Magazine article Clinical Psychiatry News

Health Disparities: Not Just a Clinical Issue

Magazine article Clinical Psychiatry News

Health Disparities: Not Just a Clinical Issue

Article excerpt

Imagine having your child exercise in the bathroom because fellow renters are sleeping in all the other rooms in your apartment, and it's too dangerous to send him outside.

This was the lament of a mother in a community where we have a program to address the high rates of childhood obesity. It illustrates why it's not enough to use a medical approach to treat health disparities such as obesity. Instead of focusing downstream on medical weight management for already obese children, we are working upstream to change the environments that breed obesity, inactivity, and too few opportunities for healthful eating.

We're working to improve nutrition standards in schools so that children are served healthy meals. Often, these are the same schools that don't have decent playgrounds or equipment, and have too few teachers for physical education; they are in neighborhoods where parks and walkways, if they exist, are too dangerous because of high traffic and crime, and the stores sell liquor and snack food, but no fresh produce. Improving food and physical activity environments in schools and neighborhoods requires that everyone pitches in.

Similarly, asthma disparities are linked to adverse conditions in communities. The San Joaquin Valley and the Los Angeles Basin have some of the worst air pollution in this country, and in turn, have high rates of asthma in children and adults. Our programs are working with community organizations, schools, and policymakers to change the conditions that lead to asthma. For instance, community advocates have persuaded industries to improve their air quality standards, have fought for stronger policies against agricultural dust and other causes of pollution, and have helped pass legislation to allow asthmatic children to carry inhalers in school.

Unemployment is a big contributor to health disparities. We support programs that help people find jobs with health insurance coverage and a living wage.

Much of our work involves strengthening community institutions. Attacking the root causes of health disparities is difficult and takes a long time. Institutions such as community organizations, schools, clinics, and local public health departments are where the work is sustained and carried out. They're in the community to stay, and they're the ones that are held accountable, too. …

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