionals can support community organizers and policy advocates fighting for policy change by using their individual and collective voices in support of those community-led efforts.
- Public health nurses can help build social cohesion and strengthen social networks when they are out in the community providing services.
- All of us in health professions can help build the capacity of low income people and people of color to advocate on their own behalf for policies that improve living conditions.
And all of us can use the power of our positions to build relationships between those facing the greatest inequities and those who can change policy.
- These are all components of a Healthy Public Policy or a Health in All Policies approach that is based on advancing health equity. Health in All Policies is the concept of incorporating health considerations into the policies and programs of sectors that are the root causes of health – education, housing, land use, transportation, jobs, and incarceration.
We know this approach works. In the early 20thcentury, child mortality rates plummeted as a result of new child labor, sanitation, worker safety, and zoning laws passed by our government and implemented in the face of opposition from those who were profiting from the lack of regulation. This all happened before penicillin was invented or immunizations were available.
So, why not get involved in policy decisions that are being debated right now? Both Governor Snyder’s proposed sales and gas tax increase and Detroit Future City will affect the health of huge numbers of people. Health must be part of the debate.
There are many excuses we can give for not doing this work, including that it makes us uncomfortable and it feels alien. But if we are serious about improving health in Detroit, these are the kinds of actions that are required of us.
Jonathan Heller is, Co-Director of Human Impact Partners, and will be the keynote speaker at the 2015 Population Health Forum on March 2.
