By Mary Kelly Persyn, associate at Ropes & Gray LLP
Health care reform legislation has passed the U.S. House of Representatives, to great fanfare, and now proceeds to the Senate, trumpeting universal coverage as it marches on. But amidst the heated debate over procedures, prescriptions and doctors, does the legislation grapple with the serious public health problem of racially isolated poverty? Have we accounted for the myriad of associated costs, both in human suffering and to the public treasury?
Characterizing racially isolated poverty as a public health issue does not require a leap of logic. The tangle of observational facts recording the coincidence of poor nutrition, violence, stress, and poor access to education is known all too well, its impact on children (especially) clearly established. Understood systemically as the risks of living in a "low opportunity" neighborhood, the net result is a constriction of life chances and outcomes unjust to those who disproportionately bear these burdens and unworthy of our nation's founding credo.
As Columbia Law School Associate Professor Olati Johnson explains:
The health of communities is related to spatial inequality and segregation. High-poverty, racially isolated neighborhoods are the ones with less access to green space, healthy food sources, clean air - all of which exacerbate health disparities. Part of the solution requires bringing opportunity and better resources to low-income neighborhoods, as well as providing poor residents access to traditionally high-opportunity areas.
In part because the popular imagination no longer understands these facts as racially inflected, the consequences slip under the national radar all too often, and yet real interventions are within reach.
What roles could nutrition possibly play in such a complicated problem? Potentially, many:
• A recent study covered in Science has demonstrated a link between nutritional supplements and substantial declines in prison violence. If these studies can be generalized beyond prison populations, they significantly empower drives toward improved nutrition.
• Areas of racially isolated poverty very commonly lack supermarkets and residents must depend instead upon convenience stores and fast food outlets. A recent program in Harlem incentivizes chain grocery stores to open where none had previously existed, resulting in upticks of fresh-food purchases. Whole Foods is thinking of opening a Harlem store.
Currently, it is "not clear how we can use law to require government to create healthier communities," Professor Johnson said. "Advocates should at minimum encourage increases in federal funding for programs specifically targeted to address nutritional and health disparities." The federal government has an opportunity here. (See Susan Eaton and Sara Abiola, Getting Under the Skin: Using Knowledge about Health Inequities to Spur Action, and a May 2009 action brief by the Charles Hamilton Houston Institute for Race & Justice Research, as well as this article from The New York Times.)
• Given the opportunity and exposure, teens can successfully agitate for better food in their communities, transforming "food deserts" into "food oases." Dorchester's Codman Academy is a classic example.
• The urban farming movement is booming, fueling farmer's markets on street corners in neighborhoods that formerly knew only packaged food. The movement stimulates the economy by providing jobs for the urban farmers and wellness (and hope) to the neighborhood residents who purchase the food.
• The impact of nutrition on learning, concentration, memory, and general health can no longer be debated. Children who have access to fresh food do better. Children living in racially isolated poverty especially need good food as a buttress against stress and in favor of learning.
First Lady Michelle Obama has made nutrition, wellness, and prevention her clarion call, and her White House assistant chef Sam Kass has helped carry the message into President Obama's innermost domestic policy circles. The First Lady aligns her efforts with health care reform and pointedly discusses their particular importance to poor children of color. But is the Hill listening as closely as Mrs. Obama's efforts warrant? Science is on her side. And if we want to crack the nut of health care reform, Congress should put its considerable weight behind her too. The results could revitalize a generation.