WORLD DEVELOPMENT REPORT 2024 - Economic Growth in Middle-Income Countries.
Designing Healthy Communities Dr. Richard Jackson
1. Richard J Jackson
MD MPH FAAP
HonAIA HonFASLA
dickjackson@ucla.edu
UCLA
Fielding School of Public Health
/
Antelope Valley
Wellness Symposium
October 29, 2015
4. “Problem” List
• Physical exam unremarkable
• Ht 54” (50%)
• Wt 115# (95%)
• BP 140/90
• Blood glucose elevated, urine normal
• Cholesterol 220
• Signs of Depression
5. Treatment Plan
• Referral to “overweight” clinic
• Weight loss program
• TV out of the bedroom; no soft drinks in
the house
• Exercise program; Encourage sports
6. Two Months Later…
• Lost One pound
• Can’t change the food at school
• Day is already too full
• No Time for exercise; “not good at
sports”
• No place to Walk
7. – Antihypertensive
medication
– Oral Hypoglycemic
agent
– Antidepressant
– Cholesterol lowering
agent
• Monthly medication costs:
– $385
2 months later the patient is taking:
8. • The “environment” is rigged against
the child…
• And the doctor,
• And the rest of US.
12. “Ask physicians across the country
what problems they want solved, and
they won't hesitate to tell you. They
worry about the growing health risks
they observe in patients based on
lifestyle choices, obesity and a
variety of social factors which they
feel powerless to change.”
Robert Pearl MD Forbes Magazine Aug 20, 2015
14. • “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
33. Obesity Trends* Among U.S. Adults
BRFSS, 1991(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19%
34. 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%
35. Obesity Trends* Among U.S. Adults
BRFSS, 2010
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
36. Fast Food
Restaurants
• “ black/low income”
neighborhoods ~
2.4 per sq. mile
• “white”
neighborhoods:
1.5 per sq. mile
American Journal of Preventive Medicine,
October 2004
37. “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
38. 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
)
WomenWomen
MenMen
<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
43. Prevalence of
and Trends in
Diabetes Among
Adults in the
United States,
1988-2012
Andy Menke; Sarah Casagrande; Linda Geiss, Catherin Cowie
JAMA. 2015;314(10):1021 doi:10.1001/jama.2015.10029
44. How Diabetes &
Prediabetes Diagnosed
In This Study
• Diabetes
– Prior Clinical Diagnosis or
– Hemoglobin A1c level of >6.4%
– Fasting Plasma Glucose >125 mg/dL
• Prediabetes
– Hemoglobin A1c level of 5.7- 6.4%,
– FPG level of 100 - 125 mg/dL
45. Diabetes Prevalence NHANES
(using Hemoglobin A1c , FPG)
Sample of US Population
All Age Groups, Races, Income and Education
1988-1994 2000-2002 2011-2012
9.8% 10.8% 12.4%
For Prediabetes
36.5%
46. 10,000 steps
• 3234 people with Pre-Diabetes
(IGT –Impaired Glucose Tolerance)
• Walked or exercised five times a week
for 30 minutes for six months
• Lost 5% to 7% of their body weight
• Reduced their risk of diabetes by 58%
47. Survival of 1263 men with Type 2
Diabetes: Fit vs Unfit
Low Cardiorespiratory Fitness and Physical Inactivity as Predictors of Mortality in Men with
Type 2 Diabetes." 18 April 2000 Annals of Internal Medicine 132, pp 605-611 M. Wei et al
48. “The Status of
Baby Boomers’
Health in the
United States:
The Healthiest
Generation?”
JAMA Internal
Medicine
February 4, 2013
49. Overall Health Status US
Persons Aged 46-64
NHANES 1988-1994 NHANES 2007-2010
Report “excellent” health
32% 13%
Limitations to Life Functions
9% 14%
Using Walking Assist (wheelchair, cane, etc)
3% 7%
53. US High Fructose
Corn Sugar
Consumption
per capita per day
• Year Pounds Calories
• 1965 0 0
• 1970 0.5 2
• 1980 19 53
• 1990 50 134
• 2000 64 179
54. Likely Results of a Sugar Sweetened
Beverage (SSB) Tax
• “A 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.”
Brownell KD, et al. The public health and economic benefits of taxing sugar-sweetened beverages.
NEJM. 2009;361(16):1599-1605.
56. • Percent of
children who
walk or bike to
school:
• 1974 66%
• 2000 13%
(CDC,
2000)
We have changed
how much we
walk or bike
57. Fitness of California Children
Annual Fitnessgram Results
Conducted in Grades 5, 7, and 9
Measures 6 major fitness areas
(e.g. aerobic capacity, body composition, flexibility)
2011 Results: Who passed all standards?
Grade 5: 25%
Grade 7: 32%
Grade 9: 37%
http://www.cde.ca.gov/nr/ne/yr11/yr11rel95.asp#tab1
60. 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 –- 8.7 years.
61. MRI Study of Brain Scans
of 120 older adults--
Half –
Moderate aerobic
exercise: 45 minutes, three
days a week, mostly walking.
Half—
No extra aerobic
exercise.
One year later:
62. MRI Study of Brain Scans of 120 older adults One Year Later—
Half – Moderate aerobic exercise --
45 minutes, three days a week, mostly walking.
Brain size increased
Half— No extra aerobic exercise --
Brain Size Decreased 1.5%
Result: 3.5% difference
Further tests showed that increased brain
volume translated into better memory.
65. • Lancaster Boulevard was a five-lane road w/ travel speeds up to 50 mph.
• In 2010, the city revitalized nine blocks of Lancaster Blvd.
• $11.6 million street renovation project.
• 800 new permanent jobs were created.
• 26% increase in sales tax revenue.
• By 2012, the project attracted $130 million in private investments and
generated $274 million in economic output.
Lancaster Boulevard, CA
5
66.
67.
68.
69. May 2014 UCLA the elevator doors in parking lots 4, 7, and 8
UCLA Department of Transportation
70. NYC Active Design Guidelines
• Resilient Bldgs
• Energy Efficient
Buildings
• Healthy Bldgs
• Smart zoning and
locations
http://www.nyc.gov/html/ddc/html/design/active_design.shtml
72. Importance of What Makes
People Happy
Marketplace is Shifting--
More than 56% of home buyers want a home
that is a walkable neighborhood with as little
need for driving as possible.
73. “The BLVD is an endeavor to bring back the downtown experience”
Lancaster, California
78. For Mariachi Plaza….”proposed eight-story medical office building and a six-level
parking garage, plus a three-floor building with street-level retail would take out a
small row of shops immediately north of the plaza…
81. Indianapolis Cultural
Trail
• 8 miles $69 million
• First $15 million from Glick
family (start with philanthropy)
• $2 million for Art
• Links the city together
• Revitalized Business
• Helps to Recruit and Retain
Top Talent
• And, yes, a GOP Mayor
Importance of Art and
Beauty and Nature
88. Economic Benefits of Urban River
Parkways
● Medical cost savings
o one study found that every $1 invested in trails for
physical activity resulted in nearly $3 direct medical
benefit
● Economic development
o sale prices up to 16% higher for homes within 1,500ft
of natural spaces
o Colorado: land value increased by $4.20 for every foot
closer to the “greenbelt”
o Philadelphia: property values increased from
$1,000/acre 2,500ft from park to $11,500/acre within
40ft
89. The Manhattan Waterfront Greenway
32-mile long walking and bicycling path around the island of Manhattan.
The majority of the Manhattan Waterfront Greenway is physically separated from auto traffic
90. • Importance of
Courage– The
NYC High Line
• AIA Report:
Local Leaders—
Healthier
Communities Through
Design
2013
91. The High
Line
NYC
A 20 block walk
in Manhattan
without a cross
street–
and it was delightful even
with a 2 year old.
101. Richard J Jackson MD MPH AIA(Hon)
FAAP ASLA(Hon) dickjackson@ph.ucla.edu
UCLA Fielding School of Public Health
We Are What We Eat…
And What We Build
http://designinghealthycommunities.org
/
Suburban versus urban annual cost to a city per household from costofsprawl.com
Suburban versus urban annual cost to a city per household from costofsprawl.com
Suburban versus urban annual cost to a city per household from costofsprawl.com
Jason P. Block, Richard A. Scribner, Karen B. DeSalvo. “Fast Food, rece/ethnicity, and income. A Geographic Analysis. American Journal of Preventive Medicine;27(3):211-217. October 2004.
*study of fast food restaurants in New Orleans, Louisiana 2001.
Relationship between BMI and risk of type 2 diabetes– corrected
The risk of diabetes increases with increasing BMI values in men and women [1,2]. Moreover, the age-adjusted relative risk for diabetes begins to increase at BMI values that are considered normal for men (24 kg/m2) and women (22 kg/m2) based on mortality risk. The marked increase in the prevalence of obesity is an important contributor to the 25% increase in the prevalence of diabetes in the United States over the last 20 years [3]. Increases in abdominal fat mass, weight gain since young adulthood, and a sedentary lifestyle are additional obesity-related risk factors for diabetes [1,4,5].
Colditz GA, Willett WC, Rotnitzky A, Manson JE. Weight gain as a risk factor for clinical diabetes mellitus in women. Ann Intern Med 1995;122:481-486.
Chan JM, Rimm EB, Colditz GA, et al. Obesity, fat distribution, and weight gain as risk factors for clinical diabetes in men. Diabetes Care 1994;17:961-969.
Harris MI, Flegal KM, Cowie CC, et al. Prevalence of diabetes, impaired fasting glucose, and impaired glucose tolerance in U.S. adults. The Third National Health and Nutrition Examination Survey, 1988-1994. Diabetes Care 1998;21:518-524.
Ohlson LO, Larsson B, Svardsudd K, et al. The influence of body fat distribution on the incidence of diabetes mellitus. Diabetes 1985;34:1055-1058.
Helmrich SP, Ragland DR, Leung RW, Paffenbarger Jr RS. Physical activity and reduced occurrence of non-insulin-dependent diabetes mellitus. N Engl J Med 1991;325:147-152.
A tax calculator that is available online can generate revenue numbers for states and 25 major cities
Soda tax info from Brownell, The Public Health and Economic Benefits of Taxing Sugar-Sweetened Beverages: http://www.ncbi.nlm.nih.gov/pubmed/18541554?dopt=Abstract
Source: American Planning Association, http://sdapa.org/go/lancaster-showcases-model-living-street/
http://bettercities.net/article/new-streetscape-spurs-downtown-turnaround-19326
As reported by the Lancaster Redevelopment Agency, the total investment for the street renovation was $11.6 million. Total project costs were $41 million. In early 2012, the Agency reported an overall investment yield of $274 million in economic output with $13.2 million generated in state and local revenue. Forty new businesses moved into the project area. The BLVD has become “the place” for community and cultural events that attract people from all over the Antelope Valley.
