How Can Policymakers and Low-Income Communities Work Together to Improve Health?

It’s often hard for policymakers and low-income communities to work together, and the reasons are multi-faceted. Barriers and possible solutions are important to explore.

First, the United States is steeped in the dominant paradigm that if someone is poor, it is their responsibility to escape it… and if they don’t, it’s their own personal failure. Many who work in government have accepted this myth, either implicitly or explicitly.

It is critical that we approach health with an understanding of historical injustices as well as the structural, commercial and social determinants of health. Historical and racial injustices have created dramatic inequities that entrench and sustain poverty. The social gradient of health correlates one’s income with one’s health status and life expectancy. That is, the lower one’s income, the worse health outcomes the individual will experience, and the lower one’s life expectancy.

Policymakers (at all levels) have the power to allocate resources… and disinvestment in neighborhoods, or harmful investment, creates conditions for poor health. Ultimately, socially just policies require inclusion, listening, cultural humility, and action on the part of the government.

Another assumption that policymakers, unfortunately make at times is that we know what is best. However, low-income communities are rich with understanding of the problems and possible solutions, and thus, community members must be viewed, and treated, as experts in this work. This is key, as the framing of a problem shapes the universe of solutions that may be considered. And thus, policymakers must seek to abide by this: Nothing about us without us.

A third barrier to low-income communities and government working together is lack of trust, which has arisen in part from egregious past violations, demonstrated in real-time by COVID-19 vaccination rates and associated health communications campaigns.

Moving forward

As funds reach local and state governments, how can we ensure these investments have the greatest possible long-term impact for those living in poverty, keeping in mind Dr. Anthony Iton’s observation that an individual’s zip code is more important than one’s genetic code? Though many policymakers have adopted a health equity lens in their work, we must also engage the persons most affected by inequities to help answer these questions.

The following are recommendations to help bridge the disconnect between policymakers and low-income communities, helping to shift the narrative about why poverty exists:

– Explicitly work to shift the narrative about the causes of poverty, from an individual- level responsibility to a realization that poverty was created and now reinforced by oppressive social policies;

– Meaningfully engage low-income communities in defining problems and developing solutions by increasing access to civic participation; this can include ensuring language access at all meetings, making meetings family friendly, and holding meetings in community centers rather than government buildings;

– Disaggregate data by race, ethnicity, gender, income, immigration status, sexual orientation, gender identity, age, and other variables, in order to make inequities visible;

– Prioritize prevention over punishment in public schools in order to dismantle the “school-to-prison” pipeline that disproportionately criminalizes Black and Brown students;

– Develop inclusive hiring practices to allow for people with criminal backgrounds to fill certain positions, especially those who may have been impacted by the war on drugs; and

– Engage in shared decision-making that invests dollars in opportunities for individuals living in low-income communities; plan together, then invest and implement solutions together.

Working at the intersection of government policy and low-income communities can be messy, but it is of national urgency that we confront the structural violence that results in poverty and disparity, particularly as we seek an equitable recovery from the COVID-19 pandemic.

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