Health is not just health care, says fellowship seminar's keynote speaker

Published on
October 4, 2009

Over $1 billion in services are poured into the 13 poorest neighborhoods of Alameda County each year. It is what Anthony Iton calls "services overkill."

Dr. Iton, who has an M.D., J.D. and MPH, is the former Director of the Alameda County Public Health Department, which serves Oakland and surrounding cities in Northern California. He gave the keynote speech to open a week-long seminar of the National Health Journalism Fellowship, emphasizing that health has to do with a lot more than just health care.

Despite the many programs meant to improve health conditions in poor communities, inequities have worsened over the last 50 years. Whether residents live in affluent neighborhoods or poor ones, they die of the same diseases: primarily heart disease, cancer and stroke. But residents of poor, non-white neighborhoods die much younger. The starkest evidence comes from an examination of death certificates and Census Bureau data -- which shows that in some cities in America, residents of affluent neighborhoods live 20 years longer than residents of poor ones. African Americans now live on average almost eight years less than whites in Alameda County. Even when HIV/AIDS and homicide deaths are subtracted from the data, the gap does not significantly decrease.

It's numbers like these that prompt Dr. Iton to challenge the philosophy driving most public health spending in America: trying to change individual behavior. Alameda County spends much of its health budget using a medical model of trying to change individual behavior with information campaigns and brochures. But these services are expensive and not necessarily effective in eliminating or reducing health disparities, said Iton. "Brochures don't change that sense of despair."

Dr. Iton proposed improving neighborhood conditions -- ranging from slum housing to high dropout rates to high unemployment -- to help increase life expectancy in poor communities. Chronic stress can change physiology and prematurely ages body systems, making people more susceptible to illness and chronic disease.

"Some part of what we do has to look at those environments," he said. "We are mapping the hazaradous social conditions, trying to make them visible," Iton said. [You can learn more about Iton's use of data and maps in a prior post.]

Dr. Iton began work two days ago as the Senior Vice President of Healthy Communities at the California Endowment, which also funds ReportingonHealth. In his new post, Iton wants to "make visible" historic patterns of discrimination in poor minority communities.

Dr. Iton overlays a redlining map of Oakland over present-day neighborhoods to show that African Americans are still concentrated in the same poor, industrial neighborhoods today, even though discriminatory housing covenants and lending practices were outlawed decades ago. Liquor licenses are issued in greater numbers in poor neighborhoods and the gap between rich and poor neighborhoods in reading proficiency widens as children get older. All these social measures of progress can be linked to health.

"Health disparities don't just exist. There's a context to them," Iton said.

Later this week, Dr. Iton will provide more information about solutions to health inequities and answer your questions. Please log in and leave your comments and questions here.