Tag Archives: Class

Fair Housing for Better Health

One year after Michael Brown was killed by police officer Darren Wilson in Ferguson, Missouri, galvanizing the Black Lives Matter movement, the role of housing segregation in perpetuating racial injustice is in the news. Residential segregation is one of the major mechanisms that produce racial health disparities in the United States, but there is some reason for optimism that new national policy efforts will challenge ongoing segregation.

Last month, the U.S. Department of Housing and Urban Development (HUD) announced the Affirmatively Furthering Fair Housing (AFFH) rule. This rule comes on the heels of the Supreme Court’s June decision that affirmed the legal rights of plaintiffs to challenge housing policies with racially “disparate impacts” – without being required to show that racial discrimination was intentional. A non-profit called the Inclusive Communities Project brought the suit against the state of Texas Department of Housing and Community Affairs, arguing that Texas was allocating too many of its federally funded tax credits for affordable housing -housing for low-income, predominantly Black residents- to developments in poor, urban neighborhoods. This decision in turn came shortly after the release of a study out of Harvard’s Department of Economics, showing that moving from a high poverty to a low-poverty neighborhood as a young child led to measurable benefits in adulthood. These included better educational outcomes and higher incomes – two of the strongest predictors of health outcomes.

With these findings in mind, the AFFH rule is designed to reduce racial and economic residential segregation, and work towards achieving the unfulfilled promises of the 1968 Housing Act, so that more children gain the benefits of living in high opportunity, low poverty neighborhoods. AFFH asks cities to generate plans for reducing segregation, and connects municipalities to HUD data and support to design and implement these plans. This Supreme Court case, and HUD’s policy response, will be equity wins if they can open up some of America’s wealthy, exclusionary and generally White neighborhoods to affordable housing development. Policy conversations about racially concentrated poverty have too often veered towards pathologizing poor Black communities – created through decades of explicitly racist housing policies – without examination of the processes of exclusion that create concentrated affluence. Sociologist Patrick Sharkey writes forcefully that,

“Living in predominantly black neighborhoods affects the life chances of black Americans not because of any character deficiencies of black people, not because of the absence of contact with whites, but because black neighborhoods have been the object of sustained disinvestment and punitive social policy since the emergence of racially segregated urban communities in the early part of the 20th Century. Residential segregation has been used consistently over time as a means of distributing and hoarding resources and opportunities among white Americans and restricting resources and opportunities from black Americans.”

This “hoarding” creates racially concentrated areas of affluence, dominated by White residents. And these communities receive plenty of government housing subsidies, in the form of mortgage interest tax deductions. One of the ways that rich White neighborhoods maintain their boundaries is through zoning restrictions that make it difficult if not impossible to construct affordable multifamily housing (whether subsidized or not.) Hopefully the AFFH can work towards ensuring that some of these neighborhoods become more racially and economically inclusive.

But some have responded to AFFH as if it’s an indication that building affordable housing in high poverty neighborhoods is necessarily wrong. It’s true that housing alone will not reverse “sustained social disinvestment” in poor Black communities, nor will it transform a punitive criminal justice system into one designed to support health. But good housing combined with sustained and comprehensive investment in public services – services that focus on community well being rather than punishment and incarceration – could work to ensure that people who do live in these neighborhoods also have the opportunity to live healthy lives. Furthermore, as previously high poverty urban neighborhoods across the United States gentrify, permanent affordable housing means that low-income families can stay in these neighborhoods and actually gain some of the benefits of new investments. Building racial and economic health equity will require both approaches – dismantling the policies that allow resource-rich places to exclude poor people, but also directing resources to communities that need them the most.

Good Jobs For All Would Boost Health, Reduce Inequities

Last week several national organizations launched the Putting Families First: Good Jobs For All campaign to bring the issues of jobs, poverty, and inequality to the center of the national debate. “Today, our country is more aware than ever before that our entire economic system is out of balance. We have reached a time in history where the need, the opportunity, and the energy are all here to create an economy that works for our families—now we need the will and the dedication of the American public to make it happen,” wrote Deepak Bhargava, Executive Director of the Center for Community Change.

The campaign will mobilize people around the country – especially poor people and people of color – to advocate for a national agenda focused on:

  1. Guaranteeing good wages and benefits, including a $15 minimum wage, access to paid sick days and paid family leave, and protections from wage theft;
  2. Valuing families by making high quality, affordable early education and child care available to all working parents and their children;
  3. Building a clean energy economy through large-scale investment to substantially reduce our reliance on carbon-based energy and to repair and rebuild our infrastructure;
  4. Unlocking opportunity in the poorest communities by channeling federal investments to communities with high unemployment and low wages to help rebuild their local economies and provide access to jobs and wealth-building opportunities; and
  5. Taxing concentrated wealth, including eliminating differences in taxation of capital gains and income, strengthening the estate tax, increasing taxes on the highest incomes, ending the ability of corporations to defer US tax payments on offshore income, and taxing corporations for wage inequality.

This is a bold and ambitious agenda that would create over five million new jobs a year by directing government to take an active role in guiding our economy through investing and shaping new and emerging sectors. These investments would be targeted to help those who need it most, closing racial and gender inequities, and be paid for by changes in our tax system that reward those who create wealth in this country – hard working people.

While those leading the campaign – the Center for Community Change (whose board I am chair of), the Center for Popular Democracy, Jobs with Justice, The Leadership Conference for Civil and Human Rights, and the Working Families Organization – are thinking about this as a jobs campaign, it is also a campaign to improve health and reduce health inequities. Several speakers at the launch event, including Senator Sherrod Brown of Ohio and SCOPE Executive Director Gloria Walton, noted the impacts of income on health and lifespan, but health is still an underutilized frame when talking about social and economic policy.

The Putting Families First campaign aligns with HIP’s new Economic Security Program, which will bring public health data, framing, and voices to social movements advancing a range of economic security policy campaigns.

As we’ve said before, no single factor is more important for healthy living than an adequate income, and none is more harmful to health than persistent poverty. Economic security is necessary for people to thrive, successfully manage stress, and prevent disease. Overwork, poor quality food, housing insecurity, and other consequences of low wages and unemployment contribute to physical and mental health problems including high blood pressure, diabetes, heart disease, and depression.

Economic security requires guaranteeing that work is available, safe, and pays a decent wage. Ensuring that families have a decent standard of living is one of the most powerful tools we have to protect and promote health.

Wages are a Public-Health Issue

The Commissioner of the Minnesota Department of Health, Dr. Edward Ehlinger, just published this article on MinnPost.com. We recently referenced the work of his Department in a February blog post about how public health should get more engaged in minimum wage campaigns. Read the article to learn more about why Dr. Ehlinger “prescribes an increase in the minimum wage to improve the lives and health of vulnerable children and families.”

Do Corporations Have a Right to Profit From Endangering Our Health?

We are re-posting a March 4, 2014 Scienceblogs.com blog by Jonathan Heller.

In his farewell address, President Dwight D. Eisenhower famously warned Americans about the growing power of the military-industrial complex. More than 50 years later, Nicholas Freudenberg, Distinguished Professor of Public Health at City University of New York, has issued a warning no less grave about “the corporate consumption complex” – the interconnected web of corporations, financial institutions and marketers that, in the name of individual rights, promote and profit from our unhealthy habits.

In Lethal but Legal: Corporations, Consumption, and Protecting Public Health, Freudenberg argues that “In a global economy that focuses relentlessly on profit, enhancing the bottom line of a few hundred corporations . . . has become more important than realizing the potential for good health.” According to Mark Bittman of The New York Times, “Freudenberg details how six industries — food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive — use pretty much the same playbook to defend the sales of health-threatening products. This playbook, largely developed by the tobacco industry, disregards human health and poses greater threats to our existence than any communicable disease you can name.”

To turn this destructive calculus around, Freudenberg told Bittman, “What we need is to return to the public sector the right to set health policy and to limit corporations’ freedom to profit at the expense of public health.”

Instead of asking “Do people have the right to smoke?,” Freudenberg and Bittman agree, we should ask: “Do people have the right to breathe clean air?” Instead of “Do junk food companies have the right to market to children?” we should ask: “Do children have the right to a healthy diet?” Instead of “Do we have a right to bear arms?” we should ask: “Do we have the right to be safe in our streets and schools?”

Reframing the debate with these questions, Freudenberg says, has led to changes in the food and beverage, tobacco, alcohol, firearms, pharmaceutical and automotive industries.

But we must go further. The labor practices of many industries also have huge impacts on health. The unspoken assumption today is business owners have the right to run their businesses as they see fit. Neoliberalism proclaims that reducing government regulation is essential for a healthy economy. But don’t workers have the right to live healthy lives?

In the past, the answer has only sometimes been yes. The once-powerful alliance of labor and workplace safety advocates won a series of rights for workers, including the 40-hour week and weekends off, a minimum wage, and occupational health and safety standards. But the political pendulum has swung back in the direction of corporate power, and dangerously too far.

  • Minimum wage hasn’t kept up with inflation, so many people are working but not earning enough to escape poverty. Living in poverty has a huge impact on health and well being. Efforts to raise the minimum wage are in progress across the nation, and public health professionals should be supporting these efforts.
  • About 40% of U.S. workers – and 70% of restaurant workers – are not given paid time off for illness. Health Impact Assessments conducted by Human Impact Partners (HIP) on paid sick days legislation show clearly that workers and society as a whole benefit when workers take time off and avoid spreading infectious disease. Visits to emergency rooms also drop.
  • Wage theft – the illegal withholding of wages or the denial of benefits rightfully owed to an employee  – is a common occurrence among low-income workers. HIP has begun a Health Impact Assessment of wage theft in Los Angeles and are finding that employers stealing their workers’ income has significant negative affects on physical and mental health and well-being for families and children.
  • Both in the U.S. and abroad, too many business owners cut corners on worker safety to increase profit. The recent garment factory fires in Bangladesh and Pakistan that killed and injured hundreds of workers are a clear example.

What obligations do corporations have back to society and their workers? Should profits for owners be valued over everything else, including health?  The public health community should lend its support to campaigns that seek to ensure that corporations are not allowed to profit at the expense of workers. Asking those questions, and others, is a good start.

Health Impacts of Upward Mobility

The link between more education, higher income and better health is well established. But now, new research suggests that the process of upward mobility can also be taxing to the health and well-being of people of lower socioeconomic status.

In a New York Times op-ed, Can Upward Mobility Cost You Your Health? Gregory E. Miller and Edith Chen of Northwestern University and Gene H. Brody of the University of Georgia report findings from a long-term study of 489 African-American youth from rural Georgia: “Those who do climb the ladder, against the odds, often pay a little-known price: Success at school and in the workplace can exact a toll on the body that may have long-term repercussions for health.”

The article struck a personal chord with my own experiences in college. Because of my undocumented status, I paid my own tuition, but was denied research opportunities and participation in some programs. Many of my experiences parallel those of the young people in the study.

For example, the researchers write: “In our studies, most participants are the first in their families to attend college. . . Many feel socially isolated and disconnected from peers from different backgrounds. They may encounter racism and discrimination.” I, too, was the first in my family to attend college. When my mother was deported I felt a responsibility to get additional jobs to help with my family’s income, and still continue as a full-time student while actively participating in a support and advocacy group for undocumented students. My school, work, personal, and family obligations left me drained and with a poor sense of belonging.

The study also found that “behaving diligently all of the time leaves people feeling exhausted and sapped of willpower. Worn out from having their noses to the grindstone all the time, they may let their health fall by the wayside, neglecting sleep and exercise, and like many of us, overindulging in comfort foods.”

My experience with the undocumented student group confirms this; it was both demanding and empowering. We relied on our limited time to strategize ways to demand the same treatment and opportunities as our non-undocumented peers, advocated for state and federal policy related to immigrant rights, and worked to increase knowledge to high students about higher education opportunities.

Despite our diligence, ambition, and dedication, our fight-or-flight responses were always on. The next meal was sometimes uncertain, so as a natural stress response we often filled up at events with free food. This illustrates how stress, sleep deprivation, poor exercise, and inadequate nutrition affect weight, blood pressure, and other chronic illnesses—as the article explains.

The researchers offer ways to mitigate the harms of being in this situation — better health education, more checkups, classes in stress management. But I personally believe that those suggestions are like putting a Band-Aid on a deep gushing wound.

Problems brought on by inequitable institutions, such as education, cannot be solved solely through health education, health screenings, and mentorship programs. My peers and I knew plenty about health education, healthy eating and exercise, and stress management. The veil of chronic stress lifted only when I got my green card, when I stopped feeling like a pariah in constant fear of deportation, and when the doors to better job opportunities opened.

Understanding the social determinants of health — our living and working conditions, and the social, economic, political, and cultural environment — is not enough unless we also act to address them.  Health Impact Assessment is one of the tools that can gradually help us reach health equity because it aims to uncover the root causes of poor health.

Stress, Status and the Myth of Upward Mobility

In the space of five days last month, The New York Times carried a pair of remarkable articles that taken together show that the growing gap between rich and poor Americans is not just a political and economic problem, but a public health crisis.

In “Status and Stress,” freelance science writer Moises Velasquez-Manoff detailed how the stress inflicted by poverty and discrimination has very real consequences for health and well-being – higher rates of depression, heart disease, obesity and other illnesses. Even if a child from lower socioeconomic strata climbs the ladders of income and status as she grows older, the stress imprinted on her when young can harm her physical and mental health well into adulthood.

The connection between status, stress and health is hardly a new topic in the public health world – HIP’s Research Director Holly Avey recently discussed it in this blog post – but significant that it was featured so prominently in the nation’s paper of record. It was the other article, “In Climbing Income Ladder, Location Matters,” that was both startling and chilling.

Times Staff Writer David Leonhardt reported on the dramatic disparities in income mobility in different parts of the country, drawing on a new report by the Equality of Opportunity Project. Researchers found that in some metropolitan regions, mostly on the coasts, children born into the lowest income levels had a markedly greater chance of growing up to reach the highest level than in other regions, mostly in the South and Rust Belt. In Atlanta, the odds of reaching the top after starting at the bottom were about 1 in 25. But even in Salt Lake City and the Bay Area, the odds of climbing the ladder were little better than 1 in 9.

In other words, the American Dream of starting with nothing and reaching the top is increasingly just that – a dream. Paired with the findings on stress and status, the barriers to upward mobility start to look like a life sentence, offering little hope that Americans of lower status can rise to the ranks of the wealthy and healthy. When assessing the consequences of public policy, we have a moral obligation to consider not just its political and economic impacts but its implications for health and well-being.