Atlanta landscape

Healing from Trauma by Building for Health

Uvalde. Buffalo. Tulsa. These are only the latest American cities to be engulfed in trauma from a ceaseless wave of gun violence. And the spasms of bloodshed those cities have endured are layered on top of ongoing harms, like structural racism, disinvestment, and inequity. Worse, those chronic traumas are now exacerbated by the powerful storms, floods, and heat waves of a changing climate.

“Rebuilding our cities for health has always been important,” said Dr. Lisa Patel of the Medical Society Consortium on Climate and Health, during a recent webinar hosted by Island Press. “But now, it feels particularly urgent.”

How can we build cities for health and healing? As Dr. Patel and her co-panelists explained, cities can heal by investing in people and places, by mitigating stressors like housing and food insecurity, and by nurturing positive social connections.

More fundamentally, they must shift from a myopic focus on problems, said Jason Corburn,  author of Cities for Life: How Communities Can Recover from Trauma and Rebuild for Health (Island Press, 2022). Instead, they must tap the deep reserves of resilience and strength inherent in cities and their people – asking, in effect: “What’s right with you?”

That’s what happened in Richmond, California, a working-class “majority-minority” community north of San Francisco. Fifteen years ago, Richmond was among the top ten worst cities in the nation for gun violence, and among the lowest in life expectancy. In 2007, a group of community-based organizations teamed up with local government and researchers from the University of California, Berkeley, to craft a healing intervention. The idea was to empower community members to define—and address—their city’s challenges.

Dr. Corburn, who was part of the Berkeley team, said, “We didn’t come in and say, ‘Hey, we’ve got the solution for you, because we’re experts. Rather, we asked, ‘what do community members say about what matters to them and their health?’”

The answer, for many, was gun violence. “The threat of violence breaks down much of what we do in city planning and public health,” said Dr. Corburn. “People living in fear stop coming outside. They stop talking to neighbors. They may even stop going to school. And when public spaces are feared, they become over-surveilled and over-policed—and that is disproportionately applied to Black and Brown young men.” Violence, Dr. Corburn said, is both a cause – and a result – of trauma.

In response, Richmond launched a “peacemaker fellowship,” in which the city identified members of the community who were likely to be engaged in gun violence. Those “fellows” were given intensive 24/7 mentorship services over the course of 18 months. The fellowship offered an ecosystem of opportunities and resources to those society deemed expendable -- investing in them and seeing them as assets. “It's about loving them up,” said Dr. Corburn, “with the product of that love a reduction in gun homicides and a healthier community for all.”

Indeed, the peacemaker fellowship produced dramatic results: Richmond saw a 55% drop in homicides after the program was launched. And, unlike many American cities, Richmond did not see a spike in gun violence during the pandemic. Moreover, the program was cost-effective: for just over $1 million per year, the peacemaker fellowship averted millions spent on emergency response, healthcare, and criminal justice – not to mention the incalculable cost in lives and trauma.

Richmond residents also reclaimed public space. Community members took charge of the city’s Elm Playlot, once described as having “more used needles than blades of grass.” The Playlot now boasts a vegetable garden, a food distribution center, a petting zoo, and exercise programs for all ages. Importantly, residents were trained to build and manage the park, which they are now paid to maintain. Today, the park “provides jobs and economic investment, not just the physical space,” said Dr. Corburn.

Lessons from Richmond could help inform cities’ response to another major threat: climate change. According to Dr. Natasha DeJarnett, Assistant Professor at the University of Louisville Division of Environmental Medicine, climate change has disproportionate impacts on the young, the elderly, low-income people, and communities of color. “Climate change can be a threat multiplier for these populations,” said Dr. DeJarnett, “exacerbating the inequities that these groups already experience.”

At the same time, hard-hit communities have great strength and resilience: “These populations have largely been making a way out of no way,” said Dr. DeJarnett. “I love the perception of looking to the strengths for building climate resilience.”

Richmond also serves as a model of the “Health in All Policies” approach to urban planning. This approach is based on the idea that “health starts with where people live, work, learn, and play, and that community health is influenced by more than individual choices,” according to the Richmond city website. “One’s physical and social environments, along with local government decisions and actions that shape these environments, have an impact on health outcomes.”

It’s an approach that has been embraced by many other cities and states, said Anna Ricklin, Health in All Policies Manager for Fairfax County, Virginia. “We’re looking to shift how our partners and other agencies are thinking, how they approach their work, the kinds of data they’re using to drive decisions,” said Ricklin. “It’s about connecting the dots so they can see themselves as public health professionals – because anyone who is shaping the environment really is a public health professional.”

In Fairfax County, that has meant a focus on transportation – providing alternatives to cars and highways. Ricklin’s office also dove into data on heat-related illness and discovered that extreme heat is not just affecting the youngest and oldest residents: “We found that it was mostly able-bodied people who were working outside – landscapers and construction workers -- who were most vulnerable,” said Ricklin. Armed with that data, the county is considering what protections it can put in place to ensure their safety.

Indeed, by focusing on the most vulnerable, climate action plans offer an opportunity to heal the traumas caused by longstanding inequity. Climate mitigation and adaptation will necessitate investments, regulations, and policy changes at all levels of government, said Katherine Catalano of the American Public Health Association’s Center for Climate, Health and Equity.

To seize the opportunity provided by climate policy, meaningful public engagement is key: “You have much better outcomes when you are able to engage as many diverse opinions as possible,” said Catalano. “Communities need to be engaged every step of the way,” she added. “Working with all stakeholders is the only way to develop solutions that will address the health burdens of climate while reducing disparities.”

The challenges are daunting, as climate change bears down on communities traumatized by violence and harmed by longstanding inequities. But solutions exist, in the minds, hearts and hands of those on the front lines of these challenges. The success we’ve seen in Richmond and other cities profiled in Dr. Corburn’s book “didn’t occur by miracle,” said Dr. Patel. “They were actively created and constructed by people coming together, despite their fears and differences, to build a vision for a new future.”