For Healthy Communities, Look Beyond Diet and Exercise - 大象传媒 Magazine Solutions Journalism

Seattle鈥檚 economy is booming. The city ranks near the top of the list of America鈥檚 healthiest cities, and young people from across the United States dream of moving there.

Yet a morning walk amid the gleaming office towers downtown reveals a different story. People sleep on the sidewalk, wrapped in blankets. A man paces back and forth violently slamming a football against his palm. A young woman shouts to no one in particular, 鈥淚 never did get a hug.鈥�

These scenes unfold just a block from City Hall, where Tyler Norris and Dr. Arpan Waghray, CEO and chief medical officer, respectively, of the newly launched Well Being Trust, are meeting with city and county officials about plans to curb homelessness by tackling wider problems such as mental health, substance misuse, unemployment, and an acute lack of affordable housing.

The mayor鈥檚 office is just one stop on a fact-finding tour that also includes Plymouth Housing, home to people who can鈥檛 find apartments because of criminal records, mental health disabilities, or poverty. Norris and Waghray are scouting for fresh ideas and successful models that can move the U.S. toward the Well Being Trust鈥檚 goal of 鈥渁 nation where everyone is well鈥攊n mental, social and spiritual health.鈥�

鈥淲hile the most fortunate among us are experiencing healthier, longer lives鈥攎any of us, especially the most vulnerable, will live sicker, shorter lives than their parents,鈥� Norris says. Indeed, Americans鈥� has actually decreased over the past three years for the first time in a century.

Emergence of the community health movement

Well Being Trust is just one player in the emerging community health movement enlisting social justice activists, business leaders, urban designers, health professionals, government officials, and locals.

The movement鈥檚 central idea鈥攖hat our individual health depends on healthy conditions in our communities鈥攇ot a huge lift from a showing that only 20 percent of a person鈥檚 overall health is attributable to access and quality of health care services. The rest depends on social, economic, environmental, mental, and personal behavior factors, according to researchers at the University of Wisconsin.

Community health advocates aim to reimagine our health system鈥攕tarting with the narrow focus on treating illness rather than eliminating the causes of illness. The U.S. spends per capita than any other developed nation yet has . Our 鈥攈eart disease, diabetes, numerous forms of cancer, obesity, asthma, and others鈥攁re significantly higher than Europe鈥檚. Treatment of these conditions consumes of the we expend on health care every year, even though most chronic diseases are preventable.

The U.S. also stands out for the glaring economic and racial inequity of its health care system. A spate of medical studies show life expectancy can vary among people living in the same community, based on whether they live in an affluent or poor neighborhood.

Facing a constant barrage of problems depletes the physical and emotional resilience of residents in lower-income areas鈥攅specially people of color, says Mindy Thompson Fullilove, professor of urban policy and health at the New School and community activist in Orange, New Jersey, a predominantly African American city near Newark. 鈥淲hat happens to them is like what happens to football players: You take too many hits and you die young.鈥�

The U.S. spends 50% more on health careper capita than any other developed nation yet has worse health outcomes.

鈥淐hronic stress wears on tissues and blood vessels to cause disease,鈥� explains Vivek Murthy, former U.S. surgeon general and a senior fellow at Well Being Trust. 鈥淚 have come to believe that emotional well-being is the foundation on which we build everything else in society.鈥�

鈥淥ur health is directly connected to our living conditions, and our living conditions are almost directly connected to our ability to make changes in our lives,鈥� said Jeanne Ayers, Wisconsin鈥檚 state health officer and administrator. 鈥淪o, to create a healthy community, we need to figure out how to build power to make change, and how to end structural inequity and racism.鈥�

Every year, the U.S. spends $1 trillion to treat diseases that are byproducts of poverty, says David Erickson, director of community development at the San Francisco Federal Reserve Bank. Looking at health through the lens of economics, he sees that there are buyers of health (patients, insurance companies, HMOs, the government) and producers of health (a long list that includes affordable housing, good schools, prenatal care, good nutrition, parks, walkable communities, youth sports leagues, and much more).

鈥淭he trick is to connect the buyers and the producers,鈥� Erickson says. He points to the fact that some hospitals around the country are with the idea that it will be less expensive than paying the Medicaid costs of emergency room visits by people living without shelter.

The idea of improving people鈥檚 health by addressing living conditions in their communities goes back to the 19th century. Public health campaigns to improve sanitation and eradicate epidemics have saved millions of lives. The healthy communities movement seeks similar breakthroughs by fixing what we know are social causes of poor health鈥攑overty, racial and economic inequity, social isolation, acute stress, poor nutrition, physical inactivity, and detrimental personal behavior.

鈥淲e now know a lot about what works to improve health, as well as what鈥檚 not working,鈥� the trust鈥檚 Norris says. 鈥淲hen you know what works to create positive outcomes, it鈥檚 unethical not to use this learning to make things better.鈥�

An American tragedy

Another emphasis for the community health movement is the fact that 1 in 4 Americans experiences a mental health challenge in any given year鈥� in a study conducted by the World Health Organization.

鈥淲e are in the midst of a full-blown mental health crisis, and there is no neighborhood that isn鈥檛 touched by it,鈥� says Chirlane McCray, New York City鈥檚 first lady and founder of Cities Thrive, a national coalition working in communities to raise awareness of the problem and expand resources for those in need. Although insurance companies and government agencies often balk at paying for psychological and substance misuse services, McCray points out, the costs of untreated mental illness such as crime, family disruption, and job loss are far more expensive over the long run.

A from the Trust for America鈥檚 Health and Well Being Trust, co-funded by the Robert Wood Johnson Foundation, documents the alarming rise in 鈥渄eaths of despair鈥濃€�1 million American lives claimed by drug overdoses, alcohol misuse, and suicide between 2006 and 2015. Follow-up research shows that have climbed precipitously over the past two decades, including a 400 percent increase in drug-related deaths.

The 鈥渧ital conditions鈥� for good health

So, what can we do about America鈥檚 declining health? Well Being Trust along with several partners identified a set of 鈥渧ital conditions鈥� for societal well-being comparable to the 鈥渧ital signs鈥� doctors use to assess patients鈥� individual health.

Basic needs for health and safety: Personal safety, nourishing food, freedom from discrimination, and access to health care are essential to our survival. To create a foundation of well-being for all Americans, reducing racism, sexism, substance misuse, acute stress, bullying, crime, and domestic violence is crucial.

Meaningful work and wealth: An adequate income is critical to staying healthy, and meaningful work is central to a satisfying life. Long-term health depends on everyone enjoying guaranteed work paying a livable wage (and adequate income for those who can鈥檛 work) as well as increased opportunities to become entrepreneurs, join cooperatives, and form unions.

Humane housing: America is experiencing a ballooning housing crisis as a third of Americans spend at least a third of their incomes on shelter. Everyone deserves an affordable home in a safe, healthy community.

Healthy environment: Clean air and water, protection from toxic chemicals, access to green spaces, and walkable neighborhoods are critical to ensuring the health of the planet and our families.

Belonging and civic muscle: Numerous medical studies show that strong social ties boost our health as much as diet or exercise. This means a robust sense of community fostered by lively public spaces, vital social institutions, and other avenues for public engagement is a basic ingredient for better lives.

Lifelong learning: More than ever, education is the ticket to a healthy, stable life鈥攚hich means those who attend under-resourced, low-performing schools suffer a severe disadvantage. Investing in educational opportunities for all Americans鈥攊ncluding debt-free college and vocational training鈥攚ill pay off in social, economic, and health dividends.

Reliable transportation: Mobility throughout the U.S. is highly dependent on the automobile even though one-third of Americans cannot drive because of age, income, or disability. Furthermore, cars pose health risks鈥攄irectly from crashes and pollution but also by discouraging physical activity and inhibiting social interaction. More convenient transportation options for everyone鈥攊ncluding walkable communities, better bike infrastructure, and improved transit鈥攑romote health, social mobility, and a greener environment.

Jay Walljasper writes, speaks, edits, and consults about creating stronger, more vital communities. He is a Senior Fellow at Project of Public Spaces, editor of the Blue Mountain Center Commons, and author of The Great Neighborhood Book and All That We Share: A Field Guide to the Commons. Walljasper is a 大象传媒 contributing editor.

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