Health Equity
By Lisa Tobe, MPH
Our neighbor’s always working on his yard - putting up a fence, painting it, building a gate for his driveway, digging out old concrete so he can create a garden, planting flowers along the alley - whatever he sees that needs to be done. I’ve seen him working on the roof, painting his house and sometimes, when we’re a little slow to get around to it, he cuts our yard. We’ll talk at the fence when I’m running in and out of work. He works second shift and is often outside when I’m starting my day. He’s told me a little about his daughter, his wife, his car that was totaled sitting on the street in front of his house by someone he thinks was using crack in the middle of the day.
He’s called me a movie star, because he saw me on Metro Television talking about how the places people live, work, play and pray have such a huge impact on their health. He sees the connection with him, a little, but not directly, not yet – says he needs to take better care of his health. And I think he does, we all need to take some responsibility for our own health. I think about myself, how I gained 15 pounds in the first six months I worked at the Center for Health Equity (CHE), which sits in the heart of the Russell Neighborhood in West Louisville, two blocks from Broadway, the most densely packed fast food corridor in Louisville.
Before starting this job, I used to walk to lunch everyday and pick up something healthy to eat. I have limited options here. There is a full-service grocery store, an uncommon phenomenon in West Louisville, within walking distance from the Center. I can get an apple for about $1 or salad for $5, or I could walk next door to McDonalds and get a quarter pounder, fries and large drink for $5 or two cheeseburgers for $1. I can afford to make the healthier choice. I live in the Highlands, a place where the median household income is $36,550. At $12,934, the household income in Russell is about a third of that; and only half of the Louisville Metro area, leaving very little money for healthy foods.
I’ve started exercising more, lost some weight. I have a citywide YMCA membership, live close to Cherokee Park, a safe, well-maintained outdoor area, own a car and ride a bike for fun. Most folks in Russell don’t have adequate transportation and can’t afford a gym membership. And while it would seem natural that they could walk for exercise, limited resources have historically gone into the West End for maintaining sidewalks or creating safe, affordable recreation areas, and crime is high. In fact, this weekend, at the end of the alley behind CHE, two people were shot, and one died. This man’s body laid next to the small front yard of a publically funded housing unit, which during the day time, is normally filled by young children playing in clusters under their parent’s watchful eyes.
Our neighbor at CHE is in his mid fifties; let’s say 54 to make the math easier. According to the average life expectancy in the Russell neighborhood, he will only live about 15 more years, 10 fewer years than someone living in an East End City Council District.
While personal responsibility plays a big role in eating healthier and exercising, it’s not always that simple. People can only make choices from the choices available to them. Low income neighborhoods and communities of color often bear a greater burden of chronic conditions such as diabetes and heart disease, because they have limited access to fresh produce and offer fewer opportunities for safe exercise. Unemployment, racism, poverty and lower educational attainment add to these effects. Since health begins with healthy communities - including safe streets with freedom from violence and parks where kids can play - we need to focus on giving people opportunities for healthy living everywhere. A recent $7.9 million Communities Putting Prevention to Work (CPPW) Grant from the U.S. Department of Health and Human Services funds local strategies that are, among other things, making healthier food options and increased physical education activities available in our schools. It is making fresh produce and opportunities to exercise available in our city’s poorer neighborhoods. It is helping to develop policies to encourage infant breastfeeding, educate consumers on the caloric content of food in restaurants and reduce advertising for high calorie foods.
In the words of Dr. Adewale Troutman, the Director of Louisville Metro Department of Public Health and Wellness, “We must remove the barriers to good health that make people sick in the first place by building an infrastructure that makes it possible for each of us to make healthy lifestyle choices and provide health equity for all.” This will make it more likely that our neighbor lives the same full life as an East End resident instead of losing 10 years of his life to conditions outside his control.
As the Director of the Center for Health Equity, an arm of the Louisville Metro Department of Public Health and Wellness, Lisa Tobe helps shape policy that focus on decreasing health inequities. Through policy change, evidence-based interventions and education, the Center for Health Equity works with communities to reshape the public health landscape and address barriers to health equity.