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EDRA44Providence keynote presentation 05.30.13

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

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EDRA44Providence keynote presentation 05.30.13

  1. 1. Richard J. Jackson, MD, MPHProfessor & Chair, Environmental HealthSciences, UCLA Luskin School of Public HealthDesigningHealthy Communities
  2. 2. Thank You to OurEDRA44ProvidenceSponsors:
  3. 3. Richard J Jackson MD MPHFAAP HonASLA HonAIAdickjackson@ucla.eduSystemic Disorders RequireSystemic Treatmentshttp://designinghealthycommunities.org/
  4. 4. We NeedSolutions ThatAddress MultipleThreats
  5. 5. The Daily Bruin October 11, 2011
  6. 6. USA Today 10/20/2011
  7. 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. 8. The CheckUp10 year oldboy
  9. 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. 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. 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. 12. – Antihypertensivemedication– Oral Hypoglycemicagent– Antidepressant– Cholesterol loweringagent• Monthly medicationcosts:– $3852 months later the patient is taking:
  13. 13. • The “environment” is rigged againstthe child…• And the doctor,• And the rest of US.
  14. 14. U.S. “Health” CareExpenditures as Percent ofGDPKeehan et al: Health AffairsMarch/April 2008 27: 145-155
  15. 15. Male Life ExpectancyUS Life Expectancy is #49 Worldwide – CIA Chartbook
  16. 16. 10 leading causes of death -United States, 19000 2 4 6 8 10 12 14PneumoniaTuberculosisDiarrhea and enteritisHeart diseaseStrokeLiver diseaseInjuriesCancerSenilityDiphtheriaPercentage
  17. 17. CDC Headquarters - Atlanta
  18. 18. July 6, 1999
  19. 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. 20. • The BuiltEnvironment –how we buildour homes,workplaces,towns, citiesand world
  21. 21. The United States hasnow paved over theequivalent area of theentire state of Georgia60,000 square milesAnd Photosynthesis isour friend!
  22. 22. American Farmland TrustLoss of Farmland
  23. 23. Two houses, adjoining back yards(From Streetsblog, 02/28/2013)
  24. 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. 25. Pedestrian Fatality Rates forCollisions at Different SpeedsZegeer et al 2002
  26. 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. 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. 28. Commuting by driving is mostly not good for you.Traffic along LA freeways and Wilshire Blvd.
  29. 29. Are More Deaths in AmericaCaused By:Vehicle Crashes?Vehicular Air Pollution?
  30. 30. Most Air Polluted CitiesOzone, “Year Round Particle”, “Short-term Particle”American Lung Association 2011 “Share the Air”
  31. 31. The Heat Island
  32. 32. Ground Level OzoneLevels increase in late afternoonas traffic and temperature peak
  33. 33. More time in a car  Higher probability of obesity
  34. 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. 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. 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. 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. 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. 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. 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. 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. 42. Theresa Devine & Amy VetalBILLBOARDS VS. HEALTH: Considering the Impact of Billboards on HealthCase Study LaBrea, Hawthorne
  43. 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. 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. 45. Percentage of US Adults with DiagnosedDiabetes - 1994
  46. 46. Percentage of US Adults withDiagnosed Diabetes - 2001
  47. 47. Percentage of US Adults with DiagnosedDiabetes - 2007
  48. 48. “The Status ofBaby Boomers’Health in theUnited States:The HealthiestGeneration?”JAMA InternalMedicineFebruary 4, 2013
  49. 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. 50. “Lifestyle Factors” USPersons Aged 46-64 (NHANES)1988-1994 2007-2010Smoking28% 21%Obesity29% 39%
  51. 51. “Lifestyle Factors” USPersons Aged 46-64 (NHANES)1988-1994 2007-2010No Regular Physical Activity17% 52%
  52. 52. “Keeling Curve”
  53. 53. “Keeling Curve”
  54. 54. Greenland SurfaceIcemeltJuly 12, 2012Deepest Pink Indicates SurfaceHas Melted
  55. 55. In the 21st Century We Need:• ResilientPeople• ResilientBuildings• ResilientInfrastructure• ResilientCommunities
  56. 56. Resilient People Who Need HealthyFoodMindfulness about whatand how we eat
  57. 57. Food
  58. 58. DOOF
  59. 59. High FructoseCorn Sugar• US annual percapitaconsumptionof HFCS• 63pounds
  60. 60. The BuiltEnvironment:DesigningCommunities toPromote PhysicalActivity inChildrenPolicy Statement AmericanAcademy of PediatricsJune 2009
  61. 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. 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. 63. Research
  64. 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. 65. “Health” “Built Environment”1980-2000 13,900 results
  66. 66. 2001-2013 32,900 results
  67. 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. 68. 2011 APHA Annual Meeting“land use” 102 matches“built environment”182 matches
  69. 69. AJPHBuilt Environmentand HealthSeptember, 2003
  70. 70. Medline Keyword Search:“Built Environment” and “Health”September 1993 - September 200358 ArticlesSeptember 2003 – May 2013665 Articles
  71. 71. Charlotte, NC, Light Rail OpenedNovember, 2007
  72. 72. Interviewed Peopleat 839 locationstwo years beforeand after CharlotteLight Rail ServiceBegan
  73. 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. 74. People
  75. 75. US Joint Degree Programs inUrban Planning and HealthBefore 2003--None2013 -- 14 Joint Programs
  76. 76. MakingHealthyPlacesA DannenbergH FrumkinR JacksonIsland Press 2011
  77. 77. Atlanta Citizens Turning Out To HelpGet Ready for The Belt LinePeople Creating Change
  78. 78. Homebuyers’ DecisionsMore than 56% of home buyerswant a home that is a walkableneighborhood with as little need fordriving as possible.
  79. 79. Policy
  80. 80. Institute of MedicineReportAccelerating Progressin Obesity PreventionMay 8, 2012
  81. 81. Resilient Communitieshttp://changelabsolutions.org/
  82. 82. Importanceof General orMaster Plans• Sonoma county:General Plan --Policies thatAddress PublicHealth Threats
  83. 83. Complete Streets Bring Equity toCommunity and Transportation• Complete Streets– social equity, aesthetics, walking, improvedlocal sales, community building
  84. 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. 85. Action
  86. 86. • The Chenoggye freeway ran through thecenter of Seoul ~1970-2005
  87. 87. Cheonggyecheon -- 8.4 km long downtown Seoul, South Korea.The $900 million project initially attracted much public criticism.
  88. 88. Vision
  89. 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. 90. Army Corps of Engineers Estimate --• Reshaping the Los Angeles River ~– $25- 100 million/mile51 miles$1.275 - $5.1 billion
  91. 91. Message and Communication
  92. 92. http://designinghealthycommunities.org/
  93. 93. We Have Solutions That AddressMultiple Threats.
  94. 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. 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. 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. 97. Richard J Jackson MD MPHFAAP HonASLA HonAIAdickjackson@ucla.eduSystemic DisordersRequire Systemic Treatmentshttp://designinghealthycommunities.org/
  98. 98. Thank You to OurEDRA44ProvidenceSponsors:

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