Yes, “Place Matters,” But How Do We Move Forward?

The annual meeting of the American Public Health Association ended this Wednesday.  The theme was “Healthography” which is near and dear to my heart. My training was as a city planner but I wound up with a career in public health due to the AIDS epidemic, which was exploding in the early and mid-eighties when I started working. In planning school, I learned about program design, implementation and evaluation as well as how to manage participatory community processes – skills that have served me well in my public health career.  This conference  has brought the other part of my training—understanding and influencing geographically defined communities—to the front and center of my chosen field or work.

This recent emphasis on place presents its own set of challenges. The current wisdom buzzing around public health circles is that “your zip code influences your health more than your genetic code.” I don’t disagree with that nor with the growing emphasis over the years on social determinants of health. But what does it mean for the discipline and practice of public health? My friend and colleague, Dr. Hortensia Amaro from UCLA, presented at a conference session organized by the American Journal of Public on Geography and Health. In her talk, Dr. Amaro called for new forms of training for public health students that emphasize the intersection of health, education, housing, and employment. She added that analytic approaches going forward need to look at neighborhoods or other geographic subdivisions. Place-specific interventions need to become the norm, with an understanding that replication or scale-up would always need tailoring based on local conditions.

This makes sense in the long term, but I also heard discussion among clinicians and treatment specialists (e.g. for chronic disease and substance use) concerned about their fears of “sending people back” to the households and communities in which they live and developed unhealthy practices. While understandable, we need to quickly move towards asset-building approaches and increased use of community health workers so that individuals have support where they live—now! It will take time and effort to mobilize the workforce and resources necessary to transform public health interventions to “place based” strategies. But I agree it is a necessary transformation if public health is to achieve the goal of improving health and achieving health equity.

 

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