Bill Owens, a 52-year-old small-business owner, loves his Seattle neighborhood of South Park for its racial and ethnic diversity. Owens has become close to his neighbors of Vietnamese, Korean, Mexican, Guatemalan, and Jamaican descent. Yet Owens and his friends are making themselves sick by residing in South Park, an industrial area south of downtown Seattle that is home to more than 3,700 people.
Among the daily risks and challenges they face are limited access to healthy food, exposure to environmental toxins, and restricted transportation options. These and other burdens, including economic insecurity, weigh heavily on South Park residents.
For Owens, who is diabetic and has high blood pressure, chronic stress feels normal. The canine-supply business he owns nearly folded after a bridge connecting South Park to the rest of Seattle closed last summer for safety reasons. Owens' trusted service dog, a chow named Honey Bear, gives him comfort, but he can't let her dig or eat grass on the banks of the highly contaminated Duwamish River, one of South Park's few green spaces. Owens can't shop at a major supermarket, because South Park doesn't have one. He helped start a farmers market two years ago so he and others could have access to cantaloupe, strawberries, spinach, and kale. The effort, though, lost so much money after the bridge closed that he likely won't try to bring it back for another season.
"It's hard to live a healthy lifestyle in South Park," Owens says.
South Park is the kind of low-income neighborhood that can be found on the margins of every major metropolitan area in the United States. In such places, residents have easy access to alcohol, tobacco, and fatty processed foods. Parks or other safe places to exercise are rare. Limited public transportation options often lead to onerous commute times for people without cars. The factors conspire to create cruel realities for the people -- mostly racial and ethnic minorities -- who live in such communities. Conditions like uncontrolled diabetes, high blood pressure, asthma, and chronic stress thrive, and life expectancies are cut short.
"In the United States, we have a very powerful narrative about the role of personal responsibility in determining your outcomes, particularly your health," says Brian Smedley, director of the Health Policy Institute at the Joint Center for Political and Economic Studies in Washington, D.C. "But we're finding that your zip code is more important than your genetic code in determining your health."
Two-thirds of South Park's residents identified themselves as persons of color, according to 2000 census data. Nearly 34 percent of the neighborhood's residents are foreign-born, and 37 percent are Hispanic. The neighborhood is also home to Vietnamese, Hmong, Chinese, Korean, and other Asian communities as well as to Pacific Islanders, Native Americans, African Americans, and African immigrants.
Dolores Acevedo-Garcia, a Harvard professor who studies the effect of segregation on health disparities, has reviewed dozens of metropolitan areas across the country and has seen the same disturbing pattern again and again: Those who live in a "high opportunity" neighborhood, which is safe, healthy, and typically white, can expect to live up to 20 years longer than residents of a "low opportunity," impoverished neighborhood in the same city.
In an effort to reverse these life-or-death disparities, the Health Policy Institute started a nationwide initiative called Place Matters, which spotlights the far-reaching effects of neighborhood geography on health. The initiative focuses on designing and implementing health-improvement strategies for residents in 21 counties and three cities; Seattle's King County is one of the project sites. Smedley says the increased risks minorities face in poor and marginalized neighborhoods are striking. Blacks across the United States, for example, are five times less likely than whites to live near a supermarket with a produce section. Fifty-six percent of residents who live near commercial hazardous-waste facilities are people of color, even though they make up less than 30 percent of the U.S. population.
"Make no mistake," Smedley says. "Those kinds of circumstances can directly shape health."
South Park is a collection of modest houses and apartment buildings amid industrial sprawl. The Boeing Company has a long-standing presence in the neighborhood; the aircraft maker's original manufacturing plant is walking distance from South Park. For decades, the trade-dependent Puget Sound region has relied on trucks rumbling through South Park to carry freight to and from Port of Seattle terminals. The neighborhood boasts one of the city's last remaining swaths of affordable homes, but the cheap housing comes at a price: Children and adults in South Park and the nearby neighborhood of Georgetown are twice as likely as other King County residents to be hospitalized for asthma.
In the absence of a major supermarket, three corner markets along South Park's main drag sell cigarettes, beer, wine, chips, candy, sugary cereals, and Hungry-Man TV dinners. Two of the three stores don't have produce sections at all. One of them, South Park Grocery, has large Camel cigarette ads on the floor directly in front of the candy selections. Antoinette Angulo, a health-education program manager with Sea Mar Community Health Centers, which provides five clinics for low-income South Park residents, says uncontrolled Type 2 diabetes is widespread among clinic patients. Worse yet, adults with diabetes here and in nearby Georgetown are more likely to die from the disease or related conditions than are adults in neighboring communities.
"There's absolutely a food desert here," Angulo says. "The whole environment is set up to make it the hardest choice possible for people to eat healthy."
South Park's food-access problems are compounded by the local Duwamish River, which is polluted with polychlorinated biphenyls and other toxins after a century of industrial use. In 2001, the U.S. Environmental Protection Agency classified the river as a Superfund site -- one of the nation's worst hazardous-waste areas.
No agency has tracked how many people rely on the river as a source of free food, but James Rasmussen, coordinator of the Duwamish River Cleanup Coalition and a member of the Duwamish Tribe, sees immigrant and tribal fishermen and their families harvesting perch, rockfish, bottom fish, crab, and other shellfish health officials have deemed too contaminated to eat.
"Thirty years ago we were fighting to put up warning signs along the river because we knew there were significant problems with the fish back then," Rasmussen says. "The signs have only been up since the mid-1990s, and in a way, they don't even matter. ... If you're on unemployment or you have a very low income, you get to a point where you know you can go fishing and at least get your family something to eat."
It's not just the seafood that is contaminated, though. South Park families who walk and play on the river's mud flats are advised to thoroughly wash their hands and shoes -- and their dogs' paws -- to avoid absorbing toxins through their skin and tracking them indoors.
While all of this has taken a gradual toll on neighborhood residents, many saw the closing of the 78-year-old South Park Bridge last June as a final blow. The bridge was a vital link in and out of the already-isolated neighborhood: About 20,000 vehicles, including 2,800 trucks, used the bridge to cross the Duwamish River each day, and South Park residents walked across it to access bus stops to commute to their jobs. After the bridge closed, most commutes grew by at least 15 to 20 minutes each way.
"We had this awful feeling of, 'Not again!'" recalls Dagmar Cronn, president of the South Park Neighborhood Association. "We had to dig our heels in and try to make something better happen."
In Seattle, local officials are well aware of the health inequities in South Park and other low-income communities. King County government staffers and elected leaders have been trying to address such issues for years, all the while highlighting startling local statistics. A Native American baby, for example, is nearly four times more likely to die before his or her first birthday than a white baby is.
In 2006, Seattle and King County's public health department partnered with Place Matters to examine the negative effects of racism on Seattle-area residents' health.
"We in society have really taken a very narrow approach to health," says Ngozi Oleru, director of the department's environmental health division. "We've ... confused 'health' with 'disease,' and because of that, we tend to talk about health as 'health care.' The focus on health care is kind of a losing battle, because you're talking about something that's already broken."
Oleru and other county officials began identifying costly public programs that swoop in at the "broken" stage: incarceration of people with untreated mental illnesses; treatment of health problems tied to obesity and uncontrolled diabetes at public-health clinics; support for shelters that give homeless people a place to sleep for the night. They began trying to imagine ways to intervene much earlier.
"It became clear that we couldn't just focus on health," Oleru explains. "Transportation, economic development, education -- all of these other disciplines also mattered. You need to have all those things in place before you can be healthy, or before you can afford to be sick."
What began as optimistic dreaming became a countywide initiative in 2008 and recently, a countywide law: Last October, the King County Council unanimously passed an ordinance believed to be the first legislation of its kind in the country. Every county department -- from transportation to health to the courts to the sheriff's office -- is responsible for making annual, measurable commitments to address equity and social justice for the communities they serve.
Though the ordinance is too new to deliver measurable results across the county, officials say the years of discussion prior to the law's passage helped set the stage for saving the South Park Bridge. Numerous projects were clamoring for funding when the bridge closed last summer, but South Park bubbled up as a top priority when officials considered the neighborhood's beleaguered demographics. King County Executive Dow Constantine led the effort to secure $100 million in bridge-construction money from numerous local agencies and from the state of Washington; once that money was in place, the county applied for a federal grant to receive the remaining $34 million. The funding was finalized in October 2010.
The county's focus on inequities may have helped the funding effort, but just as crucial were the lobbying efforts of Boeing and other area companies. The businesses wrote urgent letters of support that were included with the federal grant application. At the same time, local officials emphasized the bridge's importance to both the regional economy and the welfare of low-income residents. Cronn of the neighborhood association co-chaired the South Park Bridge Coalition, which brought together representatives from area development councils, businesses, unions, schools, and the Port of Seattle.
"This is finally a glimpse of light at the end of a long, long tunnel," Bill Owens says. "We basically pitched a fit. We got the media's attention, we got politicians' attention, and something good came of it."
Though the new bridge is a clear victory for South Park, it will be at least two years before it opens. In the meantime, the community and local officials still must address South Park's life-threatening health inequities. Cronn, Owens, and others say residents were energized after winning the new bridge, and they remain hopeful more can be done.
"When people are organized and empowered, they can bring about real change in their communities," says Smedley of Place Matters. "And when governments are responsive and act as a catalyst for change, remarkable things can happen."