Public health experts ask: Does your zip code affect your health more than your genetic code?
on January 22, 2016
“Where does your health come from?” “What are the societal determinants of health inequities?” “Is the Bay Area becoming a place for only a certain type of people?”
These are the questions that Tony Iton, senior vice president for Healthy Communities at the California Endowment, and Kimi Watkins-Tartt, deputy director of Alameda County Public Health Department (ACPHD) posed to members of the National Fellowship of Black Public Administrators (NFBPA) on Wednesday night. The group’s mission is to strengthen the position of African Americans in public administration and government by exploring national and regional issues concerning the African American community.
At their first meeting of the year at the county’s public health department headquarters in downtown Oakland, the Bay Area chapter hosted Iton and Watkins-Tartt to help its members better understand the socio-economic roots of national health disparities. Iton provided information on national trends and Watkins-Tartt helped the attendees digest the information at the county level. She also attempted to answer the question that many had: As conscious members of the community, what can we do?
“Why do we care about health?” Watkins-Tartt began. She showed a map of Oakland on the screen and explained the findings of a 2010 county report showing that a white child born in the Oakland Hills is expected to live 15 years longer than an African-American child born in West Oakland. “We care about health because we all pay a price if we don’t do it right.”
Watkins-Tartt spoke about the health department’s recent strategies and partnerships for addressing these disparities. “We ‘flipped’ the questions we were asking,” she said. “Instead of ‘Why do people smoke?’ we started asking, ‘What social and economic conditions lead people to smoke?”
Similarly, instead of asking, “How can people be healthier?” Watkins-Tartt urged attendees to ask which social and economic factors contribute to bad health, and how can each person play a role in keeping the community healthy.
According to the county’s report, West Oakland was home to 140 food stores in the 1950’s. At the conclusion of the report in 2010, there were only 20. “We need to ask what policies led to this decline,” said Watkins-Tartt.
Iton said that while the manmade environments we live in are the root of such health disparities, “We often act as if that’s not the case.” He went on to describe how people can blame bad health on a lack of healthcare or inability to afford increasingly expensive operations, and urged people to view factors in their environment, such as poverty and its stresses, or a lack of local grocery stores, as the precursors to bad health.
He brought to the screen two maps of Alameda County. One map showed the average life expectancies in different area codes, and the other showed poverty rates. The maps showed that people in wealthier areas could expect to live past 80, while poorer East and West Oakland residents could expect to live fewer than 74 years.
The 1950’s was the last decade that African Americans had a longer age expectancy than whites in Alameda County, Iton said, citing Alameda County vital statistics. In the 1960’s, whites could expect to live 2.3 years longer than African Americans. In the 80’s, whites could expect to live 4.9 years longer, and in 2005, the difference was 7.8 years.
“The difference in life expectancy is driven by chronic disease that affects those in poorer communities,” Iton said. Life expectancy rates of uneducated whites in the United States are falling, as well, Iton stated, adding that the cause of lower-than-average life expectancy is not race, but poverty.
Iton believes that the social inequalities of poverty make people feel as if they have no opportunities. “Poverty causes constant daily stressors,” Iton said. Chronic stress throws off the body’s ability to regulate itself, lowering the immune system’s response. Stress produces cortisol in the body, and constantly high levels can lead one to be at risk for diabetes.
“Healthcare is not a solution to health status,” Iton said. According to a 2011 British Medical Journal (BMJ) quality and safety report, the US spends the most money on healthcare, but less on social services than 36 other leading countries. “We have the accent on the wrong syllable,” Iton said, deliberately mispronouncing the word to emphasize the wrong half. “We’re spending our money wrong. We’re in the emergency room trying to solve social problems. We need new tools that provide opportunities to intervene.”
Watkins-Tartt has been helping the county try to find these tools over the past few years. The county’s health department has partnered with Causa Justa: Just Cause (CJJC), an Oakland-based non-profit devoted to helping low-income Bay Area residents, to assess the health effects of housing foreclosures.
“We started to see foreclosures as a public health issue,” said Watkins-Tartt, since these foreclosures are causing people to have to move from their homes. “People are being moved from Alameda County to Contra Costa County, and from Contra Costa to Solano County,” Watkins-Tartt said. She listed health effects of displacement that include, according to a2010 county report, financial strain, disruption of work and school, and psychological disturbances.
Since their partnership, ACPHD supported the passing of Oakland’s Tenant Protection Ordinance, which was approved in 2014, and contributed significant research to CJJC’s own report on displacement. Watkins-Tartt said the county plans to use data collected in their own reports along with CJJC’s 2014 report entitled “Displacement without Disruption” to “gain more leverage in the political arena. The county needs to hand off data to people who can throw the punches.”
The county has also submitted 11 policy recommendations to local city governments to prevent further negative health effects, she said. “The government can prevent displacement and should play a greater role in it to work towards development without displacement,” Watkins-Tartt said.
The department also began the Governing for Racial Equity campaign, aiming to improve racial equity and give a voice to community members. Watkins-Tartt said that the leader of this initiative, Julie Nelson, intends to change people’s reliance on “complaint-driven systems” (such as a healthcare institution that can only treat its members who call for help, who are usually the people who can afford and understand how to use the system) to be more prevention-focused and outreach-based.
Donna Linton, a retired Alameda County administrator, spoke at the end of the meeting, adding, “Citizens have a lot of power. Even though higher-up administrators seem to be more powerful, it can be hard at their level to break the mold and see the big picture. That’s why our voices are so important.”
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