What would you say is our community’s most important health issue? Twelve years ago, as I was starting a master’s degree program in Public Health at the University of Washington, I did an informal survey of people on the streets of Seattle with this exact question. Nearly all said “access to health insurance.” Of course, this was before the Affordable Care Act and Obamacare existed, which greatly improved access, but most people still equate health with health care. One of the exciting things underway in Sonoma County is that there is a “collective impact” movement to expand how people are thinking about health across all sectors of the community. Health Action is not just looking beyond health care, but “upstream” at the root causes of health and well-being. It is prioritizing education, income, and community connectedness in addition to addressing the health system. I can honestly say that since the inception of Health Action in 2007, I have seen a culture shift underway in how Sonoma County thinks about health.
Last month, my co-workers and I participated in a fundraiser that involved karaoke and lip-synching. Building up to the big day, there were rumblings around the office. Everyone was a bit distracted, trying to gauge how “into it” everyone would be, practicing their songs with other colleagues, and generally fretting. It definitely preoccupied my mind. At night after my kids were asleep, I was practicing the lines to “Gettin’ Jiggy Wit It” instead of getting an extra half hour of sleep. This stress had an end-date, but chronic stress from being poor and not being able to make ends meet, having a low-control and high-demand job, or feeling alone with limited support systems, is not only distracting, it’s bad for our health. Chronic stress triggers the production of cortisol in our bodies that can have a toxic effect on our digestive, immune, and hormone systems. Income level, educational attainment, and community connectedness aren’t just associated with poor health outcomes because of eating habits or having time to be physically active, they have a direct impact on health through stress.
A few months ago, I had the opportunity to interview four farmworkers at the Graton Day Labor Center. One of the women, Flor, shared with me that it had been over twenty years since she had seen her mother in Mexico. Her mother is old and frail and has been asking her when she will come and visit every time they speak. She loves her mother and wants to visit her, but because of her legal status, she knows she can’t go. She went on to tell me that she and her husband rented a two-bedroom apartment for themselves and their 13-year-old daughter. But, since the rents are so expensive, they had to rent one of the bedrooms out to their nephew. The daughter needs her own space, but right now she has to share a bedroom with her parents. This kind of chronic stress is toxic and out of many people’s control.
This may not be a surprise, but people living in East Bennett Valley make more money, are more highly educated, and live longer and healthier lives than people in Roseland. A recent study, A Portrait of Sonoma County, dives into details about the disparities in Sonoma County neighborhoods as well as by race/ethnicity and gender. Although this may not be rocket science, framing the data in a compelling way coupled with a very strategic outreach process has spurred some difficult conversations such as “how did we allow so much inequity to grow?”, “do we have the political will to make investments in certain priority areas of the county at the expense of other more affluent areas?”, and “is it possible to invest in certain communities without creating gentrification?”. Something that is a bit mind-blowing to me is that inequity itself is bad for our overall health. Countries with larger income disparities actually have lower overall life expectancy than countries with more equity. It suggests that the stress of seeing people struggle, and struggling ourselves to be part of the “haves” versus the “have nots”, takes a toll on all of us.
Have you heard about ACEs or Adverse Childhood Experiences? This is a study of more than 17,000 Kaiser members that shows an association between childhood maltreatment and poor health outcomes. After you calculate your own ACE Score, you can also ponder the fact that 22% of Sonoma County residents self-report an ACE Score of 4 or more! A person with 4 or more ACEs is 2.2 times as likely to have heart disease, 2.4 times as likely to have a stroke, 1.9 times as likely to have cancer, 12.2 times as likely to attempt suicide, 10.3 times as likely to use injection drugs, and 7.4 times as likely to be an alcoholic. There is a large body of brain science showing that without protective factors, toxic stress from ACEs can cause fundamental changes to a child’s basic brain architecture. I recently attended a very inspiring documentary screening of Paper Tigers, a film that shows how a continuation school in Washington uses ACEs to meet students where they are (with trauma-affected brains) and help them form positive connections and develop resiliency. Many Sonoma County groups are continuing to screen the film locally and discuss how we can transform some of our school and other institutional policies.
Health is much broader than health care.
When you define health in such broad terms, many groups of people aren’t even aware that they’re “health” workers. Health Action has a cross-sector Council of 45 members that oversees the broad work of the countywide initiative. These representatives from the business community, the education system, philanthropy, labor, place-based groups, and local government are starting to see themselves as “health” workers. Even business leaders are understanding that their decisions about employee pay and family friendly practices (e.g. schedule consistency, work day flexibility, paid sick time, etc.) affect workers’ life experiences and health.
Preschool providers, teachers and school administrators are “health” workers.
A big countywide focus this year has been Cradle to Career’s (Health Action’s Educational Attainment Initiative) effort to fund universal access to high quality preschool. Sonoma County is one of only five communities in the country working with the Institute of Childhood Success to develop an actual funding strategy. This isn’t just lip service.
City council members are “health” workers.
On more of a local level, each of Sonoma County’s nine City Councils appoints a liaison to the Health Action Council, and these City Council Liaisons have been meeting together to reflect on how everyday decisions that cities make have health impacts and to discuss Health in All Policies, incorporating health considerations into those decisions.
Community organizers are “health” workers.
St. Joseph Health has been investing in community organizers, called Neighborhood Care Staff, for years. More recently, Health Action has established a number of place-based “Chapters” throughout the county that are identifying their local priorities in alignment with the Health Action framework. Their structures vary tremendously based on their resources and relationships, but there is some exciting work underway. A couple of particularly interesting developments are two forming Chapters in Southwest Santa Rosa and Cloverdale. These groups are centered on resident organizing and engagement.
In Cloverdale, the forming Chapter group started with a core of monolingual Spanish-speaking residents. The meetings are held in Spanish; English-only speaking partners wear simultaneous translation headphones. The group has identified their priorities: the cost of housing, access to a soccer field, and affordable sports/activities for youth. The group is starting to build the capacity of residents, recently carpooling to Santa Rosa so that 22 local residents could experience North Bay Organizing Project’s Action on Rent Control. They are also building bridges to external decision makers, such as the Cloverdale City Council and housing developers.
You could be a “health” worker.
In July, the Robert Wood Johnson Foundation visited Sonoma County, which had advanced as a finalist (one of 15 in the entire country) for the Culture of Health Prize. Even being a finalist out of the more than 300 applicants was a huge accomplishment that underscores how innovative we have been in our thinking around health. However, some of the feedback about why we weren’t selected as one of the eight winners was that there isn’t enough authentic community engagement involving residents in decision-making. So, Leadership Institute Fellows, here is your call to action. Do you engage residents in your work? And, are you a “health” worker?
* * *
Beth Dadko manages Health Action’s Community Engagement and Communications at the Sonoma County Department of Health Services. In addition, Beth serves as the Chair of Santa Rosa’s Bicycle and Pedestrian Advisory Board. Beth, a 2009 Leadership Institute Fellow, sees almost everyone as a potential “health worker” and hopes that, after reading this, you do too.
This blog was produced as informational material for the Leadership for a Sustainable Future course. It has been provided to the public to promote community wide education on issues of sustainability. You can support the education efforts of the Leadership Institute, 501 (c)3 non-profit, by donating here.