Improving health means going beyond health care

To prevent disease and improve health, public policy should acknowledge issues not traditionally considered part of health care. Those include city planning, business and media, according to scientists who spoke on 20 February at the 2010 AAAS meeting in San Diego.

In addition, research methods that encourage community members to be actors in, not just subjects of, studies will help improve public understanding.

Those recommendations appear in a 2009 report from the Robert Wood Johnson Foundation.

"They go beyond the traditional health care system to include homes, communities, schools and workplaces," said Dr. Paula Braveman of the University of California, San Francisco.

At least half of all premature deaths in the United States are linked to smoking, poor diet, physical inactivity and other unhealthful behaviors, according to data from the Centers for Disease Control and Prevention. To be successful, lifestyle interventions must go beyond the individual.

Neighborhood design, for example, plays a large role in physical activity and diet. A nutritious diet is impossible if nutritious food is out of reach. Outdoor physical activity is difficult without a safe and accessible environment. If, for example, it takes a mother an hour and three bus rides to get to the nearest supermarket or park, her children likely will have to settle for nearby fast food over fresh vegetables, and staying inside over playing outdoors.

"Health outcomes vary dramatically by neighborhood," said James Sallis of the Exercise and Physical Activity Resource Center in La Jolla, Calif.

Adults in high-walkability neighborhoods were more physically active than their counterparts in low-walkability neighborhoods, according to a 2009 study in the journal Social Science and Medicine. Walkability is related to the risk of becoming overweight or obese.

Data doesn't directly show that neighborhood characteristics lead to conditions such as cardiovascular disease and diabetes. Increasingly, however, scientific evidence links those properties to physical activity, diet and obesity, which are among the leading causes of ill health and inflated health care costs.

But policy changes regarding environmental issues are typically matters of city planning, transportation, parks and recreation agencies and business—not health care.

Communities and scientists must work together to show policymakers that those problems are real and people want change, said public health expert Meredith Minkler of University of California, Berkeley.

To that end, research findings must be made available widely and numbers presented and interpreted in the context of the people and communities they represent.

"Statistics are people with the tears washed off," Minkler said.

Nontraditional research methods can help.

Community-based participatory research lets study participants contribute to planning and data collection rather than simply being passive subjects of observation.

One such study documented low access to nutritious food in a disadvantaged San Francisco neighborhood. It resulted in a public food security policy that gave stores concessions, including discounted energy-efficient appliances and free advertising in exchange for increasing the supply of healthful foods and decreasing tobacco advertising. The policy later became state law.

"Community-partnered research can produce valuable data that can be used to advocate for policy changes to create environments in which people can be healthy," Minkler said.

And computer modeling can be used to predict, for example, how health outcomes such as prevalence and diabetes treatment costs change upon implementation of early detection and management programs.

"It's a method that can be used to model effects outside the boundaries of the traditional health care system," said Patricia L. Mabry of the National Institutes of Health's Office of Behavioral and Social Sciences Research.

Ultimately, policy change comes down to effective communication. The media plays a key role spreading research results to people outside of academia.

"If no one reads it, it doesn't exist," Minkler said.

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David Lavine is a graduating senior at the University of California, Davis pursuing a degree in nutrition science. He writes for the UC Davis student newspaper, The California Aggie, and serves as production coordinator and editor for the UC Davis Nutrition Department newsletter. After graduation he hopes to continue writing about health and science. Reach him at dllavine@ucdavis.edu.

Feb. 25, 2010

Amplify the signal