Ivor Horn, MD, MPH, grew up in Jackson, Miss. at a time when, as she says, “being African American, we were always on the wrong side of the tracks.”
Yet Dr. Horn thrived. She was born in a hospital, and didn’t go to another hospital until she had a child. She had strong support from her family and community, and received a solid education. She eventually left Mississippi and went on to become medical director at the Center for Diversity and Health Equity at Seattle Children’s Hospital.
Dr. Horn was a presenter at the Colorado Health Foundation’s annual Colorado Health Symposium in Keystone July 29-31, and during her talk, she articulated a theme that came up repeatedly throughout the conference. Dr. Horn used her own life as an example of something that seems so self-evident, it’s hard to remember that it’s revolutionary: Good health frequently has almost nothing to do with health care, and everything to do with other factors.
Connections with friends and family, access to healthy food, safe streets and high-quality education: These are some of the ingredients of good health. Conversely, said fellow presenter Alexandra Drane, co-founder of the Eliza Corporation, financial stress, unhealthy relationships and divorce can be invisible burdens that make people stressed out and sick.
This focus on the social determinants of health is relatively new in the health care community, but it has quickly gained widespread acceptance. This aligns with the work of The Colorado Trust, where the focus is on advancing health equity through addressing these determinants.
These days, the debate isn’t whether socio-economic factors affect health. It’s what to do about them.
There isn’t a shortage of ideas. But with an almost unlimited array of social and economic factors to choose from, there’s no real consensus on where to begin, or how.
Joanna Frank is the Executive Director of the Center for Active Design, a New York-based nonprofit that pushes real estate developers to incorporate healthy design principles into urban planning. These principles, as laid out by the Urban Land Institute, include things like building pedestrian-friendly walkways, opening stairways up with windows and adopting pet-friendly policies.
If that sounds uncontroversial, consider that the New York City bike lanes built under these same principles became a lightning rod, inviting the wrath of inconvenienced drivers.
Or this: Frank noted that the question of gentrification comes up in every discussion she has. Do healthy design elements simply drive up housing prices in a neighborhood, and drive out the most vulnerable residents? Frank conceded that it’s a question she doesn’t like to answer.
“Gentrification has to be a policy issue,” she said.
Symposium attendees were offered guided hikes, free yoga and (very high energy!) Zumba classes, and frequent mention was made of Colorado’s aspiration to be the healthiest state. But keynote speaker Robert Lustig, MD, author of the book Fat Chance and professor of pediatrics at the University of California, San Francisco, called the idea that physical activity accounts for Coloradans’ slenderness “a sham.” (Instead, Dr. Lustig preferred to attribute much of our relatively lower obesity rate to cellular activity in response to higher altitude.)
Dr. Lustig is an outspoken critic of the food and beverage industries, saying they’ve made us unwitting participants in a large-scale research study on the impact of mass consumption of processed foods over real foods.
Despite previous decades’ focus on saturated fat, the real marker of processed food is its high sugar content, said Dr. Lustig. And while Coca-Cola and other food and beverage companies spend a lot of money promoting the idea that a calorie is a calorie, Dr. Lustig said that’s not true. Calories from sugar are metabolized differently than those from other sources, he said.
“Type 2 diabetes should be renamed ‘processed food disease,’” he proposed.
Dr. Lustig made a strong argument for government intervention in the form of removing subsidies that benefit the makers of junk food, and levying taxes that might—if they are big enough—work to decrease our consumption of it.
But in another session, activists from the Navajo Nation and Telluride described what happened when they proposed taxes on junk food in their communities: Swift and practiced opposition from major players in the food and beverage industry. A proposal to levy a small tax on soda in Telluride never passed. The Navajo Nation fared better with a tax it passed in 2014 on sugar-sweetened beverages, sweets, chips and fast food, but only after four years of sustained effort against deep-pocketed lobbyists.
Dr. Horn’s advice for advancing more equitable health outcomes came down to humility.
“We’ve been doing a lot of reaching down—what we need to do now is humble ourselves and reach up to the communities we are trying to serve,” she said. “We are in service to them; they are not in service to us.”
Are you listening, Big Soda?