Before going into the positive changes in Richmond, Ca., Jason Corburn recalled the grim statistics – 9th most violent city in the U.S. in 2007, plagued by unemployment, pollution, gun violence, and higher than average rates for asthma, cancer, heart disease and diabetes, life expectancies of five years less than neighboring San Francisco.
He could go on, but he’s anxious to get to the good part, the part where things started changing. He begins to describe the actions that set Richmond up to become the first municipality to enact a “health in all policies” ordinance, which sets a framework of collaboration within city departments as well as with community based organizations and other government agencies to address community health, equity, and sustainability.
“Even though there were a lot of challenges, there were a lot of community assets as well,” said Jason, professor of city and regional planning and public health at the University of California, Berkeley. “There’s a rich history of community organizing in this town, strong social capital that dates back to the narratives of minority communities such as the Black Panthers, Japanese Americans who were interred during World War II and a vibrant and diverse group of Latinos.”
Jason spoke at the Sharing Knowledge to Build a Culture of Health Conference last February highlighting the importance of community expertise in building a Culture of Health. For example, a group of local community organizations came together to publish a report that quantifies how serious, avoidable problems have become chronic and offers solutions for a better, more equitable way of life.
Another group conducted a health survey to gather data about local environmental health issues in Richmond that did not previously exist. As a part of their research, they found that the prevalence of childhood asthma in Richmond was more than double the national average and that a majority of respondents suffered from 1-2 acute health problems. Survey results also revealed broad concern about crime and violence but also community perceptions of strong community ties.
“To get people to take health equity seriously, we needed community ideas and evidence that policymakers could translate into action,” Jason said. “Community activists in Richmond highlighted and elevated the challenges that mattered to them and worked to build the evidence base needed to motivate action.”
Jason said these community actions built the foundation for change. And when the city’s General Plan was up for revisions, community activists were ready to ask questions about how the plan would address health equity, discrimination, and violence. Jason emphasized the many factors that came together to achieve this shift in mindset – a shift that grabbed headlines in national news outlets.
“There is no magic switch,” he said. “The response early on was ‘isn’t there a health department to deal with this?’ But we worked to help the directors of every agency – from police to libraries to transportation – see that everything they do also affects health.”
In the city’s first Health in All Policies progress report, the city manager’s quote reveals the way he internalized the city staff’s role in health going so far as to call them “community clinicians.”
“The ordinance provides city staff and me the opportunity to evaluate and prioritize services that promote health equity. It means that our employees who maintain the Dr. Martin Luther King, Jr. baseball fields are community clinicians. So are our librarians, firefighters, planners, finance team, and all other City employees and partners,” the city manager said.
Communities all over the country are working with cross-sector stakeholders to achieve similar “ah-ha” moments and the Robert Wood Johnson Foundation is working both to fund and recognize work that increases the opportunities for all residents to live healthier and longer lives. Vicksburg, Miss., a 2017 Culture of Health Prize Winner, is one example as the community has come together to set priorities and focus on core issues like decreasing the rate of obesity and increasing physical activity; raising high school graduation rates and improving the learning environment; and revitalizing downtown Vicksburg to spur economic growth.
“Once you get other systems outside of health care to recognize their role in community health and create space for them to come together in the same room, you might be surprised by what comes out,” Jason said.
Support for this blog series is provided by the Robert Wood Johnson Foundation to highlight insights from the Sharing Knowledge to Build a Culture of Health Conference, convened in collaboration with AcademyHealth. The views expressed here do not necessarily reflect the views of the Foundation.