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Reshaping Power: The Key to Tackling Decades of Health Inequities

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Our health system is one of growing inequities and the pandemic has further exposed those gaps in care. In the earlier stages of COVID-19, data showed that testing for the virus was more widely available in affluent neighborhoods. Meanwhile, the number of cases and deaths from the virus has risen among people of color from neighborhoods with higher rates of poverty.

In America, where government messages about getting enough exercise and eating fresh fruits and vegetables gloss over disparities, a person’s health comes down to power. Who decides where people live, where hospitals are built, or where bus routes are drawn? All those decisions, made by people in positions of power, can affect a person’s blood pressure, diet, and mental health. 

In "Power & Health,” experts explain how sociological, economic and racial conditions have a greater impact on our well-being than we realize. They also describe how the role of power in our society can be reshaped through community, belonging and inclusion to improve health, gain access to care and prevent chronic illnesses.

In "Power & Health,” experts explain how sociological, economic and racial conditions have a greater impact on our well-being than we realize.
Power & Health - Media Manager

To achieve that, people in the U.S. need to understand the forces that shape the conditions in which we live, said Dr. Sandro Galea, dean of Boston University’s School of Public Health. He points to data that shows that 80% of Americans are behind when it comes to keeping up with their own health. That means 4 out of 5 Americans do not or cannot participate in preventative care.  

"We like the narrative that ‘my health, my wellbeing is a function of me pulling myself up by my bootstraps’...that ‘I work hard,’ that ‘it was my force of will,  my hard work that put me in the condition to be healthy,’” Galea said. “Whenever we think that way, we forget that what (we) have achieved is a function of both luck and the conditions of the world around (us).”

"We like the narrative that ‘my health, my wellbeing is a function of me pulling myself up by my bootstraps’... “Whenever we think that way, we forget that what (we) have achieved is a function of both luck and the conditions of the world around (us).”
Sandro Galea

By luck and conditions, Galea is referring to social determinants, or the conditions of the places where people are born, grow up, live, work, and raise families.

People who reside in affordable housing, for example, almost always live next to toxic sites, freeways, or train tracks, said Ryan Petteway, an assistant professor from Portland State University, who studies such issues. He also knows this firsthand. Petteway grew up in low-income housing. His younger brother had asthma and his condition was made worse by the fumes from an industrial complex nearby. Each time his brother suffered an asthma attack, the family rushed to the emergency room. Petteway noticed that over time, the treatment for asthma improved, but the cause of his brother's asthma never changed. His family’s experience made him think of other families who live in similar conditions.

"They don't have any control over housing conditions,” Petteway said. “They don't have any control over air quality. They have no control over the larger social economic political context that shapes patterns of violence. All they have control over is whether or not they can get to the emergency room or if they have primary care possibly to get asthma treatment. And that's not solving the problem."

Where people live and what is included in those communities and neighborhoods is based on a multi-layered political structure that favors wealth, Petteway and others say in the film.

In one Southern California neighborhood, a battery recycling plant operated for 33 years with only a temporary permit issued by the state, despite warnings of environmental violations and the harmful levels of lead and arsenic released and later found in homes, yards and schools. Studies have found that children who grew up near the now-shuttered Exide plant have higher levels of lead in their blood than those who live farther away. The state recently allowed the owners of Exide to abandon the property, without having to clean the site.

Suburbs, too, are impacted by big corporations and government decisions. Los Angeles city and county officials allowed for family homes to be built on hills near a massive abandoned oil well field. The wells were later used for storage by the Southern California Gas Co. In 2015, one of the wells leaked, sending tens of thousands of tons of methane into the air, causing headaches, nosebleeds and nausea among residents in nearby Porter Ranch. Five years later, no conclusive health studies have been performed and residents continue to ask the state to shut down operations.

Government decides how communities are built, and little has changed for generations, added Melissa M. Jones, executive director for the Bay Area Regional Health Inequities Initiative.  

“The decisions that got made were oftentimes made when a concern about equity wasn't a priority,” Jones said. “Some communities are getting much more and some are getting much less, and that has made a huge difference on the communities that we see today.”

Where people live can cause chronic stress, leading to several other conditions such as depression, high blood pressure, heart disease and diabetes. 

“Racism plays two roles,” Jones said. “Racism plays the role of putting a level of chronic stress on people who are discriminated against, who are experiencing prejudice. For a long time it was not understood the level of stress that can cause and what that means for our health. Racism plays a second impact. It excludes people from opportunity.” 

Family physician Dr. Camera Jones said she found in her own studies and in those of others that it wasn’t a person’s skin color, their culture, or genes that made them suffer more from health disparities. It was the way they were identified.

“It's a very important thing for people to understand that race is not something you are born with,” Jones said. “Race is something you are assigned in a race conscious society.”

In her study, she found that blood pressure increased in Black women at a higher rate than for white women at the same age and even socio-economic background. Being identified as Black leads to more stress because of racial injustice, which can cut a person’s life expectancy by several years.

The stress of being identified as an undocumented person also weighs heavily on many communities, health experts have observed. In late 2018, the Trump administration submitted a proposal to restrict the ability of lawfully present immigrants to obtain permanent residency if they’ve used public assistance programs. The proposed rule would expand the current definition of “public charge” to include nutrition programs, health care and other services legally available to immigrants. Fears and distrust of public health care spread among people who were both undocumented people and lawfully permanent residents. Physicians and health care providers who work in community clinics, where the uninsured and underinsured people often turn to, noticed that strides made to help people manage diabetes and high blood pressure fell back, because patients stopped visiting.

Racism, Jones added, is a system of power that unfairly shapes the way some communities are structured. Through that structure, power becomes emboldened and grows. Even after some strides were made during the civil rights movement of the 1960s, social justice has remained stagnant. Frustrations fester and grow as this year’s demonstrations against the killing of George Floyd by a police officer and killing of others by law enforcement have shown.

The fight to end police brutality, cut pollution, and equalize healthcare persist.

Take a walk through your own neighborhood and notice if there are parks, how the housing stock changes, where the bus routes are located. Ask yourself, "Who decides which stores go where and what kind?" "The question 'who decides?' is at the very heart of beginning to understand your own power." — Eric Liu

To understand why those fights continue, take a walk through your own neighborhood, said Eric Liu, the founder of Citizens University. Notice if there are parks, how the housing stock changes, where the bus routes are located. Ask yourself, "Who decides which stores go where and what kind?" Liu prompted.

"The question 'who decides?' is at the very heart of beginning to understand your own power," Liu said. “The way that all of us together can change that is to stop suffering in individual isolation, to stop thinking as a matter of private pain and private shame, but to name it and to say, ’You know what? This isn't just on me. We all are feeling this pain.’”

The solution then becomes to mobilize, to share ideas, raise funds and change attitudes. Liu calls those collective voices mounds of capital. Once that mound of capital is built, make a decision to either hoard it or circulate it, he said.

“You have to make a clear and affirmative choice and a recommitment to be a circulator and not a hoard,” he added.

A South Los Angeles neighborhood illustrated how that works when they fought against one of the most powerful industries in the nation: big oil. They formed a collective of voices to fight oil extraction from a site that sat in the middle of their densely populated neighborhood. They coordinated visits to city hall, organized rallies that grew in size, and offered proof to city and health officials that the nosebleeds and headaches suffered by residents were a result of the chemicals used to pump the oil.  

“When we started nobody thought it was possible to end oil drilling in Los Angeles,” said Martha Dina Arguello, executive director for Physicians for Social Responsibility Los Angeles.

A few years later, the state ordered the company to shut the oil wells and production down.

“We had a David and Goliath battle,” Arguello said. “In that story, David won.”

Top image: Two children at Camp Christmas Seals, a racially integrated summer camp in Haverstraw, New York, 1943, featured in "Power & Health."

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