Your SlideShare is downloading. ×
0
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
EDRA44Providence keynote presentation 05.30.13
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×
Saving this for later? Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime – even offline.
Text the download link to your phone
Standard text messaging rates apply

EDRA44Providence keynote presentation 05.30.13

117

Published on

Dr. Richard Jackson explores "Designing Healthy Communities" in the EDRA44Providence keynote presentation.

Dr. Richard Jackson explores "Designing Healthy Communities" in the EDRA44Providence keynote presentation.

Published in: Health & Medicine
0 Comments
0 Likes
Statistics
Notes
  • Be the first to comment

  • Be the first to like this

No Downloads
Views
Total Views
117
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
0
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide

Transcript

  • 1. Richard J. Jackson, MD, MPHProfessor & Chair, Environmental HealthSciences, UCLA Luskin School of Public HealthDesigningHealthy Communities
  • 2. Thank You to OurEDRA44ProvidenceSponsors:
  • 3. Richard J Jackson MD MPHFAAP HonASLA HonAIAdickjackson@ucla.eduSystemic Disorders RequireSystemic Treatmentshttp://designinghealthycommunities.org/
  • 4. We NeedSolutions ThatAddress MultipleThreats
  • 5. The Daily Bruin October 11, 2011
  • 6. USA Today 10/20/2011
  • 7. Mean Mentally Unhealthy DaysUS Population – from national BRFSS0.1-1.0 million interviews per year2.93.4 days per month (17% increase)http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Category=1&Measure=3
  • 8. The CheckUp10 year oldboy
  • 9. “Problem” List• Physical exam unremarkable• Ht 54” (50%)• Wt 115# (95%)• BP 140/90• Blood glucose elevated, urine normal• Cholesterol 220• Signs of Depression
  • 10. Treatment Plan• Referral to “overweight” clinic• Weight loss program• TV out of the bedroom; no soft drinks inthe house• Exercise program; Encourage sports
  • 11. Two Months Later…• Lost One pound• Can’t change the food at school• Day is already too full• No Time for exercise; “not good atsports”• No place to Walk
  • 12. – Antihypertensivemedication– Oral Hypoglycemicagent– Antidepressant– Cholesterol loweringagent• Monthly medicationcosts:– $3852 months later the patient is taking:
  • 13. • The “environment” is rigged againstthe child…• And the doctor,• And the rest of US.
  • 14. U.S. “Health” CareExpenditures as Percent ofGDPKeehan et al: Health AffairsMarch/April 2008 27: 145-155
  • 15. Male Life ExpectancyUS Life Expectancy is #49 Worldwide – CIA Chartbook
  • 16. 10 leading causes of death -United States, 19000 2 4 6 8 10 12 14PneumoniaTuberculosisDiarrhea and enteritisHeart diseaseStrokeLiver diseaseInjuriesCancerSenilityDiphtheriaPercentage
  • 17. CDC Headquarters - Atlanta
  • 18. July 6, 1999
  • 19. Health Challenges of the21st Century• Chronic Diseases and Costs of Care forAging Populations.• Overweight, Obesity, Diabetes II, HeartDisease• Mental Disorders: Depression, Anxiety,Developmental, Substance Abuse• Macro-environment: Climate, Conflict
  • 20. • The BuiltEnvironment –how we buildour homes,workplaces,towns, citiesand world
  • 21. The United States hasnow paved over theequivalent area of theentire state of Georgia60,000 square milesAnd Photosynthesis isour friend!
  • 22. American Farmland TrustLoss of Farmland
  • 23. Two houses, adjoining back yards(From Streetsblog, 02/28/2013)
  • 24. Mega-Mileage Moms•Average minutes per day spent in car:- Women overall: 64 minutes- Single mothers: 75 minutesSurface Transportation Policy Project: 2000Overall: Compared to 1969Americans drive:- 88% farther to shop- 137% farther for errands•Family “chauffeur”
  • 25. Pedestrian Fatality Rates forCollisions at Different SpeedsZegeer et al 2002
  • 26. Automobile fatality rates by city, 1998(excluding pedestrian fatalities; deaths/100,000/year)9.8010.5211.33 13.12Source: NHTSA2.51New York3.76San Francisco6.55Portland9.80Houston10.52Phoenix11.33Dallas13.12Atlanta5.36Philadelphia
  • 27. Number of Lives Saved per yearif National Car Fatality Rate same as:• New York City 24,000• Portland 15,000• Atlanta None– 15,000 additional
  • 28. Commuting by driving is mostly not good for you.Traffic along LA freeways and Wilshire Blvd.
  • 29. Are More Deaths in AmericaCaused By:Vehicle Crashes?Vehicular Air Pollution?
  • 30. Most Air Polluted CitiesOzone, “Year Round Particle”, “Short-term Particle”American Lung Association 2011 “Share the Air”
  • 31. The Heat Island
  • 32. Ground Level OzoneLevels increase in late afternoonas traffic and temperature peak
  • 33. More time in a car  Higher probability of obesity
  • 34. Obesity Trends* Among U.S. AdultsBRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19%
  • 35. Obesity Trends* Among U.S. AdultsBRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% ≥20%
  • 36. Obesity Trends* Among U.S. AdultsBRFSS, 2010(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  • 37. Supersizing Jet Fuel Use• Mean weight gain of Americans in 1990s:10 pounds• Airline distance flown in 2000 in US:515 billion passenger-miles• Weight transported 1 mile by 1 gallon of fuel:7.3 tons (passengers or cargo)• Jet fuel to transport added weight in 2000:350 million gallons• Cost of extra fuel: $1.4 billion• (Sept 2008 prices)• CO2 emissions from extra fuel:3.8 million tonsData sources: NCHS; US Dept. of Transportation
  • 38. Fast FoodRestaurants• “ black/low income”neighborhoods ~2.4 per sq. mile• “white”neighborhoods:1.5 per sq. mileAmerican Journal of Preventive Medicine,October 2004
  • 39. “Supersizing” a fast-food meal –the real costs• Paying 67 cents to supersize an order— 73% more calories for only 17%more money• A Bargain!University of Wisconsin-Madison, Rachel N. Close and Dale A. Schoeller
  • 40. “Supersizing” a fast-food meal –the real costs• Paying 67 cents to supersize an order — 73%more calories for 17% more money• — adds an average of 36 grams ofadipose tissue.• The future medical costs for that“bargain” would be $6.64 for an obeseman and $3.46 for an obese woman.University of Wisconsin-Madison, Rachel N. Close and Dale A. Schoeller
  • 41. Theresa Devine & Amy VetalBILLBOARDS VS. HEALTH: Considering the Impact ofBillboards on HealthBILLBOARD TYPES• ALCOHOL: 12• ENTERTAINMENT: 26• FOOD: 1• PRODUCT: 16• WEIGHTLOSS: 0• OTHER: 10TOTAL 65SUNSET BLVD (HOLLYWOOD)
  • 42. Theresa Devine & Amy VetalBILLBOARDS VS. HEALTH: Considering the Impact of Billboards on HealthCase Study LaBrea, Hawthorne
  • 43. Theresa Devine & Amy VetalBILLBOARDS VS. HEALTHCASE STUDY: LA BREA HAWTHORNE)BILLBOARD TYPES• ALCOHOL: 17• ENTERTAINMENT: 3• FOOD: 4• PRODUCT: 3• WEIGHTLOSS: 4• OTHER: 4TOTAL 35
  • 44. 0255075100Relationship Between BMI and Riskof Type 2 DiabetesChan J et al. Diabetes Care 1994;17:961.Colditz G et al. Ann Intern Med 1995;122:481.Age-AdjustedRelativeRiskBody Mass index (kg/m2)WomenMen<22 <23 23-23.924-24.925-26.927-28.929-30.931-32.933-34.935+1.02.91.04.31.05.01.58.12.215.84.427.640.354.093.26.711.621.342.1
  • 45. Percentage of US Adults with DiagnosedDiabetes - 1994
  • 46. Percentage of US Adults withDiagnosed Diabetes - 2001
  • 47. Percentage of US Adults with DiagnosedDiabetes - 2007
  • 48. “The Status ofBaby Boomers’Health in theUnited States:The HealthiestGeneration?”JAMA InternalMedicineFebruary 4, 2013
  • 49. Overall Health Status USPersons Aged 46-64NHANES 1988-1994 NHANES 2007-2010Report “excellent” health32% 13%Limitations to Life Functions9% 14%Using Walking Assist (wheelchair, cane, etc)3% 7%
  • 50. “Lifestyle Factors” USPersons Aged 46-64 (NHANES)1988-1994 2007-2010Smoking28% 21%Obesity29% 39%
  • 51. “Lifestyle Factors” USPersons Aged 46-64 (NHANES)1988-1994 2007-2010No Regular Physical Activity17% 52%
  • 52. “Keeling Curve”
  • 53. “Keeling Curve”
  • 54. Greenland SurfaceIcemeltJuly 12, 2012Deepest Pink Indicates SurfaceHas Melted
  • 55. In the 21st Century We Need:• ResilientPeople• ResilientBuildings• ResilientInfrastructure• ResilientCommunities
  • 56. Resilient People Who Need HealthyFoodMindfulness about whatand how we eat
  • 57. Food
  • 58. DOOF
  • 59. High FructoseCorn Sugar• US annual percapitaconsumptionof HFCS• 63pounds
  • 60. The BuiltEnvironment:DesigningCommunities toPromote PhysicalActivity inChildrenPolicy Statement AmericanAcademy of PediatricsJune 2009
  • 61. 10,000 steps• 3234 people with IGT (Pre-Diabetes)• walked or exercised five times a weekfor 30 minutes• lost 5% to 7% of their body weight• reduced their risk of diabetes by 58%
  • 62. Gain in Longevity for a 45-Year Old Male5.8 years8.7 years0246810Low vs Moderate Low vs HighYears of added lifeAdditional years of Life:Moving from Low to Moderate Fitness -- 5.8 yearsFrom Low to High –- 8.7 years.
  • 63. Research
  • 64. Research Landmarks1988-2000: 12,600 2001-2013: 31,4001992-2002: 230 results2003-2013: 3,870 results2013September 1, 2003,Volume 93, Issue 9The National Institute of Environmental Health Sciences of the NationalInstitutes of Health and other funding agencies sponsored a range of studiesand in 2003, Richard J. Jackson, as guest editor, drew upon this body of workfor the September issue of The American Journal of Public Health, “TheImpact of the Built Environment on Health: An Emerging Field.”2003
  • 65. “Health” “Built Environment”1980-2000 13,900 results
  • 66. 2001-2013 32,900 results
  • 67. APHA National Meeting 2002-2003Abstracts with “land use” - 02002 2003A Big Shift in Public Health’s Awareness of BuiltEnvironment as a Core Determinant of Health
  • 68. 2011 APHA Annual Meeting“land use” 102 matches“built environment”182 matches
  • 69. AJPHBuilt Environmentand HealthSeptember, 2003
  • 70. Medline Keyword Search:“Built Environment” and “Health”September 1993 - September 200358 ArticlesSeptember 2003 – May 2013665 Articles
  • 71. Charlotte, NC, Light Rail OpenedNovember, 2007
  • 72. Interviewed Peopleat 839 locationstwo years beforeand after CharlotteLight Rail ServiceBegan
  • 73. • The use of Light Rail Transit tocommute to work:• Average reduction of 1.18 BMI points–For a person who is 5’5” equivalentto a relative weight loss of 6.45 lbs.• 81% reduced odds of becomingobese over time.
  • 74. People
  • 75. US Joint Degree Programs inUrban Planning and HealthBefore 2003--None2013 -- 14 Joint Programs
  • 76. MakingHealthyPlacesA DannenbergH FrumkinR JacksonIsland Press 2011
  • 77. Atlanta Citizens Turning Out To HelpGet Ready for The Belt LinePeople Creating Change
  • 78. Homebuyers’ DecisionsMore than 56% of home buyerswant a home that is a walkableneighborhood with as little need fordriving as possible.
  • 79. Policy
  • 80. Institute of MedicineReportAccelerating Progressin Obesity PreventionMay 8, 2012
  • 81. Resilient Communitieshttp://changelabsolutions.org/
  • 82. Importanceof General orMaster Plans• Sonoma county:General Plan --Policies thatAddress PublicHealth Threats
  • 83. Complete Streets Bring Equity toCommunity and Transportation• Complete Streets– social equity, aesthetics, walking, improvedlocal sales, community building
  • 84. Likely Results of a Sugar SweetenedBeverage (SSB) Tax• “A national tax of 1 cent perounce on sugar-sweetenedbeverages (SSBs) woulddecrease consumption by 23%and raise $14.9 billion in thefirst year alone.”• About $20 billion per yearBrownell KD, et al. The public health and economic benefits of taxing sugar-sweetened beverages.NEJM. 2009;361(16):1599-1605.
  • 85. Action
  • 86. • The Chenoggye freeway ran through thecenter of Seoul ~1970-2005
  • 87. Cheonggyecheon -- 8.4 km long downtown Seoul, South Korea.The $900 million project initially attracted much public criticism.
  • 88. Vision
  • 89. • AIG Bailout–$188 billion• Peak Loans to Major Banks:–Morgan Stanley --$107 billion–Citigroup --$99.5 billion– B of A -- $91.4 billion.– Goldman Sachs -- $69 billion
  • 90. Army Corps of Engineers Estimate --• Reshaping the Los Angeles River ~– $25- 100 million/mile51 miles$1.275 - $5.1 billion
  • 91. Message and Communication
  • 92. http://designinghealthycommunities.org/
  • 93. We Have Solutions That AddressMultiple Threats.
  • 94. Our patient starts to walk or bicycleto school 1 mile 4 days per week• The family car ran 1280 fewer miles inone year.• Reduces gasoline use 64 gallons• Saves $704
  • 95. The New “Active” Commuter• 30 minute walk or bicycle trip burns 125calories each way (for a 130 pound child)• 4 days per week = 1000 calories per week,40,000 calories for school year.• Converts to 11.5 pounds of body fat/yr.
  • 96. The New walk/bike StudentTwo year follow up (age 12)• Height – 59” (50%ile)• Weight – 110# (65%ile)• BP - 130/78• Blood sugar – Normal• Cholesterol – 175• Energy level and Mood – Good• Doing better in School and is Learning Better
  • 97. Richard J Jackson MD MPHFAAP HonASLA HonAIAdickjackson@ucla.eduSystemic DisordersRequire Systemic Treatmentshttp://designinghealthycommunities.org/
  • 98. Thank You to OurEDRA44ProvidenceSponsors:

×