Nothing Stops a Bullet Like a Job

That’s the motto of Homeboy Industries in Los Angeles – an innovative program that serves high-risk, formerly gang-involved men and women.

Ponder that for a moment while considering the following:

• The United States spends more money per person on health care than any other country in the world.
• Among the 34 countries tracked by the Organisation for Economic Cooperation and Development, the United States ranks very close to worst on life expectancy, infant mortality, and child poverty.

What’s the connection between the slogan and these health statistics? Social determinants of health­­­—the range of personal, social, economic, and environmental factors that influence health status.

In the case of Homeboy, it’s palpable. They connected the dots. Economic factors influence crime, including gun violence. Crime and violence produce homicides, injuries, mental health problems, and other ills. By improving economic opportunities, we can reduce crime, thereby improving a community’s health.

What about the seemingly contradictory facts on health care spending and the United States’ poor showing on health status indicators? The lack of correlation between them occurs because health care plays a lesser role in keeping us all healthy than lifestyle, economic status, and environment.

Spending more money on clinicians, hospitals, clinics, and drugs will have only a small impact on our health. We can produce a much larger, community-wide impact by improving economic opportunities, increasing high school and college completion rates, improving the housing stock, and cleaning up the air, just to name a few.

A few years ago, we completed a study with Blue Cross Blue Shield of Minnesota Foundation.   It demonstrated that neighborhoods in the Twin Cities located just minutes away from one another have very different life expectancies. Residents in some neighborhoods can expect to live at least 5 years longer than residents in other neighborhoods. That’s a lot less time to spend enjoying life on this planet, just because you have the wrong zip code.

One way to remedy this situation: Greater collaboration between two types of organizations who share similar missions, but who frequently do not work in unison. The first type, community development finance organizations, such as Twin Cities LISC, include banks and other lending institutions which have financial resources to support construction projects, provide start-up funding for entrepreneurs, and meet other capital needs of public and private organizations. They address health by attempting to improve the environment, reduce poverty, and provide infrastructure for the delivery of health and public health services. The second type incudes public health, health care, and human service organizations that promote health, work on prevention, and treat illness and disease.

While these two types of organizations share a similar vision to improve community health, they do not fully understand one another nor share a common approach. The Robert Wood Johnson Foundation recognized this and began efforts to bring these organizations together.

Wilder Research, in partnership with the Federal ReserveBank of Minneapolis, just released a special report commissioned by the Robert Wood Johnson Foundation which documented how this work occurs, what facilitates it, and what needs to occur to promote success.

We noted a number of promising examples in our report, including:

• Brandywine Center in Pennsylvania, which blended public and private money to build a health center, affordable housing for seniors, community meeting space, and a children's library. (Is a children's library a tool for health improvement? You bet!)
• Preschool Without Walls, in California, which provides early learning activities for low-income parents and their children in libraries, public parks, and at home. This strategy has successfully engaged families previously resistant to early childhood programs; it has improved school readiness.
• Bringing Health Home, also in California, which offers households with young children coupons for local farmers markets in conjunction with workshops on nutrition, preparation of healthy foods, and budgeting. 

We surveyed professionals around the nation in fields related to community development and public health.  To our pleasant surprise, they described a number of existing joint efforts to promote a culture of health in schools and workplaces, increase access to healthy foods, and improve the quality of early education and child care.

Perhaps not surprisingly, we also learned that good leadership, mutual respect and understanding among those working together, shared vision and common goals were at the top of the list of ingredients necessary for success.

Momentum exists to improve health and life expectancy for everyone. To build on the momentum:

First, we need to develop leadership at the national level to nurture collaborative initiatives and build a network for communication and learning.

Second, we need to learn how to work better in partnerships, and gain knowledge and technical skills related to funding and operating cross-sector programs.

Third, we need to build the evidence base for cross-sector initiatives to improve community health. Practitioners should initiate action based on what we know works and does not work.

We look forward to continued work to improve the large scale social trends and the small scale elements of our neighborhoods, which so strongly influence the quality and length of our lives.