Your Zipcode: What does it mean for your health?

The economic climate in the U.S. today, is one of great range. For a while now, the rich have been getting richer and the poor are getting poorer. These differences, or disparities in income and location of residence, result in huge differences in health outcomes. These are called health disparities. Health disparities are preventable differences in the burden of disease, injury, violence, or opportunities to achieve optimal health that are experienced by socially disadvantaged populations. They are a huge topic of concern in the world of Public Health, so it has been good to see it popping up in the news.

Equality-EquityIt’s important to make a distinction here before we move on. Health disparities simply refer to the differences in health we see between wealthy and poor populations. These differences often result from inequity. Health inequities refer to the environments that either promote or detriment health. Those in low-income communities have lowered living conditions which correlate with numerous health risks (air quality, water quality, crime rates), less financial resources to provide healthful food to their family, lack access to nature, and access to safe places to be physically active. Health disparities are NOT health inequities. Health disparities are a RESULT of inequity.

Screen Shot 2016-04-17 at 12.52.41 PMThe New York Times published a post this week, “The Rich Live Longer Everywhere. For the Poor, Geography Matters.”  The article shows an interactive map of the U.S. that is color-coded for lifespan and it is evident that lifespan ranges almost a decade across geographic locations. The gap in lifespan between rich and poor widened between 2001 and 2014. This means that the top 1 percent in income among American men live 15 years longer than the poorest 1 percent. (For women this gap was 10 years). The affluent (rich) not only have more resources that allow them to buy healthier products, but they also live in healthier ways; they exercise more, smoke less, feel less stress, and are less likely to be obese.

There is a very strong correlation between income and life span,” Dr. Thomas R. Frieden, director of the Centers for Disease Control and Prevention, said in an interview. “But it is not inevitable. There are things we can do to change the life trajectory of people. What improves health in a community? It includes wide access to social, educational and economic opportunity.” Preventative measures are more important to promote health, and community health initiatives can help us bridge the gap.

The same study was covered by Medical News Today. The authors of this research suggest that we can do this through local policy.  “The strong association between geographic variation in life expectancy and health behaviors suggests that policy interventions should focus on changing health behaviors among low-income individuals. Tax policies and other local public policies may play a role in inducing such changes.”

This idea of zip code as a health factor, has been powerful and is gaining traction in our understanding of health in the U.S. And health directly correlates with success. Which is the American Dream, right? Talk Poverty covered health disparities in terms of pursuing the American Dream. It’s good that this topic is gaining momentum, as it is estimated that 97% of Americans believe that everyone should have an equal shot at success. But when you think about it, it’s pretty intuitive that there are some huge gaps in opportunities for success right now in our country. If you struggle to put food on the table, and don’t have safe places to be active, or adequate medical coverage, you have many more fundamental obstacles to overcome in your journey to success when compared to an affluent competitor.

It is suggested that if we want to change this unacceptable status quo we need to work on two fronts: reinvest in impoverished neighborhoods so that residents have access to high-quality housing, jobs, good schools, transportation, and other basics; and ensure that families with low-incomes have access to affordable housing in neighborhoods that already offer residents these resources.

Currently, for every 100 households earning below 30 percent of the area median income, there are just 28 affordable and available units. That adds up to a shortage of 4.5 million units just for those very low-income households. Keep in mind, that is households, not people. Which is crazy considering that housing is such a basic life necessity. And I’m not even touching on the issue of homelessness in this post — that is a whole other topic.

You can start to get the idea of just how impactful our greatly polarized wealth distribution in the U.S. is on our nation’s health. And as this post tip-toes towards a political line, I’ll leave you with this:

Quanda Burrell, a Boston resident who was able to relocate from a low-income community to a mixed-income community and reaped the health benefits of living in a safer/healthier community said this of community activism, “A lot of people say that the political leaders in the statehouse don’t care about them,” she said. “But you got to make them care. You got to visit them, speak out. If more low-income folks were talking, I think that would make a difference.

Housing and Urban Development Secretary Castro seemed to agree, adding that the rental crisis is also harming the middle class.  “How do you mobilize folks to impress upon policymakers at all levels about the needs of different communities?” Secretary Castro asked. “I don’t see that conversation right now happening enough.

UPDATE: The New York Times recently published a follow-up, related interactive graph that educational abilities differ drastically among the rich and the poor, and between racial groups. Worth a lookhttp://www.nytimes.com/interactive/2016/04/29/upshot/money-race-and-success-how-your-school-district-compares.html?smid=fb-nytimes&smtyp=cur&_r=0

Trimming the Fat

 

This week, we’re talking about obesity. Yes, I know you probably hear the word ‘obesity’ daily, if not multiple times a day. But in what context are you hearing this information? The likely suspects talk about the skyrocketing rates of obesity, how our childhood rates of obesity are climbing in conjunction with adults, or for weight-loss promotion programs and products, right? I want to make no mistake here, I am a huge advocate for active living and healthy eating, but there are a group of people that struggle with their weight for reasons that they themselves are unsure of. This is an area that is not getting attention in the media, likely because it doesn’t (yet) offer enough appeal for making profit. But that doesn’t mean that it doesn’t have health implications for a proportion of the population, or that there is not much to be learned in understanding the problem, or ‘epidemic’ of obesity in our nation.

A story we’ve heard before. MedlinePlus is a national source for health information, and a reliable source at that (“Trusted Health Information for You”). But if you were to look at the health topic of obesity on the MedlinePlus website, you’ll see a lot of the same type of information mentioned above. The article I chose to cover here, is ‘Obesity Can Send Kids’ Blood Pressure Soaring’.

This article talks about how children and teens who become or stay obese are three times as likely to have high blood pressure compared to their slimmer counterparts. High blood pressure can detriment kidney function, increase the risk of type 2 diabetes, high cholesterol, and liver function. These health detriments can be mitigated by weight loss, but requires a shift towards healthy diet and exercise. A fairly familiar story regarding obesity, right? And while it is indeed accurate, it doesn’t raise awareness in regards to the full spectrum of factors contributing to obesity.

Let’s approach it from a new perspective. A professor at the University of Colorado School of Medicine, Kristen Boyle is doing fascinating work looking at how obesity develops in the womb. She studies stem cells, which is enabling  research on child metabolism that has not been possible before because of the ethics of testing babies for research. Regardless of your own opinion on stem cell research, (which if it matters to you, all stem cells in this research comes from the donated umbilical cords of healthy, birthed babies) the ability to study stem cells in this context, is providing a fresh perspective on the topic of obesity.

What has been found, is that the fat content in both fat and muscle tissue of babies of obese mothers is 30% higher than that of normal weight mothers. They also have lower capacity to use these excess fats. “What makes this research exciting is that, by using this infant stem cell model we can begin to address the same questions in humans as have been done in the animals. Using these cells, we may soon be able to define why children born to obese mothers are at increased risk of developing obesity and metabolic disease. In the same vein, we may be able to identify specific characteristics from mom or the intrauterine environment that are contributing to these risk factors in the baby.” says Dr. Boyle, of her work. From these findings, the next steps are to test whether interventions during pregnancy that increase physical activity of the mothers could mitigate these effects; but that remains to be seen.

This is exciting research, as it will help us to understand how the in utero environment affects disease risk of a child later in life, particularly for diseases such as obesity, diabetes or cardiovascular disease. What this means is that we have the potential to enhance prenatal care and guidelines to approach the issue of obesity from a different, yet influential perspective.

Read about the research for yourself here: http://www.ucdenver.edu/academics/colleges/medicalschool/administration/alumni/CUMedToday/features/Pages/Building-Better-Babies.aspx?source=todayAMC

You are what you eat.   If you’re never read any of the articles put out by IFL Science, you’re missing out. This website takes peer-reviewed articles (which I talked about in my last post), and makes the information easily accessible for the general public. And does a pretty good job of Obesity Evolutionmaintaining the objectivity of the journal article. In“What You Eat Could Be Affecting Your Health”, we learn of some emerging evidence that advances our understanding of factors contributing to obesity.

Researchers at the University of Cambridge have found some interesting correlations (note: correlations vs causation discussed in the previous post, “Tips and Tricks”) of the metabolism process and gene activity. Like mentioned in the previous post, it’s important to note that the subjects of this study were yeast molecules. Yeast is used a lot in formative studies as its genetic make-up is comparable to human genes, but is much more accessible and ethical to work with in initial exploratory research.

What was found in this study, was that when the yeast molecules were ‘fed’, their gene activity changed as a result of the metabolic process. Why am I talking about this in a post about obesity? Because it is plausible that these effects are comparable in human genetics, (although likely much less profound due to our complexity). What this means is that your weight is in part, a result of what you eat and how your DNA reacts to it.

That would make sense right? No?   Yes.  If you think about it, this would be an example of scientific evidence describing on a cellular level, what is commonly talked in normal conversation. Think about how often people eat the same food, but feel very differently after eating. Or why some people have such fast metabolisms while others don’t. Or why people say, “You are what you eat!” – your unique DNA is making changes based on the foods you put in your body! Kinda cool, right?

Who is still left out of the picture? Now this research, while awesome, still does not address the cause of obesity that is a systemic underlying problem in our society. Socio-economic status. This is considered a health inequity (not inequality), where American citizens are systematically unable to achieve a positive health status because of lack of access to health insurance, inability to purchase healthy foods to feed their families, and lack safe places to be active.

The article, ‘Why Poverty Leads to Obesity and Life-Long Problems’ discusses this a little further. This continues on with the consistent message we see in the media of the ‘obesity epidemic’, but discusses how despite obesity being a risk for all Americans, the most disadvantaged groups (low education, high poverty) are the most vulnerable. This ‘epidemic’, has been on the rise in conjunction with the economic insecurity of our nation. To address these systemic problems, we must think beyond individuals, and look to improve social and physical environments in these areas. It is suggested that investing in a diverse set of physical activities and nutritional programs in neighborhoods and schools may be the best way to reduce risk of obesity in young children.

The take home message here is that health issues are very complex. The mainstream message that we often receive is not the full story by any means. I may sound like a broken record with this, but you owe it to yourself, and your health to do some digging into topics that concern you, or that you feel passionate about.

There Must Be Something in the Water….

Sunset

Since the start of 2016, there have mainly been two topics in the health news; Zika (covered in previous blog post), and the Flint Water Crisis. What in the world happened in Flint MI?? This is an extremely interesting case, because in front of our eyes (if you’re looking correctly), we are seeing a disastrous result of abuse of power and how it has unraveled the daily lives of so many people.

Mainstream stories often gloss over the important details.  This story is dedicated to the apology of Michigan Governor, Rick Snyder. It briefly mentions that the crisis occurred as a result of Flint switching its water source from the Detroit water supply, to the Flint River for cost-cutting measures. “This is the kind of disaster, the kind of failure to deliver basic services that hurts people’s trust in government,” House Minority Leader Tim Greimel said. Indeed.It is briefly mentioned how this contamination was known about possibly as early as last April, but was not made public knowledge. Snyder has committed $28 million to recovery efforts and safe-keeping for the people.

So, you learned a lot from this – right? Very informative. (*sarcasm) See for yourself here:http://www.foxnews.com/politics/2016/01/20/michigan-governor-apologizes-for-flint-water-crisis-vows-will-fix-it.html

Alternative sources often paint a better picture. NPR, another somewhat common news source (and a pretty reliable one, in my opinion), highlights those that are effected by the water crisis, but will likely not be receiving any assistance from that $28 million we discussed in the story above; the undocumented.

Authorities are going door-to-door in Flint handing out water filters, however undocumented families are hesitating to open the door. It is estimated that over 1,000 people living in Flint are undocumented.  The contamination levels in the water are too high for boiling to suffice, and undocumented people who fear deportation are not even going to get tested. Additionally, the language barrier is a problem; many of these people may not even be aware of the danger because they do not speak English. Whatever your opinions on refugees and immigrants may be, can’t we all agree that it is still pretty awful that we are poisoning people with families and loved ones through their drinking water, here in the US? In 2016, no less??

As an optimistic effort, Spanish-speaking volunteers are leading a campaign to go door-to-door in these neighborhoods to convey the message, “El agua no es potable” – “the water is not safe to drink”.

Listen for yourself here: http://www.npr.org/2016/01/28/464664785/flint-s-undocumented-immigrants-hesitate-to-ask-for-help-during-water-crisis

Nerds are your best bet. And from a highly uncommon source, but science-based and reliable, we have an article from The Chronicle of Higher Education. The title of this article: The Water Next Time: Professor Who Helped Expose Crisis in Flint Says Public Science Is Broken.

I personally thought this article was fantastic. Marc Edwards, an engineering professor, found through his own testing of the water in Flint, that the water contamination was systemic. All the while the state and local authorities were telling the public the water was safe, he was trying to raise awareness where his voice would be heard. He empowered residents, who eventually rallied to call for his help, leading to some action.

It was interesting because when interviewed by The Chronicle, Mr. Edwards said that the systems that support scientists do not reward moral courage, and that if not stopped may corrode the public faith in science. However the results of scientists operating on a truly moral compass often suffer much loss. Indeed, Edwards suffered much loss in his personal circle, supporters, and funders in his pursuit to reveal the truth. Cases such as these make it extremely difficult to challenge the voice in power. In regards to the Flint case and its relationship between the government and the scientific evidence, Edwards had this to say, “In Flint, the agencies paid to protect these people weren’t solving the problem. They were the problem. What faculty person out there is going to take on their state, the Michigan Department of Environmental Quality, and the U.S. Environmental Protection Agency?”

Read for yourself here: http://chronicle.com/article/The-Water-Next-Time-Professor/235136

Final thoughts to digest…. keeping this last story in mind: You can really start to see the spectrum of coverage and availability of information out there that is impacting your life-your health- without you even realizing it! Governing hands are determining your health, without your say in the matter. So I encourage you to think about how you feel about this, and potential ways that you can take action to take steps to regain control of your health. I’ll leave you with this –

I was reading a book recently by the Dali Lama (which I HIGHLY recommend), called, Universe in Single Atom: The Convergence of Science and Spirituality. And in his discussion of ethics, and technology, and health, he said something that really resonated with me.

As science advances further, here is more at stake. Science’s power to affect the environment, indeed to change the course of the human species as a whole, has grown great. As a result, for the first time in history our very survival demands that we begin to consider ethical responsibility not just in the application of science but in the direction of research and development of new realities and technology as well.” – His Holiness, the Dali Lama.

Recommended Article on this Topic:

http://www.mintpressnews.com/nestle-guzzles-michigans-clean-water-donates-bottled-water-to-flint-water-crisis-victims/213360/