Helping the Health of the `Hood

Jan. 16--When Jason Purnell walked to his first class as a freshman at Harvard University, he thought about his great-grandfather as a tenant farmer in Mississippi. "Whoever could've imagined that in just a few generations, I'd be here?" he recalled thinking.

But it wasn't just hard work that got him in the Ivy League, Purnell said. He had parents who stressed education. They expected him to succeed. He lived in a safe neighborhood in Creve Coeur and studied at the private St. Louis University High School.

"People's outcomes are not always determined in the simplistic way of individual effort," said Purnell, an assistant professor at Washington University's George Warren Brown School of Social Work. "It's embedded in a system of resources and individual effort; it's both and not an either-or."

It's the same idea that Purnell is using to lead an in-depth study into the racial health disparities across the St. Louis area. In partnership with St. Louis University, researchers at Washington U. are working with representatives in business, education, churches, media and government to identify problems and solutions to reducing disparities -- solutions that don't involve medicine, doctors and health insurance.

When Purnell -- with a doctorate in psychology and a master's in public health -- discusses successful efforts to improve health among African-Americans, he doesn't mention health insurance or public service announcements. He talks about efforts by the Fathers' Support Center to keep dads involved with their families, the teen outreach program at the Wyman Center and Beyond Housing's success in promoting homeownership.

"We know where you live, where you work, go to school and the social conditions you live in affect your health," Purnell said. "But our efforts focus on access to care and the quality of care, which is absolutely necessary, but it's not the whole story."

Kids From Suburbs

It's a lofty project that Purnell, a 37-year-old father of two, wasn't always confident enough to pursue. Doubts were put aside, he said, when he was a freshman in college taking class from prominent philosopher and civil rights activist Cornel West.

"I asked him, 'How does this kid from the suburbs who's had a relatively privileged life impact the world for people without the same opportunities?'" Purnell recalled.

The answer was liberating: "You don't have to be from the hood to help people in the hood." But, West added, that didn't mean he could come in with his privilege and dictate what happens, which is often how efforts to help unfold.

Working with community partners and funding from the Missouri Foundation for Health, Purnell's team of researchers has completed five policy briefs on issues such as economic development, keeping kids in school and providing safe neighborhoods. Residents can add their comments to the reports online or at a March 3 meeting.

Researchers will incorporate the input into a final report presented at the Missouri History Museum on May 30, coinciding with the 60th anniversary of the Brown vs. Board of Education ruling and the 50th anniversary of the Civil Rights Act of 1964.

For the Sake of All

The study is called "For the Sake of All" because it quantifies the impact of racial health disparities on the region, and how solutions will improve the quality of life for everyone, not just African-Americans.

"We need to think seriously as a community about what factors are driving health outcomes and how that has serious economic and social consequences," Purnell said. "In order to be a viable and competitive region, you have to invest in human resources, and there are segments of the region who don't receive that investment."

Poor neighborhoods without access to nutritious food in grocery stores, quality housing, good schools and safe places to play are far less healthy than those without. African-Americans in the city and county, who are concentrated in those neighborhoods, have at least a 30 percent higher mortality rate than whites for many chronic conditions. The worst are hypertension, diabetes and kidney disease, where the rate is double or more.

Some research suggests that policies addressing education could have a bigger influence on health than all medical factors combined. Education provides a greater understanding of health, health care and caring for children; and it is linked to more rewarding jobs, healthier working conditions and health insurance.

Purnell's team estimates that in St. Louis and St. Louis County, the cost of African-Americans having less than a high school education and of early deaths due to poverty is $3.3 billion a year. Rates of emergency room visits for mental conditions in St. Louis are 121 percent higher for African-Americans compared to whites, and rates of hospital stays are 64 percent higher, at a cost of $96 million a year.

Nationwide, a generation of children may for the first time live sicker and shorter lives than their parents. Despite spending more on health care than any other country, America trails other developed nations on more than 100 health measures, such as infant mortality and life expectancy.

Start Young

Purnell's collaborative approach to improve health outside the doctor's office is one national experts agree is needed to reverse the trend. The Robert Wood Johnson Foundation, a national philanthropy focused on health care, launched a similar study on a national scale in 2008 with its Commission for a Healthier America. The commission released its latest recommendations this week.

"We cannot improve health by putting more resources into health care alone," said the commission's co-chair, Dr. Mark McClellan, former head of the Centers for Medicare and Medicaid Services. "We must find ways to help more Americans stay healthy and reduce the health care costs that are crowding out other national priorities."

The recent recommendations fall under three key strategies: broadening the scope of the medical system to include changing lifestyles, revitalizing neighborhoods to promote health and -- most important -- investing in early childhood programs to help strengthen children's resilience and ability to cope with adversity.

Purnell's childhood was filled with stories and books about Thurgood Marshall and Martin Luther King Jr. His father worked in advertising for the St. Louis Post-Dispatch and was often the first African-American hired at a business during his career. His mother was a teacher who retired as a principal, despite being told in high school that she wasn't cut out for college.

The struggles of that generation inspired him, he said. "A tradition of social justice is part of what I grew up with."

In high school, he started his own nonprofit, which surveyed youth across the region about social issues they faced, and volunteered to clean up after floods. In college, that evolved into a group that encouraged high school students to volunteer.

Purnell changed his plan to go to law school, and his path became one of counseling, teaching, researching and volunteering -- from directing a student-run homeless shelter as a graduate student to now serving on the board for the area's only free health clinic.

"This is what motivates me. To whom much is given, much is expected," he said. "I want everybody to be able to have a chance."

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