NYC public schoolchildren are less obese than 5 years ago, but is everyone benefitting equally?

After years of relentless increase, New York City Mayor Michael Bloomberg announced last week that obesity rates for public schoolchildren in NYC have decreased over the past five years. The 5.5 percent decrease in obesity rates was the biggest decline in any large city in the country, where most rates are stagnant or rising. As NYC Health Commissioner Dr. Thomas Farley put it, “What’s impressive is that it’s dropping at all.”  

This announcement came after intensive city, state, and nationwide efforts to put childhood obesity on the public’s radar as a serious and urgent health issue. In NYC, the Department of Health, the public school system, and many community organizations have been implementing programs to reduce childhood obesity by increasing access to healthy food, teaching nutrition to schoolchildren, and increasing opportunities for physical activity.  While this decline is certainly a step in the right direction, over 20% of public schoolchildren in NYC are still considered obese and further drops in obesity rates will depend on the continuation and expansion of these efforts.

In addition, though drops were felt across all racial and ethnic groups and economic levels, it was not an equitable distribution. The results, published in a report by the Centers for Disease Control and Prevention, show that declines in obesity were sharply higher among middle-class children than low-income children. In terms of race and ethnicity, the greatest decreases were observed among white children and Asian/Pacific Islanders. Though black and Hispanic children also showed some decrease, it was to a much lesser degree. As this data indicates, there is a real need for concentrated and targeted efforts to reduce childhood obesity and improve health among low-income communities of color.

Bronx Health REACH has been working within schools and communities to reduce childhood obesity through classroom-based nutrition education, the creation of school wellness councils, and partnerships with local businesses to increase the availability and affordability of healthy food. (To read more about Bronx Health REACH’s efforts in this area, click here.) The communities in which we work are largely low-income and have majority black and Hispanic populations, which as the recent report shows, have the highest prevalence of childhood obesity in New York City. These are the areas that require the greatest intervention and increased resources. This recent report proves that lowering childhood obesity rates over a relatively short timeframe is possible, now we need to make sure that efforts to do so are equitable.

America’s Health at a Glance: Findings from the OECD report

Last week, we posted a blog entry about the observations of a group of visitors from the United Kingdom on the state of health care in the United States. Our country’s fragmented and inequitable health care system shocked our visitors and they expressed great concern that the UK’s conservative led government was leaning toward a U.S. style health care system. The recent release of Health at a Glance 2011, a report published by the Organization for Economic Cooperation and Development (OECD) on the health systems of its 34 member countries, affords another opportunity to see how the U.S. stacks up to other countries throughout Europe, North and South America, and the Asia-Pacific region.

The report looks at a variety of indicators in health status and the health workforce and breaks down key findings by country. Overall, medical care has improved in OECD countries and life expectancy has increased dramatically over the past 50 years. However, the United States suffers in comparison to other OECD countries in a number of ways. While the U.S. stands out in the area of cancer care, its rate of avoidable hospital admissions for chronic conditions, such as asthma or pulmonary disease, is much greater than the OECD average. For diabetes prevalence, only the U.S. and Mexico have more than 10% of the adult population living with the disease. The U.S. is also the most obese country in the group, with 34% of its adult population classified as obese in 2008, an increase from 15% in 1980. In childhood obesity, the U.S. ranks second only to Greece.

In health care expenditures, the U.S. ranks first by far, spending 17.4% of its GDP on health care in 2009. The next closest country is the Netherlands, which allocates 12% of its GDP to health care, but has much better health outcomes. Almost all the countries in the OECD rely on the public sector as the main source of health funding, but in the U.S. more than half of health spending in 2009 was through the private sector. In other words, the U.S. spends a larger portion of its GDP on health care than any other OECD country, but it also spends proportionately less from the public coffers than the other countries in the group. Despite these huge expenditures, health outcomes in the U.S. are mediocre at best and dismal at worst when compared to other developed nations. 

These reports should serve as a wakeup call that our health care system is failing the American people. Health spending per capita is much higher in the U.S. than any other OECD country, but yet our obesity and diabetes rates are skyrocketing. The already high hospital admission rate for chronic disease will only increase as diabetes and obesity related complications require medical intervention. And the troubling childhood obesity statistics are a dangerous omen for future generations and their impact on the system. The Affordable Care Act offers some remedies for these pressing issues, such as promoting a more integrated and coordinated model of care and providing more support and incentives for primary care doctors, but to get the U.S. to where it should be there need to be major changes in how health care is delivered. Being the richest country in the world doesn’t mean as much when its people can’t live a healthy life.

Learning Exchange with UK Communities for Health

Bronx Health REACH was selected by the Centers for Disease Control and Prevention to participate in an exchange with representatives from the United Kingdom’s Communities for Health program. The Communities for Health program intends to increase the role of local government in supporting health improvement and reducing health inequalities. Bronx Health REACH hosted visitors from the city of Nottingham, including the director of the health and well being partnership of the Nottingham City Council and a Nottingham city councilwoman, on November 16^th and 17^th.

As a community coalition dedicated to the elimination of racial and ethnic health disparities, Bronx Health REACH targets individuals through programs to promote healthy lifestyle change, as well as works with policymakers and stakeholders to effect policy change. Bronx Health REACH staff put together presentations to highlight programs that work with faith-based organizations, community groups, health care providers, elected officials, and others to improve health outcomes in the Bronx. We also invited our partners to speak about their work with the coalition and how they believe that Bronx Health REACH has impacted the health of the community. On the second day of the visit, we brought our visitors to the south Bronx and had them participate in a number of events. These included a “Can I Still Be Puerto Rican and Eat Healthy?” event at the MARC Academy and Family Center and the annual Thanksgiving dinner put on by the culinary committee at Walker Memorial Baptist Church for Bronx Health REACH’s Faith-Based Outreach Initiative. This annual event showcases the healthy dishes that have come about because of the nutrition training provided by Bronx Health REACH.

Throughout the learning exchange, we had a number of interesting conversations about the state of health care in the U.S. in comparison to the system in England. Because most citizens in the UK have public health insurance through the National Health Service, the UK visitors were struck by the differences in quality of care between publicly and privately insured patients in the U.S. They also repeatedly mentioned how shocked they were by the level of poverty in the south Bronx and, after hearing about the segregated system of care in New York, said they would go back to the UK with a renewed commitment to avert any efforts by the conservative leaning coalition government to introduce any aspect of a U.S. type health care system.

Time and time again the visitors voiced their awe at how much communities, through the efforts of Bronx Health REACH and others, have undertaken to meet their health challenges from the ground up. At the same time, they also voiced their consternation at the lack of a systemic effort to address health inequities, be it at the city, state, or the national levels. However impressed our visitors were with the work that Bronx Health REACH is doing to improve health in the south Bronx area, their lasting impressions of the broken health care system in the U.S. and the pervasive inequity in our country are profound. It shocked them that the richest country in the world could have such glaring poverty and inequity.

For those of us that work in this field, these realizations are nothing new, but it’s an eye-opener when outsiders so easily see the problems in our system. The learning exchange allowed Bronx Health REACH to showcase our efforts around nutrition, fitness, and health inequity in the community, but it also provided an opportunity to think critically about how health in our country stacks up against others. Unfortunately, we learned that we don’t stack up too well. In order for health to improve in underserved communities in a lasting way, policy and systems change must be at the forefront of our efforts. We all have a part to play to improve health outcomes and the Bronx Health REACH coalition will continue to drive change in its community to achieve health equity.

Addressing the Social Determinants of Health Disparities

As those of us who work in public health know, improving health outcomes has a lot to do with improving the environment in which people live, work, and learn. Addressing the social determinants of health, such as education and income, is critical in order to create healthier communities.

At the New York REACH US Health Disparities Summit a few weeks ago, Dr. Robert Fullilove gave a keynote address on the social determinants of health disparities, exhorting the audience to look at a variety of factors when working within communities to improve health. Dr. Fullilove, the Associate Dean for Community and Minority Affairs and a Professor of Clinical Sociomedical Sciences at the Mailman School of Public Health at Columbia University, has an extensive background working on minority health issues, especially in urban environments. He spoke about rebuilding communities as a way to improve health and referenced the breakdown of family cohesion in crime-blighted neighborhoods as an impediment to public health.

Though Dr. Fullilove touched upon many social determinants of health, one of his major points was the need to engage formerly incarcerated people, especially men, in the public health field. He examined the health needs of the so-called “million dollar blocks”, single city blocks with residents whom the state spends over a million dollars per year to incarcerate. Dr. Fullilove spoke about efforts to engage these men as partners in improving the health of their community upon their reentry into society. He also addressed the plight of at-risk populations, positing that risky behavior is not always a personal decision, but a factor of the environment. He called on the audience to realize that it was necessary to rebuild communities and the social fabric in order to improve health outcomes. As Dr. Fullilove said, “We don’t need a mass movement, we’re looking for people and for communities.”

The push for a community-based solution to eliminate health disparities remains a central component of Bronx Health REACH’s mission. As a number of Bronx Health REACH’s projects have shown, building support within a community to improve health outcomes does lead to positive results. Our work in churches and schools to promote healthy eating and increased physical activity has led to behavior change, as well as changes in the environment. To take one example, Bronx Health REACH’s Culinary Initiative, which aims to introduce healthy options in church meals, has led to less fat and salt being used by church culinary committees in preparing meals. Our efforts to engage all facets of the community also resonate with Dr. Fullilove’s call to action. In the fight to achieve health equity, it’s necessary to reach out to new partners and work with them to improve health outcomes.