Chronic Diseases and Minority and Low-Income Communities

By Greg Cook, WHF Associate

Chronic diseases are found in all groups of people of all different races and income levels. However, minority and low-income groups represent a disproportionate number of those suffering from chronic diseases linked to poor nutrition, lack of physical activity, and tobacco use. The federal Centers for Disease Control (CDC) and Washington State are both addressing the health disparities found in minority communities.

Now local efforts to improve health within minority communities seem to be bearing fruit. The REACH coalition of Public Health—Seattle and King County has been working to reduce levels of diabetes in high-risk communities. The Seattle Times reports on one Mexican restaurant owner who—concerned for both his personal and community health—worked with REACH to provide a healthier menu for his patrons. Growing awareness of the costs of chronic disease among minority communities and business owners coupled with technical assistance from local public health experts is proving to be a winning combination in reducing health disparities and improving health for all of our state’s residents. Restaurant owner Ramiro Rubio recognized the possible took advantage of public health’s nutritional expertise to use more healthful ingredients to replace some of the less-healthy starches and fats. He and a nutritionist worked together to balance concerns about elements like flavor, amounts of carbohydrates, and traditions such as chips and salsa on every table. Rubio is trying to make a small contribution to the health of his community while acknowledging the deep rootedness of food habits within a culture.

Foods once considered “ethnic” are moving into the mainstream. One example of this trend is the fast-growing national chain Chipotle Mexican Grill, which operates on a “food with integrity” philosophy to serve its customers locally-sourced and nutritionally sound products. Chipotle has gone outside the standard mass-procurement model to locate and work with producers of meat, poultry, and other foods who eschew the industrial style models that prevailed for decades. Leaders in the effort to get a broader range of healthy nutritious foods to the public and especially populations in public institutions are considering alternative methods of food procurement.

Minority and low-income communities may be especially prone to chronic disease due to lack of access to a full range of nutritional food and healthy activities. The CDC’s approach to pushing down chronic disease takes into consideration those factors and uses a range of “MAPPS” strategies: Media, Access, Point of decision information, Price, and Social support/services. The Washington Health Foundation (in collaboration with the Washington State Department of Health) is guided by MAPPS in its Healthiest Communities Partnership, a public/private partnership to reduce chronic disease across Washington state and throughout all its communities.

To find out more about the Healthiest Communities Partnership click here.

Smoking Cessation Efforts for American Indians in Washington

By Coral Sisk, WHF Associate

More than 160,000 people in Washington State identify themselves as American Indian or Alaska Native. While some are members of the 29 federally-recognized tribes and live on reservations across Washington, approximately two-thirds live in or near cities such as Seattle, Tacoma, and Spokane. In Washington roughly one third of American Indians smoke commercial tobacco [1]. They also suffer from chronic diseases, such as cancer, diabetes and heart disease, at a much higher rate than the general population [2].

Tobacco cessation and prevention programs are effective and important ways to reduce the rates of chronic disease. Currently, American Indian communities across Washington are receiving funds from various sources to help them develop effective and sustainable tobacco prevention programs. These include:

• The Washington State Tobacco Prevention and Control Program, administered by the Department of Health, is currently providing $635,000 to 19 tribes, the Seattle Indian Health Board, and the American Indian Health Commission to reduce commercial tobacco in American Indian communities.
• Tribes operating gaming casinos in Washington State are required by gaming compacts to provide a percentage of their revenues on smoking cessation and prevention. For 2009 and 2010 combined, tribal casinos used over $3 million to groups around the state to discourage tobacco use. Approximately 70 percent of these funds were distributed to support Tribal smoking cessation and prevention efforts [5].
• The state Department of Health received federal stimulus funds to help addictions and mental health treatment centers to integrate tobacco cessation into their treatment plans and create tobacco free facilities. Many of the treatment centers receiving this training and technical assistance serve tribal and urban Indians [4].

The Healthiest State Campaign with help from the Washington State Department of Health is reaching out to American Indian and other communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

Sources:

1. Washington State Department of Health Tobacco Use Statistics: http://www.doh.wa.gov/tobacco

2. Northwest Area Indian Health Board Statistics: http://www.npaihb.org/programs/project/nttpn_data_statistics/

3. Indian Country Today News: http://www.indiancountrytoday.com/living/health/80266097.html

4. U.S. Dept. of Health & Human Services: http://www.hhs.gov/news/press/2010pres/02/20100205a.html

5. Washington State Gambling Commission: http://www.wsgc.wa.gov/agendas/archives/2010/jul_tribal_contributions_presentation.pdf

Quality School Physical Education Leads to More Active Kids

By Adam Nelson, WHF Associate

According to Washington State standards, students in grades 1-8 must participate in 100 minutes per week of Physical Education (PE). But a 2009 study by the University ofWashington Center for Public Health Nutrition says that the average 7^th grader takes part in 50 minutes per week of PE, and only 7 minutes of aerobic activity per PE class. Improving the quality of physical education by maximizing the quantity, enjoyment, knowledge and physical abilities for youth, is an important step toward increasing the overall physical activity children level of children in Washington.

There has been innovation in PE coming from the private sector. One company, HOPSports, developed a system to improve the quality of physical education that is now used at three sites in Washington including Camas High School. To improve traditional PE, HOPSports system is a pre-package set of video PE lessons, tailored to meeting national physical education standards. The PE teacher can choose videos based on their goals for specific lesson plans. In addition to lessons which lead students through a 10-30 minute exercise routine, the warm-up videos provide health education on topics of anti-smoking, nutrition, and the environment.

A 2008 case study of 16 North Carolina schools that implemented the program found that compared to traditional PE courses, physical activity class time increased by 45 percent, student enjoyment of PE increased significantly, and students' intent to be physically active outside of class also increased. By implementing fun innovative ways to engage a broader base of students, it makes sense that children will be more physically active.

Programs like HOPSports and SPARK are just one way to increase the quality of physical education in Washington. Moving forward on PE is only one reason the Healthiest State Campaign is teaming up with the state Department of Health to promote a new public/private Healthiest Communities Partnership. We want to make healthy choices, like regular physical activity, the easy choices in our state.

To learn more about the Healthiest Communities Partnership, click here.

Second-hand Smoke

By Coral Sisk, WHF Associate

Research on secondhand smoke exposure shows that carcinogenic compounds enter the bodies of non-smokers and can increase their risk for chronic disease [1]. Washington State has adopted tobacco bans in public spaces such as restaurants, bars, and workplaces in order to limit second-hand smoke exposure. Now an increasing number of people are demanding that they have the same protection from secondhand smoke in their homes. Many people living in apartments have chronic health conditions like asthma and suffer serious problems when even small amounts of smoke drift into their units. Apartment and condominium owners around the state are creating no-smoking policies for their multi-unit housing complexes. These policies protect people from smoke drifting into their homes while they reduce cleaning costs and risks from fire damage.

In addition to protecting non-smokers, restrictions on where people can smoke is an evidence based, public health strategy for reducing tobacco use. By limiting smoking in public spaces, tobacco use becomes more inconvenient. In 2010, smoking has become less socially desirable and less acceptable than in the past. There is strong public support for keeping secondhand smoke away from vulnerable populations such as children. By cutting down on the amount of smoking and limiting exposure to secondhand smoke we are helping Washington move up the healthiest state index.

The Healthiest State Campaign with help from the Washington State Department of Health is reaching out to communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

Reference:

1. Second Hand Smoke: Questions & Answers:

http://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS

Can We Transform WA Into a Blue Zone?

By Greg Cook, WHF Associate

Can you imagine a community where hardly anyone suffers from chronic diseases such as diabetes? A place where heart disease is a thing of the past and the smell of tobacco smoke is unknown? A location where you and your neighbors expect to live well past the average life expectancy? Such places exist in the real world, and scientists studying health and longevity have a name for them: “Blue Zones.”

Blue Zones (the title of a book) have been identified in several locations around the world. Life in a Blue Zone includes healthy eating, plenty of daily movement, and a positive outlook on life. Now there are efforts underway to replicate Blue Zones in other places. One such pilot project is underway in Minnesota, as reported on in an August, 2010 edition of U.S. News & World Report. So far, the results are promising, with increased rates of walking, a shift to better eating habits, and numerous stories of weight loss.

Could communities across Washington state become Blue Zones? There are some encouraging developments. Recent data show that our state has one of the lowest smoking rates in the nation. There is a growing consensus that school children require more exercise (including to and from schools as a part of that exercise) and better nutrition. This awareness has been bolstered by legislation on farm-to-school food purchasing and safe routes to schools infrastructure projects.

Blue Zone promoters are looking at the workplace as another front on the campaign to invest in good health and erode levels of chronic disease. Provisions in the new federal health care legislation will assist small business owners set up employee wellness programs. Such programs, when properly implemented, prove to be a win-win for employers and workers: absenteeism rates decline and employees enjoy a healthier life both at work and at home in the community.

The non-profit Washington Health Foundation through its Healthiest State Campaign in collaboration with the Washington State Department of Health is laying the groundwork for a state-wide public/private partnership to put some of these ideas into practice. The Healthiest Communities Partnership is assembling members from the business, non-profit, medical, and government sectors to begin strategizing about how to make our state a healthier state, and to make good everyday decisions about smoking, nutrition, and physical activity the easy choices.

To find out more about the Healthiest Communities Partnership click here.

Tobacco Taxes

By Coral Sisk, WHF Associate

With all the talk in recent years about obesity, it is easy to lose sight of the fact that tobacco use still “noses out” obesity as the leading cause of preventable death.

Taxing tobacco is one of the most effective ways to reduce smoking [1]. Studies show that a 10% real price increase on tobacco products results in a reduction of 6-7% in smoking among youth [2]. Voters are favorably inclined towards raising tobacco taxes [3] to address state deficits rather than increasing income or sales tax. At the same time, non-profit social organizations lack funding for programs that assist and engage the mentally ill, addicts, the poor, homeless, and minority populations in smoking cessation. Studies show that as tobacco use abates, these groups contain an increasingly disproportionate share of remaining smokers. This year in Olympia, Legislators tacked on an extra buck in tax on every pack of smokes, but the lion’s share of those funds will go into the state’s general fund. Taxing tobacco is among the most effective means for promoting cessation, so the tax is a tobacco reduction strategy in itself. But as remaining smokers become fewer and more difficult to reach, more intensive prevention programs as well as clinically provided cessation interventions require continued public funding. The Healthiest State Campaign is pleased for the legislature’s continued support, albeit at a reduced level now, for a public health approach to tax fund use to support tobacco cessation efforts as part of healthy communities and opportunities for everyone. But more still needs to be done for the sake of health and equity.

The Healthiest State Campaign with help from the Washington State Department of Health is reaching out to communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

References:

1. U.S. Department of Health and Human Services (HHS), Reducing Tobacco Use: A Report of the Surgeon General, Atlanta, Georgia: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2000/index.htm.

2. http://www.tobaccofreekids.org/research/factsheets/pdf/0021.pdf.

3. http://www.tobaccofreekids.org/reports/state_tax_report/downloads/state_tax_polling_2010.pdf.

http://www.tobaccofreekids.org/reports/state_tax_report/.

Safe Routes to School Encourage Kids to Be Active

By Adam Nelson and Greg Cook, WHF Associates

As children in Washington age they engage less and less in healthy physical activities. Sixty-two percent of 6^th graders, forty-six percent of 8^th graders, forty-four percent of 10^th graders and forty percent of 12^th graders met physical activity recommendations according to a report from the Washington State Department of Health (WSDOH) released in January 2010. What can be done and, just as important, what is being done to reverse the downward slide into inactivity? One part of the puzzle is the federally-funded Safe Routes to School program. In our state the program is administered by the Washington State Department of Transportation (WSDOT). There is also a national alliance devoted to promoting this approach to improving health and safety.

Safe Routes to School programs are foundational for promoting life-long physical activities among our state’s children. Programs like Safe Routes to School, and organizations like the Washington Bicycle Alliance and Feet First, are working to make walking or bicycling in the community safe and sustainable activities. Evidence-based research published in 2010 demonstrates that by engaging families, schools, urban planners, and public safety professionals, these programs, and programs like them, help increase the rates of physical activity by creating safe environments for youth.

In previous years WSDOT has awarded $10 million to 39 projects under Safe Routes, and another $15 million toward general pedestrian and bicycle safety. Larrabee Elementary School in the Bellingham School District is one of the first projects to be completed by the WSDOT. The project includes bicycle and pedestrian safety education, increased enforcement, a neighborhood awareness campaign and promotional events at school. The school community at Larrabee now has increased access to physical activity opportunities by engaging parents, teachers, students and school staff to turn an infrastructure improvement into a health improvement.

WSDOT is currently reviewing grant applications for Safe Routes to School projects. At the federal level, Safe Routes to School funding has been under assault but for the time being remains in place. At a time when there is growing recognition of epidemic levels of childhood obesity, cutting a program to promote childhood activity seems short-sighted. This 2008 report from WSDOH lays out the public health policy choices necessary to get us on track in the race to become the healthiest state in the nation. Safe Routes to Schools for our children can play an important role in that race and can help make walking or biking to school the easy choice.

The Healthiest Communities Partnership with help from WSDOH is reaching out to communities across the state to build a broad-based public/private partnership for preventing chronic diseases, making healthy choices about diet, exercise and tobacco the easy choices. To learn more about the Healthiest Communities Partnership, click here.