Health Equity Versus Social Equity in the Age of (Recreational) Cannabis

As California prepares to kick off the nations largest legal commerce in marijuana, its easy to salivate over the multibillion-dollar bonanza this could bring to the state and local economy, and to believe the hype that this wealth can reverse some of the damage wrought over decades by the war on drugs.

But when Los Angeles Countys Office of Cannabis Management held a series of listening sessions to seek public input on potential regulations, the question that cropped up again and again was how this might affect various communities, especially the youth.

It was particularly poignant when asked by parents in neighborhoods already contending with a glut of marijuana dispensaries and stores selling alcohol and tobacco all dependency-inducing products.

They worried that marijuana, while intended for adult use, could still affect the health of their children. This was not only because youth are particularly vulnerable to recreational marijuanas psychoactive substances but because their neighborhoods typically low-income communities of color tend to be medically underserved and already beset with higher than average rates of substance abuse disorders and other maladies.

In large swaths of South and Southeast LA, for example, the life expectancy rates ranged from 75.8 years to 80.6 years, or as many as 14 years shorter than those in Malibu and Beverly Hills, based on a recent study that starkly illustrates the health inequity among different communities in the county.

The same study added that health disparities are caused by a host of factors, including limited access to affordable and quality medical care, healthy food, clean air, good schools, jobs that reduce the stress of economic uncertainty, and safe neighborhoods where families and communities can thrive.

Health equity is an essential characteristic of a society that values the wellbeing of every one of its members. In creating the first ever regulations for marijuana commerce within the countys unincorporated areas, the Board of Supervisors has an obligation to avoid exacerbating health disparities, and an opportunity to reverse them.

It is imperative that we emphasize health equity in marijuana commerce, and wield regulations in business licensing, monitoring and enforcement so that health disparities can be eliminated or minimized. It would be similar to requiring that real estate developers mitigate their projects impact on traffic in surrounding neighborhoods as a condition of getting the green light to get their shovels ready.

A lot of attention has been paid to so-called social equity programs that would, in a sense, indemnify people who have suffered disproportionately from the war on drugs by giving them a better chance to profit from retail sales of marijuana.

But how can social equity be attained when the focus is narrowly on leveling the playing field of economic opportunity, and no attempt is made to address any other social ills facilitated by manifold addictions and exacerbated by the war on drugs? This crude attempt at social engineering can only be expected to fall short.

When evaluating a prospective retailer of marijuana, it makes sense to check whether factors that lead to health disparities are already particularly pronounced in the community where this business wants to operate, and then to assess whether marijuana commerce in that community would lead to unintended consequences. It is critical that regulations lead to responsible and conscientious businesses that will make a positive contribution to the health and wellbeing of their neighbors.

Creating programs that nurture our youth is always a good idea, but even more so now, amid widespread concerns about pot shops becoming more prevalent. We should also look into bolstering programs to prevent drug use and treat substance abuse disorders.

The newly created Center for Health Equity at the Los Angeles County Department of Public Health is on a mission to ensure that all communities have equitable access to services and programs so that everyone can achieve their highest levels of wellbeing. It can be a powerful ally in helping to close or narrow health disparities created by marijuana commerce.

The historic shift from prohibition to licensing has tossed Los Angeles County and indeed the rest the state and the nation into uncharted waters. Still, its obvious that crafting responsible and reasonable regulations is not merely a matter of economics. We must ensure that our most vulnerable communities, many of which have already endured a legacy of neglect and exploitation, are not further harmed by the legalization of recreational marijuana or even the commercialization of cannabis.