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Designing Healthy Communities by Dr. Richard Jackson

2nd Annual Antelope Valley Wellness Symposium - Antelope Valley Partners for Health

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Designing Healthy Communities by Dr. Richard Jackson

  1. 1. Richard J Jackson MD MPH FAAP HonAIA HonFASLA dickjackson@ucla.edu UCLA Fielding School of Public Health / Antelope Valley Wellness Symposium October 29, 2015
  2. 2. The Check Up 10 year old boy
  3. 3. “Problem” List • Physical exam unremarkable • Ht 54” (50%) • Wt 115# (95%) • BP 140/90 • Blood glucose elevated, urine normal • Cholesterol 220 • Signs of Depression
  4. 4. Treatment Plan • Referral to “overweight” clinic • Weight loss program • TV out of the bedroom; no soft drinks in the house • Exercise program; Encourage sports
  5. 5. Two Months Later… • Lost One pound • Can’t change the food at school • Day is already too full • No Time for exercise; “not good at sports” • No place to Walk
  6. 6. – Antihypertensive medication – Oral Hypoglycemic agent – Antidepressant – Cholesterol lowering agent • Monthly medication costs: – $385 2 months later the patient is taking:
  7. 7. • The “environment” is rigged against the child… • And the doctor, • And the rest of US.
  8. 8. USA Today 10/20/2011
  9. 9. August 20, 2015
  10. 10. “Ask physicians across the country what problems they want solved, and they won't hesitate to tell you. They worry about the growing health risks they observe in patients based on lifestyle choices, obesity and a variety of social factors which they feel powerless to change.” Robert Pearl MD Forbes Magazine Aug 20, 2015
  11. 11. Life Expectancy at Birth and Health Spending 2011
  12. 12. • “Even under the most optimistic estimates, of the 30 years of increased life expectancy achieved between the 1890s and 1990s, only 5 years can be attributed to medical care.” Bunker cited in Prescription for a Healthy Nation Farley and Cohn 2004
  13. 13. CDC Headquarters - Atlanta
  14. 14. July 6, 1999
  15. 15. • The Built Environment – how we build our homes, workplaces, towns, cities and world
  16. 16. The United States has now paved over the equivalent area of the entire state of Georgia 60,000 square miles And Photosynthesis is our friend!
  17. 17. Commuting by driving is mostly not good for you. Traffic along LA freeways and Wilshire Blvd.
  18. 18. We Used to Build Real Towns and Neighborhoods but Now…
  19. 19. Nature Does Not Tolerate Monocultures for long…
  20. 20. Two houses, adjoining back yards (From Streetsblog, 02/28/2013)
  21. 21. For every age group from 3 through 34-- crashes were the No. 1 cause of death
  22. 22. Pedestrian Fatality Rates for Collisions at Different Speeds Zegeer et al 2002
  23. 23. Obesity Trends* Among U.S. Adults BRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%
  24. 24. Obesity Trends* Among U.S. Adults BRFSS, 1997(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%
  25. 25. Obesity Trends* Among U.S. Adults BRFSS, 2010 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
  26. 26. Fast Food Restaurants • “ black/low income” neighborhoods ~ 2.4 per sq. mile • “white” neighborhoods: 1.5 per sq. mile American Journal of Preventive Medicine, October 2004
  27. 27. “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 of adipose tissue. • The future medical costs for that “bargain” would be $6.64 for an obese man and $3.46 for an obese woman. University of Wisconsin-Madison, Rachel N. Close and Dale A. Schoeller
  28. 28. 0 25 50 75 100 Relationship Between BMI and Risk of Type 2 Diabetes Chan J et al. Diabetes Care 1994;17:961. Colditz G et al. Ann Intern Med 1995;122:481. Age-AdjustedRelativeRisk Body Mass index (kg/m2 ) WomenWomen MenMen <22 <23 23 - 23.9 24 - 24.9 25 - 26.9 27 - 28.9 29 - 30.9 31 - 32.9 33 - 34.9 35+ 1.0 2.9 1.0 4.3 1.0 5.0 1.5 8.1 2.2 15.8 4.4 27.6 40.3 54.0 93.2 6.7 11.6 21.3 42.1
  29. 29. Percentage of US Adults with Diagnosed Diabetes - 1994
  30. 30. Percentage of US Adults with Diagnosed Diabetes - 2001
  31. 31. Percentage of US Adults with Diagnosed Diabetes - 2007
  32. 32. NHANES National Health and Nutrition Examination Survey
  33. 33. Prevalence of and Trends in Diabetes Among Adults in the United States, 1988-2012 Andy Menke; Sarah Casagrande; Linda Geiss, Catherin Cowie JAMA. 2015;314(10):1021 doi:10.1001/jama.2015.10029
  34. 34. How Diabetes & Prediabetes Diagnosed In This Study • Diabetes – Prior Clinical Diagnosis or – Hemoglobin A1c level of >6.4% – Fasting Plasma Glucose >125 mg/dL • Prediabetes – Hemoglobin A1c level of 5.7- 6.4%, – FPG level of 100 - 125 mg/dL
  35. 35. Diabetes Prevalence NHANES (using Hemoglobin A1c , FPG) Sample of US Population All Age Groups, Races, Income and Education 1988-1994 2000-2002 2011-2012 9.8% 10.8% 12.4% For Prediabetes 36.5%
  36. 36. 10,000 steps • 3234 people with Pre-Diabetes (IGT –Impaired Glucose Tolerance) • Walked or exercised five times a week for 30 minutes for six months • Lost 5% to 7% of their body weight • Reduced their risk of diabetes by 58%
  37. 37. Survival of 1263 men with Type 2 Diabetes: Fit vs Unfit Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with Type 2 Diabetes." 18 April 2000 Annals of Internal Medicine 132, pp 605-611 M. Wei et al
  38. 38. “The Status of Baby Boomers’ Health in the United States: The Healthiest Generation?” JAMA Internal Medicine February 4, 2013
  39. 39. Overall Health Status US Persons Aged 46-64 NHANES 1988-1994 NHANES 2007-2010 Report “excellent” health 32% 13% Limitations to Life Functions 9% 14% Using Walking Assist (wheelchair, cane, etc) 3% 7%
  40. 40. “Lifestyle Factors” US Persons Aged 46-64 (NHANES) 1988-1994 2007-2010 Smoking 28% 21% Obesity 29% 39%
  41. 41. “Lifestyle Factors” US Persons Aged 46-64 (NHANES) 1988-1994 2007-2010 No Regular Physical Activity 17% 52%
  42. 42. Thinking about solutions
  43. 43. US High Fructose Corn Sugar Consumption per capita per day • Year Pounds Calories • 1965 0 0 • 1970 0.5 2 • 1980 19 53 • 1990 50 134 • 2000 64 179
  44. 44. Likely Results of a Sugar Sweetened Beverage (SSB) Tax • “A national tax of 1 cent per ounce on sugar-sweetened beverages (SSBs) would decrease consumption by 23% and raise $14.9 billion in the first year alone.” Brownell KD, et al. The public health and economic benefits of taxing sugar-sweetened beverages. NEJM. 2009;361(16):1599-1605.
  45. 45. “Modern” Schools Credit: Constance E. Beaumant, NTHP Credit: South Carolina Coastal Conservation League
  46. 46. • Percent of children who walk or bike to school: • 1974  66% • 2000  13% (CDC, 2000) We have changed how much we walk or bike
  47. 47. Fitness of California Children Annual Fitnessgram Results Conducted in Grades 5, 7, and 9 Measures 6 major fitness areas (e.g. aerobic capacity, body composition, flexibility) 2011 Results: Who passed all standards? Grade 5: 25% Grade 7: 32% Grade 9: 37% http://www.cde.ca.gov/nr/ne/yr11/yr11rel95.asp#tab1
  48. 48. The Built Environment: Designing Communities to Promote Physical Activity in Children Policy Statement American Academy of Pediatrics June 2009
  49. 49. Institute of Medicine Report Accelerating Progress in Obesity Prevention May 8, 2012
  50. 50. Gain in Longevity for a 45-Year Old Male 5.8 years 8.7 years 0 2 4 6 8 10 Low vs Moderate Low vs High Years of added life Additional years of Life: Moving from Low to Moderate Fitness -- 5.8 years From Low to High –- 8.7 years.
  51. 51. MRI Study of Brain Scans of 120 older adults-- Half – Moderate aerobic exercise: 45 minutes, three days a week, mostly walking. Half— No extra aerobic exercise. One year later:
  52. 52. MRI Study of Brain Scans of 120 older adults One Year Later— Half – Moderate aerobic exercise -- 45 minutes, three days a week, mostly walking. Brain size increased Half— No extra aerobic exercise -- Brain Size Decreased 1.5% Result: 3.5% difference Further tests showed that increased brain volume translated into better memory.
  53. 53. From the San Diego Planning Journal
  54. 54. • Lancaster Boulevard was a five-lane road w/ travel speeds up to 50 mph. • In 2010, the city revitalized nine blocks of Lancaster Blvd. • $11.6 million street renovation project. • 800 new permanent jobs were created. • 26% increase in sales tax revenue. • By 2012, the project attracted $130 million in private investments and generated $274 million in economic output. Lancaster Boulevard, CA 5
  55. 55. May 2014 UCLA the elevator doors in parking lots 4, 7, and 8 UCLA Department of Transportation
  56. 56. NYC Active Design Guidelines • Resilient Bldgs • Energy Efficient Buildings • Healthy Bldgs • Smart zoning and locations http://www.nyc.gov/html/ddc/html/design/active_design.shtml
  57. 57. http://www.surgeongeneral.gov/library/calls/walking-and-walkable-communities/call-to-action-walking-and-walkable-communites.pdf
  58. 58. Importance of What Makes People Happy Marketplace is Shifting-- More than 56% of home buyers want a home that is a walkable neighborhood with as little need for driving as possible.
  59. 59. “The BLVD is an endeavor to bring back the downtown experience” Lancaster, California
  60. 60. CicLAvia Los Angeles April 2012 Importance of Fun… and Festivals
  61. 61. Boyle Heights, Los Angeles. The Evolution into Mariachi Plaza
  62. 62. For Mariachi Plaza….”proposed eight-story medical office building and a six-level parking garage, plus a three-floor building with street-level retail would take out a small row of shops immediately north of the plaza…
  63. 63. Atlanta Citizens Turning Out To Help Get Ready for The Belt Line Importance of Community Pride
  64. 64. Indianapolis Cultural Trail • 8 miles $69 million • First $15 million from Glick family (start with philanthropy) • $2 million for Art • Links the city together • Revitalized Business • Helps to Recruit and Retain Top Talent • And, yes, a GOP Mayor Importance of Art and Beauty and Nature
  65. 65. Home Price Growth By Neighborhood Type 2011-2014
  66. 66. Image Credit: Lehrer + Associates and LA River
  67. 67. Image Credit: Lehrer + Associates and LA River
  68. 68. Economic Benefits of Urban River Parkways ● Medical cost savings o one study found that every $1 invested in trails for physical activity resulted in nearly $3 direct medical benefit ● Economic development o sale prices up to 16% higher for homes within 1,500ft of natural spaces o Colorado: land value increased by $4.20 for every foot closer to the “greenbelt” o Philadelphia: property values increased from $1,000/acre 2,500ft from park to $11,500/acre within 40ft
  69. 69. The Manhattan Waterfront Greenway 32-mile long walking and bicycling path around the island of Manhattan. The majority of the Manhattan Waterfront Greenway is physically separated from auto traffic
  70. 70. • Importance of Courage– The NYC High Line • AIA Report: Local Leaders— Healthier Communities Through Design 2013
  71. 71. The High Line NYC A 20 block walk in Manhattan without a cross street– and it was delightful even with a 2 year old.
  72. 72. Ten Principles for Building Healthy Places The Urban Land Institute 2013
  73. 73. Urban Land Institute’s Healthy Places Toolkit Released at International Meeting in Paris February 5, 2015 http://www.uli.org/toolkit
  74. 74. http://www.uli.org/toolkit
  75. 75. http://www.uli.org/toolkit
  76. 76. http://www.uli.org/toolkit
  77. 77. Richard J Jackson MD MPH AIA(Hon) FAAP ASLA(Hon) dickjackson@ph.ucla.edu UCLA Fielding School of Public Health We Are What We Eat… And What We Build http://designinghealthycommunities.org /

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2nd Annual Antelope Valley Wellness Symposium - Antelope Valley Partners for Health

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