Chronic Illness in New York is skyrocketing; Heart Disease is the number one killer, followed by Cancer and a host of other, potentially avoidable, chronic illnesses, e.g., vascular, diabetes, HIV, and hypertension. We are seeing a major increase in death by chronic illness. Consider that over 76 percent of the latest reported deaths in New York City are due to chronic disease. That figure was 67 percent in 1997. Can these deaths be avoided or prevented?
Unlike Swine Flu (click here) or getting hit by a car, chronic illness is long-lasting, but manageable. However, the longer the patient suffers with a serious chronic condition, the more likely it is that she will have an early visit from the grim reaper. Of course, it is possible to mitigate the symptoms of some illnesses, but chronic is chronic, i.e., it is not going away. Notably, environmental factors play a part in the onset of many of these conditions, such as heart disease, pulmonary disease, and hypertension. For example, smoking causes lung disease, a high-fat diet causes heart disease, and large amounts of bad food cause obesity (which leads to diabetes).
Healthscaping is a public health concept that can, with effective intervention, help reduce the environmental causes of chronic illness. We’ve already seen the effects of the “smoking tax” in New York, where the total tax is now $5.26 a pack. With cigarettes costing 10 bucks a pack, people are reluctant to start and are eager to quit in order to save $300 or more a month. Consequently, their health improves and the the city spends less on interventions for smoking-related disease. With 6,000 premature deaths prevented, the tax on cigarettes has proven effective. Can other public health interventions work for the city as a whole? Time will tell, if the Trans-fat ban is any indication.
Artificial trans-fats, used in cooking oils and margarines, were banned by the NYC Department of Health as of July 1, 2008 in order to reduce the incidence and prevalence of cardiovascular disease in New York. Can we know, a year later, whether this Healthscape intervention has worked? While it will take more than a year to establish validity of the program, and while there might be many confounders when the metrics are compiled, we do know the validity of reducing trans-fats in the diet leading to healthier outcomes. So why NOT Healthscape?
Tom Farley, MD, the Commissioner of Health, and Deborah Cohen, MD, write about Healthscaping in the book “Prescription for a Healthy Nation”. They propose changing the environment to better promote the public health, such as setting law to sell fresh fruits and vegetables at supermarket checkouts instead of candy and silly magazines, eliminating junk food from schools, and stopping the advertising of alcohol. Walkable and bikeable neighborhoods, such as Broadway in Times Square, and the closing of Lexington Avenue for bikes and pedestrians this past summer are good examples of Healthscaping in New York City.
Corporate Healthscaping has been a function of cost savings and productivity. Pitney Bowes, for instance, has a corporate health policy that encourages employees to “Take the Stairs”, and many organizations sponsor cafeterias serving fresh wholesome food. These corporate policies not only promote health, they keep the costs of healthcare down. While mandates can be hard for the public to swallow (as opposed to, say, a Twinkie and a Pepsi), bringing health to the public is no easy task but can pay off in the long run.
While Healthscaping may be the future of public health, it has its roots in keeping healthcare costs down by keeping the community healthy. Hopefully the Healthscaping trend will continue, as forward-thinking leaders from both the public- and private-sector know that a healthy population is more productive and less costly.
What do you think? Let the dialogue begin!