When Jason Purnell walked to his first class as a freshman at Harvard University, he thought about his great-grandfather as a tenant farmer in Mississippi. 鈥淲hoever could鈥檝e imagined that in just a few generations, I鈥檇 be here?鈥 he recalled thinking.
But it wasn鈥檛 just hard work that got him in the Ivy League, Purnell said. He had parents who stressed education. They expected him to succeed. He lived in a safe neighborhood in Creve Coeur and studied at the private St. Louis University High School.
鈥淧eople鈥檚 outcomes are not always determined in the simplistic way of individual effort,鈥 said Purnell, an assistant professor at Washington University鈥檚 George Warren Brown School of Social Work. 鈥淚t鈥檚 embedded in a system of resources and individual effort; it鈥檚 both and not an either-or.鈥
It鈥檚 the same idea that Purnell is using to lead an in-depth study into the racial health disparities across the St. Louis area. In partnership with St. Louis University, researchers at Washington U. are working with representatives in business, education, churches, media and government to identify problems and solutions to reducing disparities 鈥 solutions that don鈥檛 involve medicine, doctors and health insurance.
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When Purnell 鈥 with a doctorate in psychology and a master鈥檚 in public health 鈥 discusses successful efforts to improve health among African-Americans, he doesn鈥檛 mention health insurance or public service announcements. He talks about efforts by the Fathers鈥 Support Center to keep dads involved with their families, the teen outreach program at the Wyman Center and Beyond Housing鈥檚 success in promoting homeownership.
鈥淲e know where you live, where you work, go to school and the social conditions you live in affect your health,鈥 Purnell said. 鈥淏ut our efforts focus on access to care and the quality of care, which is absolutely necessary, but it鈥檚 not the whole story.鈥
KID FROM SUBURBS
It鈥檚 a lofty project that Purnell, a 37-year-old father of two, wasn鈥檛 always confident enough to pursue. Doubts were put aside, he said, when he was a freshman in college taking class from prominent philosopher and civil rights activist Cornel West.
鈥淚 asked him, 鈥楬ow does this kid from the suburbs who鈥檚 had a relatively privileged life impact the world for people without the same opportunities?鈥欌 Purnell recalled.
The answer was liberating: 鈥淵ou don鈥檛 have to be from the hood to help people in the hood.鈥 But, West added, that didn鈥檛 mean he could come in with his privilege and dictate what happens, which is often how efforts to help unfold.
Working with community partners and funding from the Missouri Foundation for Health, Purnell鈥檚 team of researchers has completed five policy briefs on issues such as economic development, keeping kids in school and providing safe neighborhoods. Residents can add their comments to the reports online or at a March 3 meeting.
Researchers will incorporate the input into a final report presented at the Missouri History Museum on May 30, coinciding with the 60th anniversary of the Brown vs. Board of Education ruling and the 50th anniversary of the Civil Rights Act of 1964.
FOR THE SAKE OF ALL
The study is called 鈥淔or the Sake of All鈥 because it quantifies the impact of racial health disparities on the region, and how solutions will improve the quality of life for everyone, not just African-Americans.
鈥淲e need to think seriously as a community about what factors are driving health outcomes and how that has serious economic and social consequences,鈥 Purnell said. 鈥淚n order to be a viable and competitive region, you have to invest in human resources, and there are segments of the region who don鈥檛 receive that investment.鈥
Poor neighborhoods without access to nutritious food in grocery stores, quality housing, good schools and safe places to play are far less healthy than those without. African-Americans in the city and county, who are concentrated in those neighborhoods, have at least a 30 percent higher mortality rate than whites for many chronic conditions. The worst are hypertension, diabetes and kidney disease, where the rate is double or more.
Some research suggests that policies addressing education could have a bigger influence on health than all medical factors combined. Education provides a greater understanding of health, health care and caring for children; and it is linked to more rewarding jobs, healthier working conditions and health insurance.
Purnell鈥檚 team estimates that in St. Louis and St. Louis County, the cost of African-Americans having less than a high school education and of early deaths due to poverty is $3.3 billion a year. Rates of emergency room visits for mental conditions in St. Louis are 121 percent higher for African-Americans compared to whites, and rates of hospital stays are 64 percent higher, at a cost of $96 million a year.
Nationwide, a generation of children may for the first time live sicker and shorter lives than their parents. Despite spending more on health care than any other country, America trails other developed nations on more than 100 health measures, such as infant mortality and life expectancy.
START YOUNG
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Purnell鈥檚 collaborative approach to improve health outside the doctor鈥檚 office is one national experts agree is needed to reverse the trend. The Robert Wood Johnson Foundation, a national philanthropy focused on health care, launched a similar study on a national scale in 2008 with its Commission for a Healthier America. The commission released its latest recommendations this week.
鈥淲e cannot improve health by putting more resources into health care alone,鈥 said the commission鈥檚 co-chair, Dr. Mark McClellan, former head of the Centers for Medicare and Medicaid Services. 鈥淲e must find ways to help more Americans stay healthy and reduce the health care costs that are crowding out other national priorities.鈥
The recent recommendations fall under three key strategies: broadening the scope of the medical system to include changing lifestyles, revitalizing neighborhoods to promote health and 鈥 most important 鈥 investing in early childhood programs to help strengthen children鈥檚 resilience and ability to cope with adversity.
Purnell鈥檚 childhood was filled with stories and books about Thurgood Marshall and Martin Luther King Jr. His father worked in advertising for the 老澳门六合彩开奖结果 and was often the first African-American hired at a business during his career. His mother was a teacher who retired as a principal, despite being told in high school that she wasn鈥檛 cut out for college.
The struggles of that generation inspired him, he said. 鈥淎 tradition of social justice is part of what I grew up with.鈥
In high school, he started his own nonprofit, which surveyed youth across the region about social issues they faced, and volunteered to clean up after floods. In college, that evolved into a group that encouraged high school students to volunteer.
Purnell changed his plan to go to law school, and his path became one of counseling, teaching, researching and volunteering 鈥 from directing a student-run homeless shelter as a graduate student to now serving on the board for the area鈥檚 only free health clinic.
鈥淭his is what motivates me. To whom much is given, much is expected,鈥 he said. 鈥淚 want everybody to be able to have a chance.鈥