The Role of Community Development in Improving Population Health and How Pediatricians Can Help

A research article authored by Build Healthy Places Network and published by Academic Pediatrics, discusses the relationship between the zip code in which a child lives and that communities’ health implications that permeate well into adulthood. This includes the physical environment measured by things like access to healthy food, places to engage in physical activity, sanitation, and the mental and emotional environments including healthy relationships, communication with adults, and connectedness at school.

The effects of the environment in which a child is raised can be exacerbated by adverse childhood experiences (ACEs) like exposure to violence or family instability and can have negative impacts on a child’s health and into adulthood. Thee article reviews the role of pediatricians can play in advocating for community development initiatives that foster healthy neighborhood conditions where children can grow and thrive.

What Is Community Development?

Community development is a multifaceted term that has its origins in the antipoverty and racial justice movements of the 1960s. It partly began as a corrective response to racial segregation and redlining practices in the housing and finance markets that created and perpetuated low-resource neighborhoods. Organizations involved in community development work often focused on building generational wealth and quality of neighborhoods are increased through investments in affordable housing, grocery stores, health clinics schools and childcare centers, and small businesses to provide local jobs. These are direct resources in the community that are also known to have a positive effect on reducing crime, substance misuse, and other risk factors.
The Conway Center in Washington, DC  is an example. The Conway Center provides affordable family housing and housing for individuals experiencing homelessness, green space and a playground, office space, a job raining center, and a community health clinic in a property that is accessible by public transportation. The center has yet to be formally evaluated but the article’s authors advise that when such programs are evaluated the evaluators should measure its impact in ways beyond the traditional measurements of controlled or clinical experiments. For example, measures that capture the real world impact on people’s lives should be employed.

Other examples are the neighborhoods of the Villages at East Lake in Atlanta, GA and Columbia Parc in New Orleans, LA. Both communities were originally public housing projects, that now focus on children’s education and family economic success by prioritizing mixed-income housing, cradle-to=college education, healthy food access, recreation, public safety, and neighborhood services like shopping and banking. Columbia Parc has not been quantitatively evaluated, but the Villages at East Lake, Atlanta, has seen a significant decrease in violent crime, a 5-fold increase in household income, standardized test scores among the top five for K-12 schools in the Atlanta metro area, and a 97% high school graduation rate that was previously under 30% in the 1990s.

How Can Pediatricians Support Community Development?

What a child experiences and its impact on their developing minds and bodies can put them at risk well into adolescence and even adulthood. Interventions are therefore most effective when they target the early stages of a child’s life.

The opportunity to be healthy during childhood is a bridge to other opportunities – for education, emotional well-being and employment, the article states. Promoting health should therefore be a priority consideration for community development, and health experts should be included in the community development process. As experts in child health, pediatricians are uniquely qualified to integrate health as a protective factor in community development efforts. According to the National Academy of Medicine, only 10-20 percent of health status is related to medical care; the rest is accounted for by social determinants of health – opportunities for healthy behaviors like access to healthy food choices and safe and accessible places for physical activity, socioeconomic factors like education and employment,  and physical environment like housing and pollution. It is not just beneficial, but necessary for a physician to consider this holistic and interactive context in which health operates, knowing that health can be modified by any one of these non-clinical factors.

According to the article, a pediatrician therefore has a professional interest in understanding their patients’ family and community characteristics that influence health. Pediatricians’ input can help design community development initiatives that support families and children’s healthy development. Jutte, Badruzzaman, and Thomas-Squance share some tangible ways pediatrician can use their professional voice to drive neighborhood investments through a community development framework.

Next, researchers in the field of pediatrics can investigate the effects of neighborhood investments on child and adolescent health, in one potential way by studying health variables in neighborhoods where investments have already been made but impact has yet to be measured, like the Conway Center.

Policy Action is Needed

The Build Healthy Places Network’s article underscores the need for policy action Community development should be a central value and initiative in improving the health of and preventive services in neighborhoods. Neighborhood infrastructure has lasting effects on children that persist into adulthood, for both risk and protective factors. Pediatric professionals can use their expertise in the field to practice, educate, and advocate for the principles of community development that consider holistic wellness. Trust for America’s Health’s (TFAH) Promoting Health and Cost Control in States (PHACCS) report includes several policy actions that pediatricians can support in order to advance pediatric health:

• School-based health centers that meet comprehensive pediatric needs in primary care including healthcare, oral care, behavioral healthcare, and health education in fixed, mobile, or telehealth location settings.
• Early education and universal pre-kindergarten programs that benefit childhood development and reduce the likelihood of risk factors throughout the life course.
• Housing rehabilitation programs that make physical improvements in neglected properties like lead abatement, re-housing programs that offer support services for individuals experiencing homelessness to transition to permanent housing, and policies that protect the affordability of housing like tax credits and incentives.
• Developmental infrastructure like “Complete Streets” policies that promote physical activity, safer streets, and mixed-use land spaces that create inclusive, integrative, and healthier neighborhoods for living and growing.
• Affordable, sustainable quality housing that provides stability, economic and social opportunity for families, and long-term health benefits that are protective factors for life-long wellness.

For more details on these solutions and policies, see TFAH’s PHACCS initiative and accompanying reports.