Equity is Essential to Building a Healthy City

By Marice Ashe, JD, MPH

Marice Ashe, JD, MPH, is founder and CEO of ChangeLab Solutions, a public health organization working across the nation to advance equitable laws and policies that ensure healthy lives for all.

Jul 8, 2019 | Resources, Society | 1 comment


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We, the people are a city’s greatest asset. We drive economies, pass laws, volunteer in the community, and come together in times of strife and celebration. But what happens when—by design—some of our neighbors and friends are unable to access or participate in everything their city has to offer because of inequitable laws, policies, and practices?

Unfortunately, we know the answer to this question. Unhealthy communities are created and perpetuated. We are left with neighborhoods that have more liquor stores than grocery stores, toxic dumps next to playgrounds, zoning practices that weaken tax bases needed to support high-performing schools, or limited transportation that makes it hard to get to work.

Fighting for Fresh Fruits & Veggies in Fresno

This is what happened in Fresno, California. Fresno, located in the state’s Central Valley, is the largest city in California’s rich agricultural region. It is the source of much of the country’s nuts and produce, such as almonds, walnuts, peaches, oranges, tomatoes, and the famous California raisins.

However, Fresno’s own residents, many of whom are Latino families who immigrated to Southeast Fresno to work on the local farms, cannot easily afford the local produce that’s being exported around the country. Their inability to easily purchase the bountiful fresh fruits and vegetables from the farms around Fresno stems from the barriers to civic engagement, such as immigration status, language, and limited English literacy.

Farmworkers confront harsh working and living conditions that do not leave time to prioritize health and wellness. Long hours, physically demanding tasks, and overcrowded, unstable housing are the norm and contribute to high rates of chronic disease among these workers and their families.

The processes to change public policies are unfamiliar to most farmworkers, and too few decision-makers invest in relationship-building with poor people or immigrants. Despite this, residents have been coming together for grassroots community organizing to talk through their obstacles to healthy living and discuss changes that would most benefit them.

Residents partnered with a local health equity organization, Cultiva La Salud, and the organization I lead, ChangeLab Solutions, which uses law and policy to create healthier, more equitable communities. Cultiva La Salud and our ChangeLab Solutions team worked with local residents to identify relevant solutions, engage neighbors, connect with decision-makers, and enact a set of policy and environmental changes to ensure the community could gain access to healthy, affordable fruits and vegetables. ChangeLab Solutions also supported residents in enacting a new equitable active transportation plan for the city and facilitating resident participation for a new land use plan for Southeast Fresno.

A Blueprint for Changemakers

The relationship between inequity and poor health among people of relatively lower socioeconomic backgrounds is not unique to Fresno. Communities of color, low-income communities, people with low education, and other marginalized groups in cities across the country continue to be disproportionately impacted by inequitable laws, policies, and practices. As a result, these communities experience dramatically poorer health than communities with more political and economic power. This is what drove our ChangeLab Solutions team to develop A Blueprint for Changemakers, a guide to help residents and policymakers develop and advance home-grown solutions that reflect their lived experiences and is designed to create healthy, equitable communities.

The Blueprint explains the fundamental drivers of inequity—structural racism; income inequality; poverty; disparities in opportunity and power; governance that limits meaningful participation—and provides the tools and the roadmap to help local governments fix these outdated or discriminatory practices. For example:

Structural racism:

When policies, practices and other norms reinforce privileges for certain racial groups and disadvantages for others.

Priority action: To prevent biased decision-making and policy implementation, start by requiring equity analysis or staff training on equity, bias and cultural sensitivity.

Income inequality and poverty:

Laws and policies play a key role in both concentrating wealth among the wealthy and making it difficult for the poor to escape poverty.

Priority action: To reduce poverty and income disparities, start by improving wages for low-income individuals.

Disparities in opportunity:

Gaps in wealth and health continue to widen when communities lack quality schools, high-paying jobs, and access to education for skilled labor.

Priority action: To reduce disparities in opportunity, start by providing universal high-quality early childhood education.

Disparities in political power:

When laws and policies allow people who have greater power to participate more and have greater influence on legal and political processes.

Priority action: To reduce disparities in power, start by involving underserved communities in the initiation, drafting, and implementation of policy solutions to local issues related to health equity.

Governance that limits meaningful participation:

When groups are excluded from or have limited voice in decisions that shape their community and their access to resources.

Priority action: To leverage governance to promote health equity, start by formally committing to health equity through a resolution, health plan, or comprehensive plan or by stating it as a goal in all policies.

Who Should Use This Resource?

We all have a role to play in achieving a fairer, more equitable country and, like Fresno, we all benefit when our cities give everyone a fair shot at being as healthy as they can be. The Blueprint includes specific guidance for activists, policymakers, and local organizations.

  • Advocates can use the guide to educate leaders and decision-makers about the need to address inequities, the benefits of creating more equitable communities, and specific steps they can take to help children and families in their neighborhood.
  • Local governments, businesses, and community organizations will find practical, evidence-based policy tools for developing a local agenda to advance health equity. The guide provides strategies and specific policies for addressing a range of issues that impact our health and well-being, including housing, early childhood development and education, transportation, fair employment, income security, and health care.
  • Health care systems can find information in this guide that will enhance their population health initiatives. The guide helps health systems build on traditional population health interventions by addressing the social determinants of health, such as food insecurity, asthma, sub-standard housing, and community violence, through local and state policy change efforts.
  • Faith-based groups, universities, and philanthropists will find guiding principles for building health equity that can be used to urge leaders to action and evaluate ongoing efforts to address inequities and reduce health disparities.

Learn more about how you can start promoting health equity in your city with A Blueprint for Changemakers.

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  1. I am an Apprenticeship Consultant with the State of California. Apprenticeship is a workforce development tool for business that draws in a diverse employee population. Has your organization thought about sponsoring an apprenticeship program? You can participate in a program which has proven successful in implementing affirmative action for minorities and women.

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