Question Answered step-by-step Video transcript Unnatural Causes “Place Matters” Yeah if you lived… Video transcript Unnatural Causes “Place Matters” Yeah if you lived here you’d be 30% more likely to live into old age than if you lived here. If you lived in this neighborhood your child would be six times more likely to be hospitalized for asthma than if you lived in this neighborhood. Why is your street address and the place you live such a good Or of your health placed matters. That’s where someone works really go to school or where they live. Because place determines what someone’s exposed to in terms of a whole host of factors that can affect their health. So place matters because it determines what kind of physical or chemical agents you might be exposed to it matters what kind of social environment you’re exposed to. It matters if there’s a lot of violence or crime in your neighborhood it matters if it’s easily go for a walk in your neighborhood or find healthy foods. Who your neighbors are and the way you interact with your neighbors can also affect your health To place ultimately as a critical determinant of health. When we think about how we usually think about health care and access to care and quality of care. But what research clearly shows is that health is embedded in the larger conditions in which we live and work. So the quality of housing and the quality of neighborhood have dramatic effects on health. How do we make an unhealthy neighborhood healthy Here are two neighborhoods working to find answers One enrichment in Northern California and another in Seattle Washington to neighborhoods with similar problems. Today in High Point in West Seattle there’s quality low cost housing clean parks safe streets access to good food choices and sidewalks that allow lots of social interaction. These features promote health in high point but they’re not found in many low income neighborhoods. Thanks away away. Me glad bunkered age 49 a refugee from Laos. He moved to Richmond California in 1980. He works as a school generally role towards me. And I would find it hard to believe that you should you will be able to go back to work and work a full day right now. So each ten the heartbeats 15 or 20% of the blood is leaving the. Normal is 60. 60% percent. Yeah so it’s working about a third of a normal heart. Two weeks ago Guai suffered a major heart attack. So it’s a little bit. This is his first checkup since emergency surgery. Hello His cardiologist doesn’t pull punches. That’s a really good question and I’ll know you’re essentially almost died once. A lot of it depends on how it started I guess over the next three to six months. If he doesn’t get straw we unfortunately at risk of certainly dropping that. You Taobao hot stressing you mean like deaths including worry and worry society and honest than others they can play a role. Okay the question is why would a young man like this present with such severe heart disease. We can’t heart and a heart attack at such a young age. Basic causes of the disease that we we ask questions about her smoking history He’s not a tobacco user. History of diabetes she doesn’t know history of diabetes family history of heart problems at a young age no family history. And one has to wonder whether environmental factors play a role. In glides environment petrochemical companies release tons of pollutants each year. But these toxins may not be the worst environmental health thread here. Tobacco liquor and fast food are easy to find. Fresh produce Isn’t nor is quality housing. Many public places are unsafe. It’s a community And it has an enormous number of problems. So we see much higher rates of asthma hospitalization. We see much higher rates of diabetes or a lower life expectancy. When most people think of the causes of chronic disease for example cardiovascular disease. They think of individual level risk factors which we know about diet physical activity smoking. However it’s also true that they are socially patterned. And one of the dimensions across which it’s patterned is by neighborhoods. If we look at a map of almost any geographic area but I’ll just use the example of Richmond California And you map up rates of obesity for example or of hypertension or of low birthweight. We’ll see that these things overlap almost exactly. And if we overlay a map of environmental hazards it’s Goodson as well. And it’s very common to see all these dimensions cluster. And the cluster enrichment. The city has higher rates of death from heart disease and cancer Most surrounding communities in rural children are hospitalized for asthma at twice the rate of other county neighborhoods. And the risk of dying of diabetes is almost twice as high. Sometimes we naively think of improving health by simply changing behaviors. But the choices of individuals often limited by the environments in which they live. A friend of mine who worked enrichment said that she’s seen ten or 12 teenage girls now who have had gallbladder their gallbladder is removed A lot of fat in your diet you can get gallbladder disease. Turned out they’re eating virtually breakfast lunch and dinner in fast food outlets. And there were no farmers markets. There were no green grocers. There was no safe way your supermarket that was reachable by these kids. And fast food is a bargain. You can get 1500 calories for a couple of bucks. It’s not a long-term bargain but it’s a short-term borrowing. People make that trade. Even short term bargains can be few and far between that and a lot of blow sudden labor around here. Those men around here 0 150% people pay more than 30% of their income towards the house and cars. And so you’ll pay more than 30% of your income. You are not in a good situation. And it’s not just housing. According to Brookings Institution report buying a car in a low-income neighborhood cost as much as $500 more than in an affluent community. Cashing a check add up to 10% more furniture appliances and even groceries are more expensive. Researchers call this the poverty tax. Until last year I worked two jobs I went to adapt to people. My dad used to say like Mom stop. She says she doesn’t want to see her mom or dad with like that. Now I took these patients like why who come in very sick we patch them up we save their lives and send them out back in the same environment. Calcium potassium that ticket for class. I think we sometimes forget that people who live in more well-off communities have a lot of advantages because they do have a lot of the environmental support. Well why are these neighborhoods so different And of course these differences are not a natural thing. They arise as a result of policies or the absence of policies that create these enormous spacial inequalities and resources and and the environments that people live. 60 years ago. Richmond was a boomtown here with the tumbled One of the nation lives have been duckbill Army during World War Two. The Kaiser shipyards enrichment ran 24 hours a day. The war effort drew workers of all ethnicities to Richmond And when the war ended new governmental policies brought sweeping changes to communities like which. As the shipyards closed thousands of jobs left. So did anyone who could but only white families could get the new government back mortgages to buy homes in the new suburbs. Richmond population fell by a third. We had vast public investments in building the suburbs of American federally supported loans. Fha loans went to people who were moving to the suburbs and for many years up until the sixties those loans were available in a racially restrictive basis African-Americans and other people who didn’t have access to them. Until 1962 out of $120 billion in government backed home loans less than 2% went to non-white households. In Northern California between the war in 1960 of 350 thousand federally guaranteed new home loans less than 100 went to black families. In cities like Richmond African-Americans were left behind in increasingly neglected neighborhoods In the 19 eighties poor Latino and Southeast Asian immigrants began joining them in the same neighborhoods. Once the community starts to go downhill nobody wants to actually invest in the community. So the banks don’t want to come in and the shops don’t want to come and then you don’t have a commercial base. You don’t have the community taxes can then feed back into the schools now you don’t have good schools. So families don’t want to move into the community if they don’t have to because you don’t have good scores and you get a sort of vicious cycle of everybody who can will leave the community. The seasons of the hobbits overnight and it isn’t the fault of the people who live there. The people who live in low income disinvested communities did not Sales 20 years before his heart attack quiet tried to move his family out of Richmond. But 11 months later they had to move back. I can’t find my job up there and she can’t find a job up there. And more back my older son hang around with around group and then use some kind of drag. I just don’t know what to do. I tried to help me in my trying to straighten Mao spend lot of money on people a lot of money. That’s what in my own time such worry worry worry written that way. And I’m going to pay off all of these and how I’m going to do it Then I’ll comb cat cat current current can negate this penalty. If you think about when you’re worried here you’re always a little bit more activated. There’s a little bit more vigilance or sort of checking things out a little bit more carefully. And if you can imagine that happening day after day all day every day it’s exhausting and it wears on the body. Sustained. Wind stress is chronic when we’re endlessly worried about our bills our job our children’s safety the body pumps out cortisol and adrenaline But too much of these stress hormones over time can increase arterial plaque raise blood pressure and weaken our immune system increasing our risk for almost every chronic disease including heart disease is the leading killer in America. We’ve done studies that have shown that living and disadvantaged neighborhoods is related to an increased risk because about 50 to 80% increase risk of developing heart disease my own them. And this has been replicated in other studies. In our society today everybody experiences stress. However in many disadvantaged communities what we have is the accumulation of multiple negative stress source and it’s so many of them it’s as if someone has been hit from every single side and it’s not only that they are dealing with a lot of stress. They have few resources to cope. Is what again where we live is. Liu was leading the health challenges of low-income lay oceans Vietnamese and Cambodian. Or often masked when they’re lumped together as Asian Americans we’re talking about justice right guys cousin torn non-preferred organizes his community to address local health and environmental problems. Joining forces with other activists enrichment decide. By Richmond is a very diverse community and there is a very rich and historical network of community agencies and community organizations. That’s been enhanced by the new waves of immigrants who’ve brought and develop their own community agencies to address health problems. One of the greatest health challenges to the community and its children is exposure to violence. In 2005 regimen had one of the highest murder rates in the United States. It’s a brick scale detour to care Marcy said whose dad that. I say I don’t know just don’t open the door and I heard the sound light did not again and I ran back. It wasn’t. He wasn’t mapped. There should be a mechanism went out. The window who’d been on a boom and many logo go. Yohanan federal law And then they’ll move out and move on yeah. Gua and Quinones daughter. Chan was a successful student who became the mistaken target of a Southeast Asian drug gang. The specter of community violence has completely transformed the way that people live in certain neighborhoods. So it’s a public health issue not only for the prevention of premature death through homicide but for the the ripple effects it has on the other things to contribute to peoples poor health the ability of people to go out to go shopping to live a normal life. In fact research now suggests some adult health problems may be traced to living with violence as a child. The impact of that stress the impact of that exposure to violence triggers physiological responses in a child and can actually be disruptive to the developing brain and developing immune system such that you are primed fan can be more vulnerable to physical and mental health problems all through your life. Outside I heard gunshots and thereby School. And I also hear some guy shot too. We work with the kids enrichment and many of those kids didn’t think they would live beyond the age of 20. So we propose study on hope trying to show kids that they can work their life around so that they do have a future and pick a photo to write about the program that resulted or youth empowerment strategies or yes. Helps youth develop a sense of hope by showing them at an early age how by their actions they can work together to create positive change in their community. And we came up with the Apache hope impacts health because then you don’t internalize a lot of the behaviors about feeling hopeless and feeling alienated from society. What it is that you do is you feel proactive and you realize that that you have a say in how things can be. So you engage in making things be that way. Why legal control over our environment gives us reason to be hopeful and hope is an often overlooked factor for good health. But how might a neighbourhoods residents gain that control 800 miles north in Seattle Washington at high point the public health and housing agencies and developers took a radical approach to give one neighborhood. Some of the health advantages found in wealthier communities. 60 years ago high point was a lot like Richmond. It began in the forties as housing for temporary defense workers By the 990s High Point housing had deteriorated. These are built for temporary housing. We told the neighborhood. They’ll only be here a few years and they’re they’re still here 60 years later had lived in the apartment here on the Yan’an Graham here it’s right there behind that little tree. I felt anxious because bullets are flying. And you did not know when that was going to happen or what the consequences would be If it was unsafe outside it was unhealthy inside. Asthma was endemic. This is one of the old units. It’s a pretty nasty looking at when the family has just moved out of here though into what are the new units. There’s leaking off the windows that over the years lets the plasterboard soak and mold will form all along there. As you can see here they didn’t just have a mold problem but with the moisture you get more dust lights that are common Nasmyth trigger. Lot of mold growth under there and nice places for the roaches live and thrive. Not a healthy Ho. And the old high 0.1 added nine wouldn’t have ten households were effective. Miasma. Pretty much everybody knew somebody who had asked me in the community. It’s almost like it was normal asked him were so commonplace. It was normal. By 1997 it was clear to the city and residents that it was time to make a change. There was a community here even though this was a rough dangerous neighborhood there was still a community here and people living in communities actually know what they want. They wanted the kind of healthy living conditions that wealthier neighborhoods usually take for granted Working with Seattle Housing Authority and the public health department. Community one federal grants to rebuild hypo. Housing authority worked really hard to invite communities to the table and share in the design and access to power. Low-income people there used to not having power so they don’t know. They even can have power. What emerged from the design process was a new mixed income community with health as its focus We sold nine of them that are loaded. And our hope is that the High Point community now be integrated with the rest of the surrounding neighborhood and making these people to walk to stores are parked the neighborhood as a whole. There is a new clinic that’s been built here new public library that’s been built here. So those services will be available right on site to residence as well. And then there’ll be a community center and that will have all sorts of other services such as employment services and childcare and and the like the new hive point has community gardens where gardeners can sell their organic produce to neighbors. And other factor that we know promotes health. It is for people to be socially connected and having a lot of space in promoting social interaction was a conscious design element. Here. One health problem Community developers were determined to take on was asthma. Nationwide the cost of asthma in health care and law school and work days is staggering. $20 billion every year. Low income neighborhoods are the most affected. Four-year-old Stephen Truong has asthma. At nighttime. He’s sleeping then throwing up then to heart for you. Great And I just bringing good children’s hospital in the middle of the night. That time I cannot go up and down that cap and over a year’s time we found our children were spending up to 3 thousand to $5 thousand on repeated emergency room visits. That’s emergency room treatment each year for just one child. Going different now Benito Blake. A high point activist came up with the idea to build some of the new homes with a range of special features for people with asthma The ventilation system is meant to bring in fresh air from the outside even small particles that might be bad for your health such as diesel particulate a pollens in the case of an asthmatic will be filtered out. So the air inside the home is actually healthier than the air outside. Stephens family moved into a breathe easy unit. Five months ago I have Degas am now when Wang among gay and that now how it out now if I am looking at there that you’ve gotten that combine nothing no no Breathe easy homes cost about $6 thousand extra to build. That’s less than two years of emergency room services for a child like steel. But these kinds of health innovations rarely come from private developers working on. And the federal hope six program that provided financing to build the new high point is being phased out. Market-driven forces are not going to build healthy homes for low-income communities that so only going to come from policymakers who recognize the societal benefits having healthy communities like this one. But not everyone benefited some residents who were supposed to be temporarily displaced to build this mixed income community. Never came back and rebuilding a neighborhood from the bottom up isn’t possible or desirable everywhere. The real issue is who gets to make these decisions. The major health problems in a community like Richmond are extremely complicated and they’re screamingly deed. And it requires a whole spectrum of strategy’s. Everything from educating individuals to mobilizing communities and neighborhoods Building coalitions or to changing public policy. The first thing we need to do is acknowledge the way you live impacts your Hellman and that the environment in the community the social environment the physical environment and the economic environment together determine whether or not we’re going to have a healthy existence. What that means is the housing policies health policy educational policy is health policy. Anti-violence policy is health policy. Neighborhood improvement policies or health policies. Everything that we can do to improve the quality of life Visuals and L society has an impact on the health and is a health policy. No no Major funding for unnatural causes has been made possible by the Ford Foundation. The John D And Catherine T Macarthur Foundation. The California Endowment WK Kellogg Foundation. The Nathan Cummings Foundation Joint Center for political and economic studies. And Kaiser Permanente Additional funding provided by these funders This program was also made possible by the Corporation for Public Broadcasting Health Science Science Nursing NURS 474 Share QuestionEmailCopy link Comments (0)