The science is clear. The "isms" (racism, sexism, classism, ableism, ageism, heterosexism, etc.) are making us sick. Our fear of each other is literally causing us to die sooner.
Science also tells us that increasing civic engagement and more equitable policy is the most effective way to positively impact health at a population scale.
Policy is an imagining of the future. This is one of the core domains of all artists and an activity that is fundamentally cultural. To be sustainable, health and community development policies must find ways to become embedded in local cultures.
By focusing on supporting populations (communities of color, rural communities and LGBTQ+) who are subject to policies and systemic bias that limits access to opportunity, I believe we can unlock the next wave of exponential growth in America.
It’s time for America to lead in health, and that means taking three steps.
The first is to ensure that everyone can afford to see a doctor when they’re sick.
The second is to make preventive care, like screening for cancer, available to people who otherwise won’t or can’t go in for it.
The third is to stop thinking of health as something we get at the doctor’s office but instead as something that is rooted in the culture of our families, neighborhoods, schools, and workplaces.
The more health is seen this way, the more opportunities are available to improve it.
Our solutions will only be as good as our ability to listen each other, to understand each other, to work together, to value the insights that different people can bring to the table, and to see our future as connected.
In Washington, our government is polarized and the political process is gridlocked. Therefore, it increasingly falls upon local communities to develop their own best solutions for improving health and wellbeing.
Quantitative data may move governments to act. But, culture is the data of the oppressed that moves people to act.
Health, when combined with creativity and empowerment, transforms what a person can't do into what a person (or community) can do.
This is why health justice is also good business.
Healthy, creative, empowered communities can more fully participate in the economy.
When all communities are able to fully participate, it creates a more diversified workforce. Diversity is the fuel of innovation and the cornerstone of resilient, integrated economies.
Today in America, a person’s zip code matters more to their life expectancy than does their genetic code (County Health Rankings and Roadmaps).
This disproportionately impacts low-income communities. In Appalachia and the South, feelings of social isolation, combined with lack of economic mobility, cause us to bear some of the largest per capita burdens of poor physical health and depression (Appalachian Regional Commission [ARC], 2012; Centers for Medicare and Medicaid Services [CMS]).
In total, depression in America costs society $210 billion per year with 60% of this sum being related to anxiety and chronic/acute traumatic stress (Greenberg, 2015).
Contemporary structural racism is a factor significantly impacting economic upward mobility and contributing to health disparities.
The Harvard Business Review recently reported that racial health disparities are associated nationally with substantial annual economic losses, including an estimated $35 billion in excess health care expenditures, $10 billion in illness-‐related lost productivity, and nearly $200 billion in premature deaths. Concerted efforts to reduce racial disparities could thus have immense economic beneﬁts for all of society.
In an attempt to mitigate the economic impact of poor health due to poverty, health sector policy makers are increasing pressure on individuals to change their behavior and to take on the burden of austerity measures such as cuts in basic services.
The sociologist Ulrich Beck describes this situation as an attempt to find “individual solutions to systemic contradictions" (Hassan, 2014).This kind of change initiative which focuses on individual behavior, is difficult to implement and scale.
I am a gay Kentuckian born and raised in Appalachian coalfields of southeastern Kentucky, Breathitt County. This is the same county that is birthplace of Kim Davis and the focus of New York Times Best Seller, "Hillbilly Elegy."
Over the past several years, I’ve reflected a lot on the role that identity plays in health. I’ve had an abiding, deep, interest in how Twitter-sized labels -- Black or White. Gay or Straight. Urban or Rural. Rich or Poor. -- affect our policies. And, how the temptation to reduce our understanding of each other to a single monolithic word impacts our humanity.
Im not sure I can tell you what it is to be a gay Kentuckian. But I can tell you what it’s not.
It’s not hiding behind words like family and decency in order to justify my space in the world and exclude others not in agreement with me.
It's not about using religion as a weapon to gain political power.
Its not about understanding myself as a statistic.
Being a gay Kentuckian has taught me compassion and humility.
But, it is the work I am doing now with many different types of people and communities that has shown me the limitless possibilities of living.
This work has placed people in my life whose passion, compassion, humor and perseverance through adversity have provided a constant source of strength and connection.
I can see that there is so much we can do, if we go together… pioneering in the wilderness of unopened life.
CREDIT NOTE: I am inspired by the work of author Armistead Maupin and how he framed identity politics in his Letter to Mama from Tales of the City. I have borrowed from that here and wish to acknowledge my gratitude and admiration.