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101.4 The Political Determinants of Health
Voting, government and policy: how decisions shape our health
Your materials
Slides (PowerPoint) Handout (Word)
For instructors
Facilitator guide Printable pre and post tests Quiz (LMS import)
What you will learn
- Define the political determinants of health and their three parts
- Explain how redlining in Cleveland still affects health today
- Describe how Cleveland's lead safe law protects children
- Name nonpartisan ways residents can shape local decisions
Start here
Who decided where the bus line runs, where the grocery store went, and which homes still have lead paint?
Lesson
The causes of the causes
Daniel Dawes, in The Political Determinants of Health (2020), names three parts:
- Voting: Who takes part in choosing leaders and deciding ballot issues, and who is left out.
- Government: The councils, agencies and officials who run programs and spend public money.
- Policy: The laws, rules and budgets that decide who gets resources and protection.
How redlining happened
- Maps were drawn: In the 1930s, the federal Home Owners' Loan Corporation (HOLC) graded city neighborhoods A to D.
- Neighborhoods were colored: Green was best, blue next, yellow declining, and red was called most risky.
- Race was a factor: Grades looked at housing, but also at the race and ethnicity of residents.
- Loans were denied: People in yellow and red areas, mostly communities of color, were denied home loans.
- Disinvestment followed: In Cleveland, this fed white flight and disinvestment, mostly on the East Side.
Then and now
Then: policy choices
- Neighborhoods graded red were denied home loans
- Families could not buy, fix or build homes
- Businesses and public money went elsewhere
Now: health legacy
- Formerly redlined areas show more heart disease, diabetes and high blood pressure
- East Side redlined areas had the most children with high lead levels
- Poverty and poor internet access follow nearly the same borders
Lead: a policy story in Cleveland
Lead harms children's brains and bodies. Older homes can have lead paint.
- The law: In 2019, Cleveland City Council passed a law: rentals built before 1978 need Lead Safe Certification or an exemption.
- Check a home: Anyone can search an address on the city's Open Data Portal under Lead Safe Certificates.
- Get help: Call the city's Lead Safe line at 216-664-LEAD (5323) with questions or concerns.
- Test children: Encourage families to ask their child's doctor about a blood lead test.
How residents shape decisions
| Way to act | What it looks like |
|---|---|
| Vote | Register 30 days before an election; vote in every election |
| Speak at City Council | Sign up ahead for Monday public comment |
| Join a block club | Neighbors organizing for safety, cleanups and repairs |
| Call your council member | Report problems and share what your street needs |
| Join a board or coalition | Community councils, school and health advisory boards |
Looking upstream at a lead test
- What we see: Two-year-old Amari in Glenville has a high blood lead test and trouble with speech.
- Why it happens (upstream): His rental was built in 1920 with peeling paint. Decades of redlining and disinvestment left old housing unrepaired.
- What we can build on (assets): Cleveland's lead safe law, the city lead line, a block club that knows landlords, and early intervention through Help Me Grow.
Situation: the meeting about the clinic
Situation: The only clinic near Fairfax may close. Your block club president, Mr. Owens, asks you to speak at City Council public comment. A client asks you which candidate she should vote for.
What do you do as a CHW?
- Check with your supervisor about speaking for yourself or your agency
- Help residents sign up and share their own stories
- Do not tell the client whom to vote for
- Show her how to find nonpartisan voter information
Talk it over
- What decision made by government shaped your neighborhood's health?
- Who in your community has changed a local policy? How did they do it?
- What is one small civic step you could take this month?
Study sheet
The big idea: Voting, government and policy decide many of the conditions that shape our health, and residents can shape those decisions.
Key points
- Daniel Dawes names three political determinants of health: voting, government and policy.
- In the 1930s, federal HOLC maps graded Cleveland neighborhoods and led to denied loans in red areas.
- Formerly redlined areas still show more heart disease, diabetes, high blood pressure and child lead exposure.
- Cleveland's 2019 law requires Lead Safe Certification for rentals built before 1978.
- Residents act by voting, public comment, block clubs, calling council members and joining boards.
- CHWs teach civic process and stay nonpartisan: never tell anyone how to vote.
Remember
- Three parts: voting, government, policy
- Cleveland lead line: 216-664-LEAD (5323)
- Lead Safe Certification: rentals built before 1978
- Ohio voter registration closes 30 days before an election
Ask yourself
- Which policy decision has most shaped the health of my neighborhood?
- How can I help others speak for themselves without speaking for them?
Vocabulary
| Word | What it means |
|---|---|
| Political determinants of health | How voting, government and policy shape who gets resources, power and good health. |
| Policy | A law, rule or budget decision that guides what governments and organizations do. |
| Redlining | The practice of denying loans and investment to neighborhoods, often because of residents' race. |
| HOLC | Home Owners' Loan Corporation, a 1930s federal agency that drew neighborhood grading maps. |
| Disinvestment | When money for homes, businesses and services is pulled out of a neighborhood over time. |
| Lead poisoning | Harm from lead in the body, often from old paint dust, that can damage a child's brain. |
| Lead Safe Certification | Cleveland's required proof that a pre-1978 rental has been checked and is lead safe. |
| Public comment | Time at a government meeting when residents may speak to officials. |
| Block club | A group of neighbors on one or a few streets who organize to improve their area. |
| Nonpartisan | Not favoring any political party or candidate. |
Real-life situations
The peeling paint
Ms. Robinson rents a 1915 house in Slavic Village with her baby and toddler. Paint is peeling on the windowsills, and she is afraid to complain to the landlord.
What to do
- Listen to her fears and respect her choices
- Help her look up the address on the city's Lead Safe Certificates data
- Share the city lead line, 216-664-LEAD (5323), and offer to call with her
- Encourage her to ask the children's doctor about blood lead tests
Why: Cleveland law requires pre-1978 rentals to be lead safe certified. The CHW helps her use that protection and get the children tested.
The new voter
Destiny is 17 and in your youth health group in Hough. She turns 18 before the next general election and asks if she can register.
What to do
- Tell her Ohio lets her register if she will be 18 by the general election
- Show her official places to register, such as the county board of elections or the BMV
- Remind her registration closes 30 days before an election
- Do not share opinions on candidates or issues
Why: Teaching civic process is part of upstream work, and staying nonpartisan protects trust.
The block club meeting
Neighbors in Clark-Fulton are upset about dumping on a vacant lot near a school. They ask you, as a CHW, what they can do.
What to do
- Help them name the problem and what they want to change
- Show them how to report it to the city and contact their council member
- Help them sign up for City Council public comment if they choose
- Connect them to existing block clubs or community groups as partners
Why: Residents hold the most power to change their own neighborhood. The CHW supports their voice rather than speaking for them.
Activity: Follow one decision
About 30 minutes.
- Pick one thing in your neighborhood that affects health, such as a bus line, a park, a store or housing.
- Find out who decided it: a city council, a county agency, a state law, or a private company.
- Write who has the power to change it and how residents can reach them.
- Write one nonpartisan action a resident could take, such as public comment or a call.
- Share your findings in the course discussion.
Post-test
Ten questions. You need 75% to pass, with one retake. Your result is saved in this browser.
Sources
- Patient Engagement HIT, What are political determinants of health (Dawes definition)
- United Way of Greater Cleveland, Redlining: a lasting legacy
- Case Western Reserve University, Think magazine, redlining research
- Next City, Cleveland redlining history and health policy
- Spectrum News, University Hospitals study connects redlining to poor health outcomes
- City of Cleveland, Lead Safe Program: what to know
- Ohio Legislative Service Commission, Voting in Ohio
- Signal Cleveland, Public comment returns to Cleveland City Council (2024)
- Cuyahoga County, Help Me Grow
- University of Richmond, Mapping Inequality project releases new redlining maps (2023)
- Bunk History, analysis using Mapping Inequality data (links to Cleveland HOLC map)