Health disparities – and solutions – examined in depth

by Suzanne Bohan

February 26, 2013

In June 2012, I embarked on research to examine the wide disparities in health and longevity between neighborhoods just miles apart. It’s not unusual, especially in urban areas, to find that people living 10 or so miles from each other will have up to a 20-year gap in life expectancy.

I reported on this topic as a science and health writer with the Bay Area News Group (Contra Costa Times, San Jose Mercury News and Oakland Tribune) including this four-part series called “Shortened Lives.”

And poorer communities are on the losing end of this gap, coping for with more heart disease, diabetes, cancer, asthma and other diseases, as well as mental challenges. Deprivation and stress account for much of the disease burden. And the term “deprivation” covers a lot of issues – lack of access to good food and safe places to exercise, limited job and educational opportunities, lacking a feeling of security in one’s neighborhood and financial strain, to name a few.

But my research goes far beyond just examining this crisis. It’s focusing on what’s being done to shrink this gap. The problem is well known, but what far fewer know about are promising interventions that are making a difference.

Many advocates rightly point to this wide gap in health and life span as unfinished business of the Civil Rights Movement, as it largely affects blacks and Hispanics in the United States. (But not exclusively: Poor whites in the United States, largely in rural areas, also suffers similar gaps compared to wealthier whites.)

I’ll be examining a few major initiatives around the nation, especially the largest privately-funded one run by the California Endowment. It’s called “Building Healthy Communities,” and I spent much of the summer reporting on it. This current crop of blog posts come from that reporting. Rather than explaining the healthy communities’ campaign with each post, I’ll summarize it here and provide a link in all blog posts that reference it.

It came about because Dr. Robert Ross, the CEO of the California Endowment, grew disillusioned with the limits of what medicine could heal after working in a Camden, NJ community clinic as the crack epidemic broke out in the early 1980s. He realized his Ivy League medical education hadn’t given him the tools to deal with healing the social ills that create so many medical emergencies and chronic sicknesses. So he turned his attention to healing communities, not just individual patients. From that pivot in his career, the Endowment’s “Building Healthy Communities” initiative was ultimately born.

The California Endowment is the state’s largest private foundation, with some $3.7 billion in assets. In 2010, Ross and the board of directors launched the “Building Healthy Communities” campaign, and committed most of the organization’s grantmaking to it – $1 billion over 10 years. The nonprofit thoroughly researched the most distressed communities in the state, and found ones with the organizing strength and resiliency to create a better future – with some outside assistance. In exchange for hard work and inspired thinking on the part of the 14 communities, the Endowment committed to leaving them on a trajectory toward far better health and well-being, especially for the community’s children, when the initiative winds down in 2020.

These are the 14 communities participating in the campaign: Del Norte County, a rural area on the Oregon border; neighborhoods in Sacramento, Oakland, Richmond, Long Beach, Santa Ana and San Diego, near the Mexican border; two in Los Angeles – South Los Angeles and Boyle Heights; five rural or semi-rural communities – Salinas, Coachella Valley, South Kern, Fresno and Merced.

The initiative is deploying the best strategies known to bring about social change at the community-wide level, based upon examining several decades of successes and failures. In short, it rests on local leaders and community-based organizations engaging residents and local politicians to tackle major challenges stymieing progress and growth in the area. It’s all about organization, community enthusiasm, rigorous research and measuring results along the way. The initiative is strongly focused on improving schools, because health is so strongly linked to educational status and the critical thinking that education instills. And prevention is the mantra, as it’s so much more cost-effective and humane than coping with illnesses after they emerge.

And the campaign works with the nonprofits that the Endowment funds, meeting regularly and agreeing upon long-term outcomes to improve the community. The nonprofits still operate independently, but expand their mission to include the broader shared mission. The results can be exciting, as I describe in this post.

The initiative, however, goes beyond community level work by leaders, nonprofits and residents, as they alone don’t have the resources to completely turn things around – not after decades of deprivation. It takes broader policy changes and new infrastructure to secure lasting change, and that can only come from regional, state or federal policy shifts.

To that end, the initiative also deploys a statewide team to educate citizens and lawmakers about important policy decisions in the works.

This is a thumbnail sketch, and you can find more information here. I can attest that there are inspiring and exciting developments underway in these communities, with scores of smart, dedicated people determined to create real change. And there are some fantastic stories that never made the press. Some of these blog posts aim to partially fill that gap.

Health disparities

Police helicopter above high school elicits resigned shrugs

by Suzanne Bohan

February 25, 2013

A police helicopter hovers above a high school in South LA in late August. 2012.

In this photo, you’ll see a helicopter hovering in South Los Angeles, right above a high school. It’s an LA Police Department copter, and as I learned from some mothers sitting on the bleachers at a soccer field nearby, it’s not an unusual sight in South LA.

I was startled at it, but they just shrugged. Someone said there must have been gunfire at the high school, and it’s safer for police to intervene from overhead. It happens all the time, one of the women said.

So that’s part of life in South LA. In Beverly Hills, Santa Monica or Malibu, a police helicopter circling over a high school would surely make the newspapers and generate alarm. But, in a stark portrayal of the different worlds so nearby, there wasn’t a mention in a local daily and the people on the soccer field largely ignored it.

Health, Health disparities

Oscar winners may gain years in life, along with prized gold statuette

by Suzanne Bohan

February 23, 2013

Katharine Hepburn’s four Best Actress Academy Awards (Morning Glory, 1933; Guess Who’s Coming to Dinner, 1967; The Lion in Winter, 1968; On Golden Pond, 1981) on permanent display at the Smithsonian’s National Portrait Gallery in Washington, D.C.

Academy Award winners this Sunday may not realize it, but they have another reason to

clutch their newly-won Oscars so tightly: That 13-inch gold statuette can actually add years to their lives.

Movie stars who have won an Oscar live on average four years longer than stars nominated but not selected. Katharine Hepburn won a record four Oscars and lived to age 96. Anthony Quinn, the winner of two Academy Awards, won two and lived to 86. But Richard Burton, who was nominated seven times but never won, died at 58.

That research came from the University of Toronto, and the scientists behind it had wondered if the award’s boost to status and self-esteem were enough to increase lifespan. So they compared the length of life for those who won Best Actor or Best Actress awards with those who were nominated for the prize but didn’t win.

The answer was a decided yes, with a four-year life increase in longevity for those winning the prize over those nominated.₁

That’s a stunning advantage, wrote Sir Michael Marmot in his book, The Status Syndrome: How Social Standing Affects Our Health and Longevity. It’s equivalent to wiping out the mortality rates from heart disease. Marmot was knighted in 2000 by the Queen Elizabeth for his pioneering work studying the differences in health along the socioeconomic ladder.

“Winning an Oscar is like reducing your chance of dying from a heart attack from about average to zero,” wrote Marmot. “Not bad.”

That’s not the only study connecting social status and self esteem to longevity. Nobel Prize-winning scientists lived an average of two years longer than scientists nominated but who didn’t win.₂ Another famous study found that among British white-collar workers, executives and managers enjoyed a longer life span than those in mid-level management, while blue-collar workers had the shortest lives.₃

It’s long been accepted that low socioeconomic status predisposes people to health problems and shortened life spans, but it was usually attributed to limited access to health care along with poor lifestyles and diets. But the recent crop of studies show something else is at work, since movie stars, distinguished scientists and white collar workers have similar access to medical care and certainly have incomes sufficient to ensure adequate diets.

And there’s a lesson for everyone.

Donald Redelmeier, MD, one of the scientists conducting the study, which was published in the Annals of Internal Medicine, says the results suggest that the enhanced self-esteem gained by winning a prestigious award exerts a powerful effect in improving health, even in those who already had many advantages in life.

“Once you’ve got a major accomplishment that nobody can take away from you, that gives you a sense of self-esteem and makes you much more resilient to all of the other stressors in life,” he said in a radio interview.₄

That, in turn, could lower levels of stress hormones linked to cardiovascular disease and other health problems, as well as improved immune system function. Oscar winners, he wrote in the study, are also more likely to “preserve their image by continually avoiding disgraceful behaviors and maintaining exemplary conduct.” Low self esteem, in contrast, leads to depression, which weakens motivation to maintain good behaviors.

Obviously, few people will ever win an Oscar, but bioethicist Arthur Caplan, PhD, in an email exchange I had with him a few years ago, said that the Oscar study “does at least suggest that money isn’t everything in life. Achievement and social recognition count too.”

Achieving distinction – such as earning salesperson of the year award, winning an athletic event or an important recognition for your community work – can instill a sense of lasting accomplishment and boost to self-esteem. Achievement also promotes positive thinking, another attribute strongly linked to lowered stress and the practice of protective health behaviors.

To help others, you can also use your knowledge of self-esteem’s link to health to boost other peoples’ well being as well. As Caplan said, “Parents, teachers, politicians, and the media who have the power to honor and acknowledge worth might keep this in mind.”

TAKEAWAY: While a good diet and an active lifestyle are critical underpinnings of a healthy life, social factors such as status and recognition also play an important role.

—

1. Redelmeier, DA, Singh, SM. 2001. Survival in Academy Award-winning actors and actresses. Annals of Internal Medicine 15; 134 (10):955-962.

2. University of Warwick (2007, January 18). Oswald A. and Rablen, M. “Mortality and Immortality.”

3. Marmot, MG, Smith GD, Stansfeld, S, et al. 1991.Health inequalities among British civil servants: the Whitehall II study. Lancet 337(8754):1387-93.

4. Redelmeier, DA. Interview on CBS Radio One by Mary Lou Finlay, May 14, 2001.

Health, Health disparities

Street vendors furtively do business in Los Angeles

by Suzanne Bohan

February 16, 2013

He’s showing us the sherberts he sells, pedaling through neighborhoods. He keeps them cold with dry ice.

We first saw this street vendor standing next to his cart in South Los Angeles one hot afternoon last summer. Someone was purchasing one of the frozen desserts he sold from his bike/street cart, keeping it cold with dry ice.

He was leery, though, when Rudy Espinoza and I approached him, but still lifted a lid to show us the colorful frozen food.

Street vending is illegal in Los Angeles, so this vendor had every reason to worry. These solo entrepreneurs tell of their equipment and products being seized by law enforcement officials, and getting slapped with fines.

Rudy Espinoza, a program officer with the Community Financial Resource Center in South Los Angeles, is working to help street vendors operate legally.

But Espinoza was there to help, and he handed the young man his business card. He’s part of an effort to legalize street vending in Los Angeles, and to steer the vendors toward offering healthy fare in areas with few grocery stores or restaurants. These vendors often serve up foods such as quesadillas and tostadas, for as little as $2 or $3. Espinoza, a senior program officer with the Community Financial Resource Center in South Los Angeles, helps promotes business in the low-income neighborhood with microloans and business development support. He’s leading his organization’s Healthy Food Cart & Street Vendor Initiative, which began in 2011.

South LA, like many inner city neighborhoods, has few grocery stores and residents typically drive long distances or take time-consuming bus rides to shop for groceries. Many don’t have a car or the time, so instead pick up meals at fast-food restaurants or get something from a corner liquor store – often high-fat, high-calorie processed foods. This lack of easy access to affordable, healthful food is blamed as one factor behind the higher obesity rates in poor neighborhoods. One-third of adults in South LA are obese, compared with less than one-quarter overall in Los Angeles County.₁

Espinoza’s organization, in partnership with other groups including the East Los Angeles Community Corporation, is pushing City Hall to legalize street vending, particularly in neighborhoods called “food deserts” given their lack of access to quality food. They’re supported by funding from foundations to promote healthful living and economic revitalization.

The first step in the quest is permitting the street carts to sell at farmers’ markets, after they pass health inspections and other regulatory steps. That’s beginning to happen, but it’s still not the solution. Cart owners say they can’t survive just selling at farmer’s market, which are held once a week and for a few hours. They need daily access to their markets.

In the mid-90s, Los Angeles lawmakers attempted to legalize street vending, but the process was so complicated it sputtered out. And city officials have to factor in the concerns of bricks-and-mortar restaurants and food stores, who pay rent and don’t welcome low-cost competition outside their doors.

But with pressure from vendors and organizations like Espinoza’s, Los Angeles is taking another look. Mayor Antonio Villaraigosa’s spokesman said that the city is re-examining the prospect of legalizing street food vending, according to a Los Angeles Business Times article.₂And this time with an eye toward easing restrictions. To keep the pressure up, on Feb. 28 the East LA Community Corporation is hosting a panel discussion called “Make Good Food Legal.”

Other cities are far ahead of Los Angeles on the issue. New York City, for example, in 2008 started its “Green Cart” initiative, which authorized up to 1,000 licenses for street vendors to sell fresh produce in certain areas. Business blossomed after the law passed, and some 500 carts operate today, run largely by immigrants who work long hours to achieve their dream of financial independence. ₃

That’s the other boon from the legalization of street carts. It gives motivated people a chance to earn a living wage, in their community and with no fear of being fired. And while selling popular, inexpensive items conveniently near peoples’ homes.

But the street vendor Espinoza and I talked with quickly packed up his cart onto the back of his truck and drove away, clearly anxious over our encounter. That ended his prospects for sales that afternoon in that neighborhood.

TAKEAWAY: Street vending, which is popular in many other countries, could play a significant role in increasing access to locally-made, quality foods in areas with few grocery stores. But laws need changing to support it.

—

1. Los Angeles County Department of Public Health, “Trends in Obesity: Adult Obesity Continues to Rise,” September 2012.

2. Los Angeles Business Journal, “Street vendors cook up challenge to sidewalk sales ban: legalization effort turns up heat on Los Angeles City Council,”Oct. 8, 2012. (Not available free online.)

3. New York Times, Opinion Page, “Conquering Food Deserts With Green Carts,” by David Bornstein, April 18, 2012.

Health disparities – and solutions – examined in depth

Police helicopter above high school elicits resigned shrugs

Street vendors furtively do business in Los Angeles

Recent Posts

Categories

Archives