Throughout its history, the United States has implemented federal infrastructure projects that have benefited certain communities while destroying others. During the colonial era, much of the nation’s early infrastructure facilitated trade and commerce for colonists, but it also exploited indigenous civilizations. The $ 36 million Transcontinental Railroad project, started in the 1860s, displaced millions of indigenous peoples and destroyed their holy land. A century later, in the 1950s, the Interstate Highway System created an efficient mode of travel for some communities, but it also divided and destroyed other communities and exacerbated spatial segregation.1
At its core, the nation’s infrastructure projects have either reflected values of equity or a lack of such. In this context, health inequality is defined as the removal of «obstacles to health, such as poverty, discrimination and their consequences, including powerlessness and lack of access to good jobs with fair wages, high-quality education and housing, safe environments and health 2. Historically Equal health has not been at the center of decisions to build infrastructure in the United States, exacerbate or create social, economic and political disparities, which can be observed in urban, suburban and rural communities in every corner of the nation.
Despite previous challenges, it is possible to build infrastructure that improves health equality. In 2009, for example, the federal government allocated $ 19 billion through the Health Information Technology for Economic and Clinical Health Act (HITECH) to improve and accelerate health information technology in the United States.3 More than a decade later, this digital infrastructure has proven to help raise awareness of health inequalities for people of color – both in terms of infection rates and vaccination status – caused by the COVID-19 pandemic. [4]
Fortunately, with the latest version of federal infrastructure financing – the $ 1.2 trillion Infrastructure Investment and Jobs Act (IIJA) enacted in November 2021 – we have an opportunity to chart a new course and begin to focus health justice on building and restoring infrastructure.
Implementing Health Equity Infrastructure
There are six main categories of infrastructure that the federal government is most interested in funding through IIJA: transportation, water, broadband, resilience, energy and older pollution. Although some of these categories do not appear to have an obvious relationship with health equality, they all do. For example, in the “water” category, addressing health equality may mean ensuring that poorer households have as much access to clean drinking water as richer households. On the same subject : Review: IT in healthcare has produced modest changes – so far. The category “resilience” can mean ensuring that experimenting with renewable energy solutions (such as building a dam for hydropower) in one area does not pollute or damage the ecological landscape in a neighboring area. Resources for navigating IIIA funding are increasingly available.5
The power to create a more just future for all societies through infrastructure is largely in the hands of local, city, state and tribal officials. But it is also in the hands of community-based organizations, non-profit organizations and non-governmental organizations (NGOs) that are stewards of the communities that IIJA funding is meant to serve. We should not underestimate the power of non-governmental organizations to direct federal funding to projects that improve health equality, even though the roles of these organizations differ from governmental entities in important ways. The main difference is that NGOs are not always eligible for federal funding.
In general, many federal grants are available to state and local governments as well as community groups. Even individuals may occasionally receive federal scholarships for higher education and other pursuits.6 However, discretionary funds and formula funds specific to IIJA are only available to government agencies. Private organizations cannot apply directly for this funding. Nevertheless, grassroots community organizations are incredibly knowledgeable about what is happening on the ground in their local communities and often have great trust and respect in the community. For this reason, non-profit organizations and voluntary organizations are powerful gatekeepers, who promote projects that will improve health equality and advocate for projects that do not. They must play a role in guiding how this federal funding is used.
The Power of Grassroots Organizations
Many communities across the country have already recognized the importance of grassroots organizations in making effective, equitable changes in the community. Among them are the members of the Planning Exchange for Healthy Regions *, convened by the Regional Planning Association. The Planning Exchange is a nationwide partnership that brings together health professionals, planners, advocates and community leaders from major metropolitan areas, medium-sized cities and rural areas across the United States to confront and address health inequalities in urban planning on a regional scale.
During the second phase of the Planning Exchange, participants from each region collaborated to change their organizational infrastructure to create better health outcomes for their residents. On the same subject : The Tragedy to Insulin Costs in the United States, 2017-18.
The latest research from the Planning Exchange, coordinated and authored by the Regional Plan Association in collaboration with Planning Exchange participants, strives to provide a guide to centering health justice in infrastructure decisions. Investing in Infrastructure for Healthy Communities is exploring three case studies in Atlanta, GA, Rochester, NY and Umatilla Indian Reservation, OR, where organizations leverage federal resources to promote health justice by building football pitches next to train stations, and replacing a freeway with housing and community property, and expand a bus network in the countryside. The report links each case study with the work of Planning Exchange participants striving to complete similar projects in Pittsburgh, PA, Multnomah, OR and Pine Ridge, SD, respectively.
Sign up for our free newsletter
Subscribe to the NPQ newsletter to have our top stories delivered directly to your inbox. Read also : Alabama’s Javion Cohen opens up for mental health, says he spent a month in rehab.
By registering, you accept our privacy statement and terms of use, and to receive messages from NPQ and our partners.
From Identifying to Fulfilling Community Needs
These six stories illustrate that it is possible to build projects in the United States with a view to fair health. The rest of the report outlines in detail how other governmental and non-governmental organizations can follow in the footsteps of these organizations. The graphic below illustrates what the process might look like:
The first step is to identify the needs of the community. Stakeholders must assess the characteristics of the community and ask themselves: What separates the area from neighboring communities, for better or worse? Given these differences, what results do we want for society? Do we want it to be a more accessible place? A more commercial living place? A safer place?
The second step is to review existing infrastructure plans. It is important to know which projects are already in the pipeline so that we do not regret or duplicate projects unnecessarily. With this information, stakeholders can then answer the question posed in step three: Do the community’s plans match the community’s needs? Depending on the answer to this question, community representatives will either have to propose a new project that meets the needs of the community, modify an existing project to better match the needs of the community, or ideally go ahead and promote the existing project to ensure that community needs are met. fulfilled as promised.
Although this strategy is highly recommended to start building fair health, gaining confidence and healing past injuries, it is easier said than done. Existing examples and case studies are crucial because they help to illustrate the nuances of the process in different regions facing different health challenges. Some important lessons from the case studies that can be applied universally include the need to form, maintain and exploit relationships; be creative; and persevere.
Both members of the Umatilla Indian Reservation and Pine Ridge Planning Exchange participants are working to reclaim land for their people by building self-reliant transit and energy systems. For them, forming, maintaining and exploiting relationships means being in touch with society’s values and building trust from the inside out. Rochester, NY and Portland, OR, exert creativity by redefining and redefining the ways highways are used to ensure they are safe, accessible and child-friendly areas. Finally, by gaining the trust of the community and leading with community values, Atlanta, GA and Pittsburgh, PA, have been able to implement new or unconventional ideas, developed infrastructure projects that push back towards the status quo in terms of transit-oriented development looks like .
These examples show that communities in many regions across the country already envision a world where equal health dictates where and how infrastructure projects are built. This is one of the first steps towards building a fairer society. However, this vision can only be realized with federal procurement and resources, including the IIJA funding that will be made available to localities over the next five to eight years. To achieve this feat, it is crucial that government and non-governmental organizations form and maintain partnerships with each other. It is equally important that social activists are creative in the design of infrastructure projects to meet the needs of their constituents, and that they persevere and hold each other accountable until the projects are completed. To achieve true fair health and help communities move forward, we must recognize and heal past injuries. This process begins when a choice is made to prioritize health equality in everything we do.
* Bloomberg Philanthropies and the Robert Wood Johnson Foundation (RWJF) supported the Healthy Regions Planning Exchange. Views here do not necessarily reflect the views of Bloomberg Philanthropies or RWJF.
