Urban America Forward | “Building a Culture of Health and Healthy Communities”

“I don’t call them food deserts, I call them fields of fat.” – Marilyn Aguirre, CUNY

“The Healthy Food Financing Initiative provides a model of success for developing grocery stores, farmers markets, and converting mom and pop stores to have healthy products.”  Mildred Thompson, PolicyLink 

“We have to build the capacity to act based on the health insights of young people.” – Deborah McKoy, Center for Cities and Schools

“The opportunities for research are where communities are experiencing hardship but are also thriving. How can we learn from that?” – Doriane Miller, University of Chicago Medicine

A modern urban civil rights agenda aims to achieve “health equity,” that is, the outcomes secured by tackling through social justice the root causes of health disparities. Inequitable policies in education, employment, income, housing, public safety, police aggression, legal status, the environment, and access to supportive care all influence health outcomes. A culture of health and health equity are achieved when all people in a diverse society have equal opportunity to live healthy lives. 

  • A wealth of evidence demonstrates that ZIP codes may be as important as genetic codes in determining health outcomes.[1]
  • Medical care, or the lack thereof, accounts for only 10-20 percent of premature mortality in the United States. In contrast,  personal behavior; social and environmental exposures (such as where people live; access to nutritious food; public safety; education; employment; and community resources) account for the largest proportion of lost years of life. [2]
  • The Adverse Childhood Experiences Study, a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente, finds that certain childhood experiences are major risk factors for the leading causes of illness, poor quality of life, and mortality in the United States. Moreover, although the field of epigenetics is still in its infancy, studies have indicated that child maltreatment can cause epigenetic modifications in victims.[3]  

Below are the overarching themes and the corresponding policy recommendations that emerged during the Roundtable Series. 


Overarching Themes

The quality of data to address the social determinants of health is unacceptably poor. Research shows that if doctors used the best available data to determine the availability of health resources in communities, they would be correct only 64 percent of the time in referring a patient to a health service, or only 72 percent of the time in referring a patient to human services.[4]

Physicians value data to help their patients achieve a healthier lifestyle. A 2011 survey found that four out of five physicians believe patients’ social needs are as important to address as their medical conditions.[5] In addition, if physicians had the power to write prescriptions for social needs, they would prescribe fitness programs, nutritional food, transportation assistance, employment assistance, adult education, and housing assistance.

Police aggression should be included among the social determinants of health. The American Association of Family Physicians has adopted a policy statement recognizing that any use of force beyond that reasonably necessary to accomplish a lawful police purpose poses a serious ongoing public health issue that disproportionately affects minority communities.[6]

Legal status affects health. Insecurity about legal status can contribute to toxic stress, not just for undocumented immigrants but for citizen children of immigrant parents, as well as for formerly incarcerated individuals returning to their home communities on release.[7] Undocumented immigrant populations still do not have health insurance coverage under the Affordable Care Act.

Policy Recommendations

Standardize environmental, physical, and social health education. The CDC has national health education standards, but health education is being sacrificed to other academic needs and demands. More states should endorse minimum standards of physical activity and formal health education.

Embed health equity as a performance outcome in federal, state, and local programs. The first step is measuring the proposed health impact of policies.

Tailor health messages. Awareness is the first line of defense in the chain of wellness and disease; we must demand culturally competent health campaigns and programming.

Models and Tactics

MAPSCorps is an example of a program using community assets to promote health.  MAPSCorps produces reliable, annually updated information about community resources that is used by doctors and other health care providers to help people stay healthy. MAPSCorps hires youth to map their community’s health assets. Doctors then prescribe a HealthyeRx, a list of resources tailored to a patient’s condition and health needs. Patients become more aware of their community assets, youth gain professional skills and employment, and businesses and organizations in the community become stronger.[8]

Y-Plan engages young people as partners in planning healthy cities. Y-Plan empowers students to tackle real-world problems in their communities through project-based civic learning experiences. For example, in Richmond, VA, a health academy engaged 265 students and the city manager to inform the city’s climate action plan.[9]

The Healthy Schools Campaign ensures students have access to a healthy school environment, healthy food, physical activity, nutrition education, and health services. Students also develop the knowledge and skills they need to become healthy adults.

Hip-Hop Public Health is a culturally tailored and effective health campaign in the African-American community to prevent strokes. The program integrates culture and iconic artists in developing interventions to identify stroke symptoms early. The program increased the number of Harlem residents who arrived within the treatment window for a stroke and decreased the burden of disability.[10]


[1] J. Marks, “Why Your ZIP Code May Be More Important to Your Health than Your Genetic Code,” Huffington Post, May 25, 2011, www.huffingtonpost.com/james-s-marks/why-your-zip-code-maybe_b_190650.html.

[2] N. Adler, “Assessing the Health Effects of Community Development.” In What Works for America’s Communities, edited by N. Andrews and D. Jackson (San Francisco: Federal Reserve Bank of San Francisco, 2015), http://www.whatworksforamerica.org/pdf/adler.pdf

[3] U.S. Department of Health and Human Services, “Understanding the Effects of Maltreatment on Brain Development.” Child Welfare Information Gateway (Washington, DC: DHHS, Children’s Bureau, 2015).

[4] J. Makelarski et al., “Are Your Asset Data As Good As You Think? Conducting a Comprehensive Census of Built Assets to Improve Urban Population Health,” Journal of Urban Health, 90(4)(August 2013):586-601.

[5] J. Fenton, “Health Care's Blind Side: The Overlooked Connection between Social Needs and Good Health” (New York: Robert Wood Johnson Foundation, December 1, 2011), http://www.rwjf.org/content/dam/farm/reports/surveys_and_polls/2011/rwjf71795.

[6] American Association of Family Physicians, “Social Determinants of Health Take Center Stage.” 2015 Congress of Delegates report. (Washington, DC: AAFP, September 30, 2015), http://www.aafp.org/news/2015-congress-fmx/20150930hopsrefcomm.html.

[7] Human Impact Partners, “Family Unity, Family Health: How Family-Focused Immigration Reform Will Mean Better Health for Children and Families.” Executive Summary. (Oakland, CA: Human Impact Partners, June 2013), http://www.humanimpact.org/projects/hia-case-stories/family-unity-family-health-an-inquiry-on-federal-immigration-policy/

[8] For more, see MAPSCorp “About” page, http://www.healtherx.org/mapscorps/about-mapscorps.

[9] See Centers for Cities and School at http://y-plan.berkeley.edu/.

[10] For more, see Hip Hop Public Health “About” page, http://hhph.org/