Sometimes a community’s billboards are a health risk. A Louisville, Kentucky, activist decided to help heal her community by replacing demeaning billboards with messages of hope and healing.

Poet and community organizer Hannah Drake calls Smoketown, the oldest African-American neighborhood in Louisville, home. On a visit to Senegal in 2016 she was struck by how often she saw herself — her African features— in the faces on billboards, signs, and public art. She felt validated and valued. And she realized how rarely she saw her reality reflected in the signs of Smoketown.

Instead, she saw predatory and demeaning images that spoke of health risks and trauma in a neighborhood that suffers from some of the worst health outcomes in the city: signs encouraging people to sell their diabetes test strips for cash, billboards for liquor and lawyers. But Smoketown is also a place with a rich heritage. Drake knew that she could tell the story of her Smoketown, help her neighbors feel the same sense of identity and pride that she had felt visiting Senegal.

Drake and her colleagues at the artist-run nonprofit IDEAS xLab, where she is Chief Creative Officer, teamed up with community and civic partners to hold a series of community meetings, where they learned that the community’s billboards and signs really did disturb residents. Together with neighbors, the artist transformed 19 billboards in the neighborhood, replacing their negative messages with images of Smoketown residents and brief poems written by them. One of the texts — “You Are Worthy. Worthy of Everything” — became a community mantra.

One Poem at a Time had important consequences. A community-wide letter-writing campaign stopped two liquor stores from opening in the neighborhood — a neighborhood that knew it was “worthy of everything.” Local organizers also pushed Louisville to enact a city-wide policy requiring anyone attempting to open a liquor store to post prominent notices of that intent. And Smoketown community members worked with other majority-African American communities to keep liquor stores from opening in neighborhoods with high rates of alcohol-related illness and death.

PHOTO ABOVE by Josh Miller, courtesy IDEAS xLab PHOTO BELOW courtesy IDEAS xLab

If citizens are going to stay healthy, they need to understand their health risks. For people of color, one of those risks is racism — but racism’s connection to ill health is too often “explained” in social-science jargon that’s hard to grasp and make use of.

Working in the Center for Health Equity in the Department of Health and Mental Hygiene in New York City, artist and Acting Director of Health Equity in All Policies Elizabeth Hamby created a Dungeons-and-Dragons-style game that helps players understand how structural racism leads to health inequity — without obfuscation. Collaborators from the Health Department included Dr. Zinzi Bailey, Dr. Stephanie Farquhar, Hannah Seoh, and Corinna Wainwright.

Abundant data show that historically disenfranchised communities face greater health risks as a result of systemic inequality, but this data, which might help the communities understand health risks and inequities, can be difficult to decipher and understand. Hamby and her team decided to create an engaging way to make complex information about the health impacts of structural racism accessible to everyday people — including people working in a wide range of institutional settings, where workplace change is needed.

In essence, What Creates Health is a game about decision-making. Players encounter the challenges of biased policy, poor infrastructure, and other problems drawn from real experiences of health inequity. The game takes players on a historical journey, beginning in the 1930s, with the public health effects of tuberculosis, poor ventilation, and badly maintained properties in communities of color, along with the effects of redlining. Then come the 1970s, where the problems include rampant disinvestment in communities and the precipitous rise of chronic diseases like diabetes. The game ends with the impact of the stop-and-frisk policies of 2010 on mental health, substance abuse, and general wellness in communities of color.

What Creates Health models interdisciplinary collaboration; artist Hamby joined forces with epidemiologists and multiple city agencies to create the game and use it. Agency staff members used the game to open up discussions about the ways that government has created and perpetuated systems of inequality and oppression.

PHOTO ABOVE: The game in action. Players use a graphic spinner in each round, and colored scorecards to track their progress. PHOTO BELOW: "Neighborhood Improvement Tokens" from the game. Images courtesy Elizabeth Hamby.