A model for disease prevention and health promotion
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[Music]
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what determines health
my parents grew up in the new york city
area and when i was about three years of
age
we moved to the philadelphia suburbs
my parents were working with a real
estate agent and they noted that that
agent was only showing them homes
in certain communities and so they ended
up partnering with a local minister and
his wife
who were both caucasian and the minister
and his wife
actually posed as individuals who were
looking for a home
and it was through this parade that my
parents found the home
where i grew up my mother
was also a diabetic and as a child i
would frequently go with her
to see her physician and i was always
fascinated
by the interactions that she had with
her provider
she would frequently get her blood
sugars measured and when she did
her blood sugars would frequently be in
the high 200s
to 300s a normal is about 120.
on the way home we would frequently talk
about the interaction that she had with
her physician
and i would talk to my mother about her
blood sugars and i would say to her
gee mom your blood sugars seem awfully
high
my mother in a very loving and caring
way
would reassure me and tell me that for
her
her blood sugars were actually pretty
good
my mother ended up passing away from
diabetes at the age of 44
and i was 19 at the time and i remember
wondering if this was some sort of
anomaly
or not i went on to medical school and
completed residencies in both preventive
medicine
and internal medicine and during my
training
i would frequently see patients with
heart disease
and emphysema and cancer and many of
these patients continued to smoke
i would talk with them about their
encounters that they had with their
physicians
and i would ask them if their physicians
had ever talked with them
about not smoking and all too often
the answer to that question was no
you know today only eight percent of
people
are receiving the important clinical
preventive services
they need and are recommended for them
eight
percent wouldn’t it be great if instead
of that
we could focus more on prevention and
health promotion
if we could spend more time with our
patients to understand their risk
factors
but the reality is how we are trained
and how we are reimbursed as physicians
we are rewarded to treat disease not to
prevent disease
i ended up going to the cdc where i
spent over 20 years
researching racial and ethnic
disparities
in heart disease and diabetes and cancer
and through that work i learned that my
mother’s death
in reality was not some sort of an
anomaly
but for too many individuals in black
and brown communities
they’re dying at a younger age for heart
disease and diabetes
and cancer i also did some research into
my mother’s childhood
and i learned very soon that what she
was experiencing
and that she experienced a number of
stressors as a child
and these stressors had a huge impact on
her health and well-being
they were stressors like poverty and
housing
and food insecurity you know data from
the adverse childhood experiences study
shows that physical abuse by itself
can increase the risk of heart disease
by up to 50 percent
this is not just true in black and brown
communities but it’s true
in immigrant populations veterans and
the population
overall another patient that i
frequently think about
is a woman by the name of mrs means she
was 36
she was overweight she had diabetes much
like my mother
and also hypertension and arthritis as
well
during one particular visit she was she
wanted to talk with me
about losing weight and i got really
excited during that visit and
was almost jumping out of my seat with
excitement
because of my interest in health
promotion and prevention
and so i said to her mrs means we can
work together to make something work for
you
i said i want you to start out really
slowly and i want you to go outside and
walk
up and down your block there was a brief
period of silence and then mrs means
said to me
you know dr giles it’s not safe for me
to walk in my community
and i immediately came back with a
response
and i said no problem mrs means we can
make it work
i want you to go to the mall and walk
for 10 or 15 minutes at the mall
again there was this brief period of
silence she had a bewildered look on her
face
and then she said dr giles for me to go
to the mall i’ve got to take three buses
and it’s going to take me 45 minutes
each way
that’s not going to work for mrs means
the last person i want to talk about is
go to today
and talk about my uncle tommy wiggfall
tommy is an amazing individual he loves
his cosmopolitan at the end of the day
he loves sports he’s a huge tennis and
track fan
and he loves the new york giants every
sunday he’s in his man cave
which has all this new york giants
paraphernalia
throughout the room tommy also smoked
for a number of years
and he has a little bit of emphysema and
heart disease and diabetes
as well the second week of march of this
year
he developed a cough that cough got
progressively worse
he developed shortness of breath he went
into
he went to the hospital and on april 1st
seven days before his 75th birthday
he passed away from the ravages of kovid
covid19
as i think about each of these
individuals
i wonder is there something that we
could have done differently
could academic institutions and the
community come together
and you know the reality is this is a
model
that has worked throughout the decades
in north korea finland in the 1970s
a group of women were concerned because
their husbands were dying from heart
disease
at a young age they went to the
government and demanded
that the government do something
differently and the government act
asked academic institutions and the
community to come together
they developed a program and through
this program they saw
dramatic declines in smoking and
cholesterol levels
and most importantly they saw declines
in heart disease as well
more recently in the 1990s the centers
for disease control and prevention
created a program called reach racial
and ethnic
approaches to community health this
program
funded academic institutions such as my
own at the university of illinois at
chicago
and community groups to come together to
address
race disparities and through the program
we’ve seen
improvements in fruit and vegetable
consumption
physical activity and smoking
most recently because of the impact
that covid19 has had on black and brown
communities
here in the city of chicago mayor
lightfoot has created a racial
ethnic rapid response team
that team has included academic
institutions
community-based organizations chicago
department of public health
and the mayor’s office together we’re
looking and using
hyperlocal data to target
prevention and communication messages
and
also to target testing to high impact
communities
and through this program we’ve seen
dramatic declines
in mortality and cases of covet 19.
our work is clearly not completely done
but we’ve seen dramatic
improvements what if
my uncle tommy wiggfall had had such a
program in his community
that could have educated him about the
importance
of avoiding crowds and wearing a mask
what if mrs means had had such a program
in her community
and they had worked to create safe
places to be physically active
and what if my mother had had such a
program
that could have helped her to manage her
diabetes so that she knew glucoses of
290
were not good for her the reality
is this is a model that has worked
throughout the decades
we need to scale this model up to
improve health
and well-being all we need is the will
to make it happen