A Review of
How Neighborhoods Make Us Sick:
Restoring Health and Wellness to our Communities
Veronica Squires / Breanna Lathrop
Paperback: IVP Books, 2019
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Reviewed by Kendra Stanton Lee
A nurse practitioner and a non-profit development professional seem an unusual author pairing unless your go-to book is a public health manual. How Neighborhoods Make Us Sick: Restoring Health and Wellness to our Communities is not a manual, per se, though it does offer a variety of definitions and diagnoses for the state of public health in America.
What this book offers chiefly, though, is a Christian heart beating for health equity, pumped by two valves: one for community development by author Veronica Squires and one for public health by author Breanna Lathrop. The two valves draw their lifeblood from the examining table and the non-profiteer’s desk, and the two perspectives are complementary, allowing the scope of this book to be wide, but the tone and information to be balanced.
From the outset, Neighborhoods does a keen job of showing its cards. The authors, both white women who concede they grew up in financial comfort and relative safety, do not hide who they are and the privileges they’ve been granted. The foreword, written by Kerri Norris, PhD, is an earnest introduction to the authors that needs to be made, especially given the sometimes lofty prescriptions they are writing in Neighborhoods for how to make health more equitable. Readers would do well to be open to the problems and stories that draw both from the authors’ personal observations and tremendous research endeavors. Indeed, the studies from which the book frequently draws are mostly recent and from what appear to be very reputable sources. This is not a hastily drafted book but rather a composite of vulnerable narratives and information grounded in facts and fairly exhaustive research.
If there is a thesis to Neighborhoods, it is, like the title, written in two parts. The first part of the thesis is that the ZIP code into which one is born and/or primarily grows up has the greatest determinant on one’s health and general well-being. The second part is that it doesn’t have to be this way, nor should it, and as Kingdom-builders, we have agency and a responsibility to change the way our neighbors access health.
The first part of the book unpacks English physician Michael Marmot’s famous “social gradient of health” as determined by a person’s income, social status, type of employment, housing, and education (22). What could have been a long, academic overview of depressing statistics about how the poor and sick keep getting poorer and sicker, the research is interspersed with co-authors Squires’s and Lathrop’s firsthand accounts of living and working in Southwest Atlanta.
The second part of the book operates as a sort of success story of the Good Samaritan (“Good Sam”) Health Center where both authors work. Good Sam takes a holistic approach to healthcare, treating not only the whole person but seeking to be as transformative to a person’s community as a bootstrapping clinic is able. The case studies in the second part are fascinating and written in a way that shows the authors’ respect for the dignity of their Good Sam patients and providers.
The most memorable parts in Neighborhoods for me were Squires’s recollections of purchasing property and moving into Southwest Atlanta with the idealism of a young community development professional and zero experience living in a low-income, underresourced neighborhood. Squires defines “toxic stress” as prolonged exposure not to difficulty or challenge, but to consistently terrible news that directly affects one and her family (35). This is not white fragility, but throughout Squires’s time in the neighborhood, she makes it clear that she was fraught with guilt for entering into incarnational living so hope-filled, but ultimately succumbing to the toxic stress that had convinced her that “life was absent of any goodness and it would be better to die.” (35) Squires and her family committed to living in the neighborhood for five years, and “when we left after nine years, it felt like it had not been enough.” She goes on to say she doesn’t know what “enough” would have looked like, only that because of her training in community development, the sacrifice and effort seemed to have returned void.
This begs the most critical question that goes glaringly unanswered in Neighborhoods. If incarnational living, that is, moving in to the underresourced neighborhood or working directly with the poor – as Jesus did – potentially subjects those wanting to do good to so much toxic stress that it debilitates their efforts, is the empathy gained enough? Is there a better way to be proximate to the poor that will not make one potentially suicidal? The second part of the book lobbies hard for housing as the key determinant that affects all other aspects of an individual’s health (159). But what if the housing is in a neighborhood as Squires’s was–a crime-riddled food desert where one would be reliant upon one’s own transportation because sidewalks and public transportation were so abysmal? Squires and Lathrop offer an honest appraisal of how their own hearts have changed living and working alongside the poor and disenfranchised. However, the book leaves the reader wondering if incarnational living is always a failed experiment or if the model needs a more strategic implementation of a life so radical and a love so great.
Kendra Stanton Lee is a freelance writer in Boston. She lives at a boarding school with her therapist husband and two young children. Find her online at: http://www.kendrastantonlee.com