By BETSY TAYLOR
ANAHEIM, Calif. — An overweight child goes to the doctor. The physician, concerned that the child needs a weight-loss program to combat the risk of type 2 diabetes and high blood pressure, suggests lifestyle changes to promote more activity and better nutrition — no television kept in the bedroom, no sugar-sweetened beverages in the house, for example. Two months later, the doctor sees the child again. There has been no weight improvement, and the child, who has elevated blood glucose, must begin to take medication.
"The environment is rigged against the child and his doctor and the rest of us," said Dr. Richard J. Jackson, a pediatrician who previously served as director of the Centers for Disease Control and Prevention's National Center for Environmental Health. He gave a keynote address June 3 at the 2013 Catholic Health Assembly here. Jackson is a professor and chair of environmental health sciences at the Fielding School of Public Health at the University of California, Los Angeles. He has served in multiple leadership positions in environmental health and infectious disease with the California Health Department, including the highest, State Health Officer. He is known nationally for his work related to the built environment and health, including as host of a 2012 public television series Designing Healthy Communities; he is the author of a book with the same name.
Jackson noted that U.S. physicians have been telling their patients for years not to smoke, to avoid junk food and to get regular exercise, yet the nation's obesity epidemic continues unabated. Part of the problem, he said, is that planners have designed communities for ease of automobile use, rather than to encourage active, healthy residents. "We're building America around the needs of the car, and the car is owning the family rather than the family owning the car," he said.
He advocated for changes to the built environments of communities to encourage people to be more active and to make sound nutrition choices, and he called for systematic solutions to tackling health concerns. More communities should be planned with sidewalks and bike paths to encourage walking and cycling, he said, and neighborhood schools should be built close to homes so children can walk or bike to school.
Hospital planners, he said, can encourage design that includes a garden or a green space to soothe patients. Hospitals, too, should be close to where people live and to public transportation, cutting back on vehicle pollution when fewer people drive to work.
Jackson cited a study that showed residents in the Charlotte, N.C., area who began using a new light-rail system lost an average of 6.5 pounds as they did more walking to and from the rail line. The analysis, published in 2010 in the American Journal of Preventive Medicine, was based on a survey of residents in the region who self-reported their weight before and after the transit system opened. "Maybe all future Catholic hospitals should be built near a transit stop," Jackson said.
Even designing buildings with attractive, easily accessible stairwells could make a difference, he said, noting, "One flight of stairs a day is about a pound of body weight annually."
Any systematic approach to improving health must include tackling nutrition, he said, citing an effort underway to make the University of California, Los Angeles a healthier campus. This initiative includes providing healthy options in vending machines and dining halls.
Following Jackson's talk, audience member Allen Montgomery Jr., senior vice president of community health and advocacy for KentuckyOne Health, said, "I think what particularly struck me was the direct link between the built environment and healthy access to food, places to play and exercise." He said design changes could encourage people to become more active, which could have a considerable impact on reducing chronic illness and improving health.
KentuckyOne has started a "Walk with a Doc" program once a month in Louisville, where members of the public meet at a public park, listen to a talk from a physician on a health-related topic, and walk together for about an hour, Montgomery said.
He also said KentuckyOne's sponsor, Catholic Health Initiatives, has awarded $250,000 from its direct community investment funds to assist with the building of five new Habitat for Humanity homes there. Montgomery views the addition of the new Habitat for Humanity homes as not only an improvement to the built environment, but also a way to make neighborhoods safer, ultimately reducing violence and improving health.
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