Transcript: Podship Earth Episode 019: CODED INEQUALITY

JARED BLUMENFELD: Welcome to Podship Earth. This is your host, Jared Blumenfeld. Have you ever wondered how long you're going to live? I always thought that my genetics would play the critical factor in determining when I'll kick it, but researcher Dr. Tony Iton shows a very different picture. The single biggest determinant of longevity is your zip code. That's right.  Just as they say in real estate, what matters is location, location, location. Well, it turns out the same is true if you want to live a long life. In the first half of the show, Dr. Tony Iton will tell us about his discovery that within one county in California, there's a 22-year gap in life expectancy between rich and poor neighborhoods. We'll then hear from Suzanne Bohan whose new book, 20 years of Life: Why the Poor Die Earlier and How to Challenge Inequity, share stories about how communities have turned around their fate by using data, people, power and tenacity. I first met Tony when he came to speak at EPA. I was blown away by the clarity of his presentation and the shocking nature of his conclusions. Dr. Iton’s primary focus includes health of disadvantaged populations and the contribution of race, class, wealth, education, geography, and employment to health status. Dr. Iton is the senior vice president of Healthy Communities at the California endowment where he's leading a $1,000,000,000 investment in California community health. Before that, Tony served as the health director for Alameda County. I asked Tony, how did his interest in community health begin? 

DR. TONY ITON: I was in medical school from 1985 to 1989, working in Baltimore, Maryland, dealing with the crack cocaine epidemic, HIV, and we were - the medical school is located in an inner city and I could see that the social conditions were driving poor health outcomes.  In medical school, we talked about them almost as if they were biological and that never squared with me. It was this weird kind of proposition that we were trying to treat social ills with pills, and I couldn't ever accept that as an approach to trying to provide health. And so, when I trained in medicine and then subsequently worked a little bit in health policy and got into public health, I still had in the back of my mind this question about “are health disparities biological or are they essentially environmental?” 

JARED BLUMENFELD: So how did you end up in California Tony? 

DR. TONY ITON: I gravitated west over time and ended up in the San Francisco Bay area. In the San Francisco Bay area, the primary counties are Alameda, Contra Costa, San Mateo, Santa Clara, and Alameda is one of the older ones. And it's got Berkeley, it's got Oakland in it, it's got a million and a half people and it's huge. It's a large geographical territory that has both urban, suburban and rural communities within it, and it's immediately across the bay from San Francisco. 

JARED BLUMENFELD: You worked in the Department of Public Health and what were you seeing there that kind of caught your interest? 

 

DR. TONY ITON: Yeah. So, when you're the health officer and the director of health, you're the registrar of all births and deaths. And so, one of the things that we saw was that there were certainly concentrations of poor health outcomes in certain parts of the county, primarily in the flatlands of Oakland, the flatlands of Berkeley. And what I was trying to understand having been from Baltimore was, okay, so what is it about the social environment that sort of drives these poor health outcomes? And because we had all these death certificates, as I said, 10,000 a year, and every single death certificate has what somebody died of, the age they were when they died, their race, ethnicity, and where they lived. And so, you can take that data. And we did. We put together a database of close to half a million death certificates and we looked at patterns of death in Alameda County over a period of 50 years and found this concentration of premature deaths in the same neighborhoods that our nurses were spending a lot of time providing services. So, we set about trying to understand, well what is it about these neighborhoods, what's happening in these places that is actually so injurious to people's health? And that's, you know, in essence, what set us off on our course of trying to construct a practice to bring health equity to Alameda County.

JARED BLUMENFELD: What were you seeing in terms of disparity? 

 

DR. TONY ITON: Well, the really interesting thing is that when you set foot in any of these places, the first thing you notice is that every major system is pretty much offline. Transportation is inadequate. Housing is overcrowded, expensive. They're lacking sidewalks and sort of physical infrastructure. Parks are poorly maintained if they exist at all. There is generally freeways running to or through those communities. You don't have grocery stores, you have fast food places, corner stores. It's overtly obvious to the eye when you just sort of walk into the communities and sort of trying to understand why in the city of Oakland, which lives, you know - you take a neighborhood in the flatlands or neighborhood in the hills and they're under the same regulatory authority, the same city, you know, so it's the same parks department. It's the same, you know, land use, decision making agencies. It's the same public works, yet you see one part of the city managed in a completely different way than another part of the city. 

 

JARED BLUMENFELD: What did you find were the causes of this disparate treatment? 

 

DR. TONY ITON: You're forced to conclude that the difference here is that people are undervalued in these places because they don't have power. They're not seen as having a sufficient control over how decisions are made, so they're ignored and neglected and that has adverse impacts, not just on their physical environment but also on the social environment.  And the people start to feel it, they internalize that devaluation and it actually changes their physiology. That's what we've come to understand over the years, that it's not just the environment. The environment gets under their skin and changes how people's actual physiology operates. 

 

JARED BLUMENFELD: What were the actual outcomes that you saw through the death certificates?

 

DR. TONY ITON: When we did the analysis of the death certificates and it was, it was something that to my knowledge had not been done before, we wanted to actually put it on a map and show people in their neighborhood how long they could expect to live. And when we did it, we found dramatic differences. I mean we mapped the entire county at the census tract level and there are about 150 census tracks in Alameda County and there are about 10,000 people in each one. And we found life expectancy differences even within the same city in Oakland, of 22 years between a neighborhood in the flatlands and the neighborhood in the hills, which is, you know, the equivalent of living in Sweden or living in Afghanistan. You're finding the socio-ecological equivalent of a war-torn country in Alameda county, as well as some of the highest standard of living in the developed world within miles of each other. 

 

JARED BLUMENFELD: Those results when you looked at them, must have been just like hard to even digest. 

 

DR. TONY ITON: I think at some level we expect it to find difference. We didn't expect to find it on the order of decades, multiple decades of shortened life. That was shocking and still is shocking to me. And we thought that it was just Alameda county or there was something particular about this place, and we started looking around the country and we found similar even bigger differences on the east coast in Cleveland, in Baltimore and Philadelphia. We found like 28, 30 years of life expectancy difference in the same city. Every city we looked at; we looked at probably about 15 different cities. We did the same analysis and the smallest gap we found was about 15 years. So, it was a range from 15 to 30 years. This is the American pattern. You find this in every major city, dramatic differences in life expectancy that reflect very different opportunity circumstances in the same city. 

 

JARED BLUMENFELD: We used to think that it was our genetic code, and you describe it really as this is our zip code has a predetermined impact on these outcomes. 

 

DR. TONY ITON: Yeah. So, I went to Johns Hopkins Medical School and we were taught essentially that these were biological differences, although there was virtually no evidence of that. It was just basically assumed that differences of this nature had to be somehow related to genetics and over time as people have looked at that question, they found that there is no basis for that assertion whatsoever, yet it still persists in medical school. People had to get it out of their heads that this was about the people and start thinking about it as the environment. When we looked at the causes of death that explained this 22-year life expectancy difference in Oakland, it wasn't violence, it wasn't HIV Aids, it was heart disease and lung cancer and chronic obstructive pulmonary disease or emphysema. These were the same diseases that were killing wealthy people elevated currently. They were just killing low income people earlier in their lives. So, there wasn't any magical disease differential that was happening that could explain this huge gap in life expectancy. So, you know, understanding that the environments are different is the first step. Then, it is trying to understand, how does the environment change physiology? That was the next step. And the science in this area has exploded. A lot of people have stories, and it is sort of an American sort of notion that your grandmother grew up in the worst environment, walked uphill to school both ways every day without shoes and had to dodge bullets or God knows what, and now she's the CEO of Xerox. And if she could do it, anybody can do it. And you know, the truth of the matter is that is actually true, but it's very unlikely. And that's the problem with our thinking is that we seem to not understand this notion of odds or likelihood that yeah, sure your grandmother could do it, but how likely is it that anybody else could do it? And shouldn't we be in the business of trying to make it more likely that other people's grandmas could do that too. The second thing that became really important to understand is that it's not just low-income people, that we all experience stress in our life. And then as you look at how stress changes the body, you see that stress is interpreted by the body as a threat. So, when you're walking around in the low-income communities and you see essentially all of these risks and you see very little opportunity, very little in terms of resources, you essentially are interpreting a constant threat to your wellbeing. 

 

JARED BLUMENFELD: How is that stress internalized? 

 

DR. TONY ITON: That constant threat to your wellbeing basically is perceived by your brain, your hypothalamus, which sends a message to your pituitary gland, which is a gland at the base of your brain which sends a message to your adrenal glands which sit adjacent to your kidneys and they release cortisol and a group of other hormones as well, but stress hormones. And when you're constantly confronted with risk and see very little by way of resources, you basically are constantly bathed in cortisol. And when you're constantly bathed in cortisol, it has an adverse effect on all of your physiology. It makes you more prone to cardiovascular disease, makes you more prone to infection. It changes your brain. It makes you more prone to diabetes, independent of what you eat and your behavior. So, this is happening even if you're exercising and not smoking and eating well. You're still having these physiological changes happening to you through your, essentially your stress response. And that stress response can also change your genetics. It changes the way that your genes express themselves.  And strangely, or sadly enough, you can also pass this onto your children. So, we used to think of this whole notion of nature versus nurture and for a long time we thought that a lot of the differences we see in populations were due to nature, as opposed to the environment, which is nurture. We're now recognizing that nature influences nurture, nurture influences nature. So that was like a false distinction to think of essentially genes versus the environment, because they interact, and they interact powerfully. So, we now have started thinking about how the environment in and of itself is actually changing your genetics. 

 

JARED BLUMENFELD: So, in a place like Alameda County, as you mentioned, there also external environmental factors. So, you have two freeways, you have a lot of pm 2.5, pm 10, very fine particulate matter, you have hazardous waste facilities, recyclers, indoor lead paint, mold… So, there's that actual physical attributes of the environment that are negative that are also on top of that stress impacting the communities. 

 

DR. TONY ITON: Yeah, absolutely. You've got all of these noxious sources of pollution and they were cited there, and they continue to be cited there largely because in the political, they're political decisions that make these in land use site decisions happen. So, if you decide, and we were involved early on in my career in trying to change a decision around a medical waste incinerator facility. I'm in East Oakland and similarly, another temporary power plant that was going to be placed in another low-income community and the decision making behind where to site these things takes into consideration essentially the political power of the community. We used to laugh and say would you ever see a medical waste incinerator cited in Piedmont? Piedmont, which is one of the wealthiest communities in North America, and it's in the heart of Alameda County. And it's laughable. You could say that, and people would laugh.  And then you would ask them the question, well would you see it in East Oakland? And people would say, yeah, I could see that. Then you have to ask yourself, why is that? Why wouldn't we put a medical incinerator in Beverly Hills? Because we perceive those people as having power, and therefore being more valuable and more influential over the political process. So, in our minds, we recognized that we had to build a power of people living in places like East Oakland so that they could essentially harden their community against these kinds of threats which were basically political threats to their wellbeing. So that’s, in essence, these environmental decisions that lead to essentially an added burden of ill health on the backs of low-income people. That's what environmental justice is about. It's about recognizing that we have to share that risk of injury from these land use decisions.

 

JARED BLUMENFELD: Tony, it feels like the Environmental Justice Movement in California has done a really effective job of bringing attention to these health inequities. 

DR. TONY ITON: Well, we actually have to give a lot of credit to the Environmental Justice Movement and the pioneers of the Environmental Justice Movement because they taught us essentially how to structure a health justice movement and that's what we're trying to help construct today in California. It's this notion that democracy is good for your health and part of our goal is to optimize the political power of low-income communities so that they can participate in the decision making that leads to the allocation of resources, both beneficial resources as well as those noxious resources. What we've learned more recently is that health is entirely contingent on the quality of democracy, particularly for low-income populations. And there's very good data now that suggests that even wealthy populations, regardless of color, are in worse health than their similar counterparts in other countries of the world. Because we carry more stress, where we are one sort of job loss away from losing our health insurance and possibly our housing and our ability to fund our kids’ colleges. Other countries don't have that kind of stress. There's universal health insurance. College is highly subsidized that people can afford to go regardless of their income. They get paid sick leave or a whole variety of policies that buffer against the sort of inevitable kind of crisis that happens in somebody's life. We don't have any of that. So even if you're relatively well to do, you carry around in the back of your head this worry that if something goes wrong, you could lose everything. That contributes to this chronic stress, which we believe actually reduces the quality of health of even our wealthiest communities in this country. 

 

JARED BLUMENFELD: Tell us a little bit about the research that you're doing in rural California around the opioid epidemic. 

 

DR. TONY ITON: The epidemic of premature white mortality in this country since about the late 1990’s has been huge. We're talking now about half a million excess deaths, which is on par with the entire U.S. HIV AIDS epidemic. I mean, the scale of unnecessary death is enormous. It's one of the biggest epidemics we've seen in the United States ever. And the most interesting thing about it is it seems to be somewhat uniquely impacting white rural Americans. Not exclusively, but overwhelmingly. So, we looked at California. California's got 58 counties, 28 of them have accelerating white mortality rates, primarily in the northern part of the state, but also in the Central Valley. Of those 28 counties, 25 of them voted for the current president. In our estimation, this is the first time you're seeing an epidemiologic phenomenon actually driving a political phenomenon. That sense of loss, of stature, of privilege, if you will. People are expressing a sense of a loss of that vision, a loss of control over their future in that way, and they're seeing their hands slip from the rungs of the ladder of the American dream. And we believe that is at the heart of what's happening across the United States, but also, in California. When we looked at the data, we saw that the causes of death that were driving this phenomenon were three. One was a drug overdose, primarily opiates, but there was related stuff with methamphetamines and some other drugs. The second was suicide. Suicide was almost as high as the opiate overdoses. And then third was alcohol, alcohol related organ disease, primarily liver failure, but also heart disease, pancreas disease, a whole host of things that kill you from drinking too much alcohol. So, all three of those things are self-inflicted, if you will. These are people doing things to themselves, which we believe, is clear evidence of a sense of despair, a sense of the loss of hope, where people are trying to essentially manage their pain and their sense of loss with substances, or in the worst-case scenario with suicide. When you look at Hispanics, you do not see this phenomenon. In fact, you see a dramatic decrease in Hispanic mortality across the country and in California or immigrant Asians. Immigrant populations have some of the best health status in this country and as a acculturate and become more American, their health actually gets worse. So, America is not good for your health, and we have to understand why that is. A lot of people know people who died of opiate overdoses or suicide. They generally attributed to decline in economic fortunes. 

 

JARED BLUMENFELD: What specifically are they referring to? 

 

DR. TONY ITON: You know, the lack of some of the core industries that used to buttress rural America in general - so timber, mining, fishing, construction - they point out that, you know, these industries have declined, and their way of lives have been destroyed. They blame to a large extent, environmentalists. They see environmentalism as a threat to their wellbeing and their economic wellbeing and they don't trust government. They're a little bit more trusting of their local government. They tend to trust the military and they tend to trust the church. 

 

JARED BLUMENFELD: Well, when you talk to folks in these communities that were hopeful, what are their reasons for hope, and do they point to a direction out of this epidemic?

 

DR. TONY ITON: What we're still looking at this. We feel like there is opportunity to kind of re-build or strengthen the California identity, and that includes all of California, including rural California. Creating this sense of a future, that is an inclusive future where we can all work together, where we do talk about race and racism. This is one of the things that we've studied, and we recognize, that if you don't talk about those things, people kind of default to their assumptions. You have to break through that. You have to be explicit about talking about racial inequity and the history that has brought us to where we are, but we also have to recognize that we're all affected by this and our future has to get past that past, if you will.

 

JARED BLUMENFELD: After this week’s sponsor, I talk to Suzanne Bohan about innovative community projects that target the health inequities we just discussed with Dr. Tony Iton. Suzanne Bohan is a health and science journalist with an expertise in covering health inequities. From 2000 to 2012, she covered science and health issues for the largest newspaper chain in the San Francisco region, the Bay Area Newsgroup. Suzanne's won nearly 20 journalism awards including the 2010 White House Correspondence Association Edgar Poe Award for the series, Shortened Lives: Where You Live Matterson why life expectancies vary so dramatically between nearby neighborhoods. She previously worked for the Sacramento Bee. In her latest book, 20 years of life, Suzanne examines how communities are fighting back to achieve positive health outcomes for all. I start by asking Suzanne how she started reporting on this issue. 

 

SUZANNE BOHAN: I was a health and science reporter with the Bay Area Newsgroup and it was in 2009, that I co-wrote a four-part series called, Shortened Lives: Where You Live Matters,the toll of chronic stress and also the lack of basic resources for healthful living - such as safe parks to play in, places to walk, a nearby grocery store. In many of these communities, it's miles to get to a good grocery store. And I learned that the California endowment was starting a 10-year initiative called Building Healthy Communitiesin 2010, and it was going to be attacking these very issues of how to create better social conditions and physical conditions in communities in order to improve life span. The challenge always in writing about this topic is people will say, well, they're just making bad choices. They're irresponsible. This is America. Everybody has the right and the ability to make the right choice and live a healthy life. But I have spent a lot of time in these communities and it's not hard to understand how this toll of disease and shortened lives actually begins to accrue. One man told me he doesn't feel even safe walking to that liquor store to get some packaged food at night and they don't want to - You wouldn't dream of stepping outside and jogging or walking for exercise. There are packs of dogs that roam around in these neighborhoods, that's very common, that's a problem in these neighborhoods. And of course, just random violence is higher there. So, you realize they simply don't have the same options for making healthy choices. The stress effect creates incredible disequilibrium in our physiology that over years and years has a very profound effect and triggers diseases such as cancer, heart disease, diabetes, and so on.        

 

JARED BLUMENFELD:  Tell us about the studies in your book that show that individuals at the bottom of the employment ladder experience more stressed than the captains of industry. 

 

SUZANNE BOHAN: The Whitehall studies out of London and the UK.  Sir Michael Marmot, and what he found was, he studied civil servants. He found this massive difference in life expectancy and disease rates from the doorman up to the top executives, and what that shows, is that it punctures a hole in this idea that it's bad choices. Because one, decade after decade, this repeats itself. All of these people have health insurance, so it takes away the myth that healthcare will come in and solve this. Because really, we're talking about preventing disease. Whereas healthcare is about patching things up after they happen and trying to manage costly chronic conditions. They also have steady paychecks, they're not homeless. They have enough to bring, you know, decent food on the table for the most part. But it's a really clear example of the toll of chronic stress and a lack of control in your life on health and longevity. 

 

JARED BLUMENFELD:  I found it shocking. In your book, you cite this figure that by increasing graduation rates by 10 percentage points, we could prevent four hundred murders and over 20,000 assaults in California alone each year. That was just startling to me. One, that there's such a gap in graduation rates, and two, that the impact of doing that, what seemed like a relatively small change, can have such a big impact. 

 

SUZANNE BOHAN: The point of that is how high school graduation rates are so stabilizing on so many levels, and what I'm describing there is a campaign to pass school discipline reform in California. I really concentrate on trying to find the people who are doing constructive, meaningful, powerful work rather than always reporting on the problems because I think we all get a little tired of hearing about the problems. And we know it's out there. It's important to know the details of why things happen, but also, by knowing why, then you can find the intervention points for fixing it. And so, this campaign for school discipline was one of the early major successes out of this 10-year Building Healthy Communities campaign and it was completely mobilized by the people. And when kids are not graduating, they actually have a five-year loss of life expectancy right there. It's all about mobilizing political activism and community power to drive the conditions that the people living there know they need to live better. And this school discipline reform campaign is a perfect example because it came from the community. They brought it up to the highest levels of Sacramento, the education policy expert, the school superintendent of schools…

 

JARED BLUMENFELD:  In the book, it seemed like all the bureaucrats didn't even know this was an issue. 

 

SUZANNE BOHAN: None of them knew it was a problem. And so, the California endowment was able to pay, speaking of data, pay for studies to get a handle on what was going on with suspensions, and they came out with the most startling statistic anybody could have imagined, which is that California suspends or at that point was suspending more children, more high school students every year than they were graduating.    And that became the rallying cry for this campaign. So now there's 11 new laws passed. And the last tally in 2016, the state released data showing suspensions are down 360,000 per year in California and high school graduation rates are up about eight percent. So that's a direct effect on health and longevity and economic prosperity. There's one underlying message in here. Philanthropy needs to support change, not charity. There are so many opportunities for philanthropy to get into these distressed communities and support political activism, support community organizing. They

pay for polling, they pay for data. So that's where philanthropy can help. 

 

JARED BLUMENFELD: What I like about your book is your saying the benefits are also not divided equally, and if we could get more benefits for communities like parks, we could move the needle, right? 

 

SUZANNE BOHAN: Exactly. What's interesting is you talk across the political spectrum and people think this is reasonable, that these areas should have parks, these areas should have healthy retailing, because often times there's a lack of healthy retailing because some wider regional legislative body has zoned that area to allow a great number of liquor stores, and selling tobacco and liquor and lottery tickets, but they would not zone the wealthier areas to have those. Or fast food outlets, drive through fast food outlets, would be banned in one area, but allowed there. Or freeways, allowing diesel trucks would not be allowed in wealthier areas but would be in the poor areas. 

 

JARED BLUMENFELD: The story I really liked in the book, you say when Terry Stanley was 17, he joined a campaign to build a skate park in city heights, a low-income neighborhood in central San Diego. 

 

SUZANNE BOHAN: It was City Heights, which is a neighborhood in San Diego that's been historically a low-income and they did not have a skate park, and yet there was vast amounts of parkland and skate parks elsewhere in San Diego. And finally, they got fed up when one of their friends was injured in a skating accident, skating on the sidewalk. Another one, Terry Stanley actually got into trouble with the law because he was skating at an elementary school when he was not supposed to be.  So, these kids were running into scrapes with the law because they were skating where they're not supposed to be because they had no other option. About 50 youths said we want a skate park and city heights, and so, the leaders, the adult leaders there said, okay, let's work on that. And the kids really designed the campaign, and they went to well over 100 planning department meetings, city meetings, and they kept pressing, pressing, pressing. They had a number of initial defeats and setbacks, but they kept pressing on it. And finally, the staff and elected officials were so impressed with these kids’ determination that they really turned around and started supporting them. And they brought in about $5,000,000 in grants. One just opened up in January, a 19,000 square foot one. It's a direct result of these 50 kids determination, but this is also where philanthropy helped because the endowment paid for what's called a health impact assessment of having a skate park in City Heights, meaning you describe all the health benefits of having a skate park, which is kids learn cohesion, they're physically active, they learn new skills and coordination, they're off the street and so on. So, that is actually finally what swayed the city council. It was a really tight vote to support it because a lot of people didn't want the skate park. 

 

JARED BLUMENFELD: You also go up to northern California to meet the Yurok tribe up by the Klamath River. I spent time with the Yurok and was really inspired by your reporting on how they're rebuilding community through reconnecting with nature. 

 

SUZANNE BOHAN:That's a unique story up there. They had significant job losses when the logging industry faded away, when all the old growth was cut. And also, the fishing industries scaled way back due to overfishing and other conditions. But also, the Yurok tribe is there, which is California's largest tribe with about 5,000 members. So, it's unique in that there's never been a native tribe to my knowledge, involved in this wide scale, what they call community change initiatives, to try to support political organizing. The Yurok voted to bring back controlled burns on their forest land that completely took everybody by surprise in this initiative, the California endowment leadership community. Nobody had really thought about that. But then for the Native Americans, that was the key to restoring their health and giving youth something, you know, restoring their ability to connect back to their ancient culture to bring back foods that they eat. They needed to have these burns to have basket weaving material like hazel sticks. They're bringing back huckleberry. It's improving the health of the acorn crop. And so, all of these benefits have accrued. It was financed initially by the foundation, but now is 100 percent run by the Yurok tribe. I also quote a Native American scholar in there who says, of course. It's the native tradition that your health is course connected to the health of your community. Whereas for us, in this individualized sort of ethic we have, you know, you're an island and you're responsible for yourself.                      

 

JARED BLUMENFELD: On Podship Earth, we focused on the plight of people in Imperial, Coachella, San Joaquin, and the Sacramento Valley and their lack of access to drinking water.  Tell us a little bit about the relationship between democracy and getting people elected to water boards and how that's changed some of the dynamics in terms of access to healthy drinking water. 

 

SUZANNE BOHAN: A huge number of people on the eastern side of Coachella valley, which is the other end is palm springs and all the resorts and golf courses, which have all the water they need. But this other side, they were living in trailer parks. They were pulling from ground water that was contaminated with arsenic and chromium six. And so, these people, who were really very low income already, we're having to buy piles of bottled water to drink, to wash their hands, to even do their dishes. And it was an incredible way to live. And the water district had given up, said sorry, it’s just impossible for us to get a main water line out there. And everybody accepted that as the status quo. What this initiative also works on, is taking the nonprofits that are already working in the community and having them collectively work together to set one goal rather than working in silos and competing for the same grant dollars. And what they realized is they needed representation for that poor community on the water district board. It had been white men for most of its existence for decades. And so, they managed to, with a lawyer sending them a letter saying the water district was in violation, the states voting rights act by not having it by district. And the water district immediately agreed, probably realizing they wouldn't prevail, and there, for the first time there was a Hispanic member of the water district board. That led to the creation of a disadvantaged communities task force, which led to pressure to get a water main out there. And finally, people said, Oh, we actually can do this. So, what they had always said was impossible, now was seen as possible. And they are making major strides in getting all manner of fresh water and clean water to that community, but it's also driving statewide change because of the success of what's happened in Coachella valley.                          

 

JARED BLUMENFELD: Suzanne, what are the big lessons that you took away from the successful community building campaigns? 

SUZANNE BOHAN: This sort of collective action is like barn raising. It's the tradition that we've always respected and revered in this country of neighbors coming together to help neighbors. And so ultimately, it's about giving people in these distressed areas that have lacked good schools, safe parks, walking areas, healthy food retailing, giving them voice so that their needs can be heard and that they finally have a seat at the table when the decisions are made as to how to allocate public resources and how to pass policies that are equitable and health promoting. 

 

JARED BLUMENFELD: What did you find when you did research into how Democrats and Republicans view this issue? 

 

SUZANNE BOHAN: What bridged both sides was the agreement that there needs to be the same opportunity to be healthy in poor communities in everywhere in this nation. That that's a reasonable request, a reasonable position to take, that we all should have an opportunity to be able to safely exercise in our communities, to feel safe in our neighborhoods, to be able to easily access affordable, healthy foods. 

 

JARED BLUMENFELD: What are some things that they can do in their community to replicate the successes that you chronicle in your book? 

 

SUZANNE BOHAN: I try to put in some instructive steps on really the nuts and bolts of this. You've got to get people together. You need numbers and you've got to have high quality information. You've got to do good research and identify a target. Identify what you want and provide comparative data of we don't have it, but this area does, and here's the benefit they get, and then don't give up. 

 

JARED BLUMENFELD: What I took away from this week's episode was how indelibly the inequities of American society have been hardwired into nearly every facet of our collective lives. As Tony said, in one single county, you can either experience life as if you were in Sweden or as if you were living in war-torn Afghanistan. That your zip code can add or subtract 22 years from your life on the planet is so beyond shocking. The $1,000,000,000 project that Tony is leading for the California endowment and that Suzanne covers in her book not only shines a light on these inequities, but as importantly, shows us that through data, community organizing, and gaining a seat at the table, we can start to rewire the system so that all Americans have the opportunity to be healthy. Next week, we explore the ancient marble industry. More than $3,000,000,000 of stone is brought into the U.S. each year for our bathroom sinks, hotel lobbies and kitchen countertops. I talked to marble dealers in San Francisco, and then traveled to the home of Michelangelo in Italy to talk with activists worried about the impact of the marble industry on their beloved mountains. Thank you so much for being part of the Podship Earth journey. From the entire Podship Earth crew-sound engineer Rob Spate, producer Nancy Ferranti, executive producer David Kahn, and me, Jared Blumenfeld, you'll never look at your zip code the same way again. Have a great week.