By Katie Kerwin McCrimmon

Now that the Affordable Care Act (ACA) is opening the doors to care for thousands of new patients, The Colorado Trust is embarking on an even more challenging, longer-term goal: health equity.

“We’re focusing on those folks who, even with the implementation of the ACA, have a significant chance of getting left behind,” said Dr. Ned Calonge, president and CEO of The Trust.

A new health equity mission may mean looking at how schools affect the health of children. Photo: PolicyLink.

That means looking far beyond medical systems to try to reverse stubborn inequities that disproportionately affect racial and ethnic minorities, immigrants and disabled people, among others.

“We are going to have to work more broadly than just health care. We need to look at the upstream determinants of health,” Calonge said. “If you take health disparities and add the social determinants of health, then you get to health equity.”

That may mean looking at how poor schools or unhealthy communities undermine health.

To shine a brighter light on health disparities, The Trust has sponsored a health equity lecture series.

On Wednesday, Mildred Thompson, director of the California-based PolicyLink Center for Health and Place, said it’s critical to look at where people live.

Like the rest of the country, Colorado is becoming more diverse. Source: PolicyLink. Click on image to enlarge.

“Within the U.S., nearly a fifth of Americans are living in unhealthy neighborhoods with limited jobs and poor housing. They don’t have access to healthy food or safe opportunities for physical fitness,” Thompson said.

She also decried that one in four children in the U.S. lives in poverty.

“And if you’re born in poverty, you tend to stay in poverty,” she said. “Those children whose families have more wealth tend to do much better. We’re not saying that every child who’s born in poverty can’t do well.”

But living in a safe place, having enough food to eat, having enough money and having access to good schools all directly affect health.

“The bottom line is the more education you have, the longer and healthier your life will be. The more income you have, the more opportunities are available to you,” Thompson said.

To help all people understand why they should care about health disparities, Thompson showed maps that illustrate how populations are evolving across the country and in Colorado. By 2040, nearly half of the state’s residents are expected to be people of color and Latinos will comprise about one-third of the state’s population.

Some expensive chronic diseases, like diabetes, occur in much higher numbers in Latinos. So costs could rise astronomically if health officials fail to address disparities.

Thompson said foundations like The Trust need to be prepared to support promising programs for a decade or more, not just for a year or two as they launch.

PolicyLink tries to spread ideas that work including fresh food financing. The idea started in Philadelphia and is now spreading. Donors provide loans to make it easier for grocers, markets and farmers’ markets to sell healthy foods. Source: PolicyLink.

She cited programs that hold promise in Colorado and elsewhere, including:

• Fresh food financing programs that give loans to grocers and owners of small markets so they can sell healthier foods. The programs also promote farmers’ markets and community based agriculture.
• Hikes in the minimum wage.
• Health impact assessments that require developers to assess how new projects or redevelopment will affect the health of residents.
• Public health departments, like the one in Seattle, that consider health equity as part of each policy decision.

PolicyLink’s focus on place is one that The Trust hopes to emulate as it awards grants in the future. The Trust announced earlier this year that it will spend $7.2 million over the next two and a half years to fund efforts that tackle health equity.

Place-based awards might look like the work PolicyLink did in California to help with asthma prevention. Analysts mapped asthma hotspots to try to better identify causes. Here in Colorado, Calonge cited the work of the Denver Regional Equity Atlas, which maps data ranging from affordable housing to health access in the Denver area. Calonge would like to see similar health equity maps for the rest of Colorado so communities can mobilize to address disparities.

“If we are successful in having multiple communities across the state start building awareness, action and activity regarding health equity, I think we have a really good chance of moving the needle,” Calonge said.