If your skin isn’t black, why should you care about the health and well-being of African Americans in the St. Louis region?
That’s just one of the questions Washington University public health researcher Jason Purnell and his team set out to answer in a project called For the Sake of All.
Purnell, along with colleagues from Washington University and St. Louis University, assessed racial health disparities in the region and their larger impact over the course of 14 months.
The final report of the For the Sake of All project was released on Friday. Its findings and recommendations were up for discussion at a community conference at the Missouri History Museum that same morning.
The For the Sake of All project had four main goals:
- To “inform the general public about the social determinants of health as they impact African Americans, as one of the populations most impacted by health disparities.” Social determinants of health are factors like educational and economic opportunities and the circumstances in which people live and work.
- To “present the regional economic and health consequences of intervening (or failing to intervene) on social determinants of health.”
- To “provide evidence of the impact of persistent disparities on all members of the region, regardless of race or socioeconomic status.”
- To “influence the policy agenda on health disparities by broadening the conversation beyond personal responsibility and the delivery of medical care alone.”
These are just some of the key findings of the project, as summarized in the final report:
“Where you live in St. Louis has a powerful impact on your health. Residents of zip codes separated by only few miles have up to an 18-year difference in life expectancy. Because of considerable residential segregation in St. Louis, many areas with high African American populations are also areas with concentrated poverty and poor health. These neighborhoods often lack resources like healthy foods, safe green spaces for recreation, and convenient access to medical care.”
“Education is one of the strongest and most consistent predictors of health, and gaps in life expectancy between those with low and high levels of education are widening. That makes differences in academic achievement and educational attainment for many African American students in St. Louis particularly troubling. One in 10 African American in grades 9 – 12 dropped out of school in 2012, and poor performance in key subjects at critical points in their education place many others at risk.
Poor health can also act as a barrier to education, particularly when chronic childhood illnesses like asthma and mental health challenges go untreated.”
“These social and economic patterns help provide necessary context for understanding differences in mental and physical health outcomes between African Americans and whites in the St. Louis region. African Americans are more likely to experience chronic disease, violence and injury, emergency mental health treatment and hospitalization, sexually transmitted disease, adverse pregnancy and birth-related outcomes, and risk factors for disease like obesity and high blood pressure. The lack of resources and amenities in neighborhoods where many African Americans live also makes it more difficult to engage in healthy lifestyle behaviors like physical activity and eating a healthy diet.”
The For the Sake of All team also provided recommendations on what can be done to address the health disparities between blacks and whites in the St. Louis area. Here’s what they suggest:
I spoke with Purnell about the For the Sake of All project and some of his team’s findings and recommendations. You can listen to some of that conversation here and read the highlights, below:
What were some of the key findings of the For the Sake of All project?
“I think some of the most interesting probably to your listeners are in terms of a map we did of life expectancy, where we showed up to 18 years difference in how long people can expect to live based on the zip code that they live in St. Louis City and St. Louis County.
We also report on the link between education and health, as well as poverty and health. We noted that of the little over 3,100 deaths in a single year among African American adults, about one in six of those deaths were attributable to poverty and low levels of education, less than high school education.
In terms of mental health care, African Americans make up roughly 30 percent of the population in St. Louis City and St. Louis County but account for about 42 percent of ER and hospitalization charges for mental health.
[We also found] wide disparities in terms of victimization from violent crime: homicide rates that are about 12 times the rate of whites in St. Louis City and St. Louis County. [And] astronomical differences in rates of STDs.”
A lot of these issues that you’re raising are not going to come as a surprise to people. We know that these are chronic problems in St. Louis. So why do a report like this?
“These are issues that we know exist, but I’m not sure that everyone understands how they’re implicated in this. I’m not sure everyone understands the connection that someone suffering in another part of our region has on them and their family.”
Some people might listen to this conversation and say, “I know about this, I feel bad about it, but these aren’t my problems, this isn’t about me.” What would you say to those people?
"I would say these are very much all of our problems, as the title of the project suggests, “For the Sake of All.”
We spend about $1.1 billion a year on diabetes, cancer, and heart disease, just those three chronic conditions. And if we reduced or eliminated the disparity between African Americans and whites, we could save $65 million of that.
If we reduced the mental health disparities that we noted, we could save $27 million.
And just in terms of high school drop out [rates] — and education is one of the strongest and most consistent predictors of health outcomes that we have — 2,000 African Americans, 9th through 12th graders, dropped out of school 2012 alone. And we estimate that their loss, just in lifetime earnings, is between $694 million and $1.5 billion.
That is tax dollars that aren’t being paid. That’s business demand that’s not being created; homes that aren’t being bought — in addition to the social services and unemployment and crime and other things that are attached to not completing schooling.
So all of these issues are intertwined, and all of those impacts are intertwined."
These are big problems. They’re difficult to address, they take a lot of money to address, they take coordination, they take leadership. And there are a lot of reports out there that just end up sitting in a box, or on somebody’s shelf. So how are you going to turn this project into actual change in the health and well-being of African Americans in the St. Louis region?
"These do seem like big, intractable problems. But there are ways of solving them.
I’ll give you an example. We’re very excited about the child development account approach that’s being tested in the state of Oklahoma right now, where children are given a $500 college savings account at birth.
We’re already starting to see some results emerge from that, that people probably wouldn’t expect. These children are now four years old, and we’re seeing better social and emotional development for the kids who had these accounts.
We just published a paper recently showing that mothers who had these accounts had significantly lower depressive symptoms, just by having this account, just by creating a sense of hope, a sense that there’s a future for this child. Those are things we can do right here in St. Louis.
We also highlighted school-based health as a kind of intervention. Because we know that not just education is predicting health, health is also predicting educational completion."
Because if kids aren’t healthy, they’re not going to school.
"Kids aren’t attending school, they’re not paying attention when they’re at school, and it’s both mental and physical health.
We highlighted the clinic that’s being run by Mercy, at Roosevelt High School and funded by the Boeing Corporation, as an example of how you can intervene in a place where most kids spend most of their time. Why not provide the healthcare there?"
St. Louis Public Radio’s Tim Lloyd covered that school clinic as part of his Accounted For series, which explores the connection between chronic absenteeism and classroom success. You can read his story here.
"There are things that we can do. Some of this stuff is already being tried in St. Louis. It needs to be brought to scale, and people need to know that it’s happening."
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The For the Sake of All project was led by Washington University, in collaboration with colleagues at Saint Louis University as well as community partner groups that included representatives of public health and health care, business, community and economic development, civic engagement, and the media.
St. Louis Public Radio was among those media partners, as was the St. Louis Beacon, before the two organizations merged in December.
Prior to releasing their final report, the For the Sake of All team issued five interim briefs focused on African American health in the St. Louis region. Those covered the following topics:
- Brief 1 (and appendix): How the region can save lives by investing in economic and education opportunity (by Jason Purnell, Washington University); read more from St. Louis Public Radio's Robert Joiner, here.
- Brief 2: How health can influence the school dropout rate (by William F. Tate, Washington University); read more from St. Louis Public Radio's Robert Joiner, here.
- Brief 3: How to improve mental health (by Darrell Hudson, Washington University); read more from St. Louis Public Radio's Robert Joiner, here.
- Brief 4: How segregation can adversely affect health (by Melody S. Goodman, Washington University, and Keon L. Gilbert, Saint Louis University); read more from St. Louis Public Radio's Robert Joiner, here.
- Brief 5: How addressing chronic disease can lead to better health outcomes (by Bettina F. Drake, Washington University, and Keith Elder, Saint Louis University); read more from St. Louis Public Radio's Robert Joiner, here.
Follow Véronique LaCapra on Twitter: @KWMUScience