Advancing Urban Public Health: An Equity and Social Justice Approach
Creating a community-centered urban public health hub to alleviate health inequities
The Rutgers community envisions a world where every person—regardless of their location, socioeconomic status, race, ethnicity, sexual orientation, gender identity, or any intersecting identities—can achieve optimal health and well-being.
In New Jersey and throughout the United States, efforts to enhance the health of people and populations are clearly falling short, particularly for individuals who are too often marginalized or underserved. For example, Black women in New Jersey have one of the highest rates of maternal death in the country. The United States is the only developed country in which the rate of maternal mortality is increasing. COVID-19, cardiovascular disease, Type 2 diabetes, drug addiction, HIV/AIDS, obesity, and other chronic illnesses follow similar patterns in our state and in the country, with communities of color and lower-income communities experiencing disproportionate rates of illness and death.
We must change the way we solve today’s health crises by shifting our focus from an overemphasis on a biomedical approach to a biopsychosocial understanding of prevention and care—one that focuses on the interconnection between biomedical, behavioral, psychological, and socio-environmental factors and is informed by social justice.
Rutgers School of Public Health, in partnership with Rutgers University–Newark, proposes an innovative model of urban public health that is both sustainable and replicable across the state and the country.
Using a biopsychosocial lens and a commitment to equity, this multifaceted model will effectively train the current and future public health workforce; develop and implement innovative approaches to prevention and care; and expand true community-engaged scholarship.
Such a change cannot be achieved by academia alone. It must engage multiple institutions and build on Rutgers University’s partnerships with government, business, and community-based organizations, and it must ensure that voices and community-driven solutions lead the way. Achieving health equity in New Jersey’s cities is possible and can help create solutions to advance public health in other urban centers.
The following two stories are a small reflection of public health problems in New Jersey’s cities, which could be more effectively solved with our model:
A 26-year-old African-American woman from Newark’s South Ward is pregnant with her second child. Her first pregnancy and birth were without complications. She received prenatal care throughout her second pregnancy. The baby is delivered by Cesarean section, a procedure that is more commonly performed on Black women than white women, often without clear communication from medical providers about the reason for the surgery. Two days after returning home with her healthy baby, the woman spikes a fever and goes to the ER, where she is diagnosed and treated for sepsis, a severe infection likely caused by the C-section. Despite treatment, she dies. This story is all too common in New Jersey, where Black women die as a result of childbirth at a rate of four to five times that of white women. In fact, New Jersey has one of the highest rates of maternal death in the country, higher than the rates in Mississippi or Alabama.
A 48-year-old Latino father of two school-age children tests positive for COVID-19. He works as an hourly employee, so missing days of work means his family will experience challenges in paying for housing, food, and other expenses. He is not alone. While Latinos make up 18 percent of New Jersey’s population, they make up 29 percent of the state’s COVID-19 cases and 20 percent of the state’s deaths from the disease. The recent pandemic has shone a spotlight on health disparities and social and environmental inequities that burden Black and Latinx communities in New Jersey and around the country. Systemic racism and discrimination fuel disproportionate rates of the underlying diseases that can make COVID-19 more fatal; economic and educational disadvantages; lack of access to care; a greater likelihood of work that requires interacting with large numbers of people; and housing situations that make isolating with COVID more challenging.
These stories demonstrate a growing public health divide in New Jersey. The current approach to addressing these issues is clearly ineffective, rooted in a failure to recognize how systems and structures undermine health. To effect change, we must engage with people and populations across communities, from describing health problems accurately to providing sustainable solutions. This work must also be implemented with a clear recognition that people tend to face multiple health challenges simultaneously and that populations are not monolithic. We must unite biomedical and behavioral approaches with a more sophisticated understanding of the social and structural factors that lead to health inequities and a commitment to changing them.
By breaking free of old approaches that inadequately partner with the very people they aim to serve and allowing the community to become the driver of solutions, we can train new public health practitioners and support the current health and public health workforce to be guided by the voices of the people they serve.
Moreover, by tackling structural racism and myriad social and environmental conditions that contribute to health inequity directly, we can develop more just solutions that attend to the realities that shape people’s lives. But this approach must come through a reimagining—of questions, of solutions, and of how we train our public health and health care workforce.
The focus on equity and social justice will help ensure that we develop health programming that addresses systems and structures as much as behavior and biology.
Too often, ideas are simplistic and don’t reflect the complexity required to create real and lasting change. The proposed approach is needed to ensure that changes are effective and sustainable.
Perry N. Halkitis Ph.D., M.S., M.P.H.
Rutgers University School of Public Health
Dr. Halkitis is a public health psychologist, researcher, educator, and advocate who is dean of Rutgers School of Public Health and a professor of biostatistics and urban-global public health there. He is the founder and director of Rutgers’ Center for Health, Identity, Behavior, and Prevention Studies. For three decades, his research has examined the intersection of HIV and other infectious disease with drug abuse and mental health burden to determine the biological, behavioral, psychosocial, and structural factors that predispose these and other health disparities. The center is also a training site for the next generation of scholars who seek to improve the health of LGBTQ people and populations. His research has been awarded more than $30 million in grant funding. He is the recipient of numerous awards from both professional and community-based organizations and he is an elected fellow of the New York Academy of Medicine, the Society of Behavioral Medicine, the European Academy of Translational Medicine, and four divisions of the American Psychological Association. He holds degrees in psychology, education, and public health.
Leslie M. Kantor Ph.D., M.P.H.
Chair, Department of Urban-Global Public Health
Dr. Kantor is a widely recognized public health leader, researcher, educator, and advocate. She is the inaugural chair of the Department of Urban-Global Public Health at Rutgers School of Public Health. Her projects include efforts to create health-literate messaging related to COVID-19, reduce severe maternal morbidity and mortality in Newark, and increase health equity. She has served on the boards of several national organizations, including ETR Associates, the Mexican American Legal Defense and Educational Fund, Power to Decide (formerly the National Campaign to Prevent Teen and Unplanned Pregnancy), and Answer. She received the 2020 Allan Rosenfield Alumni Award for Excellence from Columbia University’s Mailman School of Public Health; the 2019 Lloyd M. Felmly Award from the New Jersey Public Health Association for advancing public health through media; and the 2018 Carl S. Shultz Lifetime Achievement Award from the Sexual and Reproductive Health Section of the American Public Health Association. She is a graduate of Barnard College, the Mailman School of Public Health, and the Columbia University School of Social Work.