A recent document from the American Medical Association and the Association of American Medical Colleges asks doctors to address health inequities by prioritizing structural conditions. Here is one example involving land use which first asks the conventional question and then highlights a health equity perspective:
How can we promote healthy behavior?
How can we democratize land use policies through greater public participation to ensure healthy living conditions?
The second perspective highlights a structural perspective in two ways.
- Healthy behavior leans more toward an individualistic perspective. A person who has health concerns should adapt their behavior in order to be more healthy. In contrast, healthy living conditions suggests there is a broader context for the individual’s health. Healthy living conditions can help lead to healthier individuals.
- With healthy living conditions in mind, the new question highlights two ways that healthy living conditions come about: land use policies and greater public participation. This likely refers to research and experiences certain communities have with decisions made about where to locate land uses – ranging from coal power plants to landfills to manufacturing facilities with toxic output and more – that then affect health. Such decisions involve power, race/ethnicity, and social class as well as decision-making processes.
More broadly, land use in the United States is often determined by zoning and profit-seeking. Zoning often has the goal of protecting single-family homes. Land and location can be turned into money. Health is not a primary concern in all of these decisions even as it can lead to better health outcomes for some compared to others.