How *Not* to Connect Health and Community Development

Posted by Miriam Axel-Lute on June 29, 2015

A few months ago as I walked to a board meeting of my local CDFI, I passed a memorial to a young man who was 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.

This section of Lark Street in Albany is pock marked with vacant buildings, many exuding a smell of mildew as you walk by. Thanks to a decades-old fiscal sleight of hand by which the county conducts the city’s tax foreclosures and makes the city whole, and then auctions off the property, it has been very hard for the city to gain any traction in the fight against speculators and irresponsible landlords, many of whom stop up from New York City. (This will hopefully be changing soon with the advent of the Albany County Land Bank.) Sidewalks are rarely shoveled in the winter.

Albany, like many Northern cities, is highly segregated by race, and this neighborhood is clearly separated from the downtown area by a very steep hill, which in many places can only be navigated on foot by means of long sets of stairs, several of which are currently closed for lack of maintenance. Retail is limited—fresh food not easily accessible. It is a familiar story.

Across from that memorial, tacked to a telephone pole is 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 extends up the hill into a much more affluent, bar-and-gallery-strewn Brooklyn-esque brownstone neighborhood.

As far as I can tell, the only actual investment in the “route” has been the signs.

The idea that someone thought this was what this neighborhood needed baffles me.

It also is a really good symbol for what could go really really wrong with our newfound focus on the connection between health and community development.

We have all now heard that zip code matters more to your life expectancy than genetic code. This is true, and the health–community development connection points to some amazing opportunities for partnership, and for getting beyond different, isolated groups working in the same areas without coordinating their knowledge and resources to an overall greater good.

But if we allow it to be perverted into primarily an impetus to preach the merits of individual healthy behaviors in those zip codes where health is weakest, we will be missing the point entirely. The problem is emphatically not that whole zip codes of people just missed the lecture on the benefits of exercise.

The problems in these zip codes are systemic. They are about gun violence, and about kids being kept indoors to keep them safe from it. They are about lead paint and mold because of slumlords and lack of affordable housing. They are about lack of access to, and money for, healthy food, or time and familiarity to prepare it. 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. 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. You get the idea.

If I were experiencing all the health effects of these systemic oppressions, poverty, and disparate geographic access to opportunity, all those signs on the telephone poles would do is deeply piss me off.

Identifying the connection between health and community development only matters if we do the right things with that recognition. That involves bringing resources (and bully pulpit power) from the health sector to bear on addressing the place-based issues that have traditionally been more in the community development sphere that damage people’s health—housing, public safety, transit access, environmental justice, economic justice. This could, for example, be health funders funding preventative projects that would have traditionally been outside of a their scope, doctors connecting patients with tenant lawyers, or a new legislative coalition to fund the National Housing Trust Fund.

From the other direction it means thinking about ways that community development projects can include some measures to mitigate some of the negative effects of poverty and disinvestment on people’s health, whether it’s ventilation to address higher levels of air pollution, building free exercise facilities in affordable housing developments, financing grocery stores, or fighting for pedestrian safety outside a senior living facility.

But what it really does not and should not mean is focusing moralizing public health campaigns even more closely on the individual behaviors of people already struggling with poverty and unhealthy conditions in their neighborhoods.

There are many people working on the kinds of projects that truly try to get at the health and community development nexus, which is really hopeful. But I’m worried that things like vaguely offensive, out-of-context walking trail signs could proliferate as well. If any of us from either sector find ourselves slipping into that approach, we could do more harm than good.

(Photo credit: Holly Gramazio via Flickr, CC BY-NC 2.0)

About the author more »

Miriam Axel-Lute is editor of Shelterforce and associate director of the National Housing Institute. Her email is miriam at nhi dot org.

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