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In the United States, some populations suffer from far greater disparities in health than others. Those disparities are caused not only by fundamental differences in health status across segments of the population, but also because of inequities in factors that impact health status, so-called determinants of health. Only part of an individual's health status depends on his or her behavior and choice; community-wide problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, interpersonal violence, and decaying neighborhoods also contribute to health inequities, as well as the historic and ongoing interplay of structures, policies, and norms that shape lives. When these factors are not optimal in a community, it does not mean they are intractable: such inequities can be mitigated by social policies that can shape health in powerful ways. Communities in Action: Pathways to Health Equity seeks to delineate the causes of and the solutions to health inequities in the United States. This report focuses on what communities can do to promote health equity, what actions are needed by the many and varied stakeholders that are part of communities or support them, as well as the root causes and structural barriers that need to be overcome.
Older Americans, even the oldest, can now expect to live years longer than those who reached the same ages even a few decades ago. Although survival has improved for all racial and ethnic groups, strong differences persist, both in life expectancy and in the causes of disability and death at older ages. This book examines trends in mortality rates and selected causes of disability (cardiovascular disease, dementia) for older people of different racial and ethnic groups. The determinants of these trends and differences are also investigated, including differences in access to health care and experiences in early life, diet, health behaviors, genetic background, social class, wealth and income. Groups often neglected in analyses of national data, such as the elderly Hispanic and Asian Americans of different origin and immigrant generations, are compared. The volume provides understanding of research bearing on the health status and survival of the fastest-growing segment of the American population.
Chronic diseases are common and costly, yet they are also among the most preventable health problems. Comprehensive and accurate disease surveillance systems are needed to implement successful efforts which will reduce the burden of chronic diseases on the U.S. population. A number of sources of surveillance data-including population surveys, cohort studies, disease registries, administrative health data, and vital statistics-contribute critical information about chronic disease. But no central surveillance system provides the information needed to analyze how chronic disease impacts the U.S. population, to identify public health priorities, or to track the progress of preventive efforts. A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases outlines a conceptual framework for building a national chronic disease surveillance system focused primarily on cardiovascular and chronic lung diseases. This system should be capable of providing data on disparities in incidence and prevalence of the diseases by race, ethnicity, socioeconomic status, and geographic region, along with data on disease risk factors, clinical care delivery, and functional health outcomes. This coordinated surveillance system is needed to integrate and expand existing information across the multiple levels of decision making in order to generate actionable, timely knowledge for a range of stakeholders at the local, state or regional, and national levels. The recommendations presented in A Nationwide Framework for Surveillance of Cardiovascular and Chronic Lung Diseases focus on data collection, resource allocation, monitoring activities, and implementation. The report also recommends that systems evolve along with new knowledge about emerging risk factors, advancing technologies, and new understanding of the basis for disease. This report will inform decision-making among federal health agencies, especially the Department of Health and Human Services; public health and clinical practitioners; non-governmental organizations; and policy makers, among others.
In their later years, Americans of different racial and ethnic backgrounds are not in equally good-or equally poor-health. There is wide variation, but on average older Whites are healthier than older Blacks and tend to outlive them. But Whites tend to be in poorer health than Hispanics and Asian Americans. This volume documents the differentials and considers possible explanations. Selection processes play a role: selective migration, for instance, or selective survival to advanced ages. Health differentials originate early in life, possibly even before birth, and are affected by events and experiences throughout the life course. Differences in socioeconomic status, risk behavior, social relations, and health care all play a role. Separate chapters consider the contribution of such factors and the biopsychosocial mechanisms that link them to health. This volume provides the empirical evidence for the research agenda provided in the separate report of the Panel on Race, Ethnicity, and Health in Later Life.
Children's health has made tremendous strides over the past century. In general, life expectancy has increased by more than thirty years since 1900 and much of this improvement is due to the reduction of infant and early childhood mortality. Given this trajectory toward a healthier childhood, we begin the 21st-century with a shocking developmentâ€"an epidemic of obesity in children and youth. The increased number of obese children throughout the U.S. during the past 25 years has led policymakers to rank it as one of the most critical public health threats of the 21st-century. Preventing Childhood Obesity provides a broad-based examination of the nature, extent, and consequences of obesity in U.S. children and youth, including the social, environmental, medical, and dietary factors responsible for its increased prevalence. The book also offers a prevention-oriented action plan that identifies the most promising array of short-term and longer-term interventions, as well as recommendations for the roles and responsibilities of numerous stakeholders in various sectors of society to reduce its future occurrence. Preventing Childhood Obesity explores the underlying causes of this serious health problem and the actions needed to initiate, support, and sustain the societal and lifestyle changes that can reverse the trend among our children and youth.
This collection of essays examines obesity not as an objective medical or psychological problem, but as a subjective social and cultural phenomenon. The contributors take a cross-cultural perspective, examining both the negative casting of obesity in developed countries and the traditional view of obesity as a positive characteristic in subsistence societies which is threatened by the dominance of Western culture.
In a brief, clear and easily accessible way, this summary illustrates the dynamics of the obesity epidemic and its impact on public health throughout the WHO European Region, particularly in eastern countries. It describes how factors that increase the risk of obesity are shaped in different settings, such as the family, school, community and workplace. It makes both ethical and economic arguments for accelerating action against obesity, and analyses effective programs and policies in different government sectors, such as education, health, agriculture and trade, urban planning and transport. The summary also describes how to design policies and programs to prevent obesity and how to monitor progress, and calls for specific action by stakeholders: not only government sectors but also the private sector - including food manufacturers, advertisers and traders - and professional consumers' and international and intergovernmental organizations such as the European Union.
The increasing prevalence and burden of obesity transcends borders, straining populations worldwide. Data shows that 50 million girls, 74 million boys, 390 million women, and 281 million men were estimated to have obesity in 2016 (NCD-RisC, 2017). The National Academies of Sciences, Engineering, and Medicine convened a workshop on October 9, 2018 to address the status of the global obesity pandemic and discuss diverse approaches to manage this problem. Speakers examined the collective prevalence, costs, and drivers of obesity around the world using cross-cultural comparisons. Panels and group discussions emphasized the need to reduce disparities in prevention and treatment efforts and to generate new policy and system initiatives related to nutrition and physical activity worldwide. This publication summarizes the presentations and discussions from the workshop.
Creating an environment in which children in the United States grow up healthy should be a high priority for the nation. Yet the prevailing pattern of food and beverage marketing to children in America represents, at best, a missed opportunity, and at worst, a direct threat to the health prospects of the next generation. Children's dietary and related health patterns are shaped by the interplay of many factorsâ€"their biologic affinities, their culture and values, their economic status, their physical and social environments, and their commercial media environmentsâ€"all of which, apart from their genetic predispositions, have undergone significant transformations during the past three decades. Among these environments, none have more rapidly assumed central socializing roles among children and youth than the media. With the growth in the variety and the penetration of the media have come a parallel growth with their use for marketing, including the marketing of food and beverage products. What impact has food and beverage marketing had on the dietary patterns and health status of American children? The answer to this question has the potential to shape a generation and is the focus of Food Marketing to Children and Youth. This book will be of interest to parents, federal and state government agencies, educators and schools, health care professionals, industry companies, industry trade groups, media, and those involved in community and consumer advocacy.
This volume summarizes the findings and insights of obesity-related research from the full range of social sciences including anthropology, economics, government, psychology, and sociology.