7. Mean Mentally Unhealthy Days
US Population â from national BRFSS
0.1-1.0 million interviews per year
2.9ď 3.4 days per month (17% increase)
http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Category=1&Measure=3
9. âProblemâ List
⢠Physical exam unremarkable
⢠Ht 54â (50%)
⢠Wt 115# (95%)
⢠BP 140/90
⢠Blood glucose elevated, urine normal
⢠Cholesterol 220
⢠Signs of Depression
10. Treatment Plan
⢠Referral to âoverweightâ clinic
⢠Weight loss program
⢠TV out of the bedroom; no soft drinks in
the house
⢠Exercise program; Encourage sports
11. Two Months LaterâŚ
⢠Lost One pound
⢠Canât change the food at school
⢠Day is already too full
⢠No Time for exercise; ânot good at
sportsâ
⢠No place to Walk
12. â Antihypertensive
medication
â Oral Hypoglycemic
agent
â Antidepressant
â Cholesterol lowering
agent
⢠Monthly medication
costs:
â $385
2 months later the patient is taking:
13. ⢠The âenvironmentâ is rigged against
the childâŚ
⢠And the doctor,
⢠And the rest of US.
20. Health Challenges of the
21st Century
⢠Chronic Diseases and Costs of Care for
Aging Populations.
⢠Overweight, Obesity, Diabetes II, Heart
Disease
⢠Mental Disorders: Depression, Anxiety,
Developmental, Substance Abuse
⢠Macro-environment: Climate, Conflict
29. Automobile fatality rates by city, 1998
(excluding pedestrian fatalities; deaths/100,000/year)
9.80
10.52
11.33 13.12
Source: NHTSA
2.51
New York
3.76
San Francisco
6.55
Portland
9.80
Houston
10.52
Phoenix
11.33
Dallas
13.12
Atlanta
5.36
Philadelphia
30. Number of Lives Saved per year
if National Car Fatality Rate same as:
⢠New York City 24,000
⢠Portland 15,000
⢠Atlanta Noneâ 15,000 additional
31. Commuting by driving is mostly not good for you.
Traffic along LA freeways and Wilshire Blvd.
32. Are More Deaths in America
Caused By:
Vehicle Crashes?
Vehicular Air Pollution?
33. Most Air Polluted Cities
Ozone, âYear Round Particleâ, âShort-term Particleâ
American Lung Association 2011 âShare the Airâ
36. More time in a car ď Higher probability of obesity
37. Obesity Trends* Among U.S. Adults
BRFSS, 1991(*BMI âĽ30, or ~ 30 lbs. overweight for 5â 4â person)
No Data <10% 10%â14% 15%â19%
38. Obesity Trends* Among U.S. Adults
BRFSS, 1997(*BMI âĽ30, or ~ 30 lbs. overweight for 5â 4â person)
No Data <10% 10%â14% 15%â19% âĽ20%
39. Obesity Trends* Among U.S. Adults
BRFSS, 2010
(*BMI âĽ30, or ~ 30 lbs. overweight for 5â 4â person)
No Data <10% 10%â14% 15%â19% 20%â24% 25%â29% âĽ30%
40. 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 tons
Data sources: NCHS; US Dept. of Transportation
41. Fast Food
Restaurants
⢠â black/low incomeâ
neighborhoods ~
2.4 per sq. mile
⢠âwhiteâ
neighborhoods:
1.5 per sq. mile
American Journal of Preventive Medicine,
October 2004
42. âSupersizingâ a fast-food meal â
the real costs
⢠Paying 67 cents to supersize an order
â 73% more calories for only 17%
more money
⢠A Bargain!
University of Wisconsin-Madison, Rachel N. Close and Dale A. Schoeller
43. âSupersizingâ a fast-food meal â
the real costs
⢠Paying 67 cents to supersize an order â 73%
more calories for 17% more money
⢠â adds an average of 36 grams of
adipose tissue.
⢠The future medical costs for that
âbargainâ 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
44. Theresa Devine & Amy Vetal
BILLBOARDS VS. HEALTH: Considering the Impact of
Billboards on Health
BILLBOARD TYPES
⢠ALCOHOL: 12
⢠ENTERTAINMENT: 26
⢠FOOD: 1
⢠PRODUCT: 16
⢠WEIGHTLOSS: 0
⢠OTHER: 10
TOTAL 65
SUNSET BLVD (HOLLYWOOD)
45. Theresa Devine & Amy Vetal
BILLBOARDS VS. HEALTH: Considering the Impact of Billboards on Health
Case Study LaBrea, Hawthorne
46. Theresa Devine & Amy Vetal
BILLBOARDS VS. HEALTH
CASE STUDY: LA BREA HAWTHORNE)
BILLBOARD TYPES
⢠ALCOHOL: 17
⢠ENTERTAINMENT: 3
⢠FOOD: 4
⢠PRODUCT: 3
⢠WEIGHTLOSS: 4
⢠OTHER: 4
TOTAL 35
47. 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)
Women
Men
<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
51. âThe Status of
Baby Boomersâ
Health in the
United States:
The Healthiest
Generation?â
JAMA Internal
Medicine
February 4, 2013
52. Overall Health Status US
Persons Aged 46-64
NHANES 1988-1994 NHANES 2007-2010
Report âexcellentâ health
32% 13%
Limitations to Life Functions
9% 14%
Using Walking Assist (wheelchair, cane, etc)
3% 7%
71. 10,000 steps
⢠3234 people with IGT (Pre-Diabetes)
⢠walked or exercised five times a week
for 30 minutes
⢠lost 5% to 7% of their body weight
⢠reduced their risk of diabetes by 58%
72. 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 â- 8.7 years.
74. Research Landmarks
1988-2000: 12,600 2001-2013: 31,400
1992-2002: 230 results
2003-2013: 3,870 results
2013
September 1, 2003,
Volume 93, Issue 9
The National Institute of Environmental Health Sciences of the National
Institutes of Health and other funding agencies sponsored a range of studies
and in 2003, Richard J. Jackson, as guest editor, drew upon this body of work
for the September issue of The American Journal of Public Health, âThe
Impact of the Built Environment on Health: An Emerging Field.â
2003
77. APHA National Meeting 2002-2003
Abstracts with âland useâ - 0
2002 2003
A Big Shift in Public Healthâs Awareness of Built
Environment as a Core Determinant of Health
80. Medline Keyword Search:
âBuilt Environmentâ and âHealthâ
September 1993 - September 2003
58 Articles
September 2003 â May 2013
665 Articles
83. ⢠The use of Light Rail Transit to
commute to work:
⢠Average reduction of 1.18 BMI points
âFor a person who is 5â5â equivalent
to a relative weight loss of 6.45 lbs.
⢠81% reduced odds of becoming
obese over time.
93. Complete Streets Bring Equity to
Community and Transportation
⢠Complete Streets
â social equity, aesthetics, walking, improved
local sales, community building
94. Likely Results of a Sugar Sweetened
Beverage (SSB) Tax
⢠âA 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.â
⢠About $20 billion per year
Brownell KD, et al. The public health and economic benefits of taxing sugar-sweetened beverages.
NEJM. 2009;361(16):1599-1605.
106. Our patient starts to walk or bicycle
to school 1 mile 4 days per week
⢠The family car ran 1280 fewer miles in
one year.
⢠Reduces gasoline use 64 gallons
⢠Saves $704
107. The New âActiveâ Commuter
⢠30 minute walk or bicycle trip burns 125
calories 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.
108. The New walk/bike Student
Two year follow up (age 12)
⢠Height â 59â (50%ile)
⢠Weight â 110# (65%ile)
⢠BP - 130/78
⢠Blood sugar â Normal
⢠Cholesterol â 175
⢠Energy level and Mood â Good
⢠Doing better in School and is Learning Better
109. Richard J Jackson MD MPH
FAAP HonASLA HonAIA
dickjackson@ucla.edu
Systemic Disorders
Require Systemic Treatments
http://designinghealthycommunities.org/