The Nutmeg State: A policy model for health equity

Connecticut is fast becoming a leader when it comes to their policy on health equity for the state’s children and families.  The Connecticut Health Equity Initiative can serve as a model for other states in thinking about how to “enhance the capacity of local health departments in partnership with community partners and leaders to achieve health equity through a focus on the social, political, economic, and environmental conditions that affect health.” 

Indeed, over the last number of years, public health officials, as well as policymakers, have begun to conceptualize health in much broader categories than previously considered.  A recent work edited by Howard Frumkin, Andy Dannenberg, and Richard C. Jackson entitled, Making Healthy Places, speaks to how the physical environment naturally impacts one’s health – everything from the roads we build to the parks we enjoy.  This type of thinking is concerned with social determinants of health, that is, as defined by the CDC, “the circumstances in which people are born, grow up, live, work, and age, as well as the systems put in place to deal with illness. These circumstances are in turn shaped by a wider set of forces: economics, social policies, and politics.”  Health equity, then, is focused on making these determinants more fair for children and families who are situated in vulnerable circumstances, either socially, financially, psychologically, through the places they lives, or a combination thereof.  Connecticut uses an integrated model in attempting to shape healthier citizens, through workforce development, community engagement, and a health equity index that they created based on eight recognized social determinants and other indicators.  Through this index, residents of Connecticut can then go on the Health Equity Alliance website and map their city or county’s health equity.  This is a stirring innovation, because it allows both public health officials and policymakers to visualize health equity.  Hopefully as this tool continues to be refined there will be opportunities to see how various localities’ health equity may change over time.  What I find particularly useful for policymakers is that along with the quantitative data, the Index allows for the collection of qualitative data -- the narrative of those experiencing or witnessing health inequities.  This feature will provide officials with stories to help get the message about health equity out.  

Connecticut is doing great work when it comes to creating tools, strategies, and awareness for sophisticated knowledge and action on health equity.  Other states could and in my opinion, should be following the Nutmeg State’s lead. 

To learn more about state policies to ensure that children are healthy visit PolicyforResults.org.               

The Convergence of Health and Place-based Policy

Place governs our lives.  Our physical environments impact our behaviors, our choices, and our life outcomes.  More recently, the Obama Administration has explicitly endorsed place-based policies and increased interagency coordination in their social policy approach.  However a number of placed-based programs existed in prior administrations including, the Community Reinvestment Act, housing redevelopment through HOPE VI, Empowerment Zones, New Markets Tax Credit investments, as well as foundation-led comprehensive community initiatives and local nonprofit ventures.  Promise Neighborhoods, a program established by the Obama Administration is an addition to the list as is The Building Neighborhood Capacity Program and Choice Neighborhoods.  The question is, why focus on place, and how do place, community health and wellbeing relate?  

In the last few years, a body of research has been growing which argues for the significance of place-based investments.  Xavier Briggs, in his text, The Geography of Opportunity, shows why segregation persists and how it undermines education, job prospects, and even health and safety for millions of minorities and low-income families.  More recently, Enrico Moretti’s book, The New Geography of Jobs, speaks to how America’s economic map shows growing differences between communities and how labor and employment is causing growing geographic disparities in all aspects of our lives, from health and longevity to family stability and political engagement. 

Given this literature, a number of states and cities have begun to think about the myriad of ways in which place, essentially where people live and work, affects the health of children and families.  The program Safe Routes to School, a national partnership, has many statewide and local initiatives, including in Arizona, California, New Jersey, Illinois, and Maryland to name just a few states.  This initiative is focused on providing youth with safe streets and access to school, while simultaneously promoting active living environments for children and their families.  In Takoma Park, Maryland, Safe Routes to School has worked with local officials to improve sidewalks and trails for enhanced student safety and walkability to and from school.  Further, SRTS has hosted an annual 5K walk/run for students, as well as organizing National Walk to School Day to support health and active lifestyles early in life.

In another initiative in the Twin Cities in Minnesota, community groups, ISAIAH, TakeAction Minnesota and national community intermediary PolicyLink launched the Healthy Corridor for All Health Impact Assessment (HIA) project to understand the potential impacts of the proposed transit-oriented land use changed on the communities that live in a proposed light-rail corridor.  They conducted a Community Health Impact Assessment to assess the impacts of the rezoning proposal on community health, health inequities and underlying conditions that determine health in the area known as the Central Corridor.  This case is a great example of improved ways of looking at the affects of land-use or other place-based policies on community health.  

State policymakers concerned with providing healthy places for children and families to work and go to school – should consider these strategies.  Partnerships like Active Living by Design and Leadership for Healthy Communities provide great resources for policymakers focused on improving the places located in their jurisdictions – and by way of that the health outcomes of the families in their communities.

For results-based policy strategies to improve health outcomes for children visit PolicyforResults.org

Building Neighborhood Capacity!

Public policy that aims to create better coordinated and comprehensive approaches to address community needs can both take advantage of community strengths and reduce program redundancy.  In an economic climate that requires stretching fewer resources to meet increased need – these approaches are ever-more important.  On the national level there are several policy initiatives that are aiming to create neighborhoods of opportunity through more comprehensive place-based programs.   One such effort is the Building Neighborhood Capacity Program.

The Building Neighborhood Capacity Program (BNCP) is designed to help low-income neighborhoods build the infrastructure and resources needed to ensure families living within these communities experience better results around education, employment, safety, housing, and other key areas. The BNCP was established in 2011 as a part of the White House Neighborhood Revitalization Initiative (NRI). The BNCP is unique in that it is focused on helping communities build and further their infrastructure to be in a better position to create coordinated community approaches.  The communities that have been  chosen for this program have historically faced barriers to revitalization, such as distressed neighborhoods that may not be well-connected with institutions such as universities and hospitals, are far from economic vitality, experience high rates of crime, and may have experienced racial or class segregation that severely limits opportunities.

The goal of the BNCP is to help neighborhoods develop knowledge, skills, relationships, and organizational resources that enable residents, civic leaders, the public and private sectors and local organizations to create comprehensive neighborhood revitalization plans. The BNCP mobilizes and empowers communities to achieve what they want for their children, families, and residents through jobs and economic success, affordable housing, good education, strong families, safe neighborhoods, and health.

The Center for the Study of Social Policy (CSSP) is collaborating with the Departments of Justice, Education and Housing and Urban Development to provide technical assistance for the BNCP. CSSP will offer training to help the BNCP neighborhoods develop and begin to pursue results-driven revitalization plans. CSSP is in collaboration with the Aspen Institute Roundtable on Community Change, the Institute for Community Peace, Living Cities, and the National League of Cities.

The Communities that have been selected for the BNCP were announced today and are: Milwaukee, Wisconsin; Flint, Michigan; Memphis, Tennessee; and Fresno, California. For more information on the selection read our Investing in Community Change post.

It is critical for policy solutions to address issues in coordinated and comprehensive ways because that is the way that best meets the needs of families and communities.  BNCP is an example of a national effort to help communities develop the infrastructure needed to begin doing work in more coordinated ways.  State policymakers could consider similar efforts for communities in their state.  To learn more about the BNCP visit CSSP’s resource page on Building Neighborhood Capacity.  To learn more about comprehensive state policy strategies for addressing issues that impact families visit Policyforresults.org.