The Pulse of Oakland

Stories on the intersection of health, wealth and race in Oakland neighborhoods.

I. The Health Gap: Is inequality making us sick?

In urban areas across the country, many people are getting sick and dying earlier than they should.

These causes can be avoided, but right now not everyone has an equal opportunity to be healthy.

Take Oakland for example. In this city, just shy of 400,000 residents, people in low-income areas like East and West Oakland are dying more than a decade earlier than people a few miles away in wealthier neighborhoods. Wealth—and, it turns out, good health—are concentrated in certain parts of the city.

Can inequality somehow make us sick? Watch the video below to visit East and West Oakland and learn more.

An African-American born in West Oakland can expect to die almost
15 years earlier
than a White person born in the Oakland Hills.
Alameda County Public Health Department report

If health was distributed evenly, life expectancy maps “would look like confetti,” says Bina Patel Shrimali, a health equity expert at the Alameda County Public Health Department, with colors sprinkled everywhere. Instead, she says, poor health and short lives are clustered in certain neighborhoods like East and West Oakland. You can see this in red on the maps below.

This is not simply a health issue, points out Sikander Iqbal, director at a community development group in East Oakland called Youth Uprising. It is also a social justice issue, he says, because people living in these areas are, for the most part, not white. West Oakland is predominantly African-American, and East Oakland is majority Hispanic.

And this is not an accident. Historical patterns of segregation pushed minorities into disadvantaged neighborhoods, and cycles of poverty and various policies have left these low-income communities of color ignored—and unhealthy.

Look at the maps of Oakland below. By clicking on the different census tracts, you can see that the neighborhoods in red have higher death rates and lower life expectancies. The same areas have high rates of poverty, shown on the second map, and are minority communities, as you can see on the third map. Here’s where health, wealth and race intersect.

See more interactive maps of data here.

Wealth—and good health—are concentrated in certain parts of the city.

“We’ve talked about racial health disparities for many years, and how income level affects health,” says Amy Smith, program manager at the Bay Area Regional Health Inequities Initiative, a cross-county organization working on environmental health issues. “Now we have to bring it to the next level, and look at the social and health problems rooted in where people live.”

So how are bad neighborhoods translating to poor health, and early death? And what is being done about it? Let’s visit East Oakland to find out.

"I wasn't supposed to be where I am now. I was set up for disaster."

Melinda Monterroso, East Oakland resident

II. Against the odds: Growing up in deep East Oakland

On the hilltop campus of Merritt College in Oakland, 18-year-old Melinda Monterroso is finally reaching her goals. As the first in her family to graduate from high school and someone who grew up on the rough streets of “deep” East Oakland, as it’s referred to by locals, it was a tough road to college.

“I got really lucky. I wasn’t supposed to be where I am now,” she says. “I was set up for disaster.”

As you drive through Castlemont, the neighborhood where Monterroso spent most of her life, the road is rough, pockmarked with potholes. The BART train doesn’t have a station out here, so people wait on benches for buses to arrive. The neighborhood Safeway moved out more than a decade ago.

Something about Castlemont is threatening to cut Monterroso’s life short.

“Where banks, grocery stores and restaurants once lined the streets, now liquor stores, check-cashing businesses and fast food establishments have taken up residence,” says a report on Castlemont from community group Youth Uprising. They built a youth center on the vacant Safeway lot in 2005, and have been working since to develop the surrounding neighborhood.

Statistics show that by living in East Oakland, Monterroso is at greater risk for health problems like diabetes, obesity, asthma and heart disease. She is more likely to be violently assaulted and less likely to find a job that pays her enough to make ends meet. She also had a lower chance of graduating high school than most other Oakland students.

For a baby born in Castlemont today, the average life expectancy is 74 years, 12 years less than a child who is born in Piedmont.
Alameda County Public Health Department

See more interactive maps of data here.

For a baby born in Castlemont today, the average life expectancy is 74 years, according to the Alameda County Public Health Department. That’s 12 years less than a child born in nearby Piedmont, a small and wealthy enclave in Oakland, a few miles north of Castlemont. The mortality rate in Castlemont is more than twice the rate of death in Piedmont, meaning Monterroso is more likely to die early while she is living in the deep east.

Monterroso’s life will likely be cut short because of where she lives.

About 4,700 people live in Castlemont, which has some of the highest rates of homicide, poverty and chronic health problems in Alameda County. A stretch of MacArthur Boulevard near the high school used to be known as the “killing fields,” because so much blood was spilled in the eight-block area from shootings. The nickname has faded in the past few years, says Sikander Iqbal, of Youth Uprising, but residents in the area still face a host of health problems—and barriers to becoming healthy—related to blight, pollution and lack of investment in their East Oakland neighborhood.

“Where you live determines your quality of life, your education options, all of that,” says Bina Patel Shrimali of the county public health department. “Whatever you have or don’t have in your neighborhood directly impacts health.”

For many people, life here is like a poker game. They could get lucky and make it to college, like Monterroso, but odds are they won’t. Someone in East Oakland is more likely to be born into poverty, and growing up they will have a difficult time getting fresh fruits and vegetables. The high levels of air pollution raise the risk of asthma, which keeps many home sick on school days. Absences, combined with violence and stress set a lot of Castlemont youth behind in their studies. If they don’t graduate from high school, they are not likely to get a job that pays well. So much of quality of life is tied to a good job and living in a good neighborhood, says Iqbal.

“The cycle just keeps going and going and going,” Monterroso says.

“Where you live determines your quality of life, your education options, all of that.”

There are about 88,000 people living in East Oakland. The “deep” east is what locals call a more specific, and troubled, area that includes Castlemont, shown in red on the map above.

The Youth Uprising community center opened its doors in 2005, in the heart of the deep east. YU is working with the county health department and other groups to figure out why East Oaklanders are dying so early, and how to improve neighborhoods like Castlemont so residents can live longer, healthier lives. And not by moving to an area like Piedmont, but by giving them more opportunities and resources where they live now.

"I was killing myself with all these stores that sell nothing but junk."

Melinda Monterroso, East Oakland resident

III. Living in a food desert: When "choice" isn't a choice

Melinda Monterroso is 18 years old, of Guatemalan and Native American heritage. Three years ago, at the age of 15, she was diagnosed with Type 2 diabetes—a disease once called “adult” onset diabetes.

“I was just a kid,” says Monterroso, remembering how much she cried during her weeklong stay at the hospital. Her mother had taken her to the emergency room after a concerned call from the school health clinic. Monterroso had a blood sugar test done the day before, and the doctor worried she was on the verge of a diabetic coma.

“Both my parents have diabetes, so I was prone to it,” Monterroso says. “I was eating junk food every day. Chips, hot pockets. We ate TV meals, processed foods that would be quick.”

It might seem obvious to some that Monterroso’s diet could develop into diabetes. But in the world which Monterroso lives, the choice between a healthy and an unhealthy diet—between fresh fruits and vegetables or a bag of chips from the corner store—isn’t much of a choice.

“Personal choice is one layer,” says Bina Patel Shrimali, of the Alameda County Public Health Department. “But think about the context in which people make decisions. Your choices are constrained.”

“It’s not accessible,” Monterroso says of fresh produce. “If I can walk down the street and get something healthy, I’d do it. But I have three corner stores around my house, all walking distance, and the nearest supermarket is three or four miles away.”

"Personal choice is one layer. But your choices are constrained."

Convenience plays a large role in a person’s food choices. For someone like Monterroso, who does not own a car, it’s the difference between a half-hour bus ride to the grocery store and a stroll to the nearby corner store. The “choice” isn’t really a choice, Shrimali says. Living in a neighborhood like Castlemont, surrounded by liquor stores and fast food, makes someone more likely to eat poorly, and in turn more likely to develop diabetes.

See more interactive maps of data here.

According to data, East Oakland residents have the highest rates of diabetes in the city. For every Piedmont resident who visits the emergency room for diabetes, there are nearly five in East Oakland. This also reflects a difference in access to health care. Piedmont residents are less likely to seek treatment at an emergency room in the first place, because they are more likely to be seeing a primary care physician on a regular basis. The high rates of emergency room visits in the deep east indicate not only that more residents have diabetes, but also that many people are not seeing a doctor to manage health conditions properly. East Oaklanders are also more at risk for other problems related to diet and lifestyle like obesity, stroke and heart disease.

See more interactive maps of data here.

“I was killing myself with all these little stores that sell nothing but junk,” Monterroso says. But for her and her family, it is hard to get anything else.

Neighborhoods full of fast food chains and no grocery stores did not happen by accident, Shrimali says. It is “part of the legacy left behind by several decades of systematic disinvestment in low-income neighborhoods of color,” according to an Alameda health department report.

The report, “Life and Death from Unnatural Causes,” says that starting in the 1930s, practices like redlining marked these neighborhoods as undesirable for investment. After World War II, the decline of manufacturing as well as regional planning strategies that encouraged suburban growth pulled businesses, jobs and healthy food out of many urban neighborhoods.

“I was just a kid,” says Monterroso, diagnosed with Type 2 diabetes at 15.

“The population in urban centers declined, and became increasingly segregated as middle-class (generally White) families migrated out of cities to settle in the suburbs,” the report says. Cycles of disinvestment have continued, leaving once-thriving East Oakland neighborhoods like Castlemont without the means to be healthy.

A recent report found that only half of residents in low-income neighborhoods in Alameda, Contra Costa and Santa Clara counties live within walking distance of a supermarket. Distance may seem like a small barrier, until you consider that many families in these neighborhoods don’t own a car.

But Castlemont residents can walk to corner stores, fast food joints and other places chock full of unhealthy food and drink. The health department report found that across the county, the number of liquor stores in low-income neighborhoods is double the number in wealthier areas.

And it’s not only a lack of access to healthy food that makes people unhealthy, Shrimali says. “Everything is conspiring to create these unhealthy conditions.”

Opportunities for physical activity, like parks, are scarce in neighborhoods like Castlemont, and fear of assault often keeps people indoors. Broader factors like transportation, affordability of food and neighborhood safety all need to be considered when health departments and community groups work to provide residents with easier access to healthy food and a healthy lifestyle.

“Health develops over time,” Shrimali says. “The root causes are beyond the scope of just public health.”

"I shouldn't have to leave my home to be a healthier person."

Lala Mann, East Oakland resident

IV. Short of breath: Living with pollution

Lala Mann has lived all over East Oakland and surrounding areas. She grew up in “Funktown,” a neighborhood close to Lake Merritt, near Highland Hospital. She has lived in San Leandro, San Lorenzo and Dublin, all cities just outside of East Oakland. And now she lives in Castlemont, and she does not plan on raising her 15-month old daughter here, she says.

“As you get deeper into East Oakland, it’s more and more deserted as far as what you need as a human being,” Mann says. “It really sucks.”

When she compares her experience in a place like Dublin to East Oakland, her description is stark: Dublin is cleaner, she says, with nice houses, grocery stores and parks. “You have everything you need right there. This place is a dump in comparison,” she says, referring to Castlemont.

Mann says that even Funktown was better than Castlemont, because it was closer to the Grand Lake neighborhood and downtown Oakland. The life expectancy at birth in the Funktown area is 78 years, four years longer than someone born in Castlemont, but still shorter than someone in Piedmont.

“It’s sad to say, but if I lived in Berkeley, if I lived in Piedmont, then my health would be a lot better,” says Mann. “But I didn’t get that luxury.”

The residents of East Oakland inhale some of the most polluted air in the Bay Area.

High blood pressure and diabetes run in her family, she says, as does asthma. Mann and her father both suffer from asthma attacks, especially on smoggy days in East Oakland.

A recent statewide map called CalEnviroScreen shows that nine of California’s most polluted communities are in the Bay Area, identifying cities like Richmond and areas like East Oakland in the top five percent. The map used data from various sources to identify ZIP codes with schools and neighborhoods near freeway interchanges, dirtier air and more hazardous waste facilities and factories.

All Bay Area residents are exposed to high levels of air pollution, but “poor people and people of color are much more likely than Whites and those with higher incomes to live in close proximity to areas with high levels of air pollution,” says the Alameda County health department report, “Life and Death from Unnatural Causes.”

The residents of East Oakland inhale some of the most polluted air in the Bay Area, which makes them more likely to develop asthma and other respiratory problems.

Rates of asthma for African-American children in Alameda County are 2.5 times higher than the overall rate in the county.
Alameda County Public Health Department

See more interactive maps of data here.

The rate of emergency room visits for asthma in East Oakland is far higher than the state average—for every 10,000 visits, about 130 in East Oakland are due to asthma. The state average is 48, and in Piedmont the rate is less than 40. This suggests that more people in East Oakland have severe or poorly managed asthma. Long-term exposure to air pollution can also put people at risk of lung cancer, says the county health department report.

“There are all these factories and stuff,” Mann says about the deep east. “You don’t see a bunch of polluting things packed into one place in many other neighborhoods.”

But there is also high pollution in West Oakland, where 20,000-plus residents live between three major highways, the port and the Union Pacific Rail Yard. Asthma rates are just as high here as they are in East Oakland. Like the deep east, West Oakland is low-income, and while East Oakland is majority Latino, more than half of residents here are African-American.

According to statistics from the Alameda County Public Health Department, rates of asthma among African-American children in Alameda County are 2.5 times higher than the overall rate in the county.

“The percentage of non-white residents, particularly African-Americans and Latinos, is greatest within one mile of a toxic release facility,” says the report. In Alameda County, 71 percent of the population living within one mile of a toxic facility is not white. Farther from these pollution sources, the population gets whiter, and wealthier.

“For multiple reasons, people who live there may be more vulnerable to the effects of air pollution,” says John Balmes, a UC Berkeley professor of environmental health. Other factors that can lead to the development of asthma and other respiratory illnesses are generally found in low-income communities, such as a poor diet, exposure to tobacco smoke and less access to health care. These can all worsen the effects of air pollution already present in high levels in East and West Oakland, says Balmes, who also serves on the California Air Resources Board (CARB).

In general, the report says, “economically disadvantaged people, many of whom are people of color, are more likely than wealthy people or White people to live close to busy freeways, ports and commercial sources of pollution.”

"If I lived in Berkeley, if I lived in Piedmont, then my health would be a lot better."

For Mann, the connection between health, wealth and race is infuriating. “I shouldn’t have to leave my home to be a healthier person,” she says. “It pisses me off. The more you see, you realize that our challenges are a result of the way things are set up in our neighborhood, compared to other neighborhoods.”

Brandon Robbins, another Castlemont resident, grew up in West Oakland and bounced between a few neighborhoods. He and his siblings all have health problems like asthma that “probably come from living in West Oakland,” he says. But he and his family can’t get away from the unhealthy environments of East and West Oakland. Though they have moved between the two areas, they have never been able to move to Piedmont or other neighborhoods in Oakland where they might lead healthier lives.

“It always comes down to financials,” Robbins says. “It’s unaffordable to live in a better neighborhood, that’s pretty much what it is.”

The Bay Area has one of the highest costs of living in the United States. The price difference of living in an area like Piedmont versus East Oakland is vast. The median housing price in Piedmont is about $650,000, more than three times what someone would probably pay in Castlemont. More than half of Castlemont residents already spend at least a third of their income on rent, according to a Youth Uprising report, and the median household income is less than $33,500 a year.

Both East and West Oakland residents face the same health problems. But it’s unaffordable to live in a better neighborhood.
Brandon Robbins, West Oakland resident

See more interactive maps of data here.

“The super high cost of living here makes it harder to afford a house in a better neighborhood,” says Amy Smith, program manager for the Bay Area Health Inequities Initiative, a partnership between nine counties working on regional health issues.

But Mann doesn’t want to live in Piedmont or Berkeley. Oakland is her home. While she doesn’t want to stay in Castlemont with the neighborhood in its current state, she says she would love to see Castlemont become a safer, more vibrant community. Mann is a coordinator at Youth Uprising, working to develop the neighborhood and offer residents more resources where they currently live, rather than simply giving them the means to move away.

She says she works at the center so that someday, she could consider raising her children in Castlemont. “I’m lucky that I can go live in some other place, but what about the other people?” Mann says. “That’s why East Oakland needs to be transformed into a better community. It can be, and it should be.”

"I’m from a neighborhood that’s known for violence."

Brandon Robbins, West Oakland resident

V. Stuck in the cycle: Unseen effects of health on success

Health problems like asthma, diabetes and obesity not only directly shorten your life; they also have more insidious effects. Youth in neighborhoods like Castlemont are less likely to graduate high school, find a job and be able to access resources like health care, quality housing and a nice neighborhood—things that will make them healthier in the long run.

“Attendance in school is affected by asthma, obesity and other health problems,” says Rebecca Brown, who studies the link between education and health at Oakland’s Urban Strategies Council. Students don’t come to school when they have to go to the emergency room for an asthma attack, or when they spend a week in the hospital because of diabetes, like Melinda Monterroso did when she was 15.

Monterroso was not having regular medical checkups when she was first diagnosed with Type 2 diabetes. Many children in East Oakland visit the emergency room when they have a serious health problem, says Brown, and do not have a doctor that they see on a regular basis. This means that issues go unnoticed and untreated in many students, and their grades can suffer as a result.

“Many kids can’t see the board because they have poor vision,” Brown says. “A lot of them have toothaches because they aren’t getting regular dental care. How you can think in school when you have a toothache?” These students probably have more dental problems because they also consume so many sugary foods and drinks, she says.

Poor health, stress and trauma all negatively affect learning in school.

Poor health among students in neighborhoods like Castlemont keeps them out of school more often, affects their ability to concentrate while they are in the classroom and can even negatively impact cognitive development and their ability to retain information. A malnourished child, Brown says, does not remember things as well as a healthy child.

When Monterroso was in elementary school in Castlemont, she says, she went to school only once a week. Instead of going to class, she worked with her parents cleaning houses, to help bring in money. “It wasn’t easy financially, for my family,” she says. “I’ve been taught by my parents that money is more important than education.” Monterroso did not know how to read until she was nine years old.

That is very telling, Brown explains. A student’s third-grade reading level can be used to predict how likely they are to drop out of high school, get a job and even go to prison, she says. Learning to read at age 9, Monterroso would not have been expected to graduate high school.

Poor health is keeping kids out of school and making it harder to study. But stress and trauma are also factors that can negatively affect learning, says Brown. Feeling unsafe and being exposed to violence can cause chronic stress in Castlemont residents, affecting brain development much like poor nutrition or lack of sleep.

Monterroso remembers one evening during her sophomore year of high school, when a man attacked her on the edge of Castlemont High’s campus. “He tried to put me in a car. He was hitting me on the back of the head, trying to knock me out,” she says, in a shaky voice.

Monterroso says when her attacker’s hand loosened for a second she slid out of his grip and bolted back into the school. When she couldn’t find a security guard, she hid in a storage closet. “I was back there crying for an hour,” she says.

“He tried to put me in a car. He was hitting me on the back of the head, trying to knock me out."

Ever since she was attacked, Monterroso says she has been scared to go out at night by herself. When she walks home from class at night, she carries a knife. After the attack, she found it hard to concentrate in school for a while.

“You have all this worry, all this anger. You’re just thinking about that,” she says. “Not A-B-C-D, one plus one equals two.”

The impact of poor health and stress on learning is reflected in the statistics about Castlemont High. For the 2010 California State standardized test, 80 percent of students scored below proficient in English Language Arts and 96 percent in math. Only 40 percent of students made it to graduation in 2010, leaving the rest to face higher rates of poverty, joblessness and health problems than their peers who earned diplomas.

See more interactive maps of data here.

East Oakland has the highest rates of violent homicide and assault in the city. For every visit to the emergency room for assault in Piedmont, there are six in the deep east. Homicide is the leading cause of death for young people in the deep east, according to a Youth Uprising report.

“Young people living in the Castlemont neighborhood must cope with many stressors in their lives, so it is not surprising that many students do not succeed academically,” says the report.

Once Castlemont students make it out of high school—whether they have a diploma or not—it can be hard to find work in their neighborhood. In both East and West Oakland, there used to an abundance of high paid, low-skill industrial jobs, says Amy Smith from the Bay Area Regional Health Inequities Initiative. But when the country’s economy shifted from manufacturing to service after World War II, there was little community development targeted at neighborhoods like Castlemont to replace the jobs that were lost.

“You have all this worry, all this anger. You’re just thinking about that. Not A-B-C-D, one plus one equals two.”

The violence and other problems in East Oakland are rooted in deprivation and inequality, says Lala Mann. “When people aren’t given what they need to survive and thrive, they get angry,” she says. There are few jobs, and business and retail opportunities are scarce. “I can’t even spend money out here,” she says. “There’s no money flowing through here unless it’s through liquor, junk food, drugs, all of that.”

Brandon Robbins, 22, who grew up in West Oakland but lives in Castlemont, says he spent a year pretty much hanging out on the streets and wasting time after he finished high school in 2009. “I got into a bit of trouble that year,” he says. “One of my biggest challenges was my identity. I’m from a neighborhood that’s known for violence. When I was younger I thought I had to mimic that.”

But he found direction when he started spending time at the Youth Uprising center in Castlemont. He began to use the music studio to record his own songs, got involved with mentoring programs for younger kids, and now works at the center full time.

“I see that a lot of other youth, they struggle and face the same issues as I did,” Robbins says. He is happy to have a job in his neighborhood, but says he doesn’t want to spend his whole life in Castlemont. “I want to live other places,” he says. “Maybe go to Japan.”

There are no opportunities for youth in East Oakland. They want wealth and education, so they leave.
Sikander Iqbal, Youth Uprising leadership director

See more interactive maps of data here.

This is a big part of the problem in Castlemont, says Sikander Iqbal of Youth Uprising. There are no viable options for successful youth that would encourage them to stick around. Young people who are motivated and do make it past the health, violence and educational challenges in East Oakland have a hard time finding jobs out here, he says. “They want wealth and education. So they leave.”

The key is to give young people the confidence and skills they need to succeed, and at the same time, give them a reason not to leave East Oakland, Iqbal says. Youth Uprising is trying to do this with community engagement and by working on city policies that encourage investment in Castlemont.

“We need to give people more opportunities where they actually live,” agrees Shrimali. “There are so many more barriers to advancing in these neighborhoods, and all these social inequities have both direct and indirect impacts on health. For our children, these factors can really play a role over a lifetime.”

"We want to lay a foundation for lifelong health."

Bina Patel Shrimali, Alameda County Public Health Department

VI. Closing the gap: New ideas for public health

During her weeklong stay at the intensive care unit after being diagnosed with diabetes, Monterroso decided that she wanted to live a healthier life. “I thought, ‘Do I want to continue the cycle, or do I want to do something different?’” she says.

Monterroso started drinking more water and eating better-quality food, and now regularly brings home vegetables to her family from the school garden at Castlemont High, which hosts a weekly farmers market and is now a new and thriving source of fresh produce in the neighborhood. She was taking insulin and four Metformin pills every day after being released from the hospital, but three years later, due to a better diet and exercise, she is down to one pill a day.

“That garden saved my life,” Monterroso says. And she is referring to more than the benefits of fresh produce. She helped plant the garden in 2010, and says having this leadership role at school made her realize she could do more. “It made me feel important, like I was part of something,” she says. “I think all kids want to find purpose.”

Monterroso is the first in her family to graduate high school and go to college.

Statistically, Monterroso should not have made it to the hills of Merritt College, where she is now enrolled. She got a lucky break, she says, when she entered high school. Instead of going to Castlemont High, she enrolled in the Leadership Public School, a charter high school on Castlemont’s campus. She got involved with Youth Uprising and another community group, the East Oakland Boxing Association. Teachers and mentors took an interest in her success, encouraged her to do better in school and helped her plan for her future.

The youngest of five children, she is the first in her family to graduate high school and go to college.

Her siblings did not see the value of education, she says, because they did not know anyone who went to college. When you don’t have parents and school counselors encouraging you, and when you live in a violent, unhealthy neighborhood, it can be hard to believe in yourself, Monterroso says.

"We think we’re not smart enough for college,”’ she says. “It’s hard to overcome that. I know a lot of people that have [gone to college], but I know more people who haven’t.”

She gives the standard line about her success in school, saying that opportunities will come to you if you open the door. But then she stops to think. “The difference out here,” she says, “is that no one ever told you there was a door. You never knew about the door, there’s no light on it. You just have to walk around blindly and open it.”

This mental barrier to success is one of the insidious aspects of neighborhoods like Castlemont that are difficult to quantify, Shrimali says, and it’s hard to calculate all the ways living in a blighted area affects health.

But the impact of these disparities can be quantified—as a difference in life expectancy.

Only a quarter of health outcomes are connected to medical care. Health is determined mostly by where we live.
Bay Area Regional Health Inequities Initiative

See more interactive maps of data here.

Only a quarter of health outcomes are connected to medical care, says Amy Smith from the Bay Area Regional Health Inequities Initiative. “The other 75 percent are where we live, environmental and social conditions.”

This is why people like Shrimali believe organizations working on public health issues need to shift their thinking from “portrait to landscape.” Over the past century, she says, the field of public health has focused on providing individual medical care and services, known as the “portrait” approach. “We need to connect that to the broader landscapes in which people live,” she says.

Medical care is an important part of the puzzle, but healthcare is a puzzle with a million pieces. To really improve the health of a neighborhood, and of people who live there, a patchwork quilt of resources and organizations is needed.

This “quilt” is being stitched together in East Oakland. The Alameda health department Best Babies Zone initiative in Castlemont focuses on improving the health of children in the early stages of life through better maternal nutrition and more child care resources for mothers. The East Oakland Boxing Association offers free after school programs for East Oakland students. Youth Uprising focuses on economic and community development, bringing businesses and jobs to Castlemont, options for healthy food, parks, health clinics and other resources.

"These problems don't fit into little boxes, and neither do the solutions."

Meanwhile, organizations like East Oakland Building Healthy Communities are working at the policy level to direct resources and investment into low-income areas. Causa Justa advocates for quality affordable housing, and Oakland Rising runs “get out the vote” campaigns in East and West Oakland to get residents more involved in policy decisions that could affect their neighborhoods. The Bay Area Regional Health Inequities Initiative is focused on issues that go beyond city limits, like air quality and transportation.

“These problems don’t fit into little boxes, and neither do the solutions,” Shrimali says. “We want to lay the foundation for lifelong health.”

There are three parts to the solution, says Sikander Iqbal of Youth Uprising: Building up people in the community, developing the neighborhood so people have a reason to stay, and working with governments to create policies that encourage investment and bring resources to low-income areas. He says this is not just a model for Castlemont, but a model for all communities.

“We can’t save everyone,” he says. “But hopefully we can take the success stories and make that the rule, rather than the exception.”

And it seems to be working—at least for those in a position to take advantage of the changes.

Monterroso graduated from high school with a 4.0 GPA and is now enrolled at Merritt College in Oakland. She is planning to study for two years at the community college and then transfer to a four-year program. Monterroso says the support and guidance of mentors at groups like Youth Uprising and EOBA helped her overcome the health challenges, both physical and mental, that she faced growing up in Castlemont. She wants to major in English or Political Science, and eventually serve on the Oakland City Council.

“I want to stop the cycle,” she says, “and make sure people can start living.”