Social Determinants of Urban Mental Health: Paving the Way Forward: Marice Ashe - Founder and CEO, ChangeLab Solutions
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Social Determinants of Urban Mental Health: Paving the Way Forward: Marice Ashe - Founder and CEO, ChangeLab Solutions
- 1. COMMUNITY DESIGN & PUBLIC POLICY HEADING HERE AND HERE SUBTITLE HERE Presented by Marice Ashe, JD, MPH CEO, ChangeLab Solutions
- 2. ChangeLab Solutions creates innovative law and policy solutions that transform neighborhoods, cities, and states. We do this because achieving the common good means everyone has safe places to live and be active, nourishing food, and more opportunities to ensure health. Our unique approach, backed by decades of solid research and proven results, helps the public and private sectors make communities more livable, especially for those who are at highest risk because they have the fewest resources.
- 3. DISCLAIMER The information provided in this discussion is for informational purposes only, and does not constitute legal advice. ChangeLab Solutions does not enter into attorney-client relationships. ChangeLab Solutions is a non-partisan, nonprofit organization that educates and informs the public through objective, non- partisan analysis, study, and/or research. The primary purpose of this discussion is to address legal and/or policy options to improve public health. There is no intent to reflect a view on specific legislation. © 2012 ChangeLab Solutions
- 4. TELL ME YOUR ZIP CODE, AND I’LL TELL YOU HOW LONG YOU’LL LIVE.
- 6. LOW INCOME VS. HIGH INCOME An African American baby in the predominantly low-income neighborhood of West Oakland compared to a white infant in the Oakland Hills is: 1.5 times more likely to be born premature, 7 times more likely to be born into poverty, and 4 times more likely to have parents with only a high school education. Source: ACDPH
- 7. LOW INCOME VS. HIGH INCOME The risks accumulate and worsen over the life course of the black baby: 2.5 times more likely to lag in vaccinations as a toddler 4 times less likely to read at grade level in fourth grade 5.6 times more likely to drop out of high school Source: ACDPH
- 8. LOW INCOME VS. HIGH INCOME In adulthood: 5 times more likely to be hospitalized for diabetes 3 times more likely to suffer a fatal stroke 2 times as likely to die of cancer The West Oakland infant can expect to die almost 15 years earlier than the white infant born in the Oakland Hills. Source: ACDPH
- 9. Education Increasing Individual Effort Needed Clinical Increasing Population Impact Interventions Long-lasting Protective Interventions Changing the Context to Make Individual’s Default Decisions Easier Socioeconomic Factors Source: http://www.healthier-communities.org/taxonomy/term/109
- 22. Deaths Prevented And Change In Health Care Costs Plus Program Spending, Three Intervention Scenarios, At Year 10 And Year 25. Milstein B et al. Health Aff 2011;30:823-832 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
- 23. Annual Deaths, Three Layered Intervention Scenarios, Year 0 To Year 25. Milstein B et al. Health Aff 2011;30:823-832 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
- 24. Annual Costs (Health Care And Program Spending), Three Layered Intervention Scenarios, Year 0 To Year 25. Milstein B et al. Health Aff 2011;30:823-832 ©2011 by Project HOPE - The People-to-People Health Foundation, Inc.
- 26. Reproduction of Bruce McCall’s Moral Guidance courtesy of Tom Merrill
- 29. Redevelopment Land Use & Economic Development Health in all Smoke Free Healthy Eating Policies and Healthy Housing Healthy and Safe Schools Active Living and Neighborhoods
- 30. Courtesy of the Library of Congress, LC-USZC4-7155
- 32. Harper’s Weekly
- 33. Harper’s Weekly
- 34. Harper’s Weekly
- 35. Harper’s Weekly
- 36. Build Complete Streets Image Source: Complete Streets on Flickr
- 37. Improve the pedestrian environment
- 39. Build new affordable housing
- 40. Create public gathering spaces
- 41. Create and Improve Parks and Open Space
- 42. Joint Use Agreements open school playgrounds
- 43. Attract New Food Stores
- 45. Plan for farmers’ markets
- 46. Mobile Markets
- 48. Redevelopment Land Use & Economic Development Health in all Smoke Free Healthy Eating Policies and Healthy Housing Healthy and Safe Schools Active Living and Neighborhoods
- 49. Thanks! Marice Ashe, JD, MPH CEO, ChangeLab Solutions www.changelabsolutions.org
Notes de l'éditeur
- These pictures are the childhood obesity equivalent to the smokey bar scene in the earlier slide. Yet, the problems related to childhood obesity are much more difficult to address than tobacco because of the complexity of social and environmental infrastructures that exacerbate obesity-related diseases. The social norm of chain restaurants with low-cost meals is most acute in low-income communities and communities of color: A California study found the state had more than four times as many fast-food restaurants and convenience stores as supermarkets and produce vendors. These restaurants were predominantly found in lower-income communities and communities of color. “The Food Landscape in California Cities and Counties”, California Center for Public Health Advocacy, 2007. See: http://www.publichealthadvocacy.org/searchingforhealthyfood.html But the main point here is that government laws and regulations – especially local land use and economic development policies shape the development of the retail environment. These laws and regs can change.
- But beyond access to unhealthy foods, is unhealthy transportation leading to a lack of physical activity. Again, laws and regulations have shaped our transportation infrastructure. The federal transportation reauthorization can direct funds to incentivize or dis-incentivize healthy modes of transportation. And note: Not only would we address obesity, but also: Climate change Asthma Mental health Aging in place And more . . .
- Deaths Prevented And Change In Health Care Costs Plus Program Spending, Three Intervention Scenarios, At Year 10 And Year 25 Individual Intervention Scenarios Exhibit 1 displays the results from simulating each intervention individually through years 10 and 25. After ten years, the status quo scenario results in twenty-two million deaths and cumulative discounted health care costs of $14 trillion. Compared to that scenario, the simulated coverage intervention would prevent 269,000 deaths; the care intervention, 953,000; and the protection intervention, 721,000.With regard to costs, the coverage intervention would increase cumulative discounted costs by $527 billion, the care intervention by $416 billion, and the protection intervention by $179 billion. Thus, in the first ten years all three interventions were likely to prevent many avoidable deaths, with the most lives saved by the care intervention, followed by protection and then coverage. The ten-year cumulative costs were lowest for protection, followed by care and then coverage, in both the baseline and the optimistic estimates. In the pessimistic estimate, these costs were highest for protection because the assumed up-front investment was so large that ten years was not long enough to accumulate sufficient health care savings to offset it. After twenty-five years, the profile of simulated results changed substantially (Exhibit 1). By then the status quo scenario would result in sixty-four million deaths and cumulative discounted health care costs of $31.5 trillion. Compared to that scenario, the coverage intervention would prevent 880,000 deaths; the care intervention, 3.4 million; and the protection intervention, 4.5 million. The coverage intervention would increase cumulative discounted costs by $1.513 trillion, and the care intervention would increase them by $1.134 trillion. In contrast, the protection intervention would save $596 billion. Thus, with respect to these metrics after twenty-five years, a focus on protection—that is, improving behavioral and environmental conditions—is likely to be both the most effective and the least costly intervention, followed by better preventive and chronic care, and then wider insurance coverage.
- Annual Deaths, Three Layered Intervention Scenarios, Year 0 To Year 25 Exhibits 2 and 3 show simulated curves for deaths and costs, respectively, relative to the status quo scenario. Both exhibits show coverage alone, coverage combined with care, and all three interventions together.45 The added contribution of each new component can be measured by comparing it to the previous scenario. influence but would ultimately produce large effects that would grow throughout the twenty-five years. Coverage alone would prevent 25,000 deaths in year 3, 38,000 in year 10, and 41,000 in year 25, or 880,000 deaths cumulatively (Exhibit 2). Coverage plus care would prevent 110,000 deaths in year 3, 180,000 in year 10, and 210,000 in year 25 (4.3 million cumulatively). Adding protection to the other two interventions would prevent 140,000 deaths in year 3, 340,000 in year 10, and 510,000 in year 25 (8.6 million cumulatively).
- Annual Costs (Health Care And Program Spending), Three Layered Intervention Scenarios, Year 0 To Year 25 Individually, both coverage and care would increase costs, with the steepest rises occurring through year 7 but continuing increases through year 25 (care alone is not shown). These two interventions would increase health care use and amplify the cost-increasing impacts of price inflation and population aging. Protection, in contrast, would increase total costs for the first six years, reflecting the program’s initial expenses, but would thereafter decrease total costs as program costs declined and disease and injury rates were reduced (not shown). In year 25 the coverage intervention alone would increase costs by $133 billion. Adding the care intervention would increase costs by $241 billion, and adding protection to the other two interventions would result in an increase of $93 billion (Exhibit 3). In other words, the baseline simulation shows that when added to coverage and care, protection would save 90 percent more lives and reduce costs by 30 percent in year 10. Those benefits would be even larger in year 25, when adding protection would save about 140 percent more lives and reduce costs by 62 percent. The timing and size of these savings varies somewhat in the optimistic and pessimistic scenarios, but the general pattern is stable despite those uncertainties.
- And, there is local government authority to control the size of beverage containers.
- In doing so, the courts have developed different tests that apply when different constitutional rights are at stake These test all involve weighing government and individual interests at play Examples of government interests that we have in public health Prevent spread of disease Prevent violence Promote balanced diet Examples of individual interests that are affected by these interests Right to be left alone Right to practice one’s religion Right to be free from government searches and seizures These tests guide courts, but they do not always point to an easy answer Often, reasonable minds differ about how the tests should apply to a given situation This is why attorneys are often unable to give an absolute yes or no response to a question of whether something is legal
- To achieve public health goals, public health agencies must work with other government agencies: Land use Redevelopment Economic development Transportation If public health fails in this work, it will fail to address transportation equity, climate change, obesity, heart disease, asthma. That simple. Public health does not control either the infrastructure or the funding that it will take to redesign communities to lead to health. These other agencies DO control such resources and public health must learn how to work in a multi-disciplinary policy environment.
- JLW note: Set this up so that the yellow text “pops” out via animation if possible. "Modern" version In the name of God, Amen. We, whose names are underwritten, the Loyal Subjects of our dread Sovereign Lord King James, by the Grace of God, of Great Britain, France, and Ireland, King, defender of the Faith, etc.: Having undertaken, for the Glory of God, and advancements of the Christian faith, and the honor of our King and Country, a voyage to plant the first colony in the Northern parts of Virginia; do by these presents, solemnly and mutually, in the presence of God, and one another ; covenant and combine ourselves together into a civil body politic; for our better ordering, and preservation and furtherance of the ends aforesaid; and by virtue hereof to enact, constitute, and frame, such just and equal laws, ordinances, acts, constitutions, and offices, from time to time, as shall be thought most meet and convenient for the general good of the colony; unto which we promise all due submission and obedience. In witness whereof we have hereunto subscribed our names at Cape Cod the 11th of November, in the year of the reign of our Sovereign Lord King James, of England, France, and Ireland, the eighteenth, and of Scotland the fifty-fourth, 1620. Also, Sanitary Laws in Virginia in 1610
- Description: John Snow memorial and pub, Broadwick Street, London Story of the pump here: http://en.wikipedia.org/wiki/John_Snow_(physician) “ By talking to local residents, he identified the source of the outbreak as the public water pump on Broad Street (now Broadwick Street). Although Snow's chemical and microscope examination of a water sample from the Broad Street pump did not conclusively prove its danger, his studies of the pattern of the disease were convincing enough to persuade the local council to disable the well pump by removing its handle. This action has been commonly credited as ending the outbreak, but Snow observed that the epidemic may have already been in rapid decline. Snow later used a dot map to illustrate the cluster of cholera cases around the pump. He also used statistics to illustrate the connection between the quality of the water source and cholera cases. He showed that the Southwark and Vauxhall Waterworks Company was taking water from sewage-polluted sections of the Thames and delivering the water to homes, leading to an increased incidence of cholera. Snow's study was a major event in the history of public health and geography. It is regarded as the founding event of the science of epidemiology. Later, researchers discovered that this public well had been dug only three feet from an old cesspit, which had begun to leak fecal bacteria. The nappies of a baby, who had contracted cholera from another source, had been washed into this cesspit. Its opening was originally under a nearby house, which had been rebuilt farther away after a fire. The city had widened the street and the cesspit was lost. It was common at the time to have a cesspit under most homes. Most families tried to have their raw sewage collected and dumped in the Thames to prevent their cesspit from filling faster than the sewage could decompose into the soil. After the cholera epidemic had subsided, government officials replaced the Broad Street Pump Handle. They had responded only to the urgent threat posed to the population, and afterward they rejected Snow's theory. To accept his proposal would have meant indirectly accepting the oral-fecal method transmission of disease, which was too unpleasant for most of the public to contemplate.[6]” Image location: http://en.wikipedia.org/wiki/File:John_Snow_memorial_and_pub.jpg This file is licensed under the Creative Commons Attribution-Share Alike 2.0 Generic license.You are free: to share – to copy, distribute and transmit the work to remix – to adapt the work Under the following conditions: attribution – You must attribute the work in the manner specified by the author or licensor (but not in any way that suggests that they endorse you or your use of the work). share alike – If you alter, transform, or build upon this work, you may distribute the resulting work only under the same or similar license to this one.
- Trash piled up on Varick Street in 1893 New York City, before sanitation reform Image permissions: public domain (published prior to 1923) The New York City Department of Sanitation is the largest sanitation department in the world, with 7,197 uniformed sanitation workers and supervisors, 2,048 civilian workers, 2,230 collection trucks, 275 specialized collection trucks, 450 street sweepers, 365 salt and sand spreaders, 298 front end loaders, 2,360 support vehicles, and handles over 12,000 tons of residential and institutional refuse and recyclables a day.
- The same corner of Varick Street, two years and a massive cleanup later. Image permissions: public domain (published prior to 1923)
- This scene at 212 Sullivan Street, in 1893, was probably not an unusual sight. Image permissions: public domain (published prior to 1923)
- Again, two years later, sanitation reform had transformed the city's streets. Image permissions: public domain (published prior to 1923)
- We have a set of model policies to promote Complete Streets. Complete Streets are… Local and state resolutions, general/comprehensive plan language, etc. As you know, the stimulus plan has lots of transportation infrastructure funding.
- This afternoon’s panel will feature a presentation on the economics of supermarket development and another on the challenges of farmers market development in low-income communities.
- This afternoon’s panel will feature a presentation on the economics of supermarket development and another on the challenges of farmers market development in low-income communities.
- This afternoon’s panel will feature a presentation on the economics of supermarket development and another on the challenges of farmers market development in low-income communities.
- This afternoon’s panel will feature a presentation on the economics of supermarket development and another on the challenges of farmers market development in low-income communities.
- To achieve public health goals, public health agencies must work with other government agencies: Land use Redevelopment Economic development Transportation If public health fails in this work, it will fail to address transportation equity, climate change, obesity, heart disease, asthma. That simple. Public health does not control either the infrastructure or the funding that it will take to redesign communities to lead to health. These other agencies DO control such resources and public health must learn how to work in a multi-disciplinary policy environment.