By RENEE STOVSKY
Dr. Richard J. Jackson has worn many hats during a long and distinguished career. He's been a novice of the Society of Jesus, a pediatrician, an epidemiologist and a state health officer. He has led the U.S. Centers for Disease Control and Prevention's National Center for Environment Health and currently is a professor and chair of environmental health sciences at the Fielding School of Public Health at the University of California, Los Angeles.
Along the way he has co-authored two books: Urban Sprawl and Public Health: Designing, Planning and Building for Healthy Communities, and Making Healthy Places, and picked up a host of accolades, from a Presidential Distinguished Rank Award to election to the Institute of Medicine of the National Academy of Sciences.
Yet Jackson — who will be a keynote speaker at the Catholic Health Assembly, June 2-4 in Anaheim, Calif. — is not sure he will ever achieve his life's ambition: helping ensure that future generations inhabit a world that is at least as good, and hopefully better, than the one he was born to.
High hurdles
"One of the things that inspired me to go into medicine was my own family's experience," he says. "My dad was a World War II fighter pilot who came back, married young and had three little boys. At 27 he did 100 push-ups one day, and two days later he died of polio, leaving us in shock and destitute."
Although the United States has made much progress since then in controlling many infectious diseases, Jackson says the current generation of children is on track to be the first to live shorter, less healthy lives than their parents.
"One hundred years ago, the average lifespan was 47 years old, and most people died of tuberculosis, pneumonia, diarrhea and other infectious diseases. Since then, we've been able to add 30 years to most people's lives — 25 due to immunizations and changes to the infrastructure, like cleaner water, but only 5 attributable to medical care.
"Now, our biggest health challenges are heart disease, cancer and diabetes. We are spending 18.1 percent of our gross domestic product on medical care, yet our lifespan has slipped to number 49 worldwide. And we are expecting health care personnel to fix environmentally induced diseases," he says.
It is, he emphasizes, a recipe for failure.
Retrofit suburbia
"The simple truth is that we are what we eat and we are what we build," says Jackson. "And our current junk-food, car-centric nation is guilty of generational health injustice.
"It is time to retrofit suburbia," says Jackson. "Before Henry Ford invented the Model T, we knew how to build good places to live within the triangle of life — sleeping, working and shopping. Then we began building our nation for cars, not people. But living life in the steel box of an automobile has led to nothing but obesity, isolation and depression.
"We have doubled the rate of diabetes in our country in the last 15 years, at the treatment cost of $200 billion a year. And diabetes is only one end-product of obesity — it also leads to heart failure, liver failure and joint problems in people as young as teenagers," says Jackson. "When I was a young pediatrician, I never saw a child with Type II diabetes. Now we treat 17-year-olds with the diseases of 70-year-olds."
Poor air quality and substandard living conditions in poor communities have contributed to asthma's emergence as the most prevalent chronic disease in America. "There are 34 million asthma sufferers in the U.S. now — and 5.6 million of them are school-aged children. Since 1980, there has been a 160 percent increase in asthma in children under the age of 5. The disease accounts for one out of every four emergency room visits, and costs $20 billion in care a year," says Dr. Jackson.
"Our built environment is social policy in concrete. If you live in a poor zip code, you are more likely to live in a 'food desert,' where it is difficult to shop for healthy foods and you are more likely to breathe polluted air," he says. "And thus, you are more likely to have a shorter life."
Turning the tide
Jackson has been instrumental in spearheading a movement to promote healthier communities nationwide. Among his recommendations: taxing manufacturers who use fructose in products along with the alcohol and tobacco industries; encouraging cities, counties and states to recreate downtowns that are live/work/play friendly; redeveloping suburban shopping malls into cultural/community centers; mandating parks and safe pedestrian routes to schools; promoting community gardens and farmers' markets; and installing light-rail lines.
Hospitals, in particular, he says, can play a big role in communities by transforming from "disease treatment centers" into "magnets for promoting good health."
"Health care organizations should provide good, safe access to hospitals with pedestrian- and bicycle-friendly routes to their campuses," he says. "They should promote physical activity among the staff, provide healthy food options, good daylight in their facilities and energy efficiency in their buildings. I've even seen some that are installing organic gardens on their roofs."
Beyond that, he says, American communities, both large and small, need to contribute to improved mental health by providing physically safe environments that encourage social interaction.
"Studies of 'Super Centennials' around the world — people who are extremely long-lived — show that in addition to eating simple, sensible diets and engaging in daily physical activity like walking, they all enjoy a sense of cultural connectedness," says Jackson.
"Contrast that to the U.S., where there has been a four-fold increase in the consumption of anti-depressants in the last 20 years, and you know that we need to focus more on how to nourish our spirits by allowing ourselves to experience joy and freedom through nature, physical activities and socialization," he says. "We all need nurturing relationships where we feel respected, valued and safe."
Copyright © 2013 by the Catholic Health Association of the United States
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