A Focus on Health to Resolve Urban Ills
By Amy Maxmen
The New York Times
19 April 2017
Photo courtesy Getty Images
On a crisp morning in the struggling Bay Area city of Richmond, California, Doria Robinson prepares a community vegetable garden for an onslaught of teenagers who will arrive that afternoon. Beyond the farm, a Chevron refinery pumps plumes of smoke into the atmosphere. The farm won’t remove the pollution, but Robinson believes it can make the city’s residents healthier in other ways, specifically by showing them that “their actions have an impact.”
Robinson is the director of Urban Tilth, a nonprofit organization that partnered last summer with the College of Environmental Design's embARC Summer Design Academy that is part of a movement in Richmond to counteract chronic stress that stems from the characteristics of the environment — abuse, discrimination, unrelenting economic worries and feelings of marginalization and lack of control — all of which scientists have linked to poor health.
Although evidence for connections between social factors and physical health has mounted for decades, interventions have remained elusive. To figure out what works, more than a dozen jurisdictions across the United States have rolled out a policy regimen titled “Health in All Policies” that has decades-old international roots; it explores new ways to improve health through social transformation, and ways to assess the impact of the changes. Robinson’s farms are among many interventions supported by the new laws.
Richmond became an early adopter of “Health in All Policies” in 2009. The basic idea is that considerations of health and health equity should be systemically woven into city plans and budget decisions ranging from transportation to housing. It was widely known that unsafe streets can directly injure an individual. What’s new is the knowledge that health also depends on how people feel when they walk down a tree-lined street rather than one with boarded-up buildings.
Richmond officials became interested in “Health in All Policies” about a decade ago, when they spoke with College of Environmental Design Professor of City & Regional Planning Jason Corburn, Director of the Institute of Urban and Regional Development and the Center for Global Healthy Cities. Corburn showed that a person’s ZIP code is more predictive of longevity than his or her genetic code — and that Richmond’s ZIP codes did not fare well. The root of the problem wasn’t the individual, he maintained, but rather the environment. “We all knew that it went beyond saying, you are unhealthy because you don’t exercise and eat bad food,” he explained. “I talked about toxic stress and structural racism as a driver of poor health outcomes.”
“The police chief immediately got it,” he said, “the mayor got it, and the city manager eventually got it too.”
Richmond officials survey residents annually to get a sense of whether they’re on the right track. On average, residents seem to be doing better since health equity became intertwined with the city’s plans. Surveys show that 43 percent of residents rated their health as excellent or good in 2015, up from 32 percent in 2011. Only 12 percent called the city a poor place to live in 2015, down from 32 percent in 2007. And with police reforms and community nonviolence campaigns, there’s been a 75 percent reduction in firearm-related homicides since 2007. Residents said they feel safer.
Corburn is eager to see if the city’s interventions — whether encouraging youths about their power to make change or assisting victims of sex trafficking to seek protection — will translate into health gains. The only way to know what may work is to try, he says.