It’s no coincidence that the people who have the least influence over California’s decision-makers also have the worst health outcomes. It’s also no surprise that the elite Californians whose interests are amplified by campaign contributions, high-paid lobbyists and electoral power are shielded from the random and deliberate causes of poor health.
The optimum health of the few often flows from the favoritism they enjoy in the corridors of power. Meanwhile, millions of Californians with less political influence – economically struggling families, people in rural areas, communities of color and others – are more likely to get sick and less likely to live longer healthy lives.
How does this happen?
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Certainly the gap in health coverage has been a historically powerful factor. Thanks to California’s strong embrace of the Affordable Care Act, that gap has narrowed dramatically. Millions more have coverage today, and our state’s health indicators are on a positive trend.
That’s good news. And if we finish the job of closing the coverage gap – including no longer demanding that immigrants have documents from Washington, D.C., to qualify for Medi-Cal – universal coverage can be a reality. That, plus incentives in the delivery system to put prevention first, will go a long way.
But health coverage is only 10 percent of improvement in health status. Most of what affects our health happens in our schools, such as whether we have at least one water fountain that actually works. It happens in the way we use our land, including whether we have parks nearby instead of liquor stores. It happens in housing and income disparities, so that low-income people have a decent place to live that isn’t tens of miles from their workplace. And it happens in the way we administer criminal justice, so that prisons aren’t simply a revolving door.
The broad-based policies decided in Sacramento and Washington, D.C. – about who gets what, who pays what and who benefits – translate into who gets sick, who stays well and even who lives the longest. At its worst, this means those living on the short end of political decisions are surrounded by toxic policy conditions that exacerbate poverty, trauma, racial disparities and chronic stress.
To counter this phenomenon requires more equitable policies to promote clean air and water, food security, healthy schools, open spaces and reinvestment from punishment to positive youth development. In a healthier state, all Californians will be surrounded by conditions of opportunity.
But healthier conditions won’t simply come from the top down. Some of the best solutions will emerge from people who are surviving the most difficult conditions – when people with the most life experience have a greater say in who represents them and how their health and well-being will be included on the priorities list. Like it or not, that’s generally how politics works.
As the federal government seems hell-bent on undermining California’s progress, it is more urgent than ever that we commit to rising together with our power in numbers. We simply can’t afford to leave anyone’s votes or voices out.
Health outcomes will improve as we elect, enact and defend the people, policies and priorities that get at the root of our inequalities. California will thrive when those who have been left out are heard and have the power to hold our systems accountable over time.
We need to act – and vote – as if our health and our lives depend on it.