Top Story: Health

Building healthier communities

What does the width of your sidewalk have to do with the diameter of your waistline?

What do shade trees have to do with how active you are?

And what does bicycle parking have in common with farmers markets and community gardens?

They’re all elements in Los Angeles County’s new Healthy Design Ordinance, initially approved by the Board of Supervisors Tuesday, and now receiving finishing touches from county attorneys.

The ordinance, expected to become law in March, represents part of a new and increasingly important partnership between planners and public health officials trying to fight an epidemic of obesity, diabetes and other diseases by making it easier for people to adopt a more active lifestyle.

To the delight of bicycle advocates, the new ordinance would require for the first time that bike parking be included in new developments in unincorporated parts of Los Angeles County. (Similar provisions are included the county’s proposed Bicycle Master Plan, which is expected to come before the board in coming weeks.)

To foster more walkable communities, the Healthy Design Ordinance also would mandate 5-foot wide sidewalks instead of the current 4-foot standard. And, to make sure those wider sidewalks are inviting, it would require that shade trees be included in future development plans.

It also seeks to bring healthy vegetables and fruits to so-called food deserts by making it easier for farmers markets and community gardens to take root in residential and other areas without a lot of red tape. And written into the ordinance is a requirement that those markets accept CalFresh payments.

Dr. Jonathan E. Fielding, the county’s top public health official, said his department was happy to have invested part of a 2010 grant it received from the federal Centers for Disease Control and Prevention to help get the Healthy Design Ordinance off the ground.

It’s all part of a shift in tactics to move disease prevention out of the doctor’s office and into the streets.

“If we want to improve the health of Angelenos, we need to start by improving our physical environment and our social environment,” Fielding said.

Supervisors praised the work that has been done so far.

“This is a big idea. This is forward-looking. This is progressive policy-making,” said Supervisor Mark Ridley-Thomas.

Board of Supervisors Chairman Zev Yaroslavsky, who initially proposed the measure along with Supervisor Don Knabe, also saluted the efforts. But he said the new ordinance is just a first step toward designing a healthier county.

“Much more needs to be done to create livable neighborhoods that do not rely solely on automobile transportation,” Yaroslavsky said. “County planners and engineers, and private developers, will have to make a concerted effort to achieve neighborhoods where people feel comfortable walking, biking, and taking transit.”

In a motion adopted along with the board’s vote Tuesday in favor of approving the ordinance, Yaroslavsky directed county staff to take a closer look at “zoning and land use policies that encourage sprawling developments which force people to drive vast distances just to get to work, or buy a gallon of milk.”

At the same time, the motion recognized that there are no one-size-fits-all approaches, and that not all healthy design features will apply to every community.

A rethinking of what planning can mean to the health of communities and individuals is “actually pretty exciting,” said Susan Tae, a supervising regional planner who led the Healthy Design team for Regional Planning. “To create a more pleasant environment is to encourage a pedestrian to take a walking trip rather than jump in a car.”

(For a look at some of the guidelines the team came up with in developing the ordinance, click here. And a two-minute summary of the ordinance’s main points is here.)

Tae said other initiatives, such as the upcoming Bicycle Master Plan and a new specific plan to create a more walkable area around Gold Line stations on the 3^rd Street Corridor inEast L.A., will help move the spirit of the new ordinance forward.

Designing for health, she said, requires thinking like a walker or cyclist and constantly asking: “How do we create things at more of a pedestrian scale?”

“If it’s not comfortable,” Tae said, “then it’s not going to be used.”

Posted 1/24/12

Eight ways to a happier 2012

What’s your New Year’s resolution?

Chances are, it’s aimed at a happier 2012. But what works when it comes to improving your day-to-day satisfaction? Can one resolution actually make any difference?

Sure, says Dr. William Arroyo, the Department of Mental Health’s regional medical director. But it may not be the sort of resolution most people are used to making. Here are his tips for a more soul-satisfying year:

1. Resolve to do a self-inventory. “Take note of all the good things, large and small, that were achieved in the prior year,” Dr. Arroyo says. Write them down—you might be pleasantly surprised at all you’ve accomplished. Now take special note of anything that was not only good for you, but also good for your family, workplace or community, and consider doing them again this year.

2. Resolve to give yourself permission to change. This is harder for some people than it sounds, Dr. Arroyo says. Behaviors become entrenched. Friends and families become invested in old habits. “It isn’t always easy to remember that it’s in our nature to pursue good,” he says. “It’s okay to do something differently, especially when doing it the same old way hasn’t worked or has offended those close to you.”

3. Resolve to build pleasure into even into the smallest of budgets. “Maybe you want to manage your money more efficiently,” says Dr. Arroyo, “or allocate for all your bills. That’s fine, but if there’s anything leftover, don’t forget to allocate some resources for pleasure—and pleasure doesn’t have to be expensive. Sometimes pleasure can be just spending time with friends and family, or with those one didn’t have time for in the prior year.”

4. Resolve to be healthy. “And that includes mental health,” the doctor says. “Pay attention to diet and exercise. Avoid harmful substances, whether it’s fatty food, or alcohol or some other potentially harmful thing. But also monitor moods and feelings. If one’s social life is unsatisfactory, think about bringing parts of that to a close. If people around you appear to jeopardize your well-being, think about changing your social circle. Whether it’s foods and beverages or people, give yourself permission to get away from toxic environments.”

5. Resolve to seek peace. “Yoga, prayer, meditation—these work wonders for many people,” says Arroyo. So, he adds, does professional counseling. “Everyone experiences worry and anxiety, but if that’s your primary mood, then it’s probably excessive and you might want to consult with a spouse, a partner, a trusted relative or member of your congregation, or you may want to seek professional help. A little bit of anxiety is normal and useful, but not to the degree where it interferes with your well-being.”

6. Resolve to communicate. “Becoming closer often entails making an inquiry,” says the doctor. If you’d like to be closer to your loved ones, “ask how you can be better with them this year. Be humble. Give the other person permission to let you know when you do something that causes them displeasure—and be willing to change it.” Or, if you aren’t getting what you need from your relationships, resolve to say so: “It’s okay to set limits with others, no matter how close or how distant they might be.”

7. Resolve not to overlook the positive. “One needs to be objective in tough times,” says Dr. Arroyo, “and to keep in mind that there is always more than one way of looking at things. Even in our darkest, most painful moments, there is often a bright side.” Hard times pass, he says, but those who weather them can come away with valuable life experience.

8. Resolve to reach out. “As folks are winding up the year, there’s always a lot of hustle and bustle, and we forget that some people are not as fortunate as we are,” Dr. Arroyo says. “Those who don’t have our means or our health or our rich circle of family and friends could benefit from some demonstration of interest in their well-being—spending time with them, conveying that we care.” Donating to charity isn’t the only route, either. “You can volunteer in an organization,” he says, “or work within your neighborhood.” The key, he says, is to connect and be useful: “It reminds that one is more than the things and money one has.”

Posted 12/30/11

Putting the squeeze on Lap-Band ads

County supervisors squared off Tuesday with promoters of the Lap-Band, featured on billboards all over Southern California but drawing increasing attention from officials concerned that the publicity blitz is obscuring a wide range of medical dangers.

After a series of sharp exchanges with representatives of 1-800 GET THIN, supervisors approved a motion by Supervisors Mark Ridley-Thomas and Zev Yaroslavsky to bring greater scrutiny to Lap-Band marketing and procedures. They directed county staff to, among other things, “develop a plan to identify medical products and services that are being marketed in a dangerously misleading manner.”

The supervisors’ action comes after the U.S. Food and Drug Administration recently sent letters to eight Southern California weight loss clinics and the 1-800 GET THIN marketing firm, warning that the company’s ubiquitous advertisements do not provide enough information about the risks of gastric bypass surgery or about the need to change eating behavior to lose weight over the long term.

“The FDA’s warnings raise significant concerns about the vulnerability of all County residents to these advertisements, particularly those who suffer from morbid obesity and wish to find a cure,” the motion said. “Medical experts and the FDA agree that the Lap-Band procedure is an aggressive treatment for obesity and should only be considered in clinically severe obesity cases.”

Robert Silverman, the president of 1-800 GET THIN, told supervisors that his firm is taking steps to bring its billboards and radio and TV spots into compliance with the FDA requirements. An attorney for the company said its surgery centers “have a better track record than just about anybody else.”

But supervisors were openly frustrated as they tried to find out more about how 1-800 GET THIN operates, in terms of referrals to clinics and responsibility for disclosing risks to potential clients.

“It’s been a long time since a witness or member of the public has come to that table and has obfuscated as consistently and persistently as you have today,” Yaroslavsky told the 1-800 GET THIN representatives. “I did not come here as a person who had any fundamental suspicion one way or the other about what you were doing. I leave here now thinking you are hiding something.”

The FDA’s action was prompted by Dr. Jonathan E. Fielding, the county’s top public health official, who last year asked the agency to investigate whether widespread Lap-Band promotion by 1-800 GET THIN was misleading.

The motion approved by supervisors Tuesday directed the Public Health Department to report back on what it is doing to get the word out about “safe and effective alternative methods to achieve and maintain a healthier weight.”

“There is no panacea for obesity, including the Lap-Band weight loss procedure,” the motion said. “However, there are proven strategies, when sustained over time, which can help people achieve a healthier weight, and decrease the risk for diabetes, heart disease and other chronic diseases.”

The motion also directed the County Counsel to provide legal options on steps the county could take to “ensure truthful advertising of aggressive obesity treatment procedures in unincorporated areas.”  And it instructed the Chief Executive Office to pursue legislation to increase supervision and oversight of clinics that perform “aggressive and invasive obesity treatment cosmetic procedures.”

Posted 12/20/11

 

Clearing the air, one city at a time

Twenty-four years ago, when health advocates in Compton tried to restrict smoking, two City Council members defiantly lit cigarettes on the dais, then killed the plan before it could come to a vote.

We’ve come a long way, baby.

Last week, Compton passed a landmark ordinance to curb secondhand smoke in outdoor dining areas, parks, apartments and condos. Meanwhile, Hermosa Beach effectively outlawed outdoor smoking in virtually every part of the city where people gather.

On the other side of the 710 Freeway, the Downey City Council instructed staff to start drafting a law to restrict smoking in parks and other public places. This week, a tough, new, smoke-free housing measure was enacted in Baldwin Park.

The flurry of grassroots legislation—with more in the pipeline—isn’t accidental. For the past year and a half, the Los Angeles County Department of Public Health has been successfully leveraging a two-year, $16 million federal grant aimed at reducing smoking and exposure to secondhand smoke.

The initiative, known as Project TRUST and managed by the department’s Tobacco Control & Prevention Program, has been so successful that its efforts already have been extended under a new and broader Community Transformation Grant, underwritten by federal health care reform funding.

Although the Department of Public Health has long done educational campaigns to help communities discourage smoking, the federal money “has let us accelerate that work, and move into more challenging policy areas,” says Dr. Paul Simon, who heads the department’s Division of Chronic Disease and Injury Prevention. “We’re now getting into 10 or 15 cities a year.”

By law, the public health department cannot lobby, but it can educate the public, thus setting the stage for a community’s own advocacy. Under the grant, the county was able to hire six “community mobilization teams” and subcontract with nine community-based organizations to provide technical and educational support for local efforts to restrict smoking.

As the teams have fanned out in the past 18 months to do local polling, hand out literature and speak to community groups about tobacco, community activism has followed. Since the Project TRUST initiative hit the ground, local smoking ordinances have been revisited or broadened in Manhattan Beach, West Hollywood, Burbank, Los Angeles, South Pasadena, Santa Monica, Huntington Park, Torrance and Inglewood, as well as the aforementioned communities. Still other cities are in various stages of readying smoking ordinances for passage.

Particularly successful have been city-level efforts to cordon off no-smoking areas in apartment and condominium buildings, where secondhand smoke chronically plagues children and nonsmokers, particularly those with asthma. A recent policy brief from the UCLA Center for Health Policy Research found that nearly 1 million children in California are exposed to secondhand smoke every year.

Mandating smoke-free housing in apartment houses can be life-altering for families in rental units, but it has historically been a tough sell in lower-income areas, where smokers—who represent about 13% of California’s population—have tended to resist the notion that shared ventilation should keep them from lighting up in their own apartments.

A new state law that goes into effect Jan. 1 gives landlords the authority to ban smoking in rental units, but doesn’t mandate smoke-free apartments and condos. With the Compton and Baldwin Park votes last week, the county now has more than a half-dozen cities with smoke-free apartment ordinances, including Calabasas, which in 2006 pioneered the local movement.

And on November 16, Project TRUST will host a major policy forum on smoke-free apartments and condos in conjunction with the American Academy of Pediatrics and Children’s Hospital Los Angeles—a response to the growing number of local governments that are moving in that direction, says Project TRUST Director Robert Berger.

“It’s big,” says Berger. “We’ve reached a major tipping point in smoke-free housing here.”

Public health campaigns at all levels have for many years raised awareness of the dangers of tobacco, and state and federal restrictions have made dramatic inroads in the fight against tobacco-related illness. California was the first state to ban smoking in indoor workplaces in 1995.

But smoking still accounts for as many as 443,000 deaths a year nationally, including as many as 49,000 from exposure to secondhand smoke alone.  According to the Centers for Disease Control & Prevention, more deaths are caused each year by tobacco use than by all deaths from HIV, illegal drug use, alcohol use, motor vehicle injuries, suicides and murders combined.

While overall smoking rates have been trending downward, higher smoking rates persist in a number of vulnerable sub-populations, including African American, Latino and Asian men, people with low income and education, the homeless, substance abusers and people living with mental illness.

In some policy efforts, such as the one that led to smoke-free housing in Pasadena, the county has played more of a supportive than lead role. In others, Project TRUST has collaborated with subcontractors such as the National Council of Alcohol and Drug Dependence South Bay or Smoke-free Air for Everyone (SAFE).

In most instances, the County’s technical and educational assistance has been welcome, but in a few, it has been met with confusion. When a City Council discussion of a ban in Downey drew a standing-room audience and a blizzard of letters, for instance, one councilman accused another of manufacturing “a sexy political issue for your campaign next year for the assembly.” Another was quoted in the local press as saying he had “never received a letter or comment on this until the last three weeks.”

Much more common, however, have been experiences like the one that will now set aside smoke-free apartments and condos in Compton, where the county’s mobilization team—a pair of young Public Health contract employees named Kristin McGuire and Amber Tsujioka—did most of the groundwork, beginning with a survey last year to assess the community’s level of concern about smoking.

As the pair became ubiquitous at PTA meetings, churches, community groups, senior centers and health fairs, the community began to coalesce in favor of smoke-free housing. Letters began to arrive at City Hall. High school kids began to show up around town in “Smoke-free Compton” t-shirts.

“A lot of the community members were unfamiliar with the impact of secondhand smoke,” says McGuire. “And when they would ask about possible solutions, we’d tell them how other communities were able to educate each other and form coalitions.”

It didn’t hurt that Compton City Councilwoman Yvonne Arceneaux had a longstanding interest in the dangers of smoking.

“I had led a movement a number of years ago to ban alcohol and tobacco billboards in the city of Compton,” says Arceneaux, “and I had had a bad experience with my daughter in an apartment situation. She’s a non-smoker with two small children and she had lived in Texas in an apartment below two smokers.

“It was coming through the vents, and for the first time in their lives, they were experiencing problems with asthma. It was horrible.”

Within six months of the county’s involvement, Arceneaux says, an ordinance was drafted, with technical help from the county.

McGuire, the Project TRUST mobilization team member, says her work in Compton has been “very rewarding” and hopes she’ll be able to continue working with the city as it implements its new ordinance.

Arceneaux, meanwhile, says the mood in Compton couldn’t be more different from that meeting in 1987. The measure passed easily, to the cheers of an audience full of teenaged Smoke-free Compton supporters. And so far, she added, no one’s complaining.

“I think this time the community was ready for it,” she says.

Posted 11/3/11

‘Tis the season for flu shots

Flu season has officially begun in Los Angeles County, and the county’s Department of Public Health is urging that you get vaccinated as soon as possible.

Four cases have already been treated for strains covered by this year’s vaccine, all from West Los Angeles and the San Fernando Valley. These officially mark the start of a flu season that is likely to last until May. says public health director Dr. Jonathan E. Fielding.

“Even healthy people can get very sick from the flu and spread it to others,” he says, recommending that everyone six months of age or older receive a flu vaccine every year.

Fielding urges residents to contact their doctors for a vaccine. Alternatively, low-cost vaccines also are available throughout the county at supermarkets and pharmacies. (Click here and then look for the blue “Flu Care” box along the right margin.)

Starting next week, the county also will offer free vaccines to people who do not have health insurance. Click here to search for a county flu clinic by ZIP Code and click here for a list of upcoming flu clinics throughout the county, or call the county Information Line at 2-1-1. And for a lot more information, click here.

Posted 10/20/11

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