Reducing Health Disparities Through a Focus on Communities

by Angela Glover Blackwell

People who live in communities that are economically and socially deprived often experience greater adverse health outcomes than those who reside in more affluent communities. Such disparities exist particularly among different racial and ethnic groups, as people of color cope with the stress associated with racism and its potential to have a harmful and long-term impact on health. Initiatives to address health disparities often focus on improving health care delivery and on expanding access to medical care and coverage. Yet, while important, these factors often overshadow the link between health and community conditions, and obscure the reality that where individuals live has a direct impact on health.

Poor neighborhoods struggle with failing schools, often located in unsafe, poorly maintained facilities; a shortage of decent, safe, and affordable housing, and a lack of access to parks and affordable recreational facilities. Healthy food choices are hard to come by in many communities of color and low-income neighborhoods because there is a scarcity of full service supermarkets stocked with fresh fruits, vegetables, and other quality food choices. Instead, on almost every street, fast and junk food establishments abut corner convenience stores that sell liquor, cigarettes, canned goods, and foods with high levels of salt and sugar that fuel the high rates of diabetes, high blood pressure, and heart disease. In contrast, communities that are better off have easier access to supermarkets and families enjoy safe and accessible parks and recreation facilities along with banks, high performing schools, and affordable housing.

Research suggests that efforts to improve health outcomes in communities of color could be most successful with a simultaneous focus on communities' economic, social, and physical environments. Eliminating health disparities requires proactive community activities along with policy driven approaches to make it possible for neighborhoods to confront the negative factors that lead to poor health.

Such policies, for example, could limit the number of convenience stores or offer customers healthier food choices. Policies can offer incentives to developers to build grocery stores and supermarkets in inner city areas. As the nation focuses attention on the rise of obesity-especially among children-community intervention and changes in policy can support the development and maintenance of safe streets, parks, and recreational facilities that encourage and enable the types of exercises that are crucial to maintaining a state of health and well-being.

PolicyLink research has focused attention on several examples of how policy can support the creation of and maintenance of healthy residents and healthy communities. Pennsylvania, for example, is home to the nation's first statewide economic development initiative aimed at improving access to markets that sell healthy food in underserved rural and urban communities. Legislation passed in Arkansas that led to the creation of a Child Health Advisory Committee, charged with developing statewide standards for nutrition and physical activity and recommending healthy food choices for vending machines. The New York State Department of Public Health has made mini-grants to a number of faith-based organizations in minority communities throughout the state to promote programs to increase physical activity.

Policy changes can help reverse high rates of school and work absenteeism related to asthma, resulting from poor air quality and high levels of toxins and pollutants. Studies conducted by the Environmental Protection Agency found a disproportionate amount of such toxins in African American and Latino communities. Policy can support the replication of efforts such as Harlem Children's Zone, which works with hospitals and city government partners to test children for asthma, mobilize residents and advocate for support from policymakers to address unhealthy community conditions. These examples and others demonstrate the commitment of people across the nation to make every community a healthy place to live. Where people live shouldn't be a metaphor for ill-health.

© 2005 KCET, Tavis Smiley Productions and PBS.

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Published: September 15, 2005