Impacting Health Through a Focus on Race and Place WHY PLACE AND RACE MATTER WHY PLACE AND RACE MATTER Judith Bell Mary M. Lee POLICYLINK POLICYLINK PolicyLink is a national research and action institute advancing economic and social equity by Lifting Up What Works®. Find this full report online at www.policylink.org. ©2011 by PolicyLink All rights reserved. Design by Bureau Blank and Leslie Yang for PolicyLink. Cover photos courtesy of iStockphoto, Lorie Slater, Photography by Hamilton, Veer, and The Central California Center for Health and Human Services (CCCHHS). Photos courtesy of The Central California Center for Health and Human Services (CCCHHS), Getty Images, iStockphoto, Lorie Slater, Photography by Hamilton, Veer (pg 8); Tim Wagnar for HEAC (pg 43); Photography by Hamilton (pg 44); Great Communities Collaborative (GCC) (pg 45); iStockphoto, Veer (pg 46); Susan Law Cain, Veer (pg 47); Community Coalition (pg 52-53); Tim Wagnar for HEAC (pg 54-55); Youth Uprising (pg 56-57); Tim Wagnar for HEAC (pg 58); Leslie Yang, Photography by Hamilton (pg 59); Centro Binacional para el Desarrollo Indígena Oaxaqueño (CBDIO) (pg 60–61); Photography by Hamilton (pg 66–67); Pattie S., PixelDigits (pg 68); Nancy Nehring (pg 69); Central California Center for Health and Human Services (CCCHHS) (pg 70–71); Jme McLean (pg 72); Jme McLean (pg 74–75); Photography by Hamilton (pg 76–77); Photography by Hamilton (pg 78–79); David Bacon Photography (pg 84–85); Corbis Photography, Leslie Yang (pg 87); David Bacon Photography (pg 88); Alex Nikada Photography (pg 89). Impacting Health Through a Focus on Race and Place TABLE OF CONTENTS Foreword ...................................................................................................................................... 09 Preface ......................................................................................................................................... 11 Acknowledgments ........................................................................................................................ 13 Health at the Juncture of Place and Race (I) ................................................................ 16 17 A Golden State for Whom? 19 Achieving Health Equity 21 Seeds of Change California’s Changing Communities (II) ......................................................................... 24 25 Immigration 27 Changing Notions of Ethnic Identity, Growing Multiethnic Neighborhoods The Roots of Health Disparities (III) ............................................................................... 30 30 The Color Lines of Socioeconomic Status 31 The Physiological Effects of Bias and Discrimination 32 Dismantling Structural Racism A Framework For Building Healthy Communities (IV) ............................................. 34 36 ECONOMIC ENVIRONMENT Case Studies: 43 Access to Healthy Food 44 Setting High Standards for Food Retailers 45 Nonprofit Community-Foundation Partnership 46 Job Training Centers and Community Partners 48 SOCIAL ENVIRONMENT Case Studies: 52 Community Coalition 54 The Photovoice Project 56 Youth UpRising 58 Transforming the Built Environment 59 Community Building in Los Angeles 60 Centro Binacional para el Desarrollo Indígena Oaxaqueño 62 PHYSICAL ENVIRONMENT Case Studies: 66 The City Project 68 Birth Defects and Hazardous Waste 70 Extending Opportunities for Physical Activity 73 Health Impact Assessment in San Francisco 74 The City of Richmond 76 Mothers Fighting Pollution in Long Beach 78 Out of a Lawsuit, a Park Grows 80 SERVICE ENVIRONMENT Case Studies: 84 Challenging Environmental lnjustice 86 The Bay Area Regional Health Inequities Initiative 87 Asian Health Services 88 Emphasizing Equity in Planning and Land Use Decision Making Taking Action (V) .................................................................................................................... 90 Establish Strategic Place Targets / Increase Political Power of People of Color and Immigrants / Enforce Laws That Prohibit Discrimination / Shift Public Perceptions / Engage Strongly with Vulnerable Communities / Target Policies That Disproportionately Hurt People of Color From Local Advocacy to Statewide Change (VI) .......................................................... 96 Appendix: List of Interviewees ......................................................................................................... 99 Notes ............................................................................................................................................. 103 PolicyLink FOREWORD PolicyLink and The California Endowment have long recognized that place and race matter. Despite the fanciful talk in the media about a “postracial” society following President Barack Obama’s election, most neighborhoods are segregated along racial lines. And neighborhood environmental factors— how we all live. Race continues to fracture our society, from economic opportunities to the physical compounding disadvantage and perpetuating it across environment to social connections among generations. The structures of racism—many of them neighbors to supportive services—profoundly rooted in discriminatory policies and practices of earlier influence the health of residents. eras—pose perhaps the most intractable barriers In 2007, we published Why Place Matters to to equitable opportunity and a healthy, prosperous examine how these environmental factors can be future. An effective agenda to improve the health of strengthened and enlivened to benefit the health all Californians must consider both race and place, of all communities. The report looked at the authentically and forthrightly. growing movement in California and around An equitable approach to building healthy the nation to develop place-based solutions to communities also requires wide-ranging approaches, place-based problems—particularly in low-income spearheaded and sustained by many, many communities and communities of color, where stakeholders. Collaboration across organizations residents are disproportionately burdened by and sectors, including the private sector, is critical to harmful environmental factors and a long list of create robust, safe, opportunity-rich communities; in associated health risks. short, the kinds of places where we all want to live. Since then, much has changed. The idea that The experience and voices of community members, place matters has percolated up from the ground, particularly people of color, must be an integral part gaining currency in public health, research, of discussions, strategic thinking, and action around government, and policy circles. Health and sustainable change. equity issues are increasingly taken into account Why Place and Race Matter dives deeply into these in decisions and investments shaping the future issues and profiles dynamic groups and initiatives of neighborhoods, cities, rural communities, and throughout California and beyond. Although regions. The groundbreaking television documentary approaches vary, each illuminates the interplay among series, Unnatural Causes: Is Inequality Making Us people, place, and race. We hope these strategies and Sick, has engaged a cross-section of the American profiles will facilitate the exchange of ideas, encourage public in an ongoing conversation about the partnerships across disciplines and sectors, and complex connections among health, place, and race. stimulate action to build healthy communities. This report builds on our earlier work to look more intentionally and explicitly at race and ethnicity and what they mean in the context of building healthy communities. Our research and our conversations with people working in the field have reaffirmed our belief that place matters. By Robert K. Ross, MD Angela Glover Blackwell the same token, race matters—a lot. Race is an President and CEO Founder and CEO overarching consideration that affects where and The California Endowment PolicyLink 9 PolicyLink PREFACE America likes to think of itself as a land of We believe as strongly as ever that place opportunity for all, but our protracted struggle matters. As this report makes clear, however, with issues related to race is far from over. race is carving up our landscape, affecting Moments of great progress repeatedly collide where and how we all live. It remains our with instances of intense polarization. The deepest fissure, compounding disadvantage election of Barack Obama as the first African and perpetuating it across generations. American president of the United States seemed An effective agenda to improve health and a triumphant example of racial healing. Yet, prosperity in California and the nation must that triumph has been short-lived, with bigoted consider both race and place. It must embrace confrontation characterizing debate over many comprehensive approaches spearheaded issues, such as immigration, and hate-filled and sustained by many, many stakeholders. speech becoming more and more a staple of Collaborative efforts must include the private media coverage and political discourse. sector and involve the voices and experience Against this backdrop, the life chances of of people of color. people of color are increasingly under assault. This update, Why Place and Race Matter, Health indicators dramatically illustrate the delves into these issues. Dynamic groups and point. In every instance, people of color suffer initiatives are featured to illuminate action at disproportionately from conditions that shorten the intersection of health, place, and