NEW ORLEANS (Verite) — At a recent New Orleans City Council committee meeting, a small group appeared before the dais to give a presentation to councilmembers. They were there to speak in favor of the “Workers Bill of Rights,” a proposed amendment to the City Charter that would affirm that New Orleans residents have the right to job safety and fair compensation and benefits.
This panel included two representatives from Step Up Louisiana, an economic justice organization, along with two local workers, one from Dollar General and the other from Starbucks. It also included someone from inside City Hall: Jeanie Donovan, the deputy director of the New Orleans Health Department.
“The Health Department is engaged in these efforts to support workers because we know that the connection between good jobs, economic stability and health is undeniable,” Donovan said in a set of pre-prepared remarks. “This Bill of Rights is an important step to make clear that we as a city recognize the value of our workers and their health.”
The presence of a Health Department official may have seemed surprising. Why would a city department that has traditionally concerned itself with things like organizing vaccination drives and educating residents on chronic disease prevention choose to weigh in on the need for higher wages, paid time off or union protections?
Over the last few years, the city Health Department has become a familiar advocate at both the state and local levels on topics that might seem, to a casual observer, well beyond its core mission. The Health Department was taking on issues of economic justice – and it wasn’t just the Workers’ Bill of Rights.
This and other Health Department initiatives are all part of an effort to address the ”social determinants of health”, a watchword in the public health world that refers to the economic and social factors that impact an individual’s health, from income and housing to education level and food insecurity. In short, it encompasses all the factors beyond the health care system that might impact how healthy a person or community is.
“What we are traditionally taught as health care practitioners is to focus on anatomy, physiology and family history, but that probably only accounts for about 20% of whether you’re going to live to 90 or to 50,” said Dr. Jennifer Avegno, who has served as the Health Department’s director since 2018. “The other 80% are what folks call the social determinants of health. So, it’s whether you have safe, stable housing, whether you have access to safe transportation, whether your neighborhood is next to a chemical plant or not.”
Avegno has also used her position to back city programs meant to improve residents’ housing conditions and provide debt relief.
In September 2022, Avegno joined a policy analyst from the Louisiana Fair Housing Action Center and a staff attorney with Southeast Louisiana Legal Services to push for the Healthy Homes ordinance, which would establish a rental registry, strengthen habitability requirements, and protect tenants from retaliation. One slide in the Health Department presentation reads, “Poor housing exacerbates health inequalities.”
In May 2023, the Health Department began overseeing a city contract with RIP Medical Debt, directing the nonprofit to use American Rescue Plan Act money to work with local health providers to forgive more than $100 million in medical debt for New Orleans residents. currently held by the local medical systems So far, RIP Medical Debt has reached one deal with Acadian Ambulance to relieve $3.4 million in ambulance debt.
“Historically, medical debt is a leading cause of bankruptcy and is directly tied to poor health outcomes,” Avegno said in a statement released by the city at the time.
The medical debt relief program in New Orleans has been slow to launch, stuck in negotiations with the city’s two largest hospital chains. Meanwhile, a recent study cast doubt on the impact of medical debt relief in improving credit scores, mental health, or the chance that someone would go to the doctor for a medical issue. But Avegno says that medical debt relief can still be impactful to those dealing with it.
“You cannot expect a program like this to absolve all of the economic sins of the American health care system,” Avegno said to Verite News. “However, it is still real and impactful to those with medical debt.”
The list of such programs goes on: The department joined two dozen organizations in supporting a policy at the state level to support paid family medical leave. It funded outreach and assistance with applications for the federally funded Supplemental Nutrition Assistance Program, helping more than 500 residents apply for the benefits. And the department committed $1 million of federal pandemic aid to address food insecurity in the city.
Community Health Improvement Plan
The department’s emphasis on economic justice under Avegno goes back to 2019, when it conducted a Community Health Assessment survey. The survey, which took 18 months and involved more than 100 organizations and almost 1,000 residents, sought to provide a “comprehensive picture of health status in the city.” It found that New Orleans is pretty unhealthy – largely because of these social determinants. In particular, the Community Health Assessment identified racial inequities and economic instability as key factors adversely impacting the health of New Orleanians.
“The lack of affordable housing, climbing rental costs, and the expense of healthy foods, coupled with low and stagnant wages and lack of stable full-time employment, makes it nearly impossible to afford basic needs,” the report’s authors found. “Every day, residents are overwhelmed by feelings of stress and hopelessness, forced to make difficult decisions that can impact their health such as what food to buy, where to live, or when to pay insurance premiums and prescription costs.”
This assessment, which both Avegno and Donovan refer to as “the CHA,” then informed the department’s Community Health Improvement Plan, or “the CHIP.” In the CHIP, the Health Department committed to three priorities for improving community health: increasing access to care, ensuring community safety, and improving economic stability.
The prioritization of economic stability has led to the department’s push for more progressive policies on housing and workplace improvement. The American Public Health Association and the U.S. Department of Health and Human Services both identify increasing economic stability as necessary to improving health outcomes. As does the State Health Improvement Plan, or SHIP. However, the SHIP states that it is important to promote “economic development” through increasing coordination between the business and education sectors so that they can better develop a “vibrant and engaged workforce.” It doesn’t mention any other substantive policies to address economic stability.
As part of the local CHIP, the Health Department has nine working groups, three dedicated to each priority. In some cases, this has meant that the Health Department and its partnerships have played an active role in drafting proposals, building coalitions, and bringing them to the government.
In other cases, the Health Department has taken a more backseat role until later in the process. Healthy Homes advocates say the Health Department was not involved in the multi-year effort to draft and bring the proposal before the City Council. But the Health Department did choose to later jump in and champion the ordinance once it was up for a vote.
“It doesn’t have to be us taking the lead,” Donovan said. “It can be us being a champion for our fellow departments or, in the case of Workers Bill of Rights, being a champion for community-based organizations who have said this is what we have identified as the solution or a step in the right direction that relates to economic stability.”
‘Our team is out everywhere’
The New Orleans Health Department, like New Orleans itself, is unusual in the landscape of Louisiana. Most places in the state receive public health services from regional offices of the Louisiana Department of Health rather than a city or parish health department. While the state health department does work in New Orleans, largely in restaurant health gradings and water safety, the New Orleans Health Department has a lot more sway when it comes to policy because of its position in the city and state.
Avegno and local partners think that the Health Department built up a lot of goodwill during the COVID-19 pandemic. The city, which was an early hotspot at the beginning of the pandemic, was more cautious about reopening and took a more aggressive approach to immunization than much of the rest of the state.
“Step Up was really inspired by the work that the health department did during COVID to protect workers and the community,” said Ben Zucker, co-director at Step Up Louisiana. “And so when we needed partners in government, they were our first call.”
Zucker noted that when the COVID-19 pandemic struck, the Health Department and Avegno took center stage in the city, as she made decisive calls for mask and vaccine mandates. The department also worked with local community organizations to test and then vaccinate essential workers, which Zucker said prioritized the well-being of frontline workers and vulnerable communities in New Orleans.
“It just built a lot of credibility with us,” Zucker said. Now, Step Up is part of one of the CHIP working groups focusing on economic stability.
Avegno also believes that their work during the pandemic helped the department build trust with community members, as well as with the rest of city government.
“I think one of the beautiful things about the Health Department is that it is rooted in community and it’s not like we’re sitting on the eighth floor of City Hall and we don’t ever figure out what’s going on on the ground,” Avegno said. “Our team is out everywhere. We have so many partners. And we get real information.”
In recent years, one factoid has become the rallying statistic for the Health Department: the city’s poorest Black neighborhoods – Central City and St Claude – have had, on average, a life expectancy of 25 years less than the richest white neighborhoods – Lakeview and Audobon.
For Donovan, this expresses not just a need to address the racial and economic inequities in New Orleans, but also the need for ambition on a community-level.
Donovan added that the overall life expectancy for everyone in the city goes down when there are large gaps in life expectancy between neighborhoods, emphasizing that even the richest, whitest census tracts have lower life expectancies than comparable census tracts in more equitable neighborhoods.
“So, this isn’t just a problem of these census tracts,” Donovan said. “[It] impacts all of us.”