Dr. Brian D. Smedley
Many state governors and legislatures want to trim Medicaid and other public programs in an effort to balance budgets. But cutting Medicaid to the bone won’t reduce the demand for health care, and it certainly won’t help people be healthy enough to contribute to an economic recovery.
Instead, policymakers should make smart investments to help people to stay healthy in the first place. How can government do this when resources are so limited?
A good start might be focusing on the places and spaces where we live, work, and play. A growing body of research shows that our neighborhoods, our workplaces, and our schools powerfully shape health in many ways. They can increase risk for poor health through things like air, water, and soil pollution, and poor quality housing. If they are characterized by high levels of crime and violence, they can increase risk for injury and an array of stressrelated illnesses. They can discourage exercise and active lifestyles if they don’t have safe places for play and pedestrian- and bicyclefriendly transportation. And they powerfully shape diet through the kinds and quality of food available for sale. Detroit, for example, has only a handful of full-service grocery stores to serve the entire city, but is overrun with fast food restaurants, corner stores selling mainly highly- processed, high-fat food, and alcohol and tobacco vendors.
Focusing on place can also enhance the effort to eliminate heath inequities that in many communities—exist literally from the cradle to the grave, in the form of higher rates of infant mortality, higher rates of disease and disability, and earlier death for many people of color and the poor relative to more advantaged groups. A large volume of research demonstrates that racial and ethnic inequities persist even after socioeconomic factors— such as income and education levels—are considered. For example, African American mothers with a college degree experience infant mortality at rates higher than white mothers who have less than a high school education.
Health inequities hurt all of us. They take a human toll and they carry a significant economic burden for America: A study released by the Joint Center for Political and Economic Studies found that between 2003 and 2006, health and health care inequalities cost the nation $1.24 trillion dollars in health care expenses as well as economic impacts, such as lost wages and productivity.
Fortunately, there are effective strategies to improve conditions for good health. State and local governments can offer tax breaks and other incentives to attract major grocers and farmers’ markets to communities that some have called “food deserts.” Schools can limit the sale of non-nutritious, high calorie foods, and increase community residents’ access to recreational facilities through joint use agreements that open school grounds to neighbors after school hours. And policy makers can work across sectors— including, for example, education, business, and faith—to improve opportunities for youth to grow up in safe, violence-free neighborhoods.
Equally as important, we need to increase opportunities for people to move to better neighborhoods. Federal and state efforts to date have been modest, but can improve access to good schools, jobs, housing, healthy food, safe recreational facilities, and other health-enhancing resources.
To be sure, times are tough. Families feel the pinch, as do governments at all levels. But if we are to reduce the demand for health care and help people stay healthy as long as possible, we must insure that conditions in their communities support healthy choices and reduce health risks. Doing so is consistent with our national values, and in our economic interests, as well.
Brian D. Smedley, Ph.D., is Vice President and Director of the Health Policy Institute (HPI) of the Joint Center for Political and Economic Studies in Washington, DC. www.jointcenter.org. Dr. Smedley has responsibility for HPI’s “Place Matters” a key initiative to improve the health of participating communities