Childhood obesity is getting national attention as a public health crisis. Native American children have the highest prevalence of obesity. Blacks and Mexican-Americans had rates higher than whites. Low-SES adolescent girls have much higher prevalence than higher-SES counterparts especially white adolescent girls. The disparities in the prevalence of obesity may be the result of the interaction between genetic and environmental factors with the latter playing a key role in fueling the obesity epidemic.
The upward trends in obesity and extreme obesity may turn downward slightly from 2003 to 2010 among preschool-aged children living in low-income families according to a research letter published in this week's JAMA by Pan et al. (CDC) using data from the Pediatric Nutrition Surveillance System which includes almost 50% of children eligible for federally funded maternal and child health and nutrition programs. In the accompanying viewpoint, Dr. Ludwig and others called for the restructuring of the Supplemental Nutrition Assistance Program (SNAP), previously known as the Food Stamp Program to focus on nutritional quality of food purchased/consumed by SNAP recipients. It has to start with a more systematic approach to data collection by the USDA and collaboration with DHHS.
We need national to grassroot level strategies to cut back on sugary drink consumption. Find out more about the unprecedented marketing of sugary drinks to youth from the Rudd Center for Food Policy & Obesity at Yale. Past proposals included penny-per-oz taxes on sugar-sweetened drinks and NYC's soda ban (prohibits sugary soft drinks larger than 16 ounces (473 ml) from being sold in restaurants, movie theaters and food carts). School, home, public education and social marketing do not seem to work?
When I first embarked on this question years ago--could physicians address social determinants of health in the clinical context? YES! This was my conviction. I believe in the physician as public health professional and as the community-responsive physician. Some physicians choose to wear different hats in a day even--caring to patients in clinic, hospital, volunteering with community organizations, advocating for policy change and researching on public health issues BUT most physicians in the US just practice medicine--what WE are best trained for. SO could we care for patients, group of patients, community, vulnerable populations, treat acute problems, manage heart failure, diabetes, stroke, mental illness as well as address issues such as poverty (very grandiose I know), racism, income inequality, physical inactivity, illiteracy, access to healthy food, transportation, crime, etc.? Could we refine our clinical skills, improve systems-based practice, coordination of care, team work, collaborate with public health department/researchers, explore further the interaction among various health determinants, divert some (MUCH MORE) resources from heatlh care delivery into addressing social determinants. I became interested in pay for performance in population health promoted by Dr. Asch and others, a lofty concept but complex in implementation. People say Obamacare, ACO are the baby steps in that direction. This website is perhaps an attempt to answer this question...
Our nation just experienced a tragic event at Sandy Hook. Dr. Suzanne Koven in her blog asked "Did any doctor ask Nancy Lanza about guns?" Would it help? Did Ms. Lanza have a PCP? Did Mr. Lanza ever seek help or disclose to anyone any trouble? answers we may never know. What is the role of doctors when it comes to gun violence? (stick to the A1C, LDL, BP and other quality measures in the 15 min visits right?). What is the evidence on gun violence? (stay tuned...)
It's the debut of the SDHPitt blog. Time to share and reflect. Peace and Joy to the world!
These are some of my favorite quotes:
“Charity depends on the vicissitudes of whim and personal wealth; justice depends on commitment instead of circumstance. Faith-based charity provides crumbs from the table; faith-based justice offers a place at the table.”
-- Bill Moyers
“It is very expensive to give bad medical care to poor people in a rich country.”
― Paul Farmer
Equality of opportunity is absolutely necessary but not sufficient in building a genuinely fair and efficient society.”
― Ha-Joon Chang, 23 Things They Don't Tell You About Capitalism
“It is more difficult to fight poverty in a rich country than in a poor one.”
-- Mother Teresa
"I wish to do something Great and Wonderful, but I must start by doing the little things like they were Great and Wonderful"