Last spring, as I walked to a board meeting of the Community Loan Fund of the Capital Region on Orange Street in Albany, I passed a memorial to a young man who had been shot and killed a couple of days earlier. There was a huge collection of candles on the ground between two stoops, marked off by caution tape, and with a large crowd of mourners around it.
Across from that memorial, tacked to a telephone pole was a relatively recent cheerful green and white sign that designates this stretch of road as part of a get-fit walking trail, and exhorts the viewer to “grab someone and take a walk!” This walking route is a loop that extends up into Center Square. I found the contrast . . . uncomfortable.
As far as I can tell, the only actual investment in the “walking route” has been the signs, which were a project of Healthy Hearts on the Hill, a now-defunct UAlbany program.
I’m sure the signs were well-intentioned. I’m sure they were based on the surge of data that has been coming out recently that links poor health outcomes to place of residence—that “your zip code matters more than your genetic code” for a host of health measures has become a frequent quip (I heard it first from Ron Sims, former King County executive and Deputy Secretary of HUD). This recognition has been followed by a wave of increased collaboration between philanthropies and nonprofits that have been traditionally focused on health and those that have focused things like affordable housing, community planning, transit access, environmental justice, economic justice, etc.
Making those connections is generally a good thing.
Unless it leads to something like these signs. Which I find, in context, to be bordering on offensive. Really? You looked around these blocks pitted with empty houses whose sidewalks go unshoveled in the winter making them treacherous for even an already healthy adult not trying to carry bags of groceries or push a stroller (I know), and at the staircases up the hill closed for lack of maintenance, and what you thought was, “I know! People here just haven’t really thought about taking a walk! What if we make some signs?”
(I tried to reach anyone involved in the creation of the signs to see if I’d missed anything in the thinking behind them, but the program was no longer in existence.)
Let’s be clear: Place-based health disparities did not arise because certain zip codes just missed the lecture on the benefits of exercise.
They come from a legacy of intentional isolation and disparate treatment, and then the ripple effects of the poverty and lack of access to resources that that causes. The entire point of identifying the spatial distribution of these health inequities is that they are coming from systemic, not individual, causes.
They are about lead paint and mold because of slumlords and lack of affordable housing. They are about certain areas being environmental dumping grounds. They are about lack of quality well-paying jobs with consistent hours making it hard for parents to hold to consistent schedules with enough sleep for young children in them. They are about lack of consistent transportation and insurance and time to get prompt and preventative health care. They are about lack of access to, and money for, buying and storing healthy food. They are about the cognitive overload of poverty keeping focus on day-to-day survival, which is a precondition to any long-term investments in healthy behaviors, which are hard for everyone. You get the idea.
Now, identifying the connection between health and place can be a great thing if we do the right things with that recognition. If the health sector started throwing its considerable weight behind Black Lives Matter, tenant lawyers, equitable access for school kids to recess and safe places to play, better transit access, or living wage laws, just to name a few things that might lessen the place-based disparities, that would be huge.
And there are even mitigation measures on the smaller scale that recognizing these disparities can prompt—ones that are supportive rather than victim-blaming: for example, ventilation in new developments to address higher levels of air pollution, building free exercise facilities or health clinics in affordable housing developments, financing grocery stores, or fighting for infrastructure improvements and pedestrian safety measures that make walking actually safer.
But focusing moralizing public health campaigns even more closely on the individual behaviors of people already struggling with poverty and unhealthy conditions in their neighborhoods, without changing anything about the context, is not only not likely to be helpful, but it adds insult to injury.
(This column was originally published in Metroland, the Capital Region of New York’s former alt-weekly, on Sept. 10, 2015.)