This statement is somewhat intuitive as tougher neighborhoods house generally less educated residents, carry higher risks of crime & violence when outside, and provide less access to fresh fruits and vegetables (read about food deserts here).
New research corresponds with this intuition. A study in the Oct. 20 edition of the New England Journal of Medicine (NEJM) found a correlation between where people live (a low-poverty area vs a high-poverty area) and their risk for obesity and diabetes. In this study, families with ties to the Housing and Urban Development Dept in numerous metropolitan cities were invited to partake in a randomized lottery to receive housing vouchers to move in to neighborhoods with either low, high or control (they can choose any area to live in) levels of poverty. Those living in the low-poverty neighborhoods had lower BMIs (body-mass indexes) and lower hemoglobin A1c levels (a 3-month average of blood sugar levels used to define and monitor control of diabetes).
This research is significant in that it gives neighborhood developers an opportunity to attempt to design healthier home environments for those living in higher poverty areas. Read the full article here.
Most Americans generally agree that our healthcare system needs a-fixin', so it shouldn't be too surprising that we were recently ranked last out of 16 "high-income" nations in preventable deaths, defined as deaths that are considered preventable with timely and effective health care (article link below). But, it still shocks me that only half of Americans are willing to DO SOMETHING about it!
When President Obama first took office, he had the support of the majority of the national population. He, along with Congress, passed the Affordable Care Act (ACA) and instead of moving forward on the act, it feels as if we've taken two steps back. A lot of this back-peddling can definitely be attributed to the fact that the economy has not yet fully recovered and there have been multiple international conflicts and natural disasters to contend with. However, it seems like the changes being made would be welcomed and utilized fully as a possible way out of this never-ending cycle of catastrophe-based, extremely expensive style of medicine we practice today.
Unfortunately, that is not the case. Congress continues to argue about the health care bill, health care in the U.S. continues to bankrupt thousands of people & businesses every year and Americans continue to getting sicker. I'm not saying the ACA is a perfect bill, but it is a step in the right direction. If only the public and those arguing against it would let it play out instead of spinning the nations' wheels, maybe we'd get somewhere. I can tell you, this young doc (and I know I'm not alone) is VERY frustrated with the system as it stands.
Let me give you an example of a situation in which an uninsured patient of mine will cost more to the system as a whole for not getting the preventive care he needs. Fred is a 50 year old male with a severe hypertriglyceridemia (in his case, a genetic problem that causes him to make an excessive amount of some fats in the blood, aka triglycerides - TGs). Fred came to me after this problem was discovered and he was started on 3 different cholesterol-lowering medications, including an infamous statin (eg, Lipitor). At my last 2 visits with Fred, I have scrambled to put together a cocktail of medications for him from our sample closet that a) work to control his TG level and b) do not damage his liver and c) do not cause his muscles to cramp (which he had experienced).
Fortunately, my clinic has a great supply of lipid-lowering medications for people in his situation (thanks to the pharmaceutical companies for providing this service).
Unfortunately for Fred, his TGs are still uncontrolled and he is at HIGH risk of having a major heart attack or stroke in the next 10 years. Another unfortunate detail is that he recently complained of chest pain and had some worrying concerns on his EKG. Fred can not afford to undergo the exercise stress test (a tried and true test that involves a person walking or jogging on a treadmill while undergoing an EKG. Any worrisome changes on the EKG send the patient directly in to the cath lab where a cardiologist goes in to their coronary vessels to unblock any clogged arteris) that I would like him to undergo. It costs ~$3000 without insurance (~$2800 of that just to be read by a cardiologist at the hospital)!!! This is an amount that most of us would not be able to shell out on the drop of a hat. When and if Fred has a heart attack (MI or myocardial infarction in medical terminology), he will be hospitalized, treated w/ very expensive medicines, taken to the cardiac catheterizetion lab (to undergo the same procedure he would have if he had an abnormal stress test now) and possibly end up having bypass surgery. All of this, including his physical therapy and time lost at work would eventually add up to ~$100,000, more or less. And Fred would end up in debt for the rest of his life...as many of Americans are today from medical expenses.
So, like some of the 50 million Uninsured in the U.S. Fred will continue his life for an unknown amount of time. He, like many of the others, is a ticking time bomb, waiting to go off at just the right unforeseen moment. Given preventive health care, Fred would be able to have the exercise stress test and/or heart catheterization procedure that would unclog his arteries today and allow him to continue working and contributing to society. Until then, I will continue to try to get his elevated TGs under control - we are working on his diet and exercise plan, however, given his genetics, this will only go so far. Hopefully, for Fred and his family, things will work out and he'll live to see his grandchildren grow up. Unfortunately, the odds are against him.
We'll have to wait and see what happens.
Thanks for reading and have a great weekend!
Here's the referenced article - http://www.commonwealthfund.org/~/media/Files/Publications/In%20the%20Literature/2011/Sep/1549_Nolte_variations_amenable_mortality_HltPolicy_09122011_ITL_v4.pdf
From the American Medical Association (AMA) newsletter I get:
Exercise may reduce cancer risk by altering cell microenvironment.
USA Today ran a number of articles discussing breast cancer, focusing in particular on the role of inflammation.
USA Today (10/3, Szabo) reports that "recently," scientists have "begun to untangle how staying active helps keep cancer at bay." In particular, exercise may change the microenvironment of cells, including "surrounding tissue, blood vessels and immune cells." Exercise may "prevent chronic inflammation, a process that can fuel cancers," lower "levels of both insulin and sex hormones, such as estrogen, which release growth factors that let tumor cells survive and spread," and "relieve psychological stress, which may further reduce inflammation."
In a separate article, USA Today (10/3, Szabo) reports, "Researchers are investigating the benefits of 'anti-cancer' diets that may help regulate both inflammation and new blood vessel growth." Research is ongoing in anti-inflammatory drugs, "such as aspirin, as a way to reduce the risk of breast and colon cancer." In addition, "doctors are testing a diabetes drug, called metformin, which lowers insulin levels, as a way to prevent relapses in women who have had breast cancer." Other work focuses on beta blockers, which reduce blood pressure. "Preliminary studies suggest that breast cancer patients who took the drugs before and after breast cancer diagnosis had a lower risk of relapse and death."
Weight, fitness may reduce disease risk. USA Today (10/3, Szabo) reports, "Women can't control the things that most strongly shape their risk: age, race, family history and the ages at which they hit puberty and menopause. ... Yet experts say women can embrace one prevention strategy with unequivocal benefits: exercise," and eating a healthful diet in order to maintain a healthy weight. Notably, "avoiding extra pounds reduces the risk of not only breast cancer, but tumors of the kidneys, esophagus, colon and uterine lining, says the National Cancer Institute. Staying lean also reduces risk of heart disease, stroke, diabetes, joint problems and other ailments." Other tips given include drinking in moderation, avoiding unnecessary radiation exposure, avoiding hormone replacement therapy, and avoiding chemicals that interfere with hormones, such as BPA or phthalates. A separate USA Today (10/3, Szabo) article also discusses the role of exercise and fitness in lowering "the risk of cancer coming back."
Dr. Maltz earned a Medical Degree and Master in Public Health from the University of Texas Medical Branch (UTMB) in Galveston, TX. She completed a combined Internal and Preventive Medicine Residency at UTMB in June, 2011. She then completed a 2-year Integrative Medicine Fellowship at Stamford Hospital in Stamford, CT, during which she simultaneously underwent an intensive 1000-hour curriculum created by The University of Arizona Integrative Medicine Program founded by Dr. Andrew Weil.