As the stimulus bill moves through Congress, the pundits stay divided on whether the plan is too bloated or too thin to make a difference. Meanwhile, the national dialogue on health (care) is suffering malnourishment of another kind.

Yes, we need to expand access, increase efficiency and deliver consistent, quality medical care. But what’s causing people to need care in the first place? While healthy lifestyles, genetics, and medical care will always be important, research tells us that community forces – the social and environmental context in which we live and work – account for more than half of what makes us healthy or sick.

As Harvard sociologist David Williams points out in the documentary series, Unnatural Causes: “Housing policy is health policy. Educational policy is health policy. Anti-violence policy is health policy. Neighborhood improvement policies are health policies. Everything that we can do to improve the quality of life of individuals in our society has an impact on their health and is a health policy.”

So, will all this land on the desk of the soon-to-be-(re)named Health and Human Services secretary? Or, perhaps this order of change must be grown locally.

A good example is happening in Las Vegas. In collaboration with Communities of Health, members of the Nevada Alliance to Eliminate Health Disparities (NAEHD) gathered in a Policy Forum in December, and outlined four broad focus areas to support a new vision for a healthy Las Vegas:

1.   safe neighborhoods that allow for an active, vibrant community;

2.   effective education as a vehicle for economic opportunity;

3.   fair access to existing health care systems; and

4.   economic development and zoning of neighborhoods.

NAEHD is working to refine these areas into short-term, medium and long-term actions to influence policy change at the state and local levels, and to engage broader participation in creating community-driven solutions.

In addition to generating tangible action, engaged local participation like this creates “control of destiny” that is essential to health. And so perhaps the most powerful, health-giving policy is one that supports an ongoing participative process that allows people to come together in ways that are mutually supportive and empowering – because support and empowerment are fundamental determinants of health.