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Jane L. Delgado, Ph.D., President and CEO Over the past forty years, we have seen enormous shifts in the health of communities. We can celebrate many successes at the community level, such as banning tobacco in public places, increasing numbers of smoke free zones, requiring seat belts and child safety seats, and decreasing infant mortality. At the same time, there appear to be indications that the overall health of communities is deteriorating. Americans are more sedentary, clean air and water is not a given in many communities, and more working families do not have health insurance. In order to change this negative trend, we need to develop strategies that apply the richness of scientific data and choose to focus on new interventions that are tailored to the individual. As we look forward to healthier communities, we need to rethink our call to action for communities and work together to inform the individual, to protect the environment, and to care for the total person. Real change happens one person at a time. To inform the individual. We must provide individuals with information that is accurate for them. Most of what we know is based on either the one-third of the population that is male and non-Hispanic white or based on aggregated data. The problem with the former is that findings are not necessarily applicable to the rest of the population, while the latter homogenizes the differences that are essential to understand and recognize what is needed to improve the health of the individual. One example of our need to rethink what we say to health consumers is heart disease. While we have decades of research and data on cardiac procedures, it was not until 2001 that we had research that documented the differences between men and women.[1] Specifically, data indicated that women’s symptoms are different than those of men. Men were more likely to complain of chest pain and diaphoresis; women more likely to complain of back pain, jaw pain, neck pain, nausea, and shortness of breath. In 2007 at the annual European Society of Cardiology meeting in Vienna, Dr. Eva Swahn of the Department of Cardiology at University Hospital in Linkoping, Sweden, reported that women who had major heart operations like a coronary bypass were more likely than men to die. This was consistent with similar concerns that led the American College of Cardiology to revise its treatment guidelines and recommend that physicians should think twice before subjecting women at low risk of heart disease to invasive procedures. What these findings demonstrate is the data need to be more finely analyzed; the information that we give people needs to tailored to them. For now, it appears that women with heart problems may need to be treated differently than men. Just as gender provides one layer of understanding, likewise race, ethnicity, and other factors provide more depth to our knowledge about the individual. The magnitude of differences can be very small. At the biological level, we know that statistically tiny variations make an enormous difference. For any two individuals their DNA will be 99.5% identical although they may seem to be totally different to the naked eye. We are just beginning to learn how to measure such similarities and differences and are only at the starting point for deciphering what these differences mean in terms of health and wellness. As our knowledge progresses, it is clear that equality in health care does not mean getting the same treatment or procedures; quite the opposite. Equality in health care means that to be most effective, care and treatment need to be tailored specifically to the individual. The challenge is to inform the individual in a timely manner of the best information and evidence we have, so he or she can make informed decisions and utilize the information wisely. At a time when consumer-directed health care is promoted, there still exists a 15-year lag between what is found at the researcher’s bench and its application at the bedside. There is much to do in this area, we need to inform individuals by providing what we know and also admitting what we do not know. To protect the environment. Americans in the 21st century are increasingly facing threats to our health— compromised air and water. These days opening a window or taking a walk outside could potentially put a person at increased risk for respiratory or cardiovascular problems. At present, the Environmental Protection Agency (EPA) conducts limited analysis of air quality. Specifically, while the National Ambient Air Quality Standards (NAAQS) measures six substances - carbon monoxide, lead, nitrogen dioxide, particulate matter, fine particulate matter, ozone, and sulfur dioxides. EPA does not report on a daily basis information about toxic releases. Add to this lack of data the fact that as global warming increases, the air quality is getting worse as the number of unsafe air days increases. On those days when the ground-level ozone is high, the number of persons who show up in emergency rooms with cardiovascular problems also increases. [2],[3] Air quality is not our only concern. As drinking water supplies become contaminated with chemicals, our ability to measure them becomes even more critical. As we improve our ability to measure substances, it is becoming evident that minute levels of chemicals have negative health consequences. Currently, the EPA standard for drinking water is set at ten parts per billion (pbb) to protect consumers served by public water systems from the effects of long-term, chronic exposure to one dangerous element - arsenic. There are countless other substances that also need to be monitored, but currently go unchecked in our water monitoring systems. While the air and water are contaminated in many communities, such assaults on the basics of life are particularly evident in low-income communities. For communities to ensure their health, they need to recognize the link between health and the environment. To care for the total person. Nowhere is the fragmentation of our health system clearer than in the continued separation of our physical and mental health systems. For decades, researchers have documented the interconnection of our physical and mental health. Nevertheless, these systems continue to be bifurcated with consumers suffering the consequences of not recognizing that health is about the interaction of physical and mental health. The long-standing fissure between healing the body and the mind requires more than co-location of services. It requires a renewed commitment to comprehensive health care. Moreover, the more we learn about the impact of our mind on our immune system and our endocrine system, the more clear the need is to provide integrated services that are – again – tailored to the individual. There is much to do in the coming years. The good news is that technology and scientific innovation are giving us new tools for change. But such opportunities must be grounded in the fundamental understanding that all community-wide and system change happens one person at a time. Endnotes [1] Seils, Damon
M.; Friedman, Joëlle Y.; and, Shulman, Kevin A., Sex Differences in the
Referral Process for Invasive Cardiac Procedures, Journal of the
American Medical Women’s Association, Vol. 56, Number 4, Fall 2001
Pages 151-154.
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A Call to Action for Healthier Communities