Thankfully, the profound connections between healthy human development and the social and economic conditions of our daily lives are starting to gain more widespread recognition and attention. The November issue of Health Affairs is devoted to how social services and community supports improve people's health. One intriguing article examines measures of neighborhood opportunities that are conducive to healthy child development: things like quality early-childhood education, proximity to parks and healthy food, and a low-poverty environment.
It’s clear that our country has a growing "health disadvantage" relative to other wealthy democracies—that is, Americans have been dying at younger ages than people in almost all other high-income countries. But we are still grappling with explanations and solutions.
The Robert Wood Johnson Foundation has been at the forefront of these issues for several decades, from its Commission to Build a Healthier America to its current efforts to infuse a "culture of health" throughout the country. This culture promotes individual and community well-being, creates physical and social environments that prioritize health, and supports access to opportunities for healthier lifestyles and high-quality healthcare for everyone. The Kresge and Annie E. Casey foundations are also leading major efforts on these fronts.
New and exciting signs of progress are appearing in communities across the country: from the Building Healthy Places Network, to Purpose Built Communities, to Magnolia Place in Los Angeles and the ReFresh Project in New Orleans. The Federal Reserve banks of San Francisco and Dallas are also focusing on the intersections of health and community development.
Earlier this year, I attended a financial innovations roundtable hosted by the Federal Reserve Board of Governors. The meeting was devoted to health-related community investments and I used many of the promising ideas shared that day to create a set of principles that can guide community-based health-oriented investments.
All other things equal:
- Invest early in life, ideally in early childhood
- Invest for the long term (for life-long, even multi-generational, benefits)
- Invest in efforts that are preventive rather than remedial
- Invest in efforts that are evidence-based or contribute to an evidence base
- Invest in efforts that respect and advance a community’s own priorities
- Invest in people or places or systems that have been traditionally underserved or unattended
- Invest in ways that foster stability and continuity (at neighborhood, community, state, or federal levels)
- Invest in ways that can transform and/or bridge major service systems, including and especially non-health systems
These principles are grounded in the growing body of research on the social determinants of health (see this and this and this). I hope others can refine them in the future.
In many ways these principles reflect, at the local level, a "health in all policies" approach that other countries have long embraced. It is very encouraging that the community development field is attending to the health and well-being of residents. Making wise investments along the way should help ensure that this attention pays off.
Photo: Children in California participate in a public school-based early-morning running program aimed at combating childhood obesity. (AP Photo/Gregory Bull)