A Health Equity Focused Model For Building Healthy Communities Urban Habitat January 12, 2011 Tony Iton, M.D., J.D., MPH Senior Vice President The California Endowment

Health ≠ Health care Where You Live Matters It Matters A LOT!

Life Expectancy by Poverty Group

Tract Poverty vs. Life Expectancy

Bay Area Poverty vs. Life Expectancy

California Poverty vs. Life Expectancy

Cost of Poverty in San Francisco Bay Area  Every additional $12,500 in household income buys one year of life expectancy  (Benefit appears to plateau at household incomes above $150,000)  Similar gradients in Baltimore, NYC, Philadelphia, Hennepin County (Minneapolis- St. Paul), Colorado, California, AND Cuyahoga County ($6304/year of life)

A 30 year longitudinal study of nearly 7000 Alameda County residents from 1965 forward. Those residents with household income 1 SD above mean were 25% less likely to die prematurely, 1 SD below mean were 35% more likely to die early.

Family &Culture Health Inequities Health Disparities

Family &Culture PlacePolicyValues

Building Healthy Communities

Human Capital: Our Greatest Resource

1.All children have health coverage 2.Families have improved access to a “health home” that supports healthy behaviors 3.Health and family-focused human services shift resources toward prevention 4.Residents live in communities with health-promoting land-use, transportation and community development 5.Children and their families are safe from violence in their homes and neighborhoods 6.Communities support healthy youth development 7.Neighborhood and school environments support improved health and healthy behaviors 8.Community health improvements are linked to economic development 9.Health gaps for boys and young men of color are narrowed 10.California has a shared vision of community health 10 Outcomes

Outco me BOYLE HEIGHTS CENTRAL/ WEST FRESNO CENTRAL LONG BEACH CENTRAL SANTA ANA CITY HEIGHTS COACHELLADEL NORTE EAST OAKLAND EAST SALINAS SOUTH FIGUEROA CORRIDOR SOUTH KERN SOUTH SACRAMEN TO SOUTWEST EAST MERCED RICHMONDCountRank Neighborhood safety 8. Economic development 4. Land use Affordable Care Act??

“Strategic Opportunism”

1.All children have health coverage 2.Families have improved access to a “health home” that supports healthy behaviors 3.Health and family-focused human services shift resources toward prevention 4.Residents live in communities with health-promoting land-use, transportation and community development 5.Children and their families are safe from violence in their homes and neighborhoods 6.Communities support healthy youth development 7.Neighborhood and school environments support improved health and healthy behaviors 8.Community health improvements are linked to economic development 9.Health gaps for boys and young men of color are narrowed 10.California has a shared vision of community health 10 Outcomes

The WHAT: Clustering Outcomes into Domains 10 BHC Outcomes 1. All Children Have Health Coverage 2. Access to a Health Home 3. Health Services Shift Resources Toward Prevention 4. Health-Promoting Land-Use 5. Neighborhoods Safe from Violence 6. Communities Support Healthy Youth Development 7. Healthy Neighborhood & School Environments 8. Health Improvements Linked to Economic Development 9. Narrowing Health Gaps for BMOC 10. Shared Vision of Community Health 3 Primary Domains of Work A. Health home/coverage/ACA B. Safety/violence prevention/youth development C. Land use/community development/school environments/HIAP Two Overarching Themes: Economic Development Structural Racialization BMoC Immigration Social Norms Change

Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy

Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy Healthy Communities Resident Power Leveraging Partnerships Changing The Narrative Youth Leadership Collaborative Efficacy

Health systems are family-centered and prioritize prevention opportunities for children, young adults, and families Human services systems are family centered, prioritize prevention, and promote healthy opportunities for children, young adults, and families Schools promote healthy behaviors and are a gateway for resources and services for families Physical, social, & economic environments in local communities support health BHC HUB 4 Systems/Institutional Targets

Current Political & Economic Landscape  Economic downturn/structural adjustment  Government contraction (devolution of programs to local level)  Assault on government  Polarized political climate  California out of step with nation  Suspicious electorate

What Is Needed  Build a pan-ethnic coalition  Develop clear & galvanizing theme(s)  Cross-sectoral collaboration-radical redefinition of agency purpose (e.g. “Corrections”)  Structural analysis & “catalytic interventions”  Deepening commitment to optimizing our democratic and participatory processes

Contact Information Tony Iton, MD, JD, MPH Senior Vice President The California Endowment