The debate about health care reform focuses on treatment, insurance and who should pay. This reflects a tradition that relies on biology and behavior as indicators of health. These are important factors to consider, but according to some public health practitioners they are inadequate in the long term.

A new approach looks at how social organization and values affect public health. Dr. Anthony Itons study of health disparities and inequities in Alameda County, Calif., illustrates these connections and offers insight into proactive, long-term solutions to public health issues that could be applied in the City of Alexandia.

Iton began by looking at mortality rates across the county. He found that mortality rates were clustered and that biology and behavior accounted for just 30 percent of the deaths. He then measured social indicators such as rates of poverty, unemployment, incarceration, education and homeownership by Census Tract. He found that tracts with the lowest life expectancies had the highest rates of unemployment, poverty and non-white residents. They also had the lowest rates of homeownership and education, and there was a strong correlation between redlining and the health of a community.

The opposite was true in the tracts with the longest life expectancies. For black residents the average life expectancy was up to 15 years shorter than the average white resident. A similar study in Baltimore found the gap in life expectancies across the city to be as great as 20 years, according to an October 2008 article in the Baltimore Sun.

The fact that entire communities are set on certain health trajectories suggests a causal factor outside of individual genetic makeup or lifestyle choices. Iton identifies values, policies and place as key components in the health of a community and the people that live there. For example, living in the ghetto (an impoverished area) is bad for a persons health not just because of poor material conditions, restricted access to societal resources, and limited opportunities through education, but also because of the stigma associated with living there. All of these factors are incorporated into the body as stress which undermines the bodys ability to be healthy.

This sheds a different light on decisions made through redevelopment processes in Alexandria. For years the city has ignored a long standing request from the Arlandria-Chirilagua community and the neighborhood health center for a place to expand the clinic. The city prioritized instead things like bike stands, a parking lot, cutting down and replanting trees over affordable preschools and new housing units. The overall message to families in this community is that they are unimportant.

The writer is director of communications for Tennents and Workers United.