November 08, 2011

A Broad Focus for Community: Occupy Health

Personal pursuits make a difference for health. Individuals who take responsible steps whether it’s more physical activity, smoking cessation or medical adherence face complex environmental challenges where place matters. Some face forces more formidable than will power. The research provides evidence to shed light on influences for health. A recent study published in the New England Journal of Medicine demonstrates how place matters.[1] These results show better health outcomes for those who have an opportunity to relocate to better living conditions. A move out of high level poverty areas improves the potential for health. Access to healthy food, safe spaces for play and adequate living conditions works in the fight against childhood obesity and diabetes compelling the need to broaden our focus in designing community-level interventions. There are many factors that influence health, the Commission for a Healthier America offers a view:

Influence on Health: Broadening the Focus

"Behaviors, as well as receipt of medical care, are shaped by living and working conditions,
which in turn are shaped by economic and social opportunities and resources" [2]

Consider another striking example: the climb of out of poverty, educational achievement and economic prosperity doesn’t change the high risk of preterm births and maternal death for black women. Dr. Michael Lu an obstetrician and gynecologist believes "that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions impacting women’s health not just when they become pregnant but from childhood, adolescence and into adulthood.” The video clip is telling as is the entire documentary series “Unnatural Causes.” [3]

There are social determinants of health. We should address issues beyond the doctor’s office that impact health. Where we live, work and play influences health, medical care and health care, our environment influences our personal efforts to achieve health. [4] Our national foreclosure crisis is making people sick, physically and mentally.[5] Yes, financial ruin is about personal responsibility. However, these situations are also tied to increasing rates of unemployment and economic downturn.  It’s like thinking about how your personal spending impacts the nation’s economy without considering the roles of financial institutions and corporations.  You make the mortgage payment every month, but the equity in your house diminishes. You go to work every day, but the same paycheck buys less of everything including healthy groceries so you grab fast, cheap food. Exercise routines may compromised when you have to work a second job to meet the bills. The stress of daily living over time may become chronic stress and put your health at risk.

The low hanging fruit to address personal behaviors may heal some, but doesn’t remedy the pervasive ills facing our society. My colleagues in community development, public health and health professions are dreamers, change agents, builders, innovators, leaders and champions for health and healthier living this makes me hopeful and willing to work for progress and the future.

  1. Ludwig J, Sanbonmatsu L, et al. Neighborhoods, obesity, and diabetes–a randomized social experiment. N Engl J Med. 2011 Oct 20;365(16):1509-19. 
  2. Prepared for the Robert Wood Johnson Foundation by the Center on Social Disparities in Health at the University of California, San Francisco. 
  3. Courtesy of UNNATURAL CAUSES: Is Inequality Making Us Sick? Produced by California Newsreel with Vital Pictures. Presented by the National Minority Consortia.;
  4. Robert Wood Johnson Foundation Vulnerable Populations brief A New Way to Talk about the Social Determinants of Health.  July 2010
  5. Robert Wood Johnson Foundation, Human Capital brief ”Foreclosure Process Takes Toll on Physical, Mental Health.” October 2011

N.B.  This post was prompted in response to Dr. Jen Gunter's blog #OccupyHealthcare post and furthers my comments.

November 01, 2011

Community Immunity: Flu

In response to low immunization rates in my community, I served on a task force to develop a community-based pilot to increase influenza vaccination. We worked in collaboration with the NYC Department of Health and Mental Hygiene, Department for Aging, Visiting Nurse Services of New York (VNSNY) and a local church health ministry.  On a Sunday morning in late November (during the CDC's National Influenza Vaccine Week) nearly 100 African-Americans received their flu shots, we also held informational talks to dispel myths and fears, made time for physician-led Q&A and served healthy refreshments throughout the day, anyone was welcome to attend. A few doctors and nurses also received their flu shots to demonstrate leadership. We carried the message, “Flu shots are for the people you love. And for you. Flu shots save lives” with health alerts, announcements and relevant educational materials. Our success led to more expansive efforts.

A few years later when my community became the epicenter of the 2009 pandemic influenza A (H1N1) outbreak, I understood more clearly the significance of our unique efforts toward community immunity and health. In our neighborhood, there are many intergenerational families making vaccination important to protect those most vulnerable, the young and the elderly who often live in the same household. The outbreak began in nearby high school. The intensity of our local health department, leaders and communities working together is noteworthy. The outbreak took its natural, rapid and widespread course, but did not cause severe illness among those confirmed with 2009 H1N1 influenza or with influenza-like illness. While there were sharp increases in Emergency Department visits as well as overwhelming public concern local health care providers were able to manage the outbreak. 

Seasonal influenza and H1N1 are different viruses -- the 2011Influenza Vaccine includes protection against H1N1 along other influenza strains.  It seems that every neighborhood in New York City now has multiple options to a receive flu shot and the public health messages abound locally and nationally because it's important.

As a physician-in-training, I've learned valuable lessons from this experience about public health.

N.B. This post also appears on the RWJF Public Health blog in the "Share Your Public Health Story." 

Wake E, Geevarughese A, Zucker JR. Influenza prevention and control, 2010-2011. City Health Information. 2010;29(6):49-56.
Lessler J, Reich NG, Cummings DA, et al. Outbreak of 2009 pandemic influenza A (H1N1) at a New York City school. N Engl J Med 2009;361:2628-2636