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Can Public Health Be Separated From Public Policy?

If a person’s life expectancy is predicated simply on where they live, as research shows, what can be done to improve the health of those in unhealthy neighborhoods? Dr. Tony Iton, senior vice president for Healthy Communities at The California Endowment, says it’ll take fighting inequities and discriminatory beliefs.


Lead a healthy lifestyle and live a longer life? Sure – if you have access to nourishing food and exercise opportunities.

But that’s not the reality for many Americans’ neighborhoods, with their “food deserts” and unsafe streets (either due to crime or cars), and so some research is finding much of what we consider public health is more a matter of public policy. In short, it may be that where you live determines much, if not most, of how long you’ll live.

Dr. Tony Iton, senior vice president for Healthy Communities at The California Endowment, made this statement during a recent conference, The Future of Inequality, hosted by the University of Southern California’s Center for Economic and Social Research.

From experience gained during his career, beginning as the as director of and health officer for the Alameda County Department of Public Health, Iton believes perhaps as much as 90 percent of what influences your life expectancy happens outside of the healthcare system.

In his presentation, “Changing The Odds For Health,” Iton said progress has been made in treating diseases, fighting their causes, and even changing behaviors to stop the onset of such fatal illnesses. However, he added, what needs to follow is a look at social inequities (e.g., Why isn’t there a grocery store for miles around?), institutional power (Why don’t banks lend to people who want to put grocery stores in underserved areas?), and discriminatory beliefs (Why does society think poor people and minorities are OK to ignore, at best, and, at worse, actively menace?).

There have been successes on these fronts, Iton noted. For example, the Affordable Care Act led to 4.5 million Californians getting health insurance. And in the state’s schools, there has been a 50 percent reduction of suspensions and expulsions for minority students, who in the past were given harsh discipline at a rate much higher than their white peers.

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