Gavin Newsom kicked off his term as governor by unveiling several health care proposals on his first day in office—a welcome development for the many California residents who, according to recent polls, say universal health care is one of their top priorities.
But to truly transform health and achieve health equity in our state, we need to address the community conditions that determine whether we will be healthy and safe in the first place, long before the medical system gets involved.
That means not just health care for all, but healthy communities for all.
One way to achieve healthy communities is through investments like the ones Governor Newsom proposes in his new budget, such as paid family leave, education, water safety and housing. An additional way would be to create a state Wellness Trust—a sustained source of funding for community-level initiatives that address health inequities and prevent the onset of some of the leading causes of illness, injury and premature death. Raising taxes on products that drive chronic disease and injury—like sugary drinks and alcohol—could go a long way to funding prevention.
Wellness trusts in Massachusetts, Minnesota and Oklahoma have raised millions of dollars to support health and shown big results. Oklahoma has seen a 45 percent drop in youth tobacco use since 2000, preventing addiction, suffering and death. In Minnesota, a small tax has funded increased access to healthy foods and physical activity for 339,000 students. In California, a Wellness Trust could be seeded by the soda tax currently being proposed by the California Medical and Dental Associations.
The federal Prevention and Public Health Fund—created in 2010 as part of the Affordable Care Act—has directed resources to communities across the country to support active living, healthy and sustainable food
systems, smoke-free spaces, and other community-level public health initiatives. But we can’t count on those funds being available over the long haul, because they’re threatened every time policymakers try to repeal the ACA. That’s why we have a responsibility to do what we can at the state level.
Once California has established a wellness trust, the next step would be to ensure that the funds are invested in the right way. We recommend that funds be distributed to community-based organizations, nonprofits and health departments to address the specific factors that shape health at the community level, with funds set aside explicitly for communities facing the greatest inequities.
From our decades of experience working with California communities to address their health and safety priorities, we’ve learned that to achieve transformative and sustainable results, there are two critical elements that should be included in any initiatives that are funded:
- Community members need to be involved in the process—from helping determine which health and safety problems should be prioritized, to designing the right solutions and interventions.
- Community members and health departments can’t be the only partners at the table. We need to involve other industries and government agencies whose activities impact community health, safety and wellbeing.
The good news is that many community improvements pack multiple benefits for health and wellbeing. When we invest in parks and green infrastructure, for example, we can improve air quality, cut greenhouse gas emissions, capture and cleanse storm water, and create opportunities for people to be physically active and socially connected.
The governor’s first budget proposal is a promising start. As we move forward, we need keep health—not just health care—front and center. That means creating healthy, safe and equitable communities.
Juliet Sims is a director at the Oakland-based nonprofit Prevention Institute. Matt Willis is the public health officer for Marin County and an executive committee member of the Bay Area Regional Health Inequities Initiative.
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