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To Get to Better Health, We Need Good Partnerships, and Good Data

11.14.2017

There was consensus at a recent LISC summit that upending health disparities requires ongoing collaboration among community groups, residents and the health sector.  And the time to act is now. 

A baby born in Los Angeles today has a life expectancy of 82 years, a robust span.

But that number varies dramatically depending on where in Los Angeles County the baby is born and grows up. In the community of Lake Los Angeles, for example, where 27 percent of the population lives below the poverty line, longevity averages 76 years. Meanwhile, in Walnut Park, a place with markedly higher income and high school graduation rates, average life expectancy is more than 90 years.

When it comes to comparing lifespans by race, the differences are even more appalling. A black baby, for example, is three times more likely to die by his or her first birthday than a white baby, and black men die an average of 12 years earlier than white men.  

“The data are horrific in terms of health outcomes,” Barbara Ferrer, director of the Los Angeles County Department of Public Health, told a room full of practitioners all too familiar with the reality of health disparities. But what was striking at the “Health, Wealth, & Housing: Promoting Cross-Sector Collaborations for Equity Conference," organized by LISC, to address the social determinants of health, was not simply the information revealed, but the audience itself.

Composed of housing, financial stability and health experts, it was a group committed to tackling poor health in underserved places by looking to new data, pooling their collective knowledge, and working on the many fronts required in order to make change. In fact, organizations that might once have worked in isolation are coordinating with each other, inspired by these data, to create more cohesive, practical strategies for improving health. This is an approach that LISC has long championed and acts on in communities all across the country.

Data from several sources, much of it focusing on disparities in Los Angeles County, underscored the shared mission of speakers and attendees at the daylong event, which was co-sponsored by the Iris Cantor-UCLA Women’s Health Education & Resource Center, LA County Department of Public Health, and the Federal Reserve Bank of San Francisco.

Among the participants, there was wide agreement that interventions need to attack the root causes of poverty-related illnesses, and that the worlds of housing, financial stability and employment are intimately connected with physical and emotional wellbeing.

“You cannot be totally healthy without a place to live,” said Sheila Keuhl, a Los Angeles County supervisor and keynote speaker at the event. “How can you have housing without financial security? How you stay there, even if you get a section 8 voucher, if something happens to displace you? How can you have housing security without a job? How can you have a job without health?”

Speakers from the medical sector noted how partnering with communities to work toward better health outcomes was probably more effective in the big picture than a 15-minute doctor’s appointment. Many stressed the importance of investing beyond the clinic walls in things that improve access to healthy food, clean air, safe places to play, good schools, housing, and jobs that allay the stress of economic insecurity.

“We see patients who come into our clinics and they need [home] repairs, but the thing that brings them in is happening outside of our hospitals,” said Pablo Bravo, vice president of community health for Dignity Health Systems, which supports affordable housing developments, community health and healthy grocery outlets in food deserts.

Shai J. Lauros, LISC National Health Program Director (right), facilitates a conversation with Barbara Ferrer, Director of LA County Department of Public Health, and Pablo Brave, Vice President of Community Health for Dignity Health Systems
Shai J. Lauros, LISC National Health Program Director (right), facilitates a conversation with Barbara Ferrer, Director of LA County Department of Public Health, and Pablo Brave, Vice President of Community Health for Dignity Health Systems

Making sure that community members themselves steer decision-making about a holistic approach to health in their neighborhoods is key, too. “We need to move the services to where people are, and delegate authority for how to use those services to local communities,” Peter V. Long, CEO of Blue Shield of California Foundation told the gathering. “We spend $3 trillion on healthcare in this country and I would be generous if I said we get moderate results.”

Esperanza Community Housing Corp., a LISC partner since 1989 whose director, Nancy Halpern Ibrahim, spoke at the meeting, is a prime example of how a community-based group can address the intersection of housing, health and wellbeing.  

Esperanza runs nine affordable housing complexes in South Los Angeles and has developed a model community health leadership program, Promotores de Salud. To date, the organization has trained 462 bi-lingual “promotores” who provide health education to residents within Esperanza’s housing sites and to neighboring communities, equip families with asthma action plans (which keeps them out of emergency rooms), and help reduce environmental causes of asthma.

“To a person, affordable housing absolutely improves health on just about every indictor we have used,” said Ibrahim.

Of course, collecting and employing health data is crucial at all points along the pathway to identifying and remedying the issues that underpin health inequity. Much of this information has been gathered, analyzed and put to use through the County Health Rankings and Roadmaps initiative supported by the Robert Wood Johnson Foundation.

In Boston, for example, these data prompted action in neighborhoods where African-American and Latino men reported suffering from high levels of anxiety and anxiety-related issues, said Shai Lauros, director of LISC’s national health program.

The numbers inspired community development organizations in the historically underinvested neighborhoods of Roxbury, Codman Square and Mattapan to coordinate their efforts to tackle a range of issues that provoke stress disproportionately among men of color.

These groups, with support from the Movember Foundation and Prevention Institute, now offer educational and advocacy programs that take on everything from credit and budgeting to tenants’ rights and one-on-one career counseling. Some have lobbied public officials for criminal justice reform, citing the stress and family instability experienced by so many formerly incarcerated men because of barriers to housing and employment.

“We all understand the connections between health, wealth and housing,” said Lauros. “What we need to do now is bring the most promising multi-sector strategies to scale."

The health data portraits of communities in places like Lake Los Angeles, Mattapan and Roxbury are daunting, to be sure. But for every person in the room at the Los Angeles event, they are also a call to action.

“The disparity data isn’t all that surprising to us,” said Tunua Thrash-Ntuk, executive director of LISC LA, echoing the sentiment of her colleagues and partners. “It is why we do what we do.” The next step, she added, is to dig in with our partners to do more.