Dr. Richard Jackson explores "Designing Healthy Communities" in the EDRA44Providence keynote presentation.

1. Richard J. Jackson, MD, MPH
Professor & Chair, Environmental Health
Sciences, UCLA Luskin School of Public Health
Designing
Healthy Communities

2. Thank You to Our
EDRA44Providence
Sponsors:

3. Richard J Jackson MD MPH
FAAP HonASLA HonAIA
dickjackson@ucla.edu
Systemic Disorders Require
Systemic Treatments
http://designinghealthycommunities.org/

4. We Need
Solutions That
Address Multiple
Threats

5. The Daily Bruin October 11, 2011

6. USA Today 10/20/2011

7. Mean Mentally Unhealthy Days
US Population – from national BRFSS
0.1-1.0 million interviews per year
2.93.4 days per month (17% increase)
http://apps.nccd.cdc.gov/HRQOL/TrendV.asp?State=1&Category=1&Measure=3

8. The Check
Up
10 year old
boy

9. “Problem” List
• Physical exam unremarkable
• Ht 54” (50%)
• Wt 115# (95%)
• BP 140/90
• Blood glucose elevated, urine normal
• Cholesterol 220
• Signs of Depression

10. Treatment Plan
• Referral to “overweight” clinic
• Weight loss program
• TV out of the bedroom; no soft drinks in
the house
• Exercise program; Encourage sports

11. 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

12. – Antihypertensive
medication
– Oral Hypoglycemic
agent
– Antidepressant
– Cholesterol lowering
agent
• Monthly medication
costs:
– $385
2 months later the patient is taking:

13. • The “environment” is rigged against
the child…
• And the doctor,
• And the rest of US.

14. U.S. “Health” Care
Expenditures as Percent of
GDP
Keehan et al: Health Affairs
March/April 2008 27: 145-155

15. Male Life Expectancy
US Life Expectancy is #49 Worldwide – CIA Chartbook

16. 10 leading causes of death -
United States, 1900
0 2 4 6 8 10 12 14
Pneumonia
Tuberculosis
Diarrhea and enteritis
Heart disease
Stroke
Liver disease
Injuries
Cancer
Senility
Diphtheria
Percentage

18. CDC Headquarters - Atlanta

19. July 6, 1999

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

21. • The Built
Environment –
how we build
our homes,
workplaces,
towns, cities
and world

23. The United States has
now paved over the
equivalent area of the
entire state of Georgia
60,000 square miles
And Photosynthesis is
our friend!

25. American Farmland Trust
Loss of Farmland

26. Two houses, adjoining back yards
(From Streetsblog, 02/28/2013)

27. Mega-Mileage Moms
•Average minutes per day spent in car:
- Women overall: 64 minutes
- Single mothers: 75 minutes
Surface Transportation Policy Project: 2000
Overall: Compared to 1969
Americans drive:
- 88% farther to shop
- 137% farther for errands
•Family “chauffeur”

28. Pedestrian Fatality Rates for
Collisions at Different Speeds
Zegeer et al 2002

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 None– 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, “Year Round Particle”, “Short-term Particle”
American Lung Association 2011 “Share the Air”

34. The Heat Island

35. Ground Level Ozone
Levels increase in late afternoon
as traffic and temperature peak

36. More time in a car  Higher probability of obesity

37. 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%

38. 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%

39. 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%

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
• “ black/low income”
neighborhoods ~
2.4 per sq. mile
• “white”
neighborhoods:
1.5 per sq. mile
American Journal of Preventive Medicine,
October 2004

42. “Supersizing” a fast-food meal –
the real costs
• Paying 67 cents to supersize an order
— 73% more calories for only 17%
more money
• A Bargain!
University of Wisconsin-Madison, Rachel N. Close and Dale A. Schoeller

43. “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

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

48. Percentage of US Adults with Diagnosed
Diabetes - 1994

49. Percentage of US Adults with
Diagnosed Diabetes - 2001

50. Percentage of US Adults with Diagnosed
Diabetes - 2007

51. “The Status of
Baby Boomers’
Health in the
United States:
The Healthiest
Generation?”
JAMA Internal
Medicine
February 4, 2013

52. 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. “Lifestyle Factors” US
Persons Aged 46-64 (NHANES)
1988-1994 2007-2010
Smoking
28% 21%
Obesity
29% 39%

54. “Lifestyle Factors” US
Persons Aged 46-64 (NHANES)
1988-1994 2007-2010
No Regular Physical Activity
17% 52%

55. “Keeling Curve”

56. “Keeling Curve”

63. Greenland Surface
Icemelt
July 12, 2012
Deepest Pink Indicates Surface
Has Melted

65. In the 21st Century We Need:
• Resilient
People
• Resilient
Buildings
• Resilient
Infrastructure
• Resilient
Communities

66. Resilient People Who Need Healthy
Food
Mindfulness about what
and how we eat

67. Food

68. DOOF

69. High Fructose
Corn Sugar
• US annual per
capita
consumption
of HFCS
• 63
pounds

70. The Built
Environment:
Designing
Communities to
Promote Physical
Activity in
Children
Policy Statement American
Academy of Pediatrics
June 2009

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 –- 8.7 years.

73. Research

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, “The
Impact of the Built Environment on Health: An Emerging Field.”
2003

75. “Health” “Built Environment”
1980-2000 13,900 results

76. 2001-2013 32,900 results

77. APHA National Meeting 2002-2003
Abstracts with “land use” - 0
2002 2003
A Big Shift in Public Health’s Awareness of Built
Environment as a Core Determinant of Health

78. 2011 APHA Annual Meeting
“land use” 102 matches
“built environment”
182 matches

79. AJPH
Built Environment
and Health
September, 2003

80. Medline Keyword Search:
“Built Environment” and “Health”
September 1993 - September 2003
58 Articles
September 2003 – May 2013
665 Articles

81. Charlotte, NC, Light Rail Opened
November, 2007

82. Interviewed People
at 839 locations
two years before
and after Charlotte
Light Rail Service
Began

83. • The use of Light Rail Transit to
commute to work:
• Average reduction of 1.18 BMI points
–For a person who is 5’5” equivalent
to a relative weight loss of 6.45 lbs.
• 81% reduced odds of becoming
obese over time.

84. People

85. US Joint Degree Programs in
Urban Planning and Health
Before 2003--None
2013 -- 14 Joint Programs

86. Making
Healthy
Places
A Dannenberg
H Frumkin
R Jackson
Island Press 2011

87. Atlanta Citizens Turning Out To Help
Get Ready for The Belt Line
People Creating Change

88. Homebuyers’ Decisions
More than 56% of home buyers
want a home that is a walkable
neighborhood with as little need for
driving as possible.

89. Policy

90. Institute of Medicine
Report
Accelerating Progress
in Obesity Prevention
May 8, 2012

91. Resilient Communities
http://changelabsolutions.org/

92. Importance
of General or
Master Plans
• Sonoma county:
General Plan --
Policies that
Address Public
Health Threats

93. Complete Streets Bring Equity to
Community and Transportation
• Complete Streets
– social equity, aesthetics, walking, improved
local sales, community building

94. 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.”
• 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.

95. Action

96. • The Chenoggye freeway ran through the
center of Seoul ~1970-2005

97. Cheonggyecheon -- 8.4 km long downtown Seoul, South Korea.
The $900 million project initially attracted much public criticism.

99. Vision

100. • AIG Bailout
–$188 billion
• Peak Loans to Major Banks:
–Morgan Stanley --$107 billion
–Citigroup --$99.5 billion
– B of A -- $91.4 billion.
– Goldman Sachs -- $69 billion

102. Army Corps of Engineers Estimate --
• Reshaping the Los Angeles River ~
– $25- 100 million/mile
51 miles
$1.275 - $5.1 billion

103. Message and Communication

104. http://designinghealthycommunities.org/

105. We Have Solutions That Address
Multiple Threats.

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 “Active” 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 – 59” (50%ile)
• Weight – 110# (65%ile)
• BP - 130/78
• Blood sugar – Normal
• Cholesterol – 175
• Energy level and Mood – 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/

110. Thank You to Our
EDRA44Providence
Sponsors: