Your Health, Your Environment
If you live in a residentially segregated area with comparatively high rates of crime and violence, limited access to healthy foods, and inadequate health care, it's going to affect your health. Public health professionals who ignore this reality do so at our peril, Carl V. Hill says.
Hill, PhD '05, believes that to address health disparities in the U.S., new steps - and an interdisciplinary team approach - are needed, "because these disparities are created and sustained at environmental, sociocultural, behavioral, and biological levels."
As he and co-authors Timothy A. Akers (a behavioral scientist) and Roberto H. Potter (a criminologist) argue in their new book, Epidemiological Criminology: A Public Health Approach to Crime and Violence, various disciplines can inform and strengthen efforts to address health disparities. Epidemiologic tools can provide quantitative research methods to help criminologists understand population phenomena, while criminology can shed light on behavioral choices such as gang membership and violence, which may serve as coping strategies for individuals facing harsh circumstances.
With homicide a leading cause of death among young African-American men, criminalization is "without a doubt" a health disparities issue, Hill says. By "criminalization" he means not just criminal activity or criminal justice, but physical environments where crime and violence may be products of high unemployment, restricted social mobility, and structural racism. Even if people have no direct interaction with the criminal justice system, residents of neighborhoods where violence is prevalent experience the negative health impacts of criminalization. "While public health has given criminalization some attention in terms of violent-behavior prevention," Hill says, "there's a broader landscape for thinking about this."
Because events that happen to us throughout the lifespan help determine health status, life expectancy, and quality of life, health-disparities research has broad implications for aging. As director of the Office of Special Populations at the National Institute on Aging, Hill has worked with colleagues to develop a framework to motivate health-disparities research related to aging - research that takes into account not just health behaviors and socioeconomic factors, but also the implications of racial discrimination, and how biological pathways and markers such as telomere attrition, epigenetic alteration, and chronic inflammation are affected to produce health disparities.
Ultimately, the goal is to intervene at critical points to change not only individual behaviors but also environmental factors, like housing and school quality, which affect health. Many times people don't choose to live in under-resourced, violent places, says Hill, who became interested in interdisciplinary health-disparities research as a doctoral student in the U-M Center for Research on Ethnicity, Culture, and Health. His experience at SPH, he adds, "has really informed and sustained my work."