A church boardroom seems like an oasis in an area so crime-ridden that iron fences topped with spikes protect most homes. Inside the church, residents settle into padded leather chairs to plan a better future for the East Oakland neighborhood of Sobrante Park. They want to reduce crime, decrease neighborhood blight, and reopen a park closed years ago after a homicide.
"It's been known as a very dangerous area," said the Rev. Jeffrey Parker, who left a comfortable home in Berkeley when he moved to Sobrante Park four years ago to lead the neighborhood's only church.
It's the relationships formed around the conference table in the Community Reformed Church that create the momentum for change.
One-fifth of Sobrante Park's 2,800 residents live in poverty. It has far higher rates of asthma hospitalizations and diabetes, and deaths from cancer and heart disease, than more affluent East Bay neighborhoods.
Residents here live on average 71.2 years, according to an Alameda County database of disease prevalence and life expectancy. They have the lowest life expectancy of any ZIP code in the East Bay.
The database reveals that disease rates drop and life-expectancy increases each rung up the social ladder. Residents in a Walnut Creek neighborhood 12 miles away, for example, live on average 87.4 years, more than 16 years longer than those in Sobrante Park.
Public health experts widely agree that poorer neighborhoods — which lack grocery stores, pharmacies, doctor's offices, post offices and parks — largely explain the wide gap in life spans.
The trying conditions ring up a toll in chronic stress that triggers numerous diseases, health experts say.
"What will deteriorate your health is fear, stress, not getting a lot of sleep if they're worried about somebody breaking into their home, even if they have alarms," said Parker, the pastor.
Tensions and changes
In 2004, Sobrante Park's community leaders gained a powerful ally in their quest to reclaim the neighborhood's thriving past when the Alameda County Public Health Department chose it as a laboratory in which to test how social cohesion among neighbors and civic leadership leads to better health and longer lives.
A lack of such social unity often characterizes poorer neighborhoods. About half of Sobrante Park's residents report mistrusting their neighbors. Racial tensions have frayed relationships in an area where 57 percent of residents are African-American and 34 percent are Latino.
Sobrante Park was once a tidy neighborhood, boasting two parks and a street lined with stores. Businesses began closing in the 1960s, and today one liquor store with packaged foods remains.
Young men gathered on street corners stand out in the largely deserted streets. Speeding cars disturb the night, residents say, as do occasional gunshots. A recent rash of brazen home break-ins has people on edge.
Once there were block parties in the adjacent Brookfield neighborhood, said Dietrich Roberson, a Community Reformed Church member.
"Everybody kind of stays to themselves now," Roberson said. "They're watching their homes. A lot of the people, they are so broke they'll try to rob you."
She and her husband have three Rottweilers, and don't like to stay away from their home for more than a few hours.
Such divided neighborhoods reveal their powerlessness when they fail to band together to fend off unwelcome intrusions, such as a fast-food outlet or an industrial operation. Nor do they as readily demand improvement of inadequate schools, opening or fixing parks or securing more police protection.
So those in poorer neighborhoods remain "underserved," in the parlance of government workers. Yet they pay taxes like everyone else, Roberson said.
"This is sad, because we need parks," said Edel Orantes, who lives in Sobrante Park with her husband and 17-year-old son.
The community's only park, Tyrone Carney Park, has been fenced off since 2002 after a homicide there, creating a community eyesore that frustrates residents.
"We need more police patrolling," so the park can reopen, Orantes said.
Social ties' benefits
The critical first step, one Alameda County health leader said, is creating neighborhood bonds to strengthen the group.
In public health circles, projects like those under way in Sobrante Park are called "community capacity building," and they focus on enabling communities to advocate on their own behalf, moving beyond a charity-based model of community health improvement.
"We feel very, very strongly that helping to strengthen communities is a key component of prevention," said Sandra Witt, deputy director of planning, policy and health equity for the Alameda County Public Health Department.
Creating stronger social ties offers immediate health benefits. Pioneering research in Alameda County in the 1960s and 1970s showed that social support reduced the harmful physiological effects of stress, increased a person's sense of control and self-worth, and influenced healthier dietary choices, physical activity and smoking reduction.
Since the Sobrante Park project began in 2004, more than 100 residents completed 16-hour leadership courses. Councils formed, or existing ones regrouped. They tackled neighborhood blight, crime prevention, disaster preparedness and strategic planning. The Alameda County Public Health Department awarded Sobrante Park groups grants of as much as $1,500 to promote healthy eating, physical activity and youth programs.
The department also helps fund an annual spring health fair in Sobrante Park, this year featuring nearly 30 booths.
The Sobrante Park Time Bank has become an esteemed program. Co-founder Paul Butler, 55, said he fields three to four calls weekly about the program.
Currently, 170 residents belong to the Time Bank, through which they exchange with other members services such as pet sitting, child care, car repair, carpentry, computer maintenance, gardening and housekeeping. More than 4,300 hours of services have been exchanged since the Time Bank opened in 2004. The health department provides $51,000 a year to fund it, mostly to pay salaries.
Butler, who moved to Sobrante Park when he was 5, said his work with the Time Bank built rapport with residents.
"Now I see them and I'm hollering at them down the street," he told a group of Shasta County public health officials visiting Sobrante Park to learn about the community-building project.
Work show progress
The work in Sobrante Park has shown results. Half the people surveyed in 2007 by the public health department said the neighborhood was cleaner than in the previous year. Calls complaining about such blight as abandoned cars and neglected buildings dropped 25 percent from 2004 to 2007.
More people attended neighborhood barbecues or block parties and more felt prepared for a disaster, such as an earthquake.
Next year, the department plans to repeat the survey. Witt said the Public Health Department plans to sustain the program for years to monitor how it affects health.
Underscoring the social and economic nature of health disparities, Shasta County's recent study of its life expectancies by ZIP code revealed a 14-year gap between adjacent neighborhoods, said Donnell Ewert, director of the public health department for Shasta County, where 87 percent of the population is white.
The intensifying regional and statewide focus on the root causes of poor health has been driven in significant part by support from the nonprofit California Endowment based in Los Angeles.
The California Endowment in the spring will begin funding its Building Healthy Communities initiative. It intends to spend hundreds of millions of dollars from 2010 to 2020 building up resource-poor neighborhoods.
Its goal: launching a "prevention movement" by reducing disease rates through community improvements.
Other communities are also moving forward.
The San Francisco Department of Public Health led a "health impact assessment" initiative to analyze the health effects of urban development and social policies. It was based on the same 1969 law, the National Environmental Policy Act, which authorized environmental impact assessments.
The San Francisco public health agency wielded that power lightly but won significant changes in new developments, such as a high-density housing project called Trinity Plaza. The San Francisco Department of Public Health has since created a voluntary checklist to raise awareness of health consequences of projects. Other cities, including Oakland, Galveston, Texas, and Denver are using the tool to guide their own urban planning.
With assistance from the California Endowment, the Humboldt County Public Health Branch also used a health impact assessment last year to develop its general plan, particularly the transportation element.
Richmond, also assisted by the endowment, adopted a health and wellness element in its draft general plan. It requires the consideration of health effects for city projects and initiatives. If approved next spring, Richmond will be the first government in the state to require such a broad consideration of health effects.
The Oakland nonprofit Human Impact Partners is also advocating for developments that consider health effects. The group, for example, completed a health impact assessment for proposed uses of the Concord Naval Weapons Station.
In need of leaders
At Community Reformed Church, Parker said conditions have improved in the four years he has been in Sobrante Park. But for him, the fenced-off park that greets all who enter the neighborhood is like a wound revealing the community's powerlessness.
"You can see the potential, and it can become this great community park where people could gather, barbecue, where kids play basketball," he said.
"This is just outright nonsense to have a park closed this long in a community," Parker said. "Because what it says to the community is: 'We don't value you; we'll get to you when we want to.' We are off the radar."
Parker's frustration underscores another critical step in attacking health inequities, and that's attaining positions of authority, said a former Alameda County health leader, who started the Sobrante Park program while director of the Alameda County Public Health Department. This fall he left the county to join the California Endowment's Oakland office, where he heads its health disparities initiative.
"I have this formula that to get anything done, you need resources, authority and charm," said Dr. Anthony Iton.
He points to Margaret Gordon, a longtime activist in West Oakland who ascended to become Port of Oakland commissioner in 2007. Gordon, a founding member of the West Oakland Environmental Indicators Project, for years has battled to reduce air pollution from the thousands of diesel trucks that drive daily into the port. West Oakland, a neighborhood of 23,000 next to the port, has the fourth worst asthma hospitalization rate in the East Bay and a cancer risk three times greater than the Bay Area average. Gordon has asthma, as do four of her grandchildren.
"Every day, you hear a truck, see a truck, and smell a truck," she said.
Gordon dreams of rerouting trucks so a buffer exists between port operations and the neighborhood's homes. "The only thing now that's a buffer is a freeway," she said, laughing.
But her humor fades when discussing the inequities she has battled most of her life.
"Let's be clear," she said. "This is a new era of civil rights.
"I've been able to inject the issue of 'you have to clean up the operation.' That's been my rallying call," Gordon said.
When asked what motivates her energetic struggles to improve her community, Gordon said, "If you're a nonparticipant, you only get what you deserve. If you know you deserve better, you're going to be part of making change."