In Communities Where Civic Health Is Poor, Lives Are Shorter

Neglected civic infrastructure — schools, parks, community centers, libraries and other public spaces that help foster a sense of belonging — coupled with barriers to participation in civic life aren’t just manifestations of poor governance. According to the 2023 County Health Rankings & Roadmaps (CHR&R) from the University of Wisconsin Population Health Institute (UWPHI), they have health consequences.

The rankings, published since 2010, were developed to provide insight and guidance for improving health equity. The new report focuses on relationships between the state of civic infrastructure, community engagement and well-being.

“There is a connection between our civic health and thriving people and places,” says Sheri Johnson, the director of UWHPI.

The pandemic made the chronic stress faced by those without access to broadband connections, safe public spaces or other civic resources more visible than ever. Public health researcher Arline Geronimus has been at the forefront of research demonstrating that the stresses of poverty and discrimination actually cause cellular-level damage, overloading the hormonal systems that help us survive dangerous situations.

Studies of this phenomenon are demonstrating that diet and lifestyle aren’t enough to explain disease rates and maternal health problems in minority communities. This work adds a new dimension to the long-established principle that social well-being is an essential component of health.

UWHPI’s What Works for Health tool offers scores of strategies to address social factors. “There are many evidence-informed solutions that local communities can take up to improve civic health, and those actions can simultaneously make a difference in how long and well we live,” Johnson says.

What Works, What Doesn’t

Chief among these solutions are investments in civic infrastructure — the public spaces that connect communities. Youth leadership and mentoring programs also foster connections, Johnson says. (In separate new research, a group of social and behavioral scientists report three out of four Americans don’t feel a sense of “belonging” in their local community.)

Counties with more available and well-resourced civic infrastructure have higher rates of high school completion, adults with health insurance and less income inequality, says Michael Stevenson, the evidence and policy analysis team leader for CHR&R. Counties in the Northeast, Midwest and West are most likely to have these characteristics.

By contrast, counties in Appalachia, the “Black Belt” region, tribal areas and along the U.S.-Mexico border have endured long-term disinvestment in civic infrastructure. This is reflected in lower high school graduation rates, greater income inequality and more children living in poverty.

Policies around voting show commitment to democratic processes and opportunities for citizens to have a say about matters that affect their lives. Gerrymandering, laws that make it more difficult to vote by restricting eligibility or registration, or otherwise disenfranchising voters, present “structural barriers,” to civic health.

Stevenson notes that in counties with such barriers, particularly those in the South, life expectancy is three years shorter than in counties where they are not prevalent.

More Than Books

Cornelius, a city of about 13,000 in Washington Country, Ore., is surrounded north and south by farmland. Latino farm workers began settling in the area 50 years ago. Today, Latinos are 53 percent of the population.

“Almost all of the rest is white,” says Karen Hill, executive director of the Cornelius Public Library. “We’re diverse, but only two kinds of diversity.”

Early on, changes in the city’s demographics created friction. Community members and progressive leaders wanted to move past divisiveness. Hill spends her working hours in a structure that is emblematic of that spirit, Cornelius Place.

The building is home to both the city library and 45 affordable housing units for residents 55 years old or older. The city spent more than a decade planning and raising money for it, intending for it to play a major role in civic life.

“Our community didn’t have a community center,” says Hill. “We didn’t have a senior center, we didn’t have a teen center — our library had to fit that need.”

The building design incorporated a large meeting room that could be split into smaller rooms and a large plaza, and the city began using it for community gatherings. Water and electrical connections were installed to support a farmers market in the alley behind the library.

Initially, Hill hired a bilingual outreach librarian and brought in bilingual volunteers for library programs. (Residents of Cornelius Place also volunteer.) Today, six of her nine full-time employees are bilingual, able to help residents who need assistance with anything from Internet connections to job applications.

“The library is not about books, it’s about getting people together to improve their lives,” says Hill. They make social connections, we connect them to agencies, we provide them with information.”

Cornelius Place serves as a gateway to the heart of downtown, says its designer, architect Ryan McCluckie. “It is a recognizable landmark of progressive public policy meeting the needs of its residents.”

Cultivating Change

City leadership isn’t the only force cultivating a sense of community in Cornelius. In the late 1960s migrant worker families began to meet and talk about what it would take to improve their access to health services, housing and jobs.

In 1972 they formed a nonprofit, Centro Cultural, to meet the needs of the Washington County farm worker community and to engage with local government to advocate for change. Since then, it has grown from a mostly volunteer group to 76 full-time staff whose funding includes federal grants and contracts, says Executive Director Maria Caballero Rubio, the daughter of migrant workers who settled in the area.

The relationship with the city of Cornelius really began to gel in the late '80s, she says. The city holds events at its facility and Centro Cultural has been involved in its planning commission. Three Latinos have been on the city council in the last four years.

In response to a pattern of profiling and targeting by local police, Centro Cultural worked with the city and the county sheriff’s office to disband the Cornelius police department and turn law enforcement over to the county.

“They have a broader perspective, they’re more open to partnering with the community,” says Rubio, who has worked in law enforcement herself at county, state and federal levels.

Building Momentum

“History shows that when previously disenfranchised groups built power and expressed their will through voting and advocacy, the policies that followed benefited the health and well-being of all,” the authors of the CHR&R observe in their introduction, citing drops in infant mortality when women gained the right to vote and health improvements following the passage of the Civil Rights Act.

Rubio believes the activism of Cesar Chavez brought inspiration and momentum to the efforts of farm workers in Washington County.

It’s not easy to read the current moment. Black Lives Matter protests, the largest in the country’s history, have yet to yield a policy victory. Reproductive rights proved to be pivotal in last year’s midterm elections after the U.S. Supreme Court struck down Roe v. Wade, but fears remain that past progress in regard to race and gender is at risk.

At the same time, nonpartisan support for civic education is growing. Many communities are reaffirming commitments to equity and inclusion. The public health community is recognizing how all this relates to health, Johnson says. “That’s exciting.”