Transcript Document

Trail Leaders
are Health
Leaders
• Richard J Jackson MD
Professor and Chair, Environmental
Health Sciences
• UCLA School of Public Health
• [email protected]
Our shaping of the built environment shapes our health, wealth,
and future.
The Check Up
40 year old parent of two children
• -- complains of “low energy”
“Problem” List
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Physical exam unremarkable but
28 pounds overweight
BP 155/95
Blood glucose elevated, urine normal
Cholesterol 270
Signs of Depression
No exercise. …Drives to work 25 miles each way
Spends 3 to 4 hours a day sitting in a vehicle
Treatment Plan
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Meeting with Nutritionist
Weight loss program
Exercise club membership
Pedometer: 10,000 steps a day
Getting more control of work and life
commitments
Two Months Later…
• Day is already too full
• No Time for exercise
• No place to Walk
2 months later our colleague is
taking:
– Antihypertensive
medication
– Oral Hypoglycemic
agent
– Antidepressant
– Cholesterol lowering
agent
• Monthly medication costs:
– $385
U.S. Health Care Expenditures as
Percent of GDP Projections
Keehan et al:
Health Affairs
March/April 2008 27:
145-155
An Aging Population
Percentage of U.S. Population over
Age 65
Percentage of Population
25
20
15
10
5
0
1930
1950
1970
1990
2010
2030
2050
Year
Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging Population
Copyright 1996, Watson Wyatt Worldwide.
Persons employed in health service
sites: United States -- 2005
• All employed civilians
141,730,000
• All health service
sites: 14,052,000
– Hospitals: 5,719,000
– Nursing care facilities:
1,848,000
http://www.cdc.gov/nchs/data/hus/hus06.pdf#summary
Of the 4,800,000 new jobs in the
US 2000-2005
• How many were in Health Care?
• 1.8 million -- 40%
http://www.cdc.gov/nchs/data/hus/hus06.pdf#summary
• “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
• We have rigged the “environment”
against us…
Obesity Trends* Among U.S. Adults
BRFSS, 1990
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
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
Obesity Trends* Among U.S. Adults
BRFSS, 2004
(*BMI ≥30, or ~ 30 lbs overweight for 5’ 4” person)
No Data
<10%
10%–14%
15%–19%
20%–24%
≥25%
Bariatric Procedures: Annual Numbers
JAMA 2005: pp1909-1917
California Prevalence of Overweight*
Children aged 5 to 20 years
25
21.7%
Percentage
20
15
10
Year
2010
target**
5
0
5-<9
9-<12
12-<15 15-<20
Age (years)
Total
* > 95th percentile BMI-for-age, CDC Growth Charts, 2000.
** Year 2010 target: reduce the proportion of children and adolescents aged 6 to 19 years
who are overweight to 5%.
2003 California Pediatric Nutrition Surveillance (PedNSS)
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: $1.1 billion
• (Oct 2005 prices)
• CO2 emissions from extra fuel:
3.8 million tons
Data sources: NCHS; US Dept. of
Transportation
Age-Adjusted Relative Risk
Relationship Between BMI and Risk
of Type 2 Diabetes
93.2
100
Men
Women
75
54.0
50
42.1
40.3
27.6
21.3
25
0
1.0
2.9
1.0
4.3
1.0
5.0
1.5
<22
<23
23
23.9
24
24.9
8.1
2.2
15.8
25
26.9
27
28.9
4.4
6.7
29
30.9
Body Mass index (kg/m2)
Chan J et al. Diabetes Care 1994;17:961.
Colditz G et al. Ann Intern Med 1995;122:481.
11.6
31
32.9
33
34.9
35+
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 1993-94
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes,
and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).
Diabetes and Gestational Diabetes Trends Among
Adults in the U.S., BRFSS 2001
No Data
<4%
4%-6%
6%-8%
8%-10%
>10%
Mokdad AH, Ford ES, Bowman BA, et al. Prevalence of obesity, diabetes,
and other obesity-related health risk factors, 2001. JAMA 2003 Jan 1;289(1).
Diabetes Projected Risks:
For Babies Born in 2000
Girls: 38% lifetime risk
–
If diabetic before age 40, Lifespan
shortened by 14 years (Quality of
life by 19 years)
Boys: 33% lifetime risk
If diabetic before age 40, Lifespan
shortened by 12 years. (Quality of life
by 22 years)
V Narayan et al: JAMA 8 Oct 2003
Life Expectancy Is Declining in
Some Pockets of the Country
NICHOLAS BAKALAR -- New York Times
Too Many Calories?
“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
Percentage of Trips in Urban Areas Made by Walking
and Bicycling: North America and Europe 1995
50
45
28
40
35
12
30
Bicycling
Walking
25
20
15
10
5
0
2
1
6
U.S
22
18
10
Canada
Germany
Holland
Pucher J and Dijkstra L. Promoting Safe Walking and Cycling to Improve Public Health: Lessons From The Netherlands and
Germany. AJPH, September 2003;93(9):1509-16.
Nurse Study 1976-2000
Risk of Death
2.4
2.5
1.9
2
1.6
Active
Inactive
1.5
1
1
0.5
0
Lean
Hu et al. NEJM, December 23, 2004; 351(26):2694-2703.
Obese
• How does this have to do with how we
build?
The United States has
paved over 60,000
square miles of its
natural landscape.
Less Density = More Driving
Miles per capita– more than doubled
in one generation
Miles per Capita: 1960 to 1995
From 4000 to 9200
VMT per person
For every age group
from 3 through 33-crashes were the No. 1
cause of death
More time in a car Higher probability of obesity
More walking: Less obesity
Higher density and connectivity: Lower obesity–
Atlanta study 2004
Schools
• Since World War II
– Number of Schools declined 70%
– Average School Size
• grew fivefold, from 127 to 653 students
We have changed
how much we
walk or bike
• Percent of
children who
walk or bike to
school:
• 1974  66%
• 2000  13%
(CDC,
2000)
Fitness of California’s Children
Annual California Fitnessgram
• Conducted in Grades 5, 7, and 9
• Measures 6 major fitness areas
(e.g. aerobic capacity, body composition, flexibility)
• 2004 Results: Who passed all standards?
Grade 5  25%
Grade 7  29%
Grade 9  26%
Institute
Institute of
of Medicine
Medicine
The
The purpose
purpose of
of public
public health
health is
is
to
to fulfill
fulfill society’s
society’s interest
interest in
in
assuring
assuring the
the conditions
conditions in
in which
which
people
people can
can be
be healthy
healthy
Mindfulness about Food
Mindfulness about what
and how we eat
“…students have
better
attendance, are
less likely to
drop out, exhibit
fewer discipline
problems, and
perform better
when attending
a smaller high
school.”
Secretary of Education Richard Riley Oct 4, 2000
Educational Benefits of
Walking and Biking to School
• Increases
concentration
• Improves mood and
ability to be alert
• Improves memory
and learning
• Enhances creativity
Children’s Contact with Nature
• School age children with ADHD who
had higher contact with nature showed
better concentration, task completion,
and following of directions.
Coping with ADD: The Surprising Connection to Green Play Settings”
Environment and Behavior, 33 (1), 54-77 AF Taylor, FE Kuo, WC Sullivan,
2001
Outdoor Physical Activity
• Studies in older children show that
improved mood and emotional well-being
are associated with physical activity.
• Mood may be affected not only by the
physical activity itself but also by exposure
to sunlight if the activity occurs outdoors
Steptoe A, Butler N. Sports participation and emotional wellbeing in
adolescents. Lancet. 1996;347:1789-1792.
Wirz-Justice A, Graw P, Krauchi K, et al. “Natural” light treatment of
seasonal affective disorder. J Affect Disord. 1996;37:109-120.
NYC Mayor
Bloomberg
Announces
PlaNYC to
place a park
or
playground
within a ten
minute walk
for every
New Yorker.
August 2007 Trust for Public Land
10% increase in
urban parks = 4°C
decrease in urban
surface
temperature
School Gardens
Exercise, Learning,
Cooperation, Fun, and
It Tastes good
“Farmer in
Chief”
Michael Pollan
New York Times
October 12, 2008
Reversing “The Disease” of the 21st
Century…
• Depression
Income and Happiness
SOURCE: Layard, R. Happiness and Public Policy. The Economic Journal 116 (March): C24-C33. Page C25.
What does make people happy?
Human Contact
• Being with People we
love and who love us
Exercise in
Healthy Places
• Treatment for
Depression—
• Exercise
• Sunlight
• Nature Contact
• The health need for
places to walk
Health – Planning Collaborations
• SF Bay Area (11 counties) meeting Dec 2006
• Los Angeles County (300 attendees) April 2007
• Marin, Napa, Sonoma, Solano, El Dorado, San
Mateo, Sacramento, San Francisco, Placer, Yolo,
Santa Barbara, San Diego, Riverside, Monterey,
Humboldt
AB 1358 -Complete Streets
Act
John P. Kouletsis, A.I.A.
Director, Strategy, Planning, & Design
National Facilities Services
New Partners for Smart Growth
Building Safe, Healthy and Livable Communities
Leveraging Size and Prominence to
Promote Sustainable Design
February 8-10, 2007
The New Bicycle Commuter
• 30 minute bicycle trip burns 250 calories
each way (for a 190 pound man)
• 3 days per week = 1500 calories per week,
78,000 calories/year.
• Converts to 22 pounds of body fat.
The New Bicycle Commuter
One year follow up
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Weight - 168 pounds (BMI 24.5)
BP - 130/78
Blood sugar – Normal
Cholesterol – 175
Energy level and Mood - Good