Health equity devolves to cities and states as the federal government cuts taxes for the wealthy

I have a bunch of pieces on equity planning and social urbanism, touched off by my experience on a DC Grand Jury.  As one of the court reporters said "breaking the cycle--man, we're just cutting the grass."  I figured that the city spends a couple billion dollars a year on the impoverished in DC, just to keep them in place.

-- "An outline for integrated equity planning: concepts and programs" (2017)
-- "Equity planning: an update" (2020)
-- "Social urbanism and equity planning as a way to address crime, violence, and persistent poverty: (not in) DC" (2022)
-- "Experiments in Social Urbanism"
-- "'Social urbanism' experiment breathes new life into Colombia's Medellin Toronto Globe & Mail
-- "Medellín's 'social urbanism' a model for city transformation," Mail & Guardian
-- "Medellín slum gets giant outdoor escalator," Telegraph
-- "Medellín, Colombia offers an unlikely model for urban renaissance," Toronto Star

Some cities have launched poverty reduction and area-based economic development programs to address this, like GrowSouth in Dallas ("Cities Need Goals and Capital to Fight Poverty," Catalyst) or Invest SouthWest in Chicago ("Johnson Administration Breathes New Life into INVEST South/West Developments in Englewood," South Side Weekly, "Invited In Only To Be Shut Out," Block Club Chicago, Next Steps, West Humboldt Park, "City announces four new targets for Invest South/West," Crain's Chicago Business).  

United Way Greater Toronto for more than a decade has focused its program funding on languishing impoverished neighborhoods ("Guiding the United Way through the next decade," Toronto Star).  From the article:

United Way Greater Toronto just launched an incredibly ambitious 10-year strategic plan. We’re going to sustain the 10 community hubs we have and create 10 more. Hubs are like a one-stop shop for social and healthcare services in neighbourhoods that need it most. So, it improves access to services. It improves quality. It pulls together organizations under one roof, so it increases collaboration across organizations.

Our second goal is a community real estate vision. Seventy per cent of the community organizations we support are at risk of losing their space, and they’re also at risk of then being, in essence, priced out of communities that need them the most. We have a real focus on supporting those organizations to ensure the stability of those physical sites being owned by community organizations and stewarded for generations to come.

At least with the cities, the programs tend to wax and wane as new administrations succeed previous ones more committed to poverty. 

If we think that cities (and counties, see "Pontiac Michigan: a lagging African American city in one of the nation's wealthiest counties" and "East County, Montgomery County, Maryland: Council redistricting spurs ideas for revitalization | Part 1 -- Overview") should focus on addressing poverty with place-based solutions, I'm thinking it's the same with health equity.  Programs like Medicaid expansion--run at the state level in most places--provide health care to people who are medically needy.

This op-ed in City & State by NYC's health commissioner, "I am New York City’s doctor. This is how we treat chronic disease" makes the point that as the federal government cuts health programs (and medical research) cities and states should step up and fill the gap.

[RFK Jr.] has fired at least 20,000 employees from the Department of Health and Human Services. Billions of dollars in lifesaving medical research have been cut. Tens of millions of Americans, including millions of New Yorkers, will lose their Medicaid, Medicare, and Supplemental Nutrition Assistance Program (SNAP) benefits because of Republicans’ “One Big Beautiful Bill.” The record-breaking government shutdown multiplied the confusion and loss.

... My job is to support all New Yorkers in leading their healthiest lives, no matter their income or neighborhood. We have the experience and expertise to improve outcomes and even prevent chronic disease entirely. We know what approaches are proven to make a lasting impact.

That’s why, at the New York City Health Department, we recently released a city-wide chronic disease prevention strategy, which outlines how local government can address the root causes of chronic disease.

The strategy recommends promoting healthy living through nutritious foods and physical activity. But we must also meet people’s material needs. Improving access to basic resources – with direct cash payments, grocery credits and more – has a proven impact on health. And informed conversations around marketing, product design and creative media approaches can increase consumer awareness of the health impacts of the products they buy.

When people can afford the things they need – housing, health care, the ability to put healthy food on the table – they aren’t waiting to be treated in the ER once they’re in crisis.

This also comes up in Chicago, with multi-decade differences in life expectancy based on race, income, and neighborhood ("As they live Chicago's 'death gap,' a 3-generation family fights to end it," Chicago Sun-Times).

These kinds of statistics are the basis of the concept of "social determinants of health" 

and programs to address the disparities.

I have a series of articles about developing a comprehensive program at the bigger city scale on health equity, but I never termed it that way.  City and county poverty amelioration programs need to focus on health equity as an element of equity planning, and these entries lay out a way forward.

-- "Ordinary versus Extraordinary Planning around the rebuilding of the United Medical Center in Southeast Washington DC | Part One: Rearticulating the system of health and wellness care East of the River" (2018)
-- "Revisiting East of the River medical care: United Medical Center" (2018)
-- "Update on DC's plans to build a new United Medical Center" (2018)
-- "A glaring illustration of the need for comprehensive health and wellness planning in DC: Providence Hospital" (2018)

-- "Community Health Improvement Planning" (2019)

-- "Hospitals as urban anchors/revitalization levers, not usually, but with great potential to serve communities in important ways: Examples are two forthcoming projects by Intermountain Health and University of Utah Health" (2023)

-- "Big omission in blog series on advance hospital/health and wellness planning, public health planning: addiction services" (2024)

-- "Costly failures in the mental health system" (2025)