Rebuilding our social compact will make us all healthier

Rebuilding our social compact will make us all healthier

For too long we’ve tried to solve the economic and social divisions in our communities by attacking the problems as individual challenges. These well-intentioned efforts have resulted in some progress, but have done little to create a sustainable community structure to give everyone a fair chance to pursue the American dream.

The challenge is that basic public resources are not fairly distributed, giving those with economic power more access to public institutions than those who don’t understand the system. Quite simply, if you have “political juice,” you get moved to the head of the line. The real-world result is that parks, housing, schools and other crucial services are much better in more affluent neighborhoods than they are in poorer neighborhoods.

It’s time to change the odds, and offer a new social compact for all of California’s residents.

I saw the problem first hand in Oakland when I was the Alameda County health officer. I found that there was a 22-year difference in life expectancy between residents in poor neighborhoods and those in more affluent neighborhoods. That’s an astounding difference, along the lines of what you might find between Afghanistan and Sweden.

We investigated this and wanted to see exactly why parks, for example, had such differences in upkeep and maintenance in the same city. We sat with the director of the parks and recreation department and were told that he had a limited budget, and had to run on a complaint basis. It turned out that complaints came from upscale neighborhoods five times more often than from poorer neighborhoods. The resources of the parks department followed the complaints.

By using a complaint-driven system, they were privileging people who understood that they could pick up the phone and tell parks and rec that their neighborhood park needed to be fixed up. The residents of poorer neighborhoods weren’t doing this because they didn’t think their voices would be heard. We have seen that often as communities begin advocating for themselves, but are ignored because they don’t have the “access” to power that privileged communities have.

The Oakland parks issue is just one example of a lack of access to our institutions, and there are others. For me, this was an “aha moment.” So this instilled in me and in my colleagues this notion that if you can give residents the ability to push back so they have more muscle to demand more equitable use of public resources, they will get better results.

This would be across the board – housing, education, transportation, access to healthy food, and in some cities it is even access to potable water. All these things are social determinants to health. We all need these things to pursue healthy opportunities. People living in stressful environments see a change in their physiology over time and live shorter lives (Modafinil). Chronic stress is a dangerous killer.

We know we can do better. We at the California Endowment have experienced this first hand. When you provide disinvested communities and neighborhoods agency/power, they become healthier, and close the life-expectancy gap. That has led me to begin saying that health is political.

When resources are being allocated and you are left out of the conversation because of a system that has shut you out, resources go elsewhere and we leave communities and people behind. As Americans, I think we need to be better than that.

Our democracy was founded on the fact that everyone has to have a voice. But we do very little in this country to make sure that actually happens.

That’s why I believe we need a new social compact in California. At UC Berkeley, john a powell of the Haas Institute for a Fair and Inclusive Society makes the argument that we need to hit the reset button to bridge the enormous divisions in our society – the need for a new social compact.

Health equity is not only about outcomes – it’s about process and the fight. It’s about the ability of all communities to take charge and hold all systems accountable. We must invest our resources to make sure that all residents have a seat at the table and can understand and participate in the civic engagement that directly impacts their communities.

Unfortunately, our social compact is steadily eroding, and our fraying social compact is driving a public health crisis. That must change, and we are working to find an inclusive process, particularly among young people.

By re-thinking the social compact and finding a comprehensive set of investments, we are reaffirming our commitment to an inclusive society in which everyone has access to opportunities and high-quality community resources.

That will lead to people living longer, more productive lives. There is no downside to all of our residents having a seat at the table and participating in our democracy. It will make us all stronger – and healthier.


Dr. Anthony Iton is senior vice president of the California Endowment overseeing the 14 Building Healthy Communities projects. He has a medical degree from Johns Hopkins University School of Medicine and a law degree from the University of California, Berkeley.