Posts about Public Health

Global Solutions President and CEO Dr. Maya Rockeymore, speaking at a panel after the screening, responded to the stark numbers presented in the film. In Baltimore, residents of the Inner Harbor have a life expectancy of 62 years while residents of North Baltimore have a life expectancy of 82 years. "Context controls choice," she said. People need access to parks, transit, safe walking and bicycle routes, and full-service grocery stores to even have the choice to be healthy.

Low-income communities and communities of color have higher rates of obesity and chronic disease. The physical neighborhood of the Inner Harbor contributes to the health disparity in life expectancy. While designed as a walkable community, the neighborhood suffers from vacant houses, streets in need of maintenance and lack of destinations to meet basic needs such as a grocery store. When the physical environment deteriorates, safety becomes an additional issue in neighborhoods.

In the United States, 66% of adults are overweight or obese and nearly 20% of children are obese. Being overweight or obese increases the risk of chronic diseases such as hypertension, high cholesterol, type 2 diabetes, and asthma in both adults and children.

Pamela Creekmur, the Acting Health Officer and Director of the Prince George's County Health Department, explained that Prince George's obesity and physical inactivity rates are higher than other jurisdictions in the greater Washington region. Though Prince George's faces a bigger challenge, all the region's communities have seen a rise in obesity rates, which range between 18 to 34 percent for adults throughout the region.

Part of the cause of this obesity epidemic is physical inactivity. There has been a 300 percent increase in driving to work since 1960. As the documentary explains, in 1969 almost 50 percent of kids walked or biked to school while today only 13 percent of kids do the same.

The lack of exercise by children extends beyond just commuting to and from school. The documentary shows a mom who takes her children to a parking lot because it is the only open space they have to play. This environment isn't hospitable to the kind of physical activity a good park encourages.

Whether it's questions of commuting or questions of parks, transportation and planning professionals make decisions that affect travel and open spaces every day. These decisions need to be viewed as public health decisions.

The Centers for Disease Control and Prevention (CDC), the federal agency charged with health promotion and disease prevention, agrees. It has recognized that transportation policy, street-scale improvements, and access to places suitable for physical activity matter to our health. Among the CDC's recommendations is to participate in Safe Routes to School initiatives and adopt Complete Streets policies.

The Guide to Community Prevention Services, written by an independent group of public health and prevention professionals appointed by the CDC director, outlines several more environmental and policy approaches to provide opportunities for people to be physically active. These include the connectivity of sidewalks and streets, providing places for physical activity such as trails, and street-scale improvement such as street lighting and traffic calming. Such urban design features have been shown to improve some aspect of physical activity by 35 percent, not to mention the accompanying benefits of reduced crime and stress.

Of course, these improvements do not come overnight. After the screening, an elected official and audience members noted that such changes are not easy. After all, parks do not generate tax dollars.

But that does not mean that our environments must stagnate while our health deteriorates. Local communities can bring about change even when the federal government or state government seems stuck. Port Towns Youth Council President Erick Vargas talked about how his group took matters into their own hands by doing an audit of the streets and reporting the problems.

Prince George's County is taking action through a partnership of towns within the county. The Port Towns Community Health Partnership has a policy development team focused specifically on the built environment and nutrition policy to improve options for active living and healthy eating.

The group, which includes the towns of Bladensburg, Colmar Manor, Cottage City, and Edmonston, included a community health and wellness section in the Port Towns sector plan with the goals of providing safe places to walk and exercise and access to nutritious foods. The group is following through on sector plan recommendations to formalize a wellness opportunity zone as part of the zoning code. This would include changes in the built environment, access to healthier foods, and improved environmental stewardship.

Across the Potomac, the Fairfax County Health Department established the Partnership for a Healthier Fairfax, a group of community members and organizations concerned with public health. The Partnership created an environment and infrastructure strategic issues team as one of five teams who will make recommendations for improving health in Fairfax County. The first focus is a on local policy. The team is doing a scan of policies, including transportation and land use, that could be modified to promote a healthier and safer physical environment.

In the Washington region, better transportation and planning decisions can improve our health by increasing our access to efficient transit and space to run, bike, and play. We also create a healthier context for our environment—and as Dr. Rockeymore said, context controls choice. Throughout the region, local groups are working to give more of their neighbors the choice to live healthier lives.

Investments in traffic safety finally began to matter in 2004. According to the Brookings Institution, "driving, as measured by national VMT, began to plateau as far back as 2004 and dropped in 2007 for the first time since 1980," obviously due to rising gas prices. As a result, the rate of traffic fatalities per 100,000 population finally began a much steeper decline in 2004 compared to earlier periods when safety improvements had been largely undermined by VMT increases.

But did this demonstrate the urgency of reducing traffic? Not according to NHTSA Administrator David Strickland, who said the following in a press release celebrating the decline:

This continuing decline in highway deaths is encouraging, but our work is far from over. We want to see those numbers drop further. We will not stop as long as there are still lives lost on our nation's highways. We must continue our efforts to ensure seat belts are always used and stay focused on reducing distracted and impaired driving.

Attributing the recent decline in traffic fatalities solely or primarily to safety improvements is not only sloppy statistics given that safety improvements have lead to steady declines in fatalities per VMT for decades. It also sends the wrong message—people can feel safe driving, as driving itself is not part of the problem—a message which will only increase VMT further and bring a halt to reductions in traffic fatalities.

Attributing the declining fatality rate to safety improvements also allows the myth to perpetuate that moving to the suburbs is safer than living in the city, a myth that, left unchallenged, increases VMT and undermines safety improvements. This myth was exposed by the New York City Department of Health, which recently revealed that their low VMT per child made NYC a much safer place for children than the rest of the country.

So why does the CDC, WHO, NIH, NHTSA and probably every other public health agency treat poor traffic safety as the preventable cause of the top killer of children worldwide, and not traffic as well? And how many children will have to die for this to change? Are we serious about public health? The sooner we start demanding honesty about the causes of the top killer of children here and abroad the better, because during the 2 minutes you spent reading this article, another child died in a traffic collision.

Compare the possible benefits of a soda tax to the cigarette tax. Taxing cigarettes has proven to be highly successful in reducing consumption. For every 10 percent increase in the price of cigarettes reduces sales by 3 to 5 percent and has lead to better health outcomes. Sugary beverages like soda can lead to negative health outcomes for children and adults. Obesity-related medical expenditures cost tax payers approximately 74 billion a year through Medicaid and Medicare.

A reduction in child obesity could lead to major savings for DC tax payers over the long term. In 2008 36 percent of high school students were clinically overweight and obese. If we assume that the patterns of obesity are the same among younger children, then about 41,000 children 18 and younger are overweight or obese in the District.

Researchers estimate that the cost of health care associated with obese children in 2008 is $15.97. If we multiply the number of overweight and obese children in the District by $15.97, then the total cost of obesity related health care is approximately $655,000.

While a small tax can generate millions, will it actually have the effect of reducing soda consumption? Most likely not. Studies indicate that a tax of at least 18 percent would be needed. Experts at the Rudd Center for Food Policy and Obesity argue that the tax needs to be high if we want to change American's addiction to sugary drinks. However, city council members and the voting public may be less willing to accept a tax much higher than 1 cent. Only those who truly think that obesity is a major problem for the district would be willing to pay a higher soda tax.

Opponents of a soda tax argue that a tax would disproportionately hurt the poor who spend a larger proportion of their income on food. This may be true, but only for poor people who consume more soft drinks. The bigger problem for low-income households is having access to grocery stores that offer healthy, affordable food options. It is no coincidence that areas of the District that lack access to grocery stores (mainly in Wards 5, 6, 7, and 8) tend to have higher rates of obesity than wards in the upper Northwest. Hopefully Cheh's program could be extended to provide food subsidies to families living in areas with few healthy food options.

The beverage industry is fiercely opposing the proposed tax. The Maryland-Delaware-D.C. beverage association and more than three dozen city grocers and restaurants have formed a group called No D.C. Beverage Tax. The group has run full-page ads in the Metro along with other local papers and radio spots.

The Campaign for Healthy Kids argues that the American Beverage Association has spent $5.4 million to fight various state and local initiatives to tax soda, and that DC is now it's new target. They have started a petition to urge the City Council to pass Cheh's proposal.

While much of the debate regarding the soda tax is focused on the "tax" itself, proponents of the tax need to focus more on the public health message. The purpose behind the Healthy Schools act is to fund nutrition programs and reduce consumptions of unhealthy products. Hopefully it will be the public health message, and not the industry message, that will resonate with city council members when the act is up for a final vote later this month. Pass the soda tax, it's good public health policy.