New Clear Vision


constructive commentary for the chronically farsighted


Save Money, Stay Healthy!

May 11, 2011 By: NCVeditor Category: Community, Diane Lefer, Ecology, Economy

Building a World of Wealth and Wellbeing for All

by Diane Lefer

Okay, so the headline to this article may not garner as many hits as Sarah Palin or Charlie Sheen, but maybe it will bring in more readers than “Cumulative Environmental Impacts in Los Angeles: Public Health’s Role in Emerging Policy Solutions.” I’m trying to put into practice something I learned at a conference by that name where I also got enough facts to delight any data junkie. But speaker Dr. Tony Iton, senior vice president of the California Endowment said the public health community has put “too much emphasis on facts and data” out of the belief that “once people know the truth, things will change.” But they don’t change. So instead of offering data, I’d rather tell a story about two neighborhoods.

My story starts with a friend who lived in Pasadena years ago when smog obscured the view. When she returned more recently for a visit, she looked around in shock and said, “Were those mountains always there?” An air quality success! Then the story goes on to tell of the children, K-8th grade, who attend the Hudson School in West Long Beach and study and play next to the road on which 500 trucks an hour travel from the port up to the Union Pacific railyard, emitting carcinogenic diesel exhaust. Andrea Hricko of the USC Environmental Health Sciences Center told us that the Air Quality Management District has measured the highest level of toxic particulates anywhere in the region right at the site of the school. Now Union Pacific wants to double the size of their yard. Burlington Northern Santa Fe proposes to build a new one nearby.

What story do you imagine those little kids tell about themselves and their lives?

Dr. Iton told a story too, about two universes co-existing in the same city, in this case, Baltimore, where there’s a 30-year difference in life expectancy between people in a high-income neighborhood and people in a low-income neighborhood. (Guess which universe boasts longer-living residents?) “There’s a cost to being poor,” he said, “and you can measure it in death.” In the Bay area where Dr. Iton served as director of the Alameda County Public Health Department and also as a physician for the San Francisco Dept of Public Health, the gap between life expectancy for white males and black males increased between 1960 to 2005. (In case you’re wondering, deaths attributed to homicide and HIV/AIDS were statistically insignificant. The disparity was based on chronic conditions such as heart disease, cancer, and stroke).

“We can’t regulate one facility and one chemical at a time,” said Dr. Rachel Morello-Frosch of the UC Berkeley School of Public Health, because of the cumulative impact of “multiple hazards and greater vulnerability due to social stressors.” Particulates, for example, affect all people who are exposed and lead to lowered birth weights, but the effect is strongest on African American babies. Similarly, there are higher rates of pre-term deliveries for all people living in heavy traffic corridors, but the rate is highest in poor neighborhoods.

Land use and planning has allowed toxic release industries and waste sites to concentrate in LA’s low-income communities of color near homes, churches, senior centers, daycare centers and schools. Pesticide factories. Chrome-plating factories. Railway yards. Metal recyclers. Auto-body paint shops. Many of these businesses are small so they are unregulated or entirely unknown to regulators while structural inequality makes poor people more vulnerable to toxins and chronic disease as they cope with bad schools, low-wage jobs, violence on the street and at home, discrimination, substandard housing, inadequate nutrition, and chronic stress.

“Health care,” said Dr. Iton, “is only a small part of overall health.” He told us studies showed “every additional $12,500 in household income buys another year of life.”

I get it. I’m convinced. But, I wondered, when people who’ve done well in life feel they’ve earned that greater income and therefore earned those extra years, what do you say to convince them something is wrong with this picture? Call them names?

We need to “construct a new narrative,” Iton said, one “that speaks to the values of the dominant society.” Then, we can hope, more people will get on board, participating in solutions.

Dr. Richard Jackson of the UCLA School of Public Health, an expert on effect of the environment on health, especially on children, offered an example. For years, he fought to regulate or ban one pesticide after another and always lost — as long as he kept focusing on the harmful effects on farmworkers and their children. When he started to talk about the dangers that pesticide residue on foods pose to all Californians and their children, the cause got traction. I could get mad at the people who cared only about their own families but maybe it makes more sense to seek common ground and alliances with them (while, of course, continuing to organize in low-income communities of color to challenge the structural conditions that generate health disparities).

Can we create the narrative in which everyone — regardless of income and neighborhood — has a stake in healthy communities?

How about this narrative, suggested by Dr. Iton? Paying for health care, including care mandated under state employee pension plans, is a major budget buster for California. Much of what we’re paying for — a whopping 75% of health care expenses — goes to treat chronic conditions such as heart disease, stroke, cancer, and diabetes. If factors in the LA County environment contribute to these disease conditions, let’s look at the environment. Maybe we can improve health and fiscal stability at one and the same time.

Hricko suggested that in land use and zoning decisions, it’s not enough to require an environmental impact report which considers air pollution and noise. A more holistic approach is needed in the form of a health impact assessment. “What about light, blight, safety, and social cohesion?” she asked. According to Dr. Jonathan Fielding, director, LA County Department of Public Health, the quality of a person’s social interactions is a major component of health. Having someone to confide in and being connected to a neighborhood and community organizations turn out to be as significant as such choices as not smoking. This means we can look at gentrification and displacement of people from their neighborhoods as still another blow to good health.

From the audience, LaVonna Lewis from the USC School of Policy, Planning, and Development recommended a publication by the Robert Wood Johnson Foundation, “A New Way to Talk about the Social Determinants of Health,” and suggests right off the bat not to use any academic jargon including, yes, the phrase “social determinants of health.”

Judging from their website, it was clear that the Prevention Institute (sponsor with the Liberty Hill Foundation of the conference) learned that lesson. The Institute’s Healthy Places Coalition frames the concept this way: “Where we live, work, play, and learn shapes our health.”

Adjusting the language we use would, I think, work in many advocacy efforts, not only in the public health/environmental justice field.

Here are some suggestions from the publication in talking to audiences with conservative outlook:

“Incorporate the role of personal responsibility. The importance of all Americans having equal opportunity to make choices that lead to good health resonated with participants across the political spectrum. Incorporating this point made respondents more receptive to the idea that society also has a role to play in ensuring that healthy choices are universally available.”

“Focus broadly on how social determinants affect all Americans (versus a specific ethnic group or socioeconomic class). This research showed that Americans believe in equal opportunity to health, but describing actual disparities consistently evokes negative reactions.”

Instead of talking about poverty or low-income families, the publication suggests using language like “Americans struggling to get by” or “People who work for a living and still can’t pay their rent.”

I shared these ideas with an activist friend who thought it was outrageous to censor language relating to inequality, poverty, and race. Granted, this is not the language of community organizing and empowerment but it’s not intended for that use. It’s a way to speak with people who haven’t yet made an empathetic identification with others who don’t live near them and don’t look like them. It’s only a first step, using language aimed at encouraging dialogue rather than polarization. It’s about encouraging people to look at the world around them.

“The built environment,” said Dr. Jackson, “is social policy in concrete.” He showed a slide of a home with a garage as big as the living space — a shelter for cars rather than people. An aerial view of a freeway interchange: “The California state flower.” What we build tells us a lot about how we live and who we are.

We can raise awareness about how individual initiative is never the whole story. The built environment affects our choices in daily life, wherever we live. In middle class suburban communities, would you walk more if there were any places worth working to within walking distance? Would your kids walk to school or walk around the neighborhood if there were real pedestrian crossings with traffic signals instead of zebra lines painted in the street where you take your life into your hands any time you try to cross?

“The less we walk,” said Dr. Jackson, “the less fit we become.” We face an epidemic of childhood obesity. The rate of adult onset diabetes in children has doubled in one generation to the point, he said, to the point that there aren’t enough pediatric endocrinologist to deal with it. “Kids don’t walk or bike to school anymore” — a trip that also once included a lot of social learning. “You don’t learn,” he said, “being strapped in the back of Mom’s car or Dad’s car.” Would you sometimes bike to work if it didn’t feel dangerous to ride in traffic? Would you let your kids bike to school and to their friends’ homes? When you were a kid, did you walk and run and bike and isn’t that how childhood ought to be? Do you regret — in a world of climate change and high gas prices — that you have to drive to a health club in order to exercise?

Dr. Fielding noted there are at least 6,500 premature deaths a year due to air pollution while at least 20 new residential developments have been proposed or built near freeways since 2000. The 7,200 housing units are not only for poor people.

Once people understand we all face some built-in obstacles to healthy living, it’s easier to understand the kid who lives where the air is toxic and there are no parks and no safe places to walk and no access to transportation to go anywhere else.

What about the people of Wilmington, right off the 710 where the plan is to expand the freeway to 14 lanes? According to Bill Gallegos, executive director of Communities for a Better Environment, residents cope with emissions but also pollution from the local oil refinery. “Every other home in the area near Conoco-Phillips has someone dying of cancer.” His organization had a recent significant success — winning stringent regulation of the refinery’s highly toxic practice of “flaring” excess gases.

Wilmington, along with Pacoima and Boyle Heights, has now been designated a Green Zone, for which the plan is to offer incentives to attract green businesses, prevent the siting of additional toxic industries in these hot spots, and work to clean up or mitigate the problems caused by existing businesses. You don’t target one business at a time, said Gallegos, but the whole community, as you don’t want to create a situation in which a company that’s being environmentally responsible is undercut competitively by bad businesses.

The Clean Up/Green Up campaign in Wilmington has had a side benefit. It brought community members together with a common purpose, creating more of that healthy social connectedness.

Elva Yañez, policy coordinator for the LA Collaborative for Environmental Health and Justice, pointed out that “policy innovations comes from the bottom up” and localities don’t have to (and shouldn’t) wait for action on the state or federal level. Looking at the “booze, butts, and bullets campaigns,” she noted that smoke-free laws began at the local level and spread across the country. Grassroots groups in South LA have worked to limit liquor stores in the neighborhood. Local restrictions on firearms began when West Hollywood banned the Saturday Night Special. Healthy food initiatives can succeed locally, too, she said while Dr. Fielding cited policy changes that have made a difference, such as helmet and seatbelt laws. But national policy can either hinder or assist. He asked why not direct agricultural subsidies to fruits and vegetables rather than to producers of high-fructose corn syrup?

“Booze, butts, and bullets” slides right off the tongue, but as Yañez noted, “‘cumulative environmental impacts” does not. For anyone with a better suggestion, the comment box is open.

And speaking of words, I won’t mince any more now in addressing the activist community. What are we going to do about justice? About our fellow Angelenos who are — in Yañez’s words — “permanently relegated to shorter, sicker lives.” Let me quote Gallegos, who paused to remember the recent passing of African American scholar Marable Manning — who had spent a lifetime thinking about how to change a “bleak and relentless set of conditions” and concluded that you do it by building social movements. “Messaging is important,” said Gallegos, “but who carries that message? Building the movement is the message.”

Diane Lefer is an author, playwright, and activist whose recent book, California Transit, was awarded the Mary McCarthy Prize in Short Fiction. Her stories, novels, and nonfiction often address social issues and draw on such experiences as going to jail for civil disobedience and her volunteer work as a legal assistant/interpreter for immigrants in detention. Her new book, The Blessing Next to the Wound, co-authored with Hector Aristizábal, is a true story of surviving torture and civil war and seeking change through activism and art. Lefer writes for LA Progressive, where this article originally appeared. More about her work can be found at: http://dianelefer.weebly.com/.

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