health starts in our communities: the prevention crisis
TRANSCRIPT
Health starts in our communities: The Prevention
CrisisAlison Scott, PhD
The College of William and MaryDepartment of Kinesiology and Health Sciences
Image: NC Community Health Assessment Initiative, http://www.schs.state.nc.us/SCHS/about/chai.html
Roadmap
1. Why a prevention focus?2. What matters for prevention and health
promotion?3. What can we do??
Health Care Expenditure per Capita
http://www.unnaturalcauses.org/interactivities_04-3.php
Life Expectancy at Birth
http://www.unnaturalcauses.org/interactivities_04-1.php
‘Actual causes of death’ (2000)
• Tobacco18%
• Physical inactivity and poor diet 17%• Alcohol consumption 4%• Microbes 3%• Toxic agents 2%• Motor vehicles 2%• Firearms 1%
Bad news and good news…
BAD NEWS: We can’t treat our way out of 28th place.
GOOD NEWS: We can prevent our way out of 28th place. *Cost-effectively!
What matters for prevention and health promotion?
• Simple!– Education– Personal responsibility – Good behavior choices
A. Whether or not you smokeB. What you eatC. Whether or not you are wealthyD. Whether or not you have health
insuranceE. How often you exercise
On average, which of the following conditions is the strongest predictor of your health?
ANSWER: C. Whether or not you are wealthy
Even if you control for health behaviors.
Life Expectancy by Income
80.7
78.9
76.4
74.2
72
74
76
78
80
82
<$20K $20-40K $40-80K >$80K
Income Level
Lif
e S
pan
Source: National Longitudinal Mortality Study 1988- 1998. Adapted from work prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco; and Norman Johnson, U.S. Bureau of the Census.
Life Expectancy by Income and Race
68
70
72
74
76
78
80
82
84
White Black Hispanic
Lif
e S
pa
n
<20K
<20K
<20K
20-40K 20-40K 20-40K40-80K 40-80K>80K >80K >80K40-80K
September 20, 2012
Life Spans Shrink for Least-Educated Whites in the U.S.By SABRINA TAVERNISE
For generations of Americans, it was a given that children would live longer than their parents. But there is now mounting evidence that this enduring trend has reversed itself for the country’s least-educated whites, an increasingly troubled group whose life expectancy has fallen by four years since 1990. Researchers have long documented that the most educated Americans were making the biggest gains in life expectancy, but now they say mortality data show that life spans for some of the least educated Americans are actually contracting.
http://www.nytimes.com/2012/09/21/us/life-expectancy-for-less-educated-whites-in-us-is-shrinking.html
So…
• Only educated, wealthy, white people make good health behavior choices?
Because…
•Health and healthy choices are shaped by where we live, work, and play.
• Why living environments matter:1. Opportunities for healthy behaviors2. Exposure to chronic stress3. Social support
US Geological Service, http://www.cnrfc.noaa.gov/rfc_photo.php?id=crec1&photo=upstream
1. Healthy behavior opportunities
• Living environments matter for…1. Healthy behavior opportunities.
• Our neighborhoods.
• Our schools and workplaces.
2. ‘Chronic Stress’
• Living environments matter for– healthy behavior opportunities– stress exposure
(Cohen, Janicki-Deverts , and Miller 2007; Ader, Felten, and Cohen 2006)
Psychoneuroimmunology
• Studies the interplay of psychology, the nervous system, and the immune system.
• Findings: Psychosocial stressors can lead to – impaired immune function– unregulated inflammation– hormonal and metabolic imbalances– via dysregulation of the HPA axis.
• Mind-Body dichotomy artificial
(Cohen, Janicki-Deverts , and Miller 2007; Ader, Felten, and Cohen 2006)
• Chronic stress increases disease risk.–Hypertension–Heart Disease–Cancer–Obesity–HIV disease progression…
• Stress in our neighborhoods?
• Stress in our schools and workplaces?
We are especially vulnerable in early life.– Chronic stress in kids damages the developing brain,
immune system, metabolism.– Parents’ home ownership can predict immunity to colds as
adults…– Childhood ACE can double risk of autoimmune disease as
adults…
– Experiences in childhood lay the foundation for a lifetime of health or illness.
Cohen et al, Dube et al 2009
Discrimination is a potent chronic stressor.
• Race, sex, sexual orientation, size… • Experiences of lifetime racism are associated
with stress-linked health risks.– Hypertension– Obesity– Depression
3. Social Support
• Living environments matter for:1. Healthy behavior opportunties2. Stress3. Social support
3. Social support
• Being connected to others is good for our health.
• Emotional• Instrumental• Informational
• Supports healthy behaviors• Increases our resistance to disease
• “tend and befriend”
• Happy marriage is good for health– Longer life, cancer, heart disease,
depression• Communities have ‘dispositions’ that
matter for health and violence– Trust, reciprocity, sense of fairness
Connecting the dots…
• Resources and education link to:– Living environments more conducive to
healthy choices– Fewer chronic stressors–More social support– In a gradient.
Being poor and uneducated: A ‘health risk pile-up’
Poor access to healthy foods, substandard housing and homelessness, low control/ high stress jobs, lack of sleep, fear of neighborhood violence, higher density of liquor stores and illegal drug markets, multiple jobs, poor quality schools, unemployment and underemployment, lack of recreational facilities, environmental degradation, lack of transportation, lack of health insurance, low educational attainment, lack of bridging social capital, lack of quality and affordable child care, low knowledge levels about nutrition and self-care, inability to buy and prepare healthy meals, lack of green space, air and noise pollution, lack of reciprocity and trust, lower instrumental social support……..+/- discrimination
What can we do?
• Lots!
• A broader frame for action for health.
Work toward communities that….• catalyze healthy choices• minimize chronic stress• support people emotionally and instrumentally
Direct Community Action
1. Form partnerships…– Public Health departments and organizations
2. Assess…–Challenges–Capacities
3. Act…4. Evaluate!
School lunches, food in public buildings and jails
Build or repair playgrounds
Community center
Farmer’s market with EBT
Worksite wellness
Media campaigns
Enterprise zonesCommunity gardens
Transport service or public transport Peer education
Sports teams or clubs
Sidewalks
Smoke-free environments
Fast food-free zones
Job counseling
Coalitions to address environmental concerns
Community summits on race, class…
Policy Involvement– Voter awareness and Advocacy• Health policies
– Clean Air Act– Prevention and Public Health Fund (ACA)
• Policies and programs that buffer chronic stress and provide opportunities for healthy choices. These are health policies too!
•scholarships and loans for education, food support, child care support, unemployment insurance, universal health coverage, workplace protections and labor laws, affordable housing, living wage…
–These are the keys to climbing the health ladder.–A good investment. $1 trillion productivity losses
each year from chronic illness alone.
Conclusions
• The opportunity to be healthy begins at birth, and continues across the lifespan.
• By embracing the work of primary prevention in our communities, we can work toward providing all Americans the opportunity to make healthy choices, irrespective of income, race, or education.