How about this narrative, suggested by Dr. Iton? Paying for health care, including care mandated under state employee pension plans, is a major budget buster for California. Much of what we’re paying for–a whopping 75% of health care expenses–goes to treat chronic conditions such as heart disease, stroke, cancer, and diabetes. If factors in the LA County environment contribute to these disease conditions, let’s look at the environment. Maybe we can improve health and fiscal stability at one and the same time.
Hricko suggested that in land use and zoning decisions, it’s not enough to require an environmental impact report which considers air pollution and noise. A more holistic approach is needed in the form of a health impact assessment. “What about light, blight, safety, and social cohesion?” she asked. According to Dr. Jonathan Fielding, director, LA County Department of Public Health, the quality of a person’s social interactions is a major component of health. Having someone to confide in and being connected to a neighborhood and community organizations turn out to be as significant as such choices as not smoking. This means we can look at gentrification and displacement of people from their neighborhoods as still another blow to good health.
From the audience, LaVonna Lewis from the USC School of Policy, Planning, and Development recommended a publication by the Robert Wood Johnson Foundation, “A New Way to Talk about the Social Determinants of Health,” which can be downloaded here and suggests right off the bat not to use any academic jargon including, yes, the phrase “social determinants of health.”
Judging from their website, it was clear the Prevention Institute (sponsor with the Liberty Hill Foundation of Wednesday’s conference) learned that lesson. The Institute’s Healthy Places Coalition frames the concept this way: “Where we live, work, play, and learn shapes our health.”
Adjusting the language we use would, I think, work in many advocacy efforts, not only in the public health/environmental justice field.
Some suggestions from the publication in talking to audiences with conservative outlook:
“Incorporate the role of personal responsibility. The importance of all Americans having equal opportunity to make choices that lead to good health resonated with participants across the political spectrum. Incorporating this point made respondents more receptive to the idea that society also has a role to play in ensuring that healthy choices are universally available.”
“Focus broadly on how social determinants affect all Americans (versus a specific ethnic group or socioeconomic class). This research showed that Americans believe in equal opportunity to health, but describing actual disparities consistently evokes negative reactions.”
Instead of talking about poverty or low-income families, the publication suggests using language like “Americans struggling to get by” or “ People who work for a living and still can’t pay their rent.”
I shared these ideas with an activist friend who thought it was outrageous to censor language relating to inequality, poverty, and race. Granted, this is not the language of community organizing and empowerment but it’s not intended for that use. It’s a way to speak with people who haven’t yet made an empathetic identification with others who don’t live near them and don’t look like them. It’s only a first step, using language aimed at encouraging dialogue rather than polarization. It’s about encouraging people to look at the world around them.
“The built environment,” said Dr. Jackson, “is social policy in concrete.” He showed a slide of a home with a garage as big as the living space–a shelter for cars rather than people. An aerial view of a freeway interchange: “The California state flower.” What we build tells us a lot about how we live and who we are.
We can raise awareness about how individual initiative is never the whole story. The built environment affects our choices in daily life, wherever we live. In middle class suburban communities, would you walk more if there were any places worth working to within walking distance? Would your kids walk to school or walk around the neighborhood if there were real pedestrian crossings with traffic signals instead of zebra lines painted in the street where you take your life into your hands any time you try to cross? “The less we walk,” said Dr. Jackson, “the less fit we become.” We face an epidemic of childhood obesity. The rate of adult onset diabetes in children has doubled in one generation to the point, he said, to the point that there aren’t enough pediatric endocrinologist to deal with it. “Kids don’t walk or bike to school anymore” — a trip that also once included a lot of social learning.
“You don’t learn,” he said, “being strapped in the back of Mom’s car or Dad’s car.” Would you sometimes bike to work if it didn’t feel dangerous to ride in traffic? Would you let your kids bike to school and to their friends’ homes? When you were a kid, did you walk and run and bike and isn’t that how childhood ought to be? Do you regret –in a world of climate change and high gas prices–that you have to drive to a health club in order to exercise?
Dr. Fielding noted there are at least 6,500 premature deaths a year due to air pollution while at least 20 new residential developments have been proposed or built near freeways since 2000. The 7,200 housing units are not only for poor people.
Once people understand we all face some built-in obstacles to healthy living, it’s easier to understand the kid who lives where the air is toxic and there are no parks and no safe places to walk and no access to transportation to go anywhere else.
What about the people of Wilmington, right off the 710 where the plan is to expand the freeway to 14 lanes? According to Bill Gallegos, executive director of Communities for a Better Environment, residents cope with emissions but also pollution from the local oil refinery. “Every other home in the area near Conoco-Phillips has someone dying of cancer.” His organization had a recent significant success–winning stringent regulation of the refinery’s highly toxic practice of “flaring” excess gases.
Wilmington, along with Pacoima and Boyle Heights, has now been designated a Green Zone, for which the plan is to offer incentives to attract green businesses, prevent the siting of additional toxic industries in these hot spots, and work to clean up or mitigate the problems caused by existing businesses. You don’t target one business at a time, said Gallegos, but the whole community, as you don’t want to create a situation in which a company that’s being environmentally responsible is undercut competitively by bad businesses.
The Clean Up/Green Up campaign in Wilmington has had a side benefit. It brought community members together with a common purpose, creating more of that healthy social connectedness.
Elva Yañez, policy coordinator for the LA Collaborative for Environmental Health and Justice, pointed out that “policy innovations comes from the bottom up” and localities don’t have to–and shouldn’t–wait for action on the state or federal level. Looking at the “booze, butts, and bullets campaigns,” she noted that smoke-free laws began at the local level and spread across the country. Grassroots groups in South LA have worked to limit liquor stores in the neighborhood. Local restrictions on firearms began when West Hollywood banned the Saturday Night Special. Healthy food initiatives can succeed locally, too, she said while Dr. Fielding cited policy changes that have made a difference, such as helmet and seatbelt laws. But national policy can either hinder or assist. He asked why not direct agricultural subsidies to fruits and vegetables rather than to producers of high-fructose corn syrup?
“Booze, butts, and bullets” slides right off the tongue, but as Yañez noted, “‘cumulative environmental impacts” does not. For anyone with a better suggestion, the comment box is open.
And speaking of words, I won’t mince any more now in addressing the activist community. What are we going to do about justice? About our fellow Angelenos who are–in Yañez’s words– “permanently relegated to shorter, sicker lives.” Let me quote Gallegos who paused to remember the recent passing of African American scholar Marable Manning who spent a lifetime thinking about how to change a “bleak and relentless set of conditions” and concluded you do it by building social movements. “Messaging is important,” said Gallegos, “but who carries that message? Building the movement is the message.”
And, oh yes, the data. The entire conference will eventually be streamed (soon, I hope) at the Liberty Hill Foundation website where you can already download the report: “Hidden Hazards: A Call to Action for Healthy, Livable Communities,” with charts, graphs, numbers, and footnotes and the mapping of hazards and sensitive areas. The California Environmental Protection Agency released “Cumulative Impacts: Building a Scientific Foundation” and the executive summary of a forthcoming report on “Global Trade Impacts: Addressing the Health,
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