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The Healthy Communities Agenda: How Environment Impacts Health and Wellness
1. The Healthy Communities Agenda: How We Can Work Together Dee Merriam, FASLA Community Planner National Center for Environmental Health U.S. Centers for Disease Control and Prevention “ The findings and conclusions in this presentation have not been formally disseminated by the Centers for Disease Control and Prevention and should not be construed to represent any agency determination or policy.” June 13, 2009 Congress for the New Urbanism
2. U.S. Health Care Expenditures as Percent of GDP Projections Keehan et al: Health Affairs March/April 2008 27: 145-155
3. For every age group from 3 through 33--crashes were the No. 1 cause of death Injury -Vehicle Crashes
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6. Climate- The European Heat Wave of 2003 Source: Earth Policy Institute Excess deaths France 14,802 Germany 7,000 Spain 4,230 Italy 4,175 UK 2,045 Netherlands 1,400 Portugal 1,316 Belgium 150 TOTAL 35,118
15. Strength of Community Positive Interactions Know People on Floor Know Next Door Neighbor Unity / Cohesion not at all a little quite very somewhat No Trees No Trees No Trees trees no trees
16. Strength of Community Positive Interactions not at all a little quite very somewhat No Trees No Trees No Trees Many Visitors Daily Socialize within Bldg. Know People in Bldg. trees no trees
17. Strength of Community Positive Interactions not at all a little quite very somewhat No Trees No Trees Acknowledge Each Other Help Each Other trees no trees
18. 0 .1 .2 .3 .4 .5 .6 spiteful threatened to hit threw or smashed threw at partner Proportion Yes Aggressive behavior against partner Negative Interactions No Trees No Trees No Trees No Trees trees no trees
19. 0 .1 .2 .3 .4 .5 .6 Hit with something Hit with fist Beat them up Used gun or knife Proportion Yes No Trees No Trees No Trees No Trees Aggressive behavior against partner Negative Interactions trees no trees
20. Aggressive and Violent Behavior No Trees No Trees No Trees Aggressive behavior against partner Negative Interactions 0 0.2 0.4 0.6 0.8 1 1.2 1.4 1.6 Psychological Aggression Mild Violence Severe Violence Mean Values trees no trees
33. Destinations are not connected. PP slide courtesy of Doug Allen Sam’s house Park Joe’s house
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37. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 10% 1985 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 2 001;286:10.
38. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1990 Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
39. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 5 states over 15% 1991 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
40. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1992 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
41. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1993 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
42. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1994 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
43. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1995 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
44. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1996 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
45. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1997 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. 3 states over 20%
46. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1998 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
47. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 1999 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
48. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2000 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10.
49. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2001 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Source: Mokdad AH, et al. J Am Med Assoc 1999;282:16, 2 001;286:10. Alabama over 25%
50. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2002 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
51. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2003 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
52. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2004 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
53. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2005 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
54. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2006 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
55. Obesity Trends* Among U.S. Adults, BRFSS (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) 2007 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30% Only 1 state under 20%
56. NHANES -- Measured NHANES – In person interview-- self-reported BRFSS – Telephone Interview BMI US Females 1988-1994
57. download from CDC at: www.cdc.gov / nccdphp / dnpa / obesity / trend / maps The data shown in these maps were collected through the CDC’s Behavioral Risk Factor Surveillance System (BRFSS) .
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59. Walking good for… Obesity! Heart disease! Cancer! Depression! Diabetes! Gall bladder! Social life!
61. Physical activity Air pollution And by the way… Infrastructure costs Social capital CO 2 emissions Depression Injuries Osteoporosis
You might think, so what’s a little heat. Unfortunately, heat kills. In 2003, a heatwave in Europe killed 35,000 people. The built environment contributes to heat through the heat island effects as well as influencing climate change which leads to an increase in extreme events, like this.
Another component of injury has to do with how the built environment affects heat related illness. The more concrete and less green space, the hotter the air will get.
U.S. Department of Health and Human Services. Physical Activity and Health: A Report of the Surgeon General. Atlanta: Centers for Disease Control and Prevention, 1996. [ii] . NIH Consensus Development Panel on Physical Activity and Cardiovascular Health. NIH Consensus Conference: physical activity and cardiovascular health. JAMA 1996;276:241-246. [iii] . Wannamethee SG, et al. Lifestyle and 15-year survival free of heart attack, stroke, and diabetes in middle-aged British men. Arch Internal Med 1998;158(22):2433-40. [iv] . Wannamethee SG et al. Physical activity and the prevention of stroke. J Cardiovasc Risk 1999;6(4):213-6. [v] . Pate RR, et al. Physical activity and public health: a recommendation from the Centers for Disease Control and Prevention and the American College of Sports Medicine. JAMA 1995;273:402-407. [vi] . Lee IM, Paffenbarger RS Jr. Associations of light, moderate, and vigorous intensity physical activity with longevity. The Harvard Alumni Health Study. Am J Epidemiol 2000;151:293-9. [vii] . Wannamethee SG, et al. Changes in physical activity, mortality and incidence of coronary heart disease in older men. Lancet 1998;351:1603-08. [viii] . Wei M, et al. Relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. JAMA 1999;282:1547-1553. [ix] . Sesso HD, et al. Physical activity and cardiovascular disease risk in middle-aged and older women. Am J Epidemiol 1999;150(4):408-16. [x] . Wei M, et al. Relationship Between Low Cardiorespiratory Fitness and Mortality in Normal-Weight, Overweight, and Obese Men. JAMA 1999;282:1547-1553. [xi] . Blair SN, et al. Influences of cardiorespiratory fitness and other precursors on cardiovascular disease and all-cause mortality in men and women. JAMA 1996;276:205-210.
Relationship between BMI and risk of type 2 diabetes 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/m 2 ) and women (22 kg/m 2 ) 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.
Where does it start – here as kids. Hedley, AA, Ogden, CL, Johnson, CL, Carroll, MD, Curtin, LR, Flegal, KM. Overweight and obesity among US children, adolescents, and adults, 1999-2002. JAMA 291:2847-50. 2004. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999-2000. JAMA 288:1728-32. 2002.
Hubbard Lake Elementary School is located at the intersection of Hubbard Lake Road and Nicholson Hill Road in Hubbard Lake, Michigan. The school is approximately 7.5 miles west of the town of Ossineke and 20 miles southwest of the city of Alpena. As you can see from the picture above, Hubbard Lake School certainly lives up to its motto: &quot;Outstanding In Its Field!&quot; How many children can use the playground after school to play? Schools can be a vital component of the community. They may offer amenities for the community as a whole and everyday, children learn how to travel by traveling to school. What lessons do they learn by driving?
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
We have never had an epidemic like this that we have been able to track so thoroughly and see. As I told you, this is conservative. About 60 million adults, or 30 percent of the adult population, are now obese, which represents a doubling of the rate since 1980.
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On the other hand, we can use a preventive approach: walking or biking to school,…