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Vol. LXI, No. 16
August 7, 2009

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Researcher Describes Barriers to Health In Poor Communities

For all the talk of advances in race relations in the wake of the 2008 election, there is a lot of evidence that shows minorities in America have much further to go to achieve equality across the board.

One of the most striking categories is health.

To address this issue, the National Center on Minority Health and Health Disparities recently kicked off a new seminar series and, for its first event, welcomed speaker Dr. Brian Smedley, vice president and director of the Health Policy Institute and Joint Center for Political and Economic Studies in Washington, D.C. His organization, what he calls a “think and do” tank, not only analyzes the data coming out of scientific and public health studies concerning health equity and access, but also operates as a vocal player in the formation of health policy.

“How we apply science to policy is critically important,” he said. “This is where the rubber meets the road.”

Smedley laid out a wealth of information culled from numerous studies that indicates both black and Latino people in the United States face many hurdles to achieving consistent good health. The contributing causes of these hurdles include lower socioeconomic status, continued residential segregation, risks and dangers while on the job that can lead to accidents or hazardous exposures, and differences not only in patterns of health-seeking behaviors, but also in access to care and the level of care received once it’s found.

For example, said Smedley, it is difficult to encourage minority communities to eat healthy foods and spend time outdoors when the resources to make that happen aren’t a reality for people in low-income neighborhoods.
Dr. Brian Smedley gives the first lecture in a new health disparities seminar series.
Dr. Brian Smedley gives the first lecture in a new health disparities seminar series.

“Many of these neighborhoods contain a high percentage of liquor stores, convenience stores and fast-food restaurants,” he said. “There is less access to quality foods, few sidewalks to walk on and few parks to play in. It does little good talking about eating five fruits and vegetables a day when they don’t have a grocery store or farmers market nearby.”

Further, many children of disadvantaged minorities fight an uphill battle just by virtue of being born into a poor family that lives in a poor neighborhood, especially if it’s a community that experiences such a stark lack of options for healthy living. Add to that enrollment at a poor, mostly minority school funded by a depressed tax base, filled with aging books and facilities and taught by low-paid teachers, and you’ve got what Smedley calls triple jeopardy.

“It’s not the fact that our schools remain deeply segregated, it’s the lack of resources associated with that segregation,” he said. “Here we are some 50 years after the Brown vs. Board of Education decision. These limited resources for poor children constrain life opportunities. That means the experience of poverty for white children is very different, strikingly different than it is for children of color.”

This all translates into a culture of recurrent, cyclical poverty that keeps poor people from achieving a mentally, emotionally and physically healthy way of life. And this is where Smedley says policy can play a big role by intervening to stop this cycle.

“We need to work for greater housing mobility, build incentives for farmers markets, structure land use and zoning policy to reduce the concentration of health risks and improve the physical environment of communities. And we need to expand opportunities for quality education,” he said. Smedley indicated these interventions should be woven into the permanent fabric of neighborhoods.

“It’s going to take a while,” he said. “These are not 3- or 5-year interventions, they have to become part of the culture.”

Smedley offered data that shows how effective intervention programs can be, using the widely regarded Head Start program as an example.

“For every $1 you invest in pre-school programs, you save $17 on the back end on things like health issues, incarceration costs, unemployment and other social services,” he said. “That’s certainly an argument for exposure to quality pre-school programs.”

Asked by an audience member how scientists can participate in policy-making without feeling like politicians and thereby compromising their objectivity, Smedley suggested that science has too long existed in a vacuum.

“We’ve got to get over these notions,” he said. “We’ve got to start with our institutions, with our research and academic institutions and help [them] understand that the application of knowledge to policy and practice is why these institutions are created in the first place.”

Smedley called for greater participation by minorities in the scientific and public health fields to help close the gap between science and understanding.

“It’s not just an issue of trying to change the complexion of the faces around the room, it’s a scientific issue,” he said. “It’s a question of who is asking the questions, how do we pose the questions that are being asked and how do we interpret what we’re learning?”

The next seminar in the health disparities series will be Aug. 13 from 2 to 3:30 p.m. in the Natcher Bldg. Two speakers will discuss community-based participatory research. NIHRecord Icon

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