A Health Equity Focused
Model For Building Healthy
Communities
Urban Habitat
January 12, 2011
Tony Iton, M.D., J.D., MPH
Senior Vice President
The California Endowment
Health ≠ Health care
Where You Live Matters
It Matters A LOT!
Life Expectancy by Poverty Group 2000-2003
Alameda County
100
95
Life Expectancy (Years)
90
85
80
75
70
65
60
55
50
0%
10%
20%
30%
Poverty Rate
40%
50%
60%
Tract Poverty vs. Life
Expectancy
San Francisco County
100
95
90
Life Expectancy (Years)
85
Alameda County
100
95
85
75
70
65
60
80
55
75
50
0%
70
10%
20%
30%
40%
50%
60%
40%
50%
60%
Poverty Rate
65
Contra Costa County
60
100
55
50
0%
95
10%
20%
30%
40%
50%
60%
90
Poverty Rate
Life Expectancy (Years)
Life Expectancy (Years)
90
80
85
80
75
70
65
60
55
50
0%
10%
20%
30%
Poverty Rate
Bay Area Poverty vs. Life Expectancy
BARHII Life Expectancy and Poverty by Tract
100
95
90
Life Expectancy (Years)
85
80
75
70
65
60
55
50
0%
10%
20%
30%
Poverty Rate
40%
50%
60%
California Poverty vs. Life Expectancy
Life Expectancy v. Percentage Poverty
100
y = -13.539x + 81.084
R 2 = 0.1183
95
Life Expectancy
90
85
80
75
70
65
60
0%
10%
20%
30%
40%
50%
Percentage Poverty
60%
70%
80%
Cost of Poverty in San Francisco
Bay Area
 Every additional $12,500 in
household income buys one year
of life expectancy

(Benefit appears to plateau at household
incomes above $150,000)
 Similar gradients in Baltimore, NYC,
Philadelphia, Hennepin County (MinneapolisSt. Paul), Colorado, California, AND
Cuyahoga County ($6304/year of life)
A 30 year longitudinal study of nearly 7000
Alameda County residents from 1965 forward.
Those residents with household income 1 SD
above mean were 25% less likely to die
prematurely, 1 SD below mean were 35% more
likely to die early.
Family &
Culture
Health
Health
Inequities Disparities
Family &
Culture
Values
Policy
Place
Building Healthy Communities
Human Capital: Our Greatest Resource
10 Outcomes
1. All children have health coverage
2. Families have improved access to a “health home” that supports
healthy behaviors
3. Health and family-focused human services shift resources
toward prevention
4. Residents live in communities with health-promoting land-use,
transportation and community development
5. Children and their families are safe from violence in their homes
and neighborhoods
6. Communities support healthy youth development
7. Neighborhood and school environments support improved
health and healthy behaviors
8. Community health improvements are linked to economic
development
9. Health gaps for boys and young men of color are narrowed
10.California has a shared vision of community health
BOYLE
HEIGHTS
Outco
me
1
2
3
CENTRAL/
WEST
FRESNO
CENTRAL
CENTRAL
CITY
EAST
LONG
COACHELLA DEL NORTE
SANTA ANA HEIGHTS
OAKLAND
BEACH
EAST
SALINAS
SOUTH
FIGUEROA
CORRIDOR
SOUTH
KERN
SOUTH SOUTWEST
SACRAMEN
EAST
RICHMOND Count Rank
TO
MERCED
Affordable Care
Act??
4 6
7 5
3 7
4
4. Land use
9 3
5
5. Neighborhood safety
11 1
6
8 4
7
7 5
8
8. Economic development
10 2
9
3 7
10
2 8
“Strategic
Opportunism”
10 Outcomes
1. All children have health coverage
2. Families have improved access to a “health home” that supports
healthy behaviors
3. Health and family-focused human services shift resources
toward prevention
4. Residents live in communities with health-promoting
land-use, transportation and community development
5. Children and their families are safe from violence in
their homes and neighborhoods
6. Communities support healthy youth development
7. Neighborhood and school environments support improved
health and healthy behaviors
8. Community health improvements are linked to
economic development
9. Health gaps for boys and young men of color are narrowed
10.California has a shared vision of community health
The WHAT: Clustering Outcomes into
Domains
3 Primary Domains of Work
10 BHC Outcomes
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
All Children Have Health Coverage
Access to a Health Home
Health Services Shift Resources
Toward Prevention
Health-Promoting Land-Use
Neighborhoods Safe from Violence
Communities Support Healthy
Youth Development
Healthy Neighborhood & School
Environments
Health Improvements Linked to
Economic Development
Narrowing Health Gaps for BMOC
Shared Vision of Community
Health
Social Norms
A.
Health home/coverage/ACA
B.
Safety/violence
prevention/youth development
C.
Land use/community
development/school
environments/HIAP
Two Overarching Themes:
Economic Development
Structural Racialization

BMoC

Immigration
Healthy
Communities
Changing
The
Narrative
Leveraging
Partnerships
Collaborative
Efficacy
Youth
Leadership
Resident
Power
Healthy
Communities
Healthy
Communities
Healthy
Communities
Leveraging
Partnerships
Leveraging
Partnerships
Changing
The Narrative
Collaborative
Efficacy
Youth
Leadership
Resident
Power
Healthy
Communities
Resident
Power
Leveraging
Partnerships
Changing
The Narrative
Youth
Leadership
Collaborative
Efficacy
Resident
Power
Youth
Leadership
Leveraging
Partnerships
Resident
Power
Leveraging
Partnerships
Youth
Leadership
Healthy
Communities
Collaborative
Efficacy
Healthy
Communities
Leveraging
Partnerships
Healthy
Communities
Leveraging
Changing
The Narrative Partnerships
Resident
Power
Youth
Leadership
Youth
Leadership
Collaborative
Efficacy
Changing
The Narrative
Collaborative
Efficacy
Collaborative
Efficacy
Leveraging
Partnerships
Resident
Power
Healthy
Communities
Changing
The Narrative
Collaborative
Efficacy
Changing
The Narrative
Changing
The Narrative
Collaborative
Efficacy
Healthy
Communities
Leveraging
Partnerships
Youth
Leadership
Healthy
Communities
Youth
Leadership
Resident
Power
Resident
Power
Healthy
Communities
Leveraging
Partnerships
Collaborative
Efficacy
Changing
The Narrative
Changing
The Narrative
Collaborative
Efficacy
Leveraging
Partnerships
Collaborative
Efficacy
Healthy
Communities
Leveraging
Partnerships
Changing
The Narrative
Resident
Power
Collaborative
Efficacy
Changing
The Narrative
Resident
Power
Youth
Leadership
Resident
Power
Changing
The Narrative
Resident
Power
Youth
Leadership
Healthy
Communities
Youth
Leadership
Leveraging
Partnerships
Collaborative
Efficacy
Healthy
Communities
Youth
Leadership
Leveraging
Partnerships
Collaborative
Efficacy
Changing
The Narrative
Resident
Power
Youth
Leadership
Changing
The Narrative
Resident
Power
Youth
Leadership
4 Systems/Institutional Targets
Health systems are
Human services
systems are family centered,
family-centered and prioritize
prevention opportunities for
children, young adults, and
families
prioritize prevention, and
promote healthy opportunities for
children, young adults, and
families
BHC
HUB
Schools promote healthy
behaviors and are a gateway for
resources and services for
families
Physical, social, &
economic environments in
local communities support health
Current Political & Economic
Landscape
 Economic
downturn/structural adjustment
 Government contraction (devolution of
programs to local level)
 Assault on government
 Polarized political climate
 California out of step with nation
 Suspicious electorate
What Is Needed
 Build
a pan-ethnic coalition
 Develop clear & galvanizing theme(s)
 Cross-sectoral collaboration-radical
redefinition of agency purpose (e.g.
“Corrections”)
 Structural analysis & “catalytic
interventions”
 Deepening commitment to optimizing our
democratic and participatory processes
Contact Information
Tony Iton, MD, JD, MPH
Senior Vice President
The California Endowment
aiton@calendow.org
510 271-4310