Healthscaping: Public health necessity?

September 8, 2009
Courtesy NYC Dept of Health and Mental Hygeine

Courtesy NYC Dept of Health and Mental Hygeine

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!


Pandemic is here: Time to panic?

July 6, 2009

The World Health Organization has finally called Swine Flu H1N1 a Pandemic! And yesterday the Wall Street Journal reported that Argentina has declared a health emergency due to the Swine Flu, with over 26 dealths and a rapid increase in the death rate as the winter sets in.  As of now, Argentina is behind the US and Mexico, with 27,717 and 8,680 cases, and 127 and 126 deaths, respectively, due to H1N1.  And Sri Lanka has an estimated 18 Swine Flue cases!  As Swine Flu spreads through South America, and back up to the US and abroad, should we worry? WHO Map_20090701_1100

The World Health Organization (WHO) map to the right shows, as of yesterday, that much of the world has been  stricken by Swine Flu, some countries significantly more than others.  Should New Yorkers be worried that, as the crossroads of the world, we’re subjected to greater incidence and higher death rates from Swine Flu?  Well, yes and no.

Reporting to the WHO may be reliable, but insofar as timeliness is concerned it may lack, and countries may not want their public health reputation sullied by a timely reporting of a pandemic virus.  Nobody can tell how long the pandemic will last, nor how many lives will be taken as a result of H1N1.  Combine H1N1 with other viruses (remember H5N1 – the Bird Flu – from 2005?  Well, that’s back in 2009 as well!) and seasonal effects to the health system (read here) and you can count on a nasty pandemic if you’re not careful.  The US Centers for Disease control recommends that the elderly, immunocompromised, and young children be guarded and careful about their personal habits and interactions.  Here are some suggestions on how to prevent and care for yourself if you think you’re sick with H1N1.

On the other hand, if we’re smart about how we sneeze and interact with others, we should be ok.  Just remember, that the 1918 Spanish Flu killed over 500,000 in the US alone (and the CDC estimates that >500 million worldwide were infected!), the 1957 Asian Flu pandemic caused more than 70,000 US deaths, and the Hong Kong Flu pandemic of 1968 killed more than 34,000 in the US.  Granted, we have much more sophisticated medical and epidemiological science now, but viruses, like people, travel, and when they do it’s incumbent upon us all to take care.

So yes, we should be careful.  Panic?  Not just yet.

For more info:

Steps to take to avoid Swine Flu infection

World Health Organization Pandemic Alert

Timeline of Human Flu Pandemics

Be careful at the beach: Don’t get sick

July 2, 2009

Sewage, medical waste, and garbage of all sorts and kinds end up in the waters of New York’s local beaches; According to the NYC Department of Health (DOH), “…the majority of pollutant discharge into NYC’s adjacent water originates from Combined Sewer Overflows, stormwater overflows, bypass of pollution control plants, and urban surface runoff.”

Now that summer’s here you need to be careful about how and when to visit the beach. Jesse, a surfer buddy of mine, regularly hits Rockaway Beach when the waves get to 3 feet. He, and his surfing colleagues “get sick whenever it’s been raining and we go out surfing.” The high level of bacteria in the water can hit the heartiest of immune systems.

“…beach closings and advisories are the results of bacteriological contamination.” The DOH closes the beaches for a reason, not to upset beachgoers! This contamination not only includes sewage, and medical waste, but also bird waste! There are nearly 30,000 birds around the New York beaches, and sick birds as well as bird waste are a contributing factor to contamination.

Typically, water pollution and beach closings are due to:
• combined sewer/storm overflows
• bypass of wastewater pollution control plants
• urban surface runoff
• animal waste
• poorly functioning septic tanks systems
• boating wastes
• sewage and oil spills
• medical waste and floatable trash/debris

Risks of swimming in polluted water include (per the DOH):
• Gastroenteritis – chills, nausea, diarrhea, stomach ache, head ache, fever
• Diseases of the eye, ear, skin
• Upper respiratory infections

Highly polluted water can cause more serious diseases:
• Amoebic dysentery, Cholera, Giardiasis, Hepatitis, Intestinal parasites, Norwalk Virus, Shigellosis, Viral Gastroenteritis, and Viral Respiratory Infections.

Also, children, infants, the elderly, and those with immune system compromise (chronic illness, diabetes, rheumatoid arthritis, HIV/AIDS, etc.) are likely to develop illnesses or infection after swimming in polluted water.

If you’ve been to the beach and you feel sick, call your doc right away.

The locations of the seven Parks Department public beaches in New York City are:

The Bronx: Orchard Beach
Queens: Rockaway Beach
Brooklyn: Brighton Beach & Coney Island
Brooklyn: Manhattan Beach (go figure, Manhattan Beach is in Brooklyn!)
Staten Island: Midland Beach
Staten Island: South Beach
Staten Island: Wolfe’s Pond Beach

The DOH has safety notices for these beaches as well as for all the private beaches in the city, so be sure to check for the water safety before you head out by clicking the links below.

So let’s hit the beaches!

For more info:

Beach Status for The Bronx and Queens,

Beach Status for Brooklyn and Rockaways,

Beach Status for Staten Island

Swine Flu Kills Again!

June 25, 2009

A 10-year old boy died on the morning of June 19th just across the river in Morristown, NJ. Strangely enough, he became ill on June 12th, the same date that NYC DOHMH published its “decline” message.

According to the New York City Department of Health, on June 12th, “Community transmission of the H1N1 virus appears to be declining in New York City…” True, Morristown is most definitely not NYC, but it’s not that far away either.

The message, then, is that we must all be diligent. Here’s what to do to reduce the risk of infection, and what to do if you feel sick:

1. Wash your hands – your mom was right! You touch doorknobs, handrails, bus poles, grocery carts, and who knows what else in your day to day activities. Viruses spread on contact. Wash your hands!

2. Cover your mouth and nose when you cough or sneeze. Your mom was right again! If you don’t have a hankie or tissue then sneeze into your upper arm. This is what chefs do in the kitchen! This prevents your cold or flu from spreading.

3. If you feel ill, call your doc and get in as soon as you can. Don’t forget that there are Community Health Centers throughout the city that see patients on a walk-in basis. Call first.

4. Go to to find a health center near you.

5. If you are elderly and have a fever or cold, you should be under the care of a doc anyway, but you’re most likely not subject to the H1N1 virus, as you were around for the previous flu pandemics in the 1950’s! Call your doc first with any questions.

6. If you have an infant, or a child with a fever or who is sick, get her or him to a doc IMMEDIATELY. This is where it’s OK to take them to the Emergency Room!

7. If you’re an adult with sniffles, stay in bed for a day and take what you usually take to get rid of the cold. If you develop a fever, get to a doc. See the Community Health Centers in #4 above if you don’t have a doc.

8. Remember, if all else fails, get yourself to an Emergency Room. 911 is always there.

So, unless you’re traveling to Mexico or in contact with already-infected New Yorkers (or anyone else by now), following the above suggestons will more than likely keep you out of the Emergency Room! So wash your hands!

For more info:

NYC Department of Health

Centers for Disease Control H1N1 Flu Website

U.S. Declares Public Health Emergency Over Swine Flu

April 27, 2009

So, now we know.  I’m a born skeptic.  At least now there are federal resources at work.  But HHS has no Secretary so will we find a listless effort here?   Is Tamiflu the be-all and end-all?

“We’re in a period in which the picture is evolving,” said Dr. Keiji Fukuda, deputy director general of the World Health Organization. “We need to know the extent to which it causes mild and serious infections.”

Without that knowledge — which is unlikely to emerge soon because only two laboratories, in Atlanta and Winnipeg, Canada, can confirm a case — his agency’s panel of experts was unwilling to raise the global pandemic alert level, even though it officially saw the outbreak as a public health emergency and opened its emergency response center.

Mexico swine flu deaths spur global epidemic fears

April 24, 2009

At least the AP is on the trail.  While Texas and California are first to report, we’ll see how long it takes for other states to report as well.  Surveillance, or lack thereof, needs a big, big boost.

MEXICO CITY – A unique strain of swine flu is the suspected killer of dozens of people in Mexico, where authorities closed schools, museums, libraries and theaters in the capital on Friday to try to contain an outbreak that has spurred concerns of a global flu epidemic.

The worrisome new virus — which combines genetic material from pigs, birds and humans in a way researchers have not seen before — also sickened at least eight people in Texas and California, though there have been no deaths in the U.S.

“We are very, very concerned,” World Health Organization spokesman Thomas Abraham said. “We have what appears to be a novel virus and it has spread from human to human … It’s all hands on deck at the moment.”

Unusual Strain of Swine Flu Is Found in People in 2 States

April 24, 2009
Let’s see, Mexico is just south of California.  “We don’t yet know the extent of the problem…”  Yeah, that’s an understatement.

The New York Times  By DONALD G. McNEIL Jr. Published: April 24, 2009

An unusual strain of swine flu is circulating among people in the Southwest but is not known to have caused any deaths, the Centers for Disease Control and Prevention said Thursday.

The agency, which has found only seven cases, expects to find more now that it has begun looking intensively for them.

“We don’t yet know the extent of the problem,” said Dr. Anne Schuchat, the director of respiratory diseases for the agency, “but we don’t think this is a time for major concern.”

Five of the people infected were in Imperial and San Diego Counties in California and two were in San Antonio. They were 9 to 54 years old.

None had any contact with pigs, and in two sets of cases — involving a father and daughter and two 16-year-old schoolmates — those infected had contact with each other. That convinced the authorities that the virus was being transmitted from person to person.

The seven people were apparently infected from late March to mid-April. Only one was hospitalized, and all recovered.