social health | Paths to Rebuilding and Healing Abandoned Communities: Equitable, Healthy

What is meant by social health? And what does neoliberalism and gentrification have to do with health? In rebuilding communities through neoliberal practices that result in displacement, homelessness, and gentrification the health of the community is affected (1). The fact is that the social, political, and economic systems in a society such as the US affect the health of individuals and populations. These systems separate and place economic, social, and political values on populations according to categories of race/ethnicity, income level, education level, gender, immigrant status, religious affiliation, sexual orientation, place of birth, dominant language, physical and mental ability, and age. The socioeconomic and political economic systems use these hierarchies to determine our place in society which in turn determines our health.

Using race and class identity as examples, individuals who discriminate based on these two factors will negatively affect the psychological and physical health of low income people of color through the stress experienced daily by the effects of their implicit bias (2, Implicit Attitude Test, Experience of Discrimination). On an institutional level, the health outcomes of low income communities of color during redevelopment is partially determined by the discriminatory neoliberal policies and practices-a norm of the socioeconomic and political economic systems of the US. Such practices/policies include: policies which allowed disinvestment of low-income neighborhoods, mayoral-governments partnered with private developers, legislators passing and funding racist laws, lack of policies/laws which demand affordable housing and local hiring, city and state officials enacting education, housing, transportation policies and practices which benefit wealthy developers and displace community residents, developers building only market-rate housing in low and moderate-income communities, planning boards lacking community participation, corporate university and philanthropic boards who approve cleansing of low income and of color communities. Besides the collective stress experienced from being forced to move, the lack of affordable housing and products, the fear of eventual displacement, lack of ability to have decision-making in your community, displacement to other under-resourced communities (in school, livable employment, access to healthy and affordable food, infrastructure that allows physical activities, safety) are risk factors for poor health outcomes. Such neoliberal rebuilding practices which lead to displacement and gentrification can only occur in societies where the political economic and socioeconomic systems support them. This is the concept and action of social health, neoliberalism, and gentrification.

The mechanisms of neoliberal processes in community rebuilding such as tax subsidies and exemptions, rezoning, lack of transparency and accountability, ‘shadow governments’ of developers and corporate foundations navigated through public:private partnerships, state redistribution of land to private entities, propaganda media, greed, devaluing of non-productive members of society, non-participatory planning in community rebuilding and its social health impacts must be identified, reported, challenged, prevented-again and again. Such practices unleashed in communities of low and moderate income and color find little resistance due to the political economy of development capital and state politics. This process of community rebuilding is supported by strong ties between the developer and government which overwhelms the power of the local community to demand equitable development and community participation-there are minimal ties between the local community and government (3). Newly organized communities are displaced to different parts of the city, some county, loosing the growing power-base and social capital which could challenge the powerful developers and public partners. Because of the unfair advantage of such public:private partnerships social capital/economic and political benefit is accumulated disproportionately by the powerful developers.

For example, displacement of communities of low-income and color disinvested by government and neighboring institutions, for expansion of a prestigious institution like Johns Hopkins results in stress for residents and poor health outcomes: gentrification and health. The disruption of social networks, root shock, results in acute and chronic trauma to residents as they loose their familiar base and try to anchor themselves in new neighborhoods (4). Such continued serial displacement is a major social determinant of continued poor health outcomes. Children are particularly susceptible to these changes and have difficulty establishing new peer groups (5). In this example, neoliberal practices through public:private partnerships of the university, Annie E. Casey Foundation and others, and the city planned and carried out displacement, demolition, and construction of a new place/community unaffordable to previous residents and the peripheral communities. After more than 800 households were displaced less than 10% low income and minority families have been allowed back to inhabit the more than 700 units rehabbed or newly constructed to date. Construction of a new contract school, managed by JHU and supervised by a board of directors led by Hopkins assures that the neoliberal agenda of dispossession of education occurs-another risk factor for health (6, 7). This new school which selectively engineers a ratio of white and non-white, poor and non-poor for their neoliberal formula of experimental ‘urban’ education continues. The right of existing residents to attend the school is ignored, preference is offered to the powerful university and affiliates, while the department of education requires no meetings for transparency or accountability, and the wealthy developer and corporate philanthropists of Casey and other foundations continue on unimpeded. The school is a magnet for gentrification, attracting the race and class of people comfortable to the powerful Johns Hopkins University. Whether the children of the surrounding neighborhood have access to this new school is a determinant of health. Access to early childhood development resources and education is a determining factor for health of children as they grow to adulthood. Neoliberalism, gentrification, and the new urban education are factors determining the social health of East Baltimore and Baltimore because the neighborhoods displaced residents are forced to move into may be similarly disinvested, contributing to diminished health. Residents must be able to stay in the neighborhoods undergoing revitalization and participate in all the amenities (education, parks, housing, health, employment, transportation): this is a more participatory model of community rebuilding-one which emphasizes community participation before development to ensure that participation continues during and after, and does not result in gentrification, displacement, segregation and poor health. How do we do that?

Alameda County Public Health Department (ACPHD) along with Causa Justa:Just Cause’s (CJJC) recent report shows the negative health effects on communities in the Bay Area undergoing gentrification (8). Among others, they recommend Health Impact Assessments (HIA) before development occurs to determine potential negative health outcomes caused by gentrification and displacement; their recommendations emphasize the necessity of community participation in all processes of development. In 2009 similar recommendations were made by the Association of Bay Area Governments and Policy Link. However the current recommendations by ACPHD and CJJC is the first to directly show quantitative changes in population health during all stages of gentrification processes, clarifying the health consequences of displacement. HIAs can also be used to substantiate the need for community-driven rebuilding processes as done by the Los Angeles Community Action Network. They used a HIA to leverage a commitment for more than $20 million to limit displacement through affordable housing, local hiring, support for tenant rights and preventive health programs.

In 2003, Save Middle East Action Committee, Inc. requested that Hopkins/East Baltimore Development Inc. conduct a HIA before demolition and rebuilding began. This was particularly important because the majority of the housing stock was built during the period of lead-based paint and because previous studies of demolition by the university showed contamination of the surrounding air with lead. Even with this evidence, the timeline of the university’s first Biotech building was more important than the health of low income and African American residents. This type of public:private development project ignored the health of residents then just as a current development project in Los Angeles targeting public housing conversion into a mixed-income development is attempting to ignore the health of low income people of color (9). Such racism and classism driving neoliberal community rebuilding chooses to ignore existing communities where the majority of residents are people of color with little resources and the lowest life expectancy. These and previous examples confirm that the value placed on low income and racial/ethnic minority communities are minimal compared to that of higher income and white communities, and that the growth of inequitable power in majority white and higher income communities will continue to drive these unhealthy socioeconomic and political economic practices.

Gentrification and its neoliberal agenda has arrived in full force in the 21st century. New York’s Brooklyn and the Bronx, Sommerville, Portland, Chicago, Denver, and DC are facing the effects of gentrification and unaffordable housing, all risk factors and outcomes of displacement and negative health outcomes (10-16). Cities implementing new transportation systems face similar risk of gentrification and displacement as reported by a 2010 report: Maintaining Diversity in America’s Transit-rich neighborhoods: Tools for equitable neighborhood change (17). Neoliberalism’s new attire of greater public:private partnerships with the propaganda of equitable public benefit supported by the media drives gentrification through accumulation of land by the wealthy and dispossession of civil rights of the disenfranchised- in the US and abroad (18). Such inequitable societies lead to inequitable health of individuals and populations as seen with life expectancy differences between the rich and the poor of up to 19 years (19). Confronting and ending these violations of human rights through coalition building across struggles for equity of race, income, housing, food, education, environment and all other social factors is necessary and possible. It may be the only possible way to reclaim a collective right to occupy the city, making it balanced, healthy, and whole.