Friday, July 22, 2016

The expulsion of poor people from our cities

I attended one day of the annual meeting of the National Association of City and County Health Officers (NACCHO). It had the bold theme of "creating a culture of health equity." It was interesting to listen to the presentations -- I'd say NYC, under the leadership of Dr. Mary Bassett, and with a new Center for Health Equity, is defining the cutting edge. Others are focused on righting obvious disparities in resources, but without an adequate analysis of the social processes driving inequity. Dr. Camara Jones asked the key question just at the closing bell: How we consider outcomes AND process as we create public health programs?

What are these processes?  Gentrification is an obvious one.  The New York Times had a sobering story about the "loneliness of black people in San Francisco."  Black people have been part of San Francisco since the Gold Rush days, but their numbers increased dramatically in World War II, when blacks from Texas and Louisiana moved there to work in the war industries.  They settled in the Fillmore, which had been left empty by "internal resettlement" of Japanese residents -- forced into concentration camps because they were presumed to be a threat to national security.   The newcomers quickly built a vibrant community, known as a center of American jazz.  Urban renewal, in the1950s, declared the Fillmore a "blight" on the city, the area was bulldozed and rebuilt.  This was a major blow to the black community.  Deindustrialization, which got started in the 1960s, undermined the economic foundation of the community.  Gentrification has really been the great force, driving working people out of the city.  The Mission District, a center of Hispanic life for many decades, is rapidly shifting the population there.  Rebecca Solnit's devastating article, "Death by Gentrification," told a story of a young man's death, triggered by the suspicions of newcomers who thought he was dangerous when in reality he was eating a taco.

The drama of expulsion -- going on in major cities across the US and the world -- has implications for everything from electoral politics to public health campaigns.  Take a simple example.  A public health program wants to enhance food options for a community that is considered a "food dessert."  they succeed, but so gentrification, which the public health program did not target for intervention.  The food options have improved but no poor people live in the neighborhood.  Did the public health program "work"?

One example of taking public health leaders taking on the process is found in the report, Development without Displacement: Resisting Gentrification in the Bay Area.  This report was written by Causa Justa::Just Cause, with policy and data analysis support from the Alameda County Public Health Department's Place Matters Team.  This is the kind work that is all too frequently missing from our public health agenda -- it is urgent that we understand and act on the massive displacement that is reshaping our urban regions and redefining massive communities.  We do not succeed if all we've done is create great food options for arriving hipsters.

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