A healing centered approach helps communities write their own public health interventions

What brought you to the field of public health?

I grew up in New York City, where I experienced and lived in very unequal neighborhoods. I always just kind of accepted that folks in neighborhoods where I grew up had more asthma, were more prone to disease than other places.

I started to think that maybe the way we did our urban planning—where the bus depots were located, where waste treatment plants keep getting put—was wrong. I began to realize that the best way to reinvest in my community would be to work in urban policy and environmental policy.

So that’s where I focused and got my start working on environmental justice issues. I quickly realized that in every environmental justice community, issues like multi-generational trauma and violence—not just physical violence, but violence from disinvestment of city government, racism, and segregation—were all at the top of people’s agenda. It wasn’t always about a disease, environmental pollutants, or toxins, which is what I originally prepared to focus on.

I’ve worked for the New York City government as an environmental planner, working on major projects in the Bronx and Brooklyn involving communities of color and environmental racism issues. That inspired me to think more broadly about these issues and led me to public health, because, again, I was focused initially on environmental health and urban policy and planning.

And then I realized that, actually, public health and urban planning as disciplines kind of grew up together, were formed together, but they kind of split and, you know, rarely talked to one another for at least 100 years. Now in the last couple of decades they have begun to come back together as we think about how our built environment and our social conditions get into our bodies and shape our health and well being.

What inspired you to write Cities for Life?

After over a decade of work with community residents on health equity issues in multiple cities around the world, I kept seeing the same need for what I call the “healing centered approach,” which means not focusing on just one disease or not focusing even on health, but communities expressing a need to heal from decades, if not, centuries of inequitable policies. Our traditional public health approach, according to all my partners in this work on the ground, really was not meeting their needs.

It’s not healing in the sense of a clinician or healing in the sense of what we would call a clinical approach, but it is communities coming together and healing by focusing both on people, what people needed, and also their place, their communities. And through that, coming together to build power, and often that power was trying to change policy. So those were a lot of the inspirations for me for writing this book and the content and, and the stories that are in there.

What were some of the biggest lessons you learned while visiting and working in these cities?

One of the biggest lessons I learned was that community members hold vast amounts of expertise in health and healing. In other words, they’re not just advisors but they’re experts in knowing stuff about their own experience, their communities, and what their communities may need.

I also learned about the idea of moving away from focusing on one disease at a time. We’re hearing a lot lately about the risk of one disease behavior, or even one exposure. Instead, I started thinking about this idea of healing, which I, again, learned from community members. Of course, this is not unique, but healing is a process. It’s an ongoing process. Social connections and relationships are critical for healing.

We can treat people, and of course that’s important, but we’re often sending them back into the living and working conditions in neighborhoods and communities that are making them sick in the first place. We’re also not focusing on improving social relationships and connections that are so, so important for healing. I was really inspired by the persistence of particularly poor communities, communities of color, communities with few resources to find ways to heal together.

What’s your advice for cities and communities who are trying to fix policies and practices to be more focused on healing and health?

Seeing, valuing, and investing in people’s humanity. Everyone needs to be a priority. Folks that have been traumatized are often stigmatized as diseased, unworthy, or not participants in the public health or healing process.

Second, you have to focus on people and places at the same time. We must focus on improving community conditions or the context in which people live, their environmental conditions. We need to recognize that many of the city policies that have been entrenched for a long time, either policies or practices—things like residential segregation, environmental and land use planning—are sources of trauma for people’s bodies. We need a healing approach to reverse and address those traumas. Cities need to stop thinking about those traumas as just policy or economic development issues. But they’re actually health issues. Housing and land use, and related policies, including education, youth, and childhood policies are all potentially healing policies that cities have control over.

Why did you choose to focus on these three cities (Richmond, Medellín, and Nairobi) in particular?

My work didn’t start as a book project. I’ve been working in each of these places for 12 years or so, in partnership with local activist community residents, organizations, and local governments.

I’ve worked in Richmond addressing environmental injustice and health inequalities that the city has faced, including high rates of gun violence for many years. In Nairobi, Kenya, I worked in partnership with community residents in informal settlements for a long time as they tried to gather data to make their living conditions inequitable. Over time, I began to see the parallels in these places. And that’s what I highlight in the book.

The shift from a focus on disease or risk or health to healing was what I was hearing in these three very different parts of the world. Each of them has very different political systems, very different kinds of wealth. But each community sat in the most unequal places in their region. Some of the neighborhoods in Richmond are the most unequal in the Bay Area, one of the wealthiest parts of the world. In Nairobi, the communities that we worked in are informal settlements, sometimes called slums, but really more like self-built communities that are some of the most impoverished, most under-resourced living conditions in the world. They neighbored golf courses and wealthy high-rise buildings. Same thing in Medellín, Colombia, which, of course, was once the most violent city in the world.

The book was kind of a backward project in the sense that I was already doing participatory work in these three places, and began to see the parallels over a decade, working in partnership with communities.

What do you hope readers take away from reading your book?

That we really have to question what we’re doing in public health. We’re still, for example, in our school of public health, training people around single diseases or sectors like environmental or health policy, but we’re not preparing our students to really think about urban health.

We are living on an urban planet. A majority of the planet is living in cities or metropolitan regions. But we’re still training people as if it’s a 19th- or 20th-century model. There’s a lot to learn from what we did well and didn’t do well in the history of public health. I want people to look critically at our history to have a sense of what works.

And, as I mentioned earlier, we need to expand the notion of public health expertise. We’ve seen, particularly now during the pandemic, that often the conversation has been very limited in terms of who’s involved in studying policy and who may be impacted, and whose voice is considered in deciding whether a public health policy is going to have the best and widest impact, particularly on the most vulnerable populations.

So there’s been, I think, a failure to include a wide range of voices, particularly community voices, or non-expert voices, in our public health policy decision-making. And I would hope that people take away from this book, the need for that really good science, good public health evidence, and more importantly, relevant interventions, healing-focused interventions, and demand that community expertise in that community knowledge.