Seeing great community organizers at work changed the way I think about health.
From 2000 to 2003, I was director of health and human services for Stamford, Connecticut in Fairfield County, one of the most unequal places in America. While hedge fund managers help give Fairfield one of the higher median household incomes in the country, nearly one-fifth of its African-American and Hispanic residents live in poverty. Some of the health disparities are just as stark. During my time in Connecticut, state-wide, the mortality rate for black women was 20 percent higher than the rate for white women, which equated to a nearly five-year life expectancy gap.
These were the types of statistics I had at my disposal when I was asked to speak at a local meeting of the AFL-CIO labor federation about some of the health needs of people with low-income in our area. Traditional labor organizing is hierarchical, male, and laser-focused on benefits and pay. But, like the service sector more broadly, AFL-CIO’s members were increasingly female, black, and Latino. They were concerned not just about their jobs but about their children and the state of their communities. So the federation set up shops to teach labor leaders the skills of community organizers.
I had numbers in my head and notes in hand, but within minutes I saw that if there were a single picture of public health in Stamford—its gaps and its potential—you could take it in that room. Many there that night earned low wages. Some were non-native English speakers. Some were undocumented. They talked about the havoc that overnight shifts cleaning offices wreaked on their family lives and sleep, the neighborhood conditions their kids were exposed to, poor access to food, and the stress of trying to pay the bills.
Here I was health director laboring under the assumption that public health was about good data and reports. Both are necessary, but they’re not sufficient.
In low-income communities, every system is on life support. Residents have difficulty finding work, good schools, adequate transportation. Stress incubates in these places where people feel they have no opportunities, and it manifests in poor health. My sense is that the way poverty kills you is through a lack of control. Many in poor communities feel they have no power over what will happen next month, next week, or even in the next minute. This lack of control creates hopelessness, and that hopelessness is deadly. So if organizing cultivated hope, it seemed plausible to me that it could literally save, or at least lengthen, these women’s lives.
As a medical doctor and former city health director, I’d been thinking about all of this for some time when I arrived at The California Endowment. But it wasn’t clear to me how to act on it until I met community organizers like Nicole Lee. Lee is executive director of Urban Peace Movement (UPM) and a proponent of what she calls “healing-centered youth organizing.” Through UPM, young people in neglected communities work simultaneously on what Lee describes as inner and outer forces. The outer force is oppression, deep social and economic inequalities that produce violence. The inner forces are the pain and turmoil that oppression creates. Participants are given space where they can be heard, validate each other’s experiences, and heal, along with leadership roles in campaigns on issues like juvenile justice reform and local economic development that can improve external conditions. Youth who were written off find their voice.
The lessons I and others at The Endowment learned from community organizers informed Building Health Communities, a 10-year, $1 billion effort to measurably improve health status in 14 low-income California communities by focusing on the social determinants of health. A prime example is our Fresno site. When young people in South Fresno learned that kids in wealthy North Fresno enjoyed on average four and a half times more park space per acre, they created an ad campaign pointing out the gap. When the city refused to allow the ads on public buses, citing a prohibition against political messaging, media picked up the story. Fresno Building Healthy Communities has used the attention to push for an equitable and long-overdue update to Fresno’s park master plan. That battle is ongoing, but they’ve already won concessions, including an increase in the amount of green space on school grounds.
Increased access to parks and recreation will support greater health in South Fresno, but what may do even more for residents’ quality of life, stress levels, and physical well-being is knowing that they have agency, that they can exert control over their lives and the external forces that shape them, that they can be effective in supporting each other.
Money can do a lot to alleviate poverty, but I’m part of a billion-dollar bet that says a redistribution of power can do even more.
Anthony Iton is senior vice president of Healthy Communities at The California Endowment and a member of the US Partnership on Mobility from Poverty.