“Do something now,” Chanelle P. Hardy, keynote speaker of the “For the Sake of All” community conference, urged a packed auditorium at the Missouri History Museum on Friday morning.
Hardy is senior vice president for policy and executive director of the National Urban League Washington Bureau. She was asked to lend national perspective to “For the Sake of All,” a multi-disciplinary report on the health of African Americans in St. Louis that was released at the conference.
The study – conducted by seven researchers from Washington University and Saint Louis University and led by Jason Q. Purnell, an assistant professor at WUSTL’s Brown School of Social Work – revealed 67 pages of evidence that blacks in the St. Louis region endure hideous disparities in health outcomes, compared to their white counterparts.
Rather than be paralyzed by all this depressing, impressively presented data, it is important to “do something now” to make it better, Hardy said.
The researchers who conducted the study agree. The report concludes with a set of recommendations for positive change, including invest in early childhood education, create economic opportunities for low-income families, establish coordinated school health programs, and improve screening and treatment for mental health problems.
Three lively panels of regional experts and organizers backed up both the researchers’ findings and their call to action. The underlying assumptions of the study title, “For the Sake of All,” are that this is not a black problem and not only black people are needed to address it. More than one-fourth (29 percent) of the people in St. Louis city and county are black, and such poor health outcomes – tied to low educational and economic achievement – of blacks hold back the entire region.
Mike Jones, senior policy advisor for County Executive Charlie Dooley, explained this with a characteristic sports analogy.
“This region is not going to be competitive with 25 percent of the players on the bench or not productive,” Jones said. “You’ll never beat anybody playing four on five.”
The connections between education and economic opportunity are central to the study. “The largest single contributor to premature death is behavior,” Purnell said. “But behavior happens in a context.” That context, he said, is largely determined by access to education and economic opportunity.
Crystal Gale, principal of Roosevelt High School in the St. Louis Public Schools, said undiagnosed and untreated mental health problems are a major contributor to her students’ lagging economic performance.
“Before we can teach them, we need to make sure students are in the right frame of mind to learn,” Gale said. “And teachers need the training to recognize behavioral patterns of mental illness rather than just throw students out of the classroom.”
Joe Yancey, executive director of Places for People, said routine exposure to violence and danger is damaging the health of young people and adults in many St. Louis neighborhoods.
“People know they don’t feel safe,” Yancey said, “but they don’t recognize the impact that has on their physical and, potentially, mental health – and what they can do about it.”
Rev. Rodney Francis, pastor of Washington Tabernacle Missionary Baptist Church, said that clergy can play a role in addressing the stigma associated with mental illness in the black community. “There is still a stigma, a shame,” he said. “We say that people are ‘touched.’ It is a disease and it needs our care and concern, our passion and not our pity.”
Will R. Ross, MD, associate dean for diversity at Washington University School of Medicine, has seen the effects of poverty on health as a practicing physician. He spoke of seeing a patient after a very long delay due to missed appointments. “He told me he couldn’t afford the medication,” Dr. Ross said, “so he didn’t want to waste my time.”
Structural solutions
Michael Sherraden, founder of the Center for Social Development at the Brown School at WUSTL, said there has been too much talk of structural problems. “I like to think of structural solutions,” he said.
One such “structural solution” is to help ensure access to educational opportunity for all children by investing in a college savings plan for all children. He is leading a study in Oklahoma that has shown that such savings plans can be created for all children who are offered one through a random sampling. Mothers of those children report higher expectations for their children, he said, which correlates to better educational outcomes. He said these mothers also report fewer depressive symptoms than a control group of mothers.
“This shows you can actually put in place better economic opportunities for people, and people will respond to those opportunities,” Sherraden said, “and evidence suggests that as a result people’s lives will be better.”
Locally, Beyond Housing has established a college savings plan for all children in the Normandy School District as part of its 24:1 initiative. Sherraden said St. Louis Treasurer Tishaura O. Jones is working with him to start a college savings plan in the city.
Kendra Copanas, executive director of the Maternal, Child and Family Health Coalition, said problems associated with maternal health need a structural solution that starts before pregnancy.
“We need to focus our approach across a woman’s life starting in early childhood,” she said. “Our work needs to be coordinated with all other systems that touch families.”
For more structural solutions to structural problems, a number of experts and organizers said, we need a more engaged community.
Susan Stepleton, director of the Policy Forum at the Brown School, has experience advocating for early childhood education as former president of Parents As Teachers.
“The problem is there is too small of a group of child advocates,” Stepleton said, and given that many advocates are teachers they are dismissed as “self-interested.”
The rare and surprising collaboration between Washington University and Saint Louis University on “For the Sake of All” was noted by one of the researchers, Melody S. Goodman, an assistant professor at WUSTL School of Medicine. The researchers’ deliberate and intense public engagement on this study also was praised throughout the conference.
The community needs such engagement from academic experts, according to Sherrill Jackson, founder of the Breakfast Club, a community advocacy group for breast cancer survivors. “Our mobile mammography van was developed with researchers’ input,” Jackson said.
Will Jordan, executive director of the Metropolitan St. Louis Equal Housing
Opportunity Council, said he started to get better results after he forged partnerships with area law schools. Now those students are lawyers arguing cases, judges adjudicating cases and law professors teaching the next generation of attorneys – and they understand fair housing law from the community’s perspective.
“Those partnerships have really made a difference,” Jordan said. “They see fair housing is not just the law. It’s what’s right.”
If the community needs more help from academic and civic institutions, Dr. Ross said, then community-minded professionals within the academy need more leverage from the community.
“Hospitals and universities need to better align our resources with community needs,” Dr. Ross said. “To hold academic centers and hospitals more responsible for this, we need a greater push from the community.”
To engage the business community, we need to assemble the data that investing in poor communities will improve their bottom line, according to Sandra M. Moore, president of Urban Strategies.
“When you are dealing with funders, you need to make translations for funders,” Moore said. “You have to show how and why you’ll protect their investment. I haven’t seen one yet that is not concerned with a return on their investment.”
Chris Krehmeyer, president and CEO of Beyond Housing, has succeeded in attracting investment for new banking services, healthy food options and residential stock in Pagedale. He agreed that the structural solution is the way to go, but it is not an easy way.
“We need to do this all together intentionally,” Krehmeyer said. “The reality is that is really hard to do. To do this work is really hard and it will make us uncomfortable at times.”
Doing the work is the next step, according to Purnell, who is directing the effort.
“Now we have some common goals and some common metrics,” he said. “Next we will call everyone around the table, get to work together and measure our progress together.”
