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Building Healthy Communities:

A Public Health Imperative

Paul Simon, MD, MPH

Director, Chronic Disease and Injury Prevention

Los Angeles County Department of Public Health

October 7, 2011

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Trend in Life ExpectancyLos Angeles County, 1991-2007

74

75

76

77

78

79

80

81

82

1991 1993 1995 1997 1999 2001 2003 2005 2007

LifeExpectancyinYe

ars

75.8

80.8

Los Angeles County Department of Public Health

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An Aging PopulationPercentage of U.S. Population over Age 65

Source: From Baby Boom to Elder Boom: Providing Health Care for an Aging PopulationCopyright 1996, Watson Wyatt Worldwide.

0

5

10

15

20

25

1930 1950 1970 1990 2010 2030 2050

Year

Percentage

ofP

opulation

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Prevalence of Chronic Conditions in the U.S.by Age Group, 2004

26%

40%

68%

90%

6%

15%

42%

72%

0%

20%

40%

60%

80%

100%

Ages 0-19 Ages 20-44 Ages 45-64 Ages 65+

Percentofpopulation

1 or more chronic conditions 2 or more chronic conditions

SOURCE: Medical Expenditure Panel Survey, 2004

Anderson, G., Public Health Reports, 2007

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Per Capita Healthcare Spending in the U. S. byNumber of Chronic Conditions, 2004

$994

$2,753

$5,062

$7,381

$10,091

$16,819

$0

$2,000

$4,000

$6,000

$8,000

$10,000

$12,000

$14,000

$16,000

$18,000

0 1 2 3 4 5+

Number of Chronic conditions

A

veragepercapitas

pending

SOURCE: Medical Expenditure Panel Survey, 2004

Anderson, G., Public Health Reports, 2007

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Prevalence of Obesity and Diabetes AmongAdults in Los Angeles County, 1997-2007

14.3%16.7%

18.9%20.9% 22.2%

5.7% 6.7%7.0%

8.1% 8.7%

0%

10%

20%

30%

40%

1997 1999 2002 2005 2007

Year

Prevalence(%)

Obesity Diabetes

Los Angeles County Department of Public Health

Los Angeles County Health SurveyDepartment of Public Health

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Average Weight Among Adults inLos Angeles County, 1997-2007

167.7166.8 lbs

164.5 lbs163.6 lbs160.9 lbs

140

150

160

170

180

1997 1999 2002 2005 2007

Year

Averageweight(

lbs)

The countys adult population gained51 million lbs from 1997-2007.

Los Angeles County Public Health, Office of Health Assessment and EpidemiologySource: Los Angeles County Health Survey

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Prevalence of Hypertension Among Adults inLos Angeles County, 1997-2007

15.8%

19.1%20.1%

23.4%24.7%

0%

10%

20%

30%

40%

1997 1999 2002 2005 2007

Year

Prevalence

(%)

Los Angeles County Department of Public Health

Los Angeles County Health SurveyDepartment of Public Health

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Obesity Prevalence Among School ChildrenLAUSD vs. Rest of L.A. County, 1999-2008

18.9% 19.5%19.8%

20.7% 20.3% 20.4%

22.6%

25.2%26.2% 26.0% 26.3%

15.9%

18.4%20.3%

26.1%24.4%

23.2%

20.2%

0%

5%

10%

15%

20%

25%

30%

35%

1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

Healthy People 2010 Goal: 5%

LAUSD

LA County(excluding LAUSD)

Source: California Physical Fitness Testing Program, California Department of Education. Includes 5th, 7th, and 9th graders enrolled in

Los Angeles County public schools.

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Cities/Communities with Lowest and HighestChildhood Obesity Prevalence, 2008

*Table excludes cities/communities where number of students with BMI data < 500.Source: California Physical Fitness Testing Program, California Department of Education. Includes 5th, 7th, and 9thgraders enrolled in LA County public schools; 2000 Census

Top 10*

City/Community NameObesity

Prevalence(%)

Rank ofEconomicHardship(1 - 128)

Manhattan Beach 3.4 2

Calabasas 5.0 8

Hermosa Beach 5.1 1

Agoura Hills 5.3 10

Beverly Hills 5.4 19

Malibu 5.9 4

Palos Verdes Estates 7.3 5

San Marino 7.8 15

Rolling Hills Estate 8.4 9

La Canada Flintridge 8.5 18

Average 10 lowest 6.2%

Ave Median Household Income $99,555

Bottom 10*

City/Community NameObesity

Prevalence(%)

Rank ofEconomicHardship(1 - 128)

West Athens 30.6 94

South Gate 30.7 110

Florence-Graham 31.0 128

West Whittier-Los Nietos 31.1 81

West Carson 31.4 56

Vincent 32.2 69

East Los Angeles 32.9 117

Hawaiian Gardens 33.4 107

South El Monte 34.5 111

Walnut Park 38.7 113

Average 10 highest 32.7%

Ave Median Household Income $37,747

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Benefits of Physical Activity

Increased life span and improved function

Reduced hypertension, heart disease, andstroke

Prevention of diabetes and relatedcomplications

Decreased risk of colon cancer

Improved mental health

Body weight maintenance and obesitycontrol

Increased bone mass Improved immune function

Reduced health care costs

Surgeon Generals Report, 1996

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Physical Activity and Health

Dose-ResponseCurve

A=SedentaryB=Moderately Active

C=Active

Bene

fit

Baseline Activity StatusLow High

A B C

Source: Pate et.al., JAMA, 1995

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Community Guide Promoting PA:Summary of Findings

Recommended:

Community-wide info campaigns

Point-of-decision prompts

Individually-adapted health behavior change

School-based physical education

Social support interventions in community settings

Increasing access to places for PA with info outreach activities

Urban planning approaches (zoning and land use)

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traffic safety

air pollution

water quality & quantity

physical activity & diet

obesity & chronic disease

crime & violence

social capital elder health & mobility

mental health

health disparities

Community Design:Multiple Health Impacts

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Los Angeles CountyDepartment of Public Health Initiatives

PLACE Program (Policies for Livable Active

Communities and Environments)

RENEW LA County (Renewing Environments forNutrition, Exercise, and Wellness)

Community transformation grant

(ChooseHealthLA)

Community liaison program

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We shape our buildings

- Winston Churchillwww.theaerialphotographer.com

and thereafter

they shape us.