Category Archives: Health

We are full of garbage

We’ve all seen the copious quantities of garbage cans that line our streets and trash closets on collection day and it seems almost impossible that anyone could run out of garbage but it’s happened to Sweden. The country has actually run out of trash.

Cities in Sweden burn garbage for the energy to power their buildings and plants; nearly half of the structures in Oslo are powered by the burning of garbage. Sweden’s use of garbage for fuel, coupled with their extensive and popular recycling programs leaves only 4 percent of their solid waste going to landfills. What percent of household trash from the United States ends up in a landfill, you ask? An estimated 50 percent. In fact, one garbage burning plant owner in Oslo has expressed interest in purchasing American garbage. They’re already paying neighboring countries for their trash.

Available data for landfill use in the United States is a little bit old, but nevertheless startling. In 2003, Americans landfilled 2.46lbs of garbage…per person….per day. We have 3,091 active landfills across the states and while we are in no danger of running out of fill, we should consider that we may run out of land.

In the Lehigh Valley, there has been some discussion about the necessary expansion of the IESI Bethlehem landfill that operates off of Applebutter Road in Lower Saucon Township. The expansion would require a rezoning of the nearby area to accommodate waste, but the Lehigh Valley Planning Commission voted against this redesignation.  So, where is the trash to go? The United States recycles 34.7 percent of its Municipal Solid Waste (MSW), burns 11.7 percent of it and discards 53.7 percent. With our population and rate of consumption, this leaves us with a lot of stuff packing our landfills while our municipalities are opposed to expanding landfills.

Should we start burning our trash for energy like Sweden? Try to recycle more? Or should we sell our trash?

What do you think is the SUSTAINABLE solution for the Lehigh Valley?

Farming and Community Health

How does the protection of farmland correlate to the health of a community? Kane County, Illinois is working to find out.

Over the past ten years, their farmland protection program has preserved over 5500 acres of farmland in the county and they are currently considering a new amendment to broaden investments in local food production. New investments would include small farms and organic farmers producing fruits, vegetables and meats, intended to increase availability of fresh produce in schools, farmers markets, corner stores, and other sites in the community.

Enter the Health Impact Project. HIP is a project funded by the Pew Charitable Trust and Robert Wood Johnson Foundation to fund Health Impact Assessments (HIA) that will be used to inform policies at any level of government. Kane County won funding from this project and is expected to produce their HIA next month with measurements from their community. The HIA will assess the ways in which their new amendment could affect the health of local residents through, for example, changes in availability and price of fresh fruits and vegetables, food safety, and economic changes resulting from increased food production in the region.

HIAs are conducted by a panel of stakeholders in the community to ensure that they are engaged in considering health and health disparities with any given policy. The assessment is completed in six steps:
A Health Impact Assessment has six steps:

  1. Screening: Determines the need and value of a HIA;
  2. Scoping: Determines which health impacts to evaluate, the methods for analysis, and the work plan for completing the assessment;
  3. Assessment: Provides: a) profile of existing health conditions, and b) evaluation of health impacts;
  4. Recommendations: Provides strategies to manage identified adverse health impacts;
  5. Reporting: Includes development of the HIA report and communication of findings and recommendations; and
  6. Monitoring: Tracks impacts of the HIA on decision making processes and the decision, as well as impacts of the decision on health determinants.

Kane County hopes to use this assessment to inform the debate surrounding their new amendment, hoping that they will find it could lead to improved health.

The Health Care Council of the Lehigh Valley is doing similar work much closer to home. They created a forum process where they engaged stakeholder organizations from the Valley to discuss their input on community health, and held two series of meetings. In the second set of meetings, they were able to bring back results and analysis from the first round. Participants in the forums were asked what they thought the biggest health concerns in the region were, what would help their community become healthier and what leads to health problems in their area. They were asked follow up questions to these in the second round of meetings.

In these public meetings held last fall, they found that the health care system and services are fragmented, that there is a lack of communication and connection between the community and care providers as well as poverty, lack of jobs and language differences being barriers of access to medical resources. There were also positive findings, the community responded that the local health care providers care about the community and were willing to listen to their needs as well as looking for short and long term solutions to improve community health. Their Community Health Profile breaks down their findings and the particular issues in each city, and can be found here.

State of the Lehigh Valley

Thank you to everyone who attended the “State of the Lehigh Valley” lunch event on February 15th, and a special thanks again to our sponsors, without whom this event would not have been possible:  Highmark Blue Shield, Lehigh Valley Economic Development Corporation, Capital Blue Cross, PPL, Air Products, Susquehanna Bank, Lehigh University’s Social Science Research Center, Just Born, Inc., Spillman Farmer Architects, and the United Way of the Greater Lehigh Valley!

With President Obama recently delivering his State of the Union address and Governor Corbett giving us the state of the commonwealth budget, it is an appropriate time to consider the “State of the LehighValley.” (To read the report: State of the Lehigh Valley 2011.) Last year the Lehigh Valley Research Consortium (LVRC) partnered with Renew LehighValley (RenewLV) to present “State of the Lehigh Valley 2010: Community Trends at a Glance” to an audience of 250 concerned LehighValley residents.

 This year’s presentation of the 2011 data focused on the livability of the LehighValley as measured by indicators like health, economics, education, environment, and quality of life standards. This year’s results suggest that the LehighValley “is in a better position economically and socially than in the recent past” even though most will agree that there are still many challenges to overcome before we can boast of regional prosperity.  The luncheon was very participatory, with audience members providing their perspectives about the LehighValley’s competitiveness, public schools, disparities in access to health care, air quality, jobs, housing, and quality of life using a hand-held electronic response system, thus allowing for real time results. There were community experts in attendance to facilitate discussion based on these results.

The LehighValley is a very diverse collection of 62 municipalities and 17 public school districts within two of Pennsylvania’s 67 counties, all acting independently to govern and lead in the best interest of each area’s residents. While it is the uniqueness of each area that makes it pleasing to its inhabitants, the similarities from one municipality to the other and how they assimilate to form the Lehigh Valley is a natural progression of governance and decision-making, unnoticed by most who live here.

 In looking at just one section of data from the report, one sees that the Lehigh Valley’s current unemployment rate is higher than the Pennsylvania average, but lower than New Jersey and the national average, and our job growth is also below the rate of growth of Pennsylvania as a whole. On the other hand, average weekly wages in the LehighValley are higher than the state average but lower than New Jersey and the national average, and LehighValley residents as a group had higher median household incomes than the state and the nation. The report highlights how educational attainment is tied to this data. Perhaps a surprising statistic, graduation rates are not very different when economically disadvantaged student rates are compared to overall graduation rates, and in some districts the rate of graduation is higher among the economically disadvantaged students.

What does this mean?  Well, 90 percent of all residents surveyed rated the LehighValley as either good or excellent with regard to living in this area.  In light of the dissatisfaction with the economic situation, this is a significant statistic. It is indicative of the many great things the LehighValley offers its residents that are above and beyond dollars and cents: a relatively low crime rate, good public schools, easy access to goods and services, and a great network of hospitals and health care professionals. All of these are highlighted in the report.

I’m going to borrow a thought from this Sunday’s sermon (hope you don’t mind Father Steve) and if you have ever played sports, you will appreciate this. Were you ever a bench warmer?  Did you like sitting on the bench?  Or for that matter, if you were a starter, did you like coming out and watching from the sidelines?  I bet the answer is no. You wanted to be involved, to make your mark, to influence the outcome of the contest, to be heard and noticed.

Well now is your chance to do that for your community, our community, the community we all call home. Whether you live in the northern-most point of the Slate Belt or the west end of Allentown, you are a LehighValley resident and the health and well-being of our residents and our cities and boroughs is your business and your voice should be heard.  Time to get off the bench. Time to get involved. This is your opportunity to be in the starting five.  Take it and join the discussion.

Health Commission To Meet in January

On Monday, January 9, 2012, the Health Commission will hold its annual meeting at the Lehigh County Government Center. The newly elected Northampton County Council members, along with the Lehigh County commissioners, will be present at this meeting. This is the perfect opportunity to speak out in support of the Bi-County Health Bureau which has been studied and proposed for the Lehigh Valley and is supported at the state level (October 17 2011 Health Commission Presentationfinal [final10-17]).  All we need is support from both county councils to create the first bi-county health bureau in the state. This type of cooperation and partnership is indicative of joint ventures for which the Lehigh Valley is known and rewarded across the state. Please mark your calendar!

Making “Smart Growth” Mainstream

Unless this is the first Crossroads article that you have read (in which case, welcome!), I assume that you’ve noticed a trend throughout many of our posts on smart growth: studies show that average people want it, local mayors and town boards aim for it, small businesses benefit from it, and neighborhoods thrive on it. We’ve written about studies that demonstrate how various principles of smart growth benefit the economy, the environment, and public and private health. Lately, we’ve been able to blog about how the nation is seeing more and more of it.

But all too often, the overwhelming evidence of local and nonpartisan support for smart growth feels a bit…lacking. Sure, a survey of 2,071 people from the United States shows that 77% of them support smart design programs. Yeah, an analysis of how local transportation money has been spent proves that complete streets are spreading both in major cities like New York and San Francisco and in small towns in Idaho. But what does that mean for us? These are local efforts, and while they demonstrate a trend, we have yet to feel that “woah…Smart Growth is awesome” moment for ourselves in the Lehigh Valley.

But let’s say that this is your first visit to Crossroads. Have you ever heard of “smart growth” before?

Even if you do not know the term, chances are pretty good that you are familiar with the principles it represents. You wish it was easier to use mass transit, you’ve heard of “urban revitalization,” and you’ve noticed at some point in your life that it feels safer to walk on a sidewalk than on a poorly lit street on which cars routinely try to shatter the sound barrier. You want to feel safe letting your kids ride their bikes to friends’ houses, and you wish you could walk around the corner when you need one or two things for dinner, instead of having to jump in the car.

The guiding phrase itself is far less important than the practices it stands for. While the common word is a useful way to connect with like-minded groups and succinctly refer to a varying collection of thoughts, to the average person “smart growth” changes nothing — but the installation of sidewalks does.

Using and spreading the obscure phrase will not help us promote “smart growth” among the average people (all of us) who stand to benefit from it. Only two things that can do that. One, as I mentioned before, is the “woah” moment. Imagine, after having lived in Allentown for the past 10, 20, or 30 years, leaving. Imagine returning five years later. Imagine coming back to find a thriving downtown. Fantastic, affordable, safe places to live, just blocks from restaurants, bars, and your office. Drastically less traffic on the streets. Unobtrusive bike racks on curbs, for you, your neighbors, and your coworkers. A healthy, vibrant, safe, happy community.

If we continue to move forward, that’s coming. But it might take a bit of time, and it will definitely take a bit of work.

Until that moment, we rely on the second thing to promote the movement: the making mainstream of principles included in “smart growth.” While we try to work towards that through Crossroads, Facebook, and Twitter, we are clearly biased. What we need is institutional acknowledgment of Smart Growth.

Fortunately, we have lately begun to see this on the federal level. The EPA supports sustainable development. The President and the Department of Transportation and the continue to push for mass transit and alternative transportation, and the Department of Housing and Urban Development sponsors many programs consistent with Smart Growth.

There’s also the Centers for Disease Control.

While economic and environmental benefits are frequently touted by the smart growth community, public health benefits are sometimes mentioned as an afterthought. They’re just as important, just as easy to prove, but somehow, they tend to take a backseat. RenewLV has made an effort over the past year or so to bring public health to the forefront of our push for smart growth in the Valley, both through the inevitable health benefits that come from other policies (such as walkability and mass transit), and through the establishment of a Regional Health Department (see here for more information about this campaign).

The federal government appears to see the health benefits of smart growth, as well. The CDC has a page dedicated to “community design.” It echos the public health arguments that RenewLV has made:

Community design refers to all the elements of a community that are human-made and form the physical characteristics of that community. It includes:

  • buildings, such as schools, workplaces, and homes,
  • roads,
  • parks and recreation areas,
  • transportation systems, and
  • places to buy food.

Well-designed communities can improve public health. The design and maintenance of our communities may be related to:

  • chronic diseases,
  • obesity,
  • injury rates,
  • mental health, and
  • the effects of climate change.

Through design, communities can attempt to offer residents:

  • opportunities to incorporate routine physical activity into our everyday lives,
  • cleaner air,
  • lower risk of injury from vehicle accidents, and
  • decreased effects of climate change.

According to the page, the CDC actively tracks data on community design as it relates to public health concerns including “types of transportation to work, air quality (ozone and PM 2.5), childhood lead poisoning, and motor vehicle-related fatalities.”

The page is not promoting anything specific, nor does it represent the transformation of the CDC into a leading “smart growth” advocacy group. It simply represents an acknowledgment that Smart Growth has real effects: this is not some crazy scheme based on theory and fantasy. Smart Growth is real, it benefits everyone in many different ways, and it can be successful in any urban community.

Like what you see? Join the effort to make Smart Growth work for us! Sign up for e-mail updates and visit our homepage to learn how you can get involved!

Urban Design that Fights Obesity and Promotes Physical Activity

Sure, we all know that regular exercise and eating well are essential components of a healthy lifestyle and are important in fighting obesity. But rather than just telling people to go to the gym, how can we make physical activity a more realistic (and exciting!) option that will encourage people to abandon their sedentary lifestyles?  

The authors and collaborators of the NYC Active City Guidelines propose active urban design as the key to promoting more physical activity and fighting the obesity epidemic. The Guidelines are the product of a collaborative effort between NYC public health professionals, architects, urban designers, and urban planners.

 The Guidelines are grounded in the idea that the design of the built environment can have a crucial and positive influence on improving public health.

They propose interesting strategies as to how planners can transform the built environment to encourage more active lifestyles for its residents and visitors through stair climbing, walking, bicycling, transit use, active recreation, and healthy eating.

While they focus ostensibly on New York City, the Guidelines can also be applied to other cities and communities.

These are my ten favorite suggestions, and perhaps the ones most pertinent to communities in the LehighValley:

1. Consider shared-use paths in areas with viewing attractions.

  • Check out Allentown’s plans to encourage active transportation: This Morning Call article discusses the plan to connect local bicycle and walking trails.

2. Explore bicycle share programs to increase access to bicycles for both city residents and visitors. 

3. When designing sites that include parking, consider how the provision of parking can affect the use of more active modes of travel such as walking, bicycling, and public transit. In general, when parking is available, people use it. Research in California indicates that increased parking supply may result in reduced active transportation and public transit use. Design car parking so as to reduce unnecessary automobile travel, particularly when walking, bicycling, and public transit are convenient alternatives.

4. Locate new projects near existing public and private recreational facilities and encourage development of new facilities, including indoor activity spaces.

5. In the design of parks and playgrounds, create a variety of climate environments to facilitate activity in different seasons and weather conditions. For example, include sunny, wind-protected areas for use in the winter and shaded zones for use in the summer.

6. Design plazas that allow for diverse functions. Plazas can accommodate physical activities like dance and volleyball, passive activities like sitting and chess, and cultural events such as concerts, exhibits, and historical celebrations. Plazas can also provide space for café style seating and farmers’ markets. When programming plazas, consider the needs of users with varying mobility levels. Seek partnerships with community groups to maintain and program plazas.

7. Incorporate temporary and permanent public art installations into the streetscape to provide a more attractive and engaging environment. Seek collaborations with local arts organizations, philanthropic institutions, or other nongovernmental groups to create and help maintain the artwork.

8. Provide safe walking and bicycle paths between densely populated areas and grocery stores and farmers’ market sites.

9. Further develop Greenways—alternative routes that are integrated into the regional park system. Greenways feature relatively few intersections, many plantings, and a dedicated bicycle right of way. These routes can serve as commuter corridors during the week and recreational paths on the weekend. Connect Greenways to street bikeways.

10. Design stairs to be more visible, in order to encourage their everyday use.

A Financial Case for Public Health

Pay now or pay later. States face this choice every day, particularly with how and when they invest in clinical preventive health services leading to prevention and reduced economic burden in terms of length of hospital stay and general health care costs.

The rewards of paying now are better known than ever before. Research has demonstrated that supporting healthy early childhood development–from before through age 5–generates substantial educational, social and financial benefits for individuals, families and communities.

A major study, The High Costs of Failing to Invest in Young Children produced by Partnership for America’s Economic Successhighlighted that the price society pays when a single person experiences child abuse, drops out of high school, or abuses alcohol can range up to tens to thousand dollars over that person’s lifetime. The study’s purpose was to help policy makers and the public fully evaluate the consequences of their present funding decisions.

The latest RWJ/University of Wisconsin County Health Ranking (CHR) revealed that morbidity numbers are rather low in Lehigh County (37 out of 67 counties) and Northampton County (a shocking 60 out of 67). Morbidity is a term that refers how healthy people feel in the community while alive and it captures the Birth Outcomes along with Health-related quality of life (HRQoL) within the community. Birth Outcomes are measured using low birth weight (LBW) that represents child’s current and future morbidity. Low birth weight is reported to be higher in both Lehigh Valley (8.3%) and Northampton County (8.7%) as compared to the State average of 8.2% and way higher than the national average of 6.0%, according to CHR report.

It was mentioned in the blog on County Health Ranking Across Pennsylvania that the public health spending in Pennsylvania is extremely low as compared to other states in U.S. In this context of scarce resources, the advantage of economic analysis is that helps substantiate present action in terms of investing in prevention and public health. Such an analysis helps providers in managing an individual’s health and administrators in appropriately focusing resources, and — moreover — illustrates the return on investment (ROI) for public health initiatives. According to a study in Western New York, a positive ROI was demonstrated for a prenatal program developed at the Managed Care Organization using a model of economic analysis.

In general clinical preventive services are cost-effective; some are cost-saving. Some clinical preventive services prevent disease or injury (e.g. cervical cancer screening); some preventive services catch disease in early stages when treatment is most effective and least expensive (e.g. STI screening). Because clinical preventive services can prevent or reduce the need for treatment, they provide a cost-offset. Lehigh County has the highest number of sexually transmitted infection rates as compared to state or national average, according to CHR report. Key studies have been done that support the cost-offset value of prevention.

Below are the examples of cost-offset of clinical preventive services recommended in the Plan Benefit Model conducted as part of study that provides rationale to our current work on establishing a regional health department for Lehigh Valley. Of particular note is the cost offset by screening for Chlamydia and Sexually Transmitted Diseases (STDs). Screening for gonorrhea and Chlamydia allows for early recognition of diseases that could prevent the costly implications of late stage complication such as Pelvic Inflammatory Disease (PID). The average life-time cost of PID and its major complications for women have been estimated to be in the range of 1,060-6,840 US dollars. Check out the image below for details on how investment in prevention saves financial resources over the long term.

County Health Rankings Across Pennsylvania

When the annual County Health Rankings were released late last month, the Morning Call, Express Times and Patch reported on the very high morbidity numbers in Northampton County and Lehigh County. Meanwhile, these county rankings received coverage that looked at how other parts of the state were faring as well. Union County was ranked the highest [Check out WNEP news for more info] and Philadelphia was ranked the least in regards to health outcomes and health factors [Here’s the link]. Closer to home, both Montgomery and Bucks Counties ranked in the top 10 of Pennsylvania counties in terms of overall health [Here’s the link here for phillyburbs.com article].

Generally, the rankings showed that counties located in south and central Pennsylvania performed better than did counties in the northeast and northwest. Also, more of the urban counties are ranked in top half than the rural counties — this using the definitions of “urban” and “rural” developed by the Center for Rural Pennsylvania (The Center defines rural vs. urban Pennsylvania based on population density).

Amid these overall regional trends, in some cases the rankings show significant differences even among neighboring counties. Consider the area to the north of Harrisburg, where Union and Snyder Counties both are amongst the top five counties statewide in overall health, while adjacent Northumberland County is ranked in lower one-third. The factors that contribute to such great disparities among neighboring counties would lend itself to further analysis that could shed light on the local conditions that contribute to – or stand in the way of – good health. (As a side note: For an interesting resource on county-level conditions across economics, demographics, and other areas, check out Patchwork Nation – an interactive data site.)

While considering how Pennsylvania counties fare among themselves, it is important to look at where Pennsylvania stands nationally on support for public health. Public health infrastructure in Pennsylvania clearly lags that in others. For its population size, Pennsylvania has the lowest number of public health professionals. Also, according to a study released last month, public health spending in Pennsylvania is very low itself. Here’s the link.

Ultimately, failing to adequate support public health is a short-sighted policy and an unwise investment of public dollars. As noted in the local coverage of the county health rankings [Patch article], we either invest upfront in public health and prevention or we spend far more on what it takes to address illness and injury after they occur.

What is impressive and valuable about the County Health Rankings is not only the numbers themselves, but the huge potential to use these data to improve the health of our communities. Look here to see how people can take action. Patrick Remington, who is the University of Wisconsin Professor and has lead the County Health Rankings report, remarks that the County Health Rankings report is a teaser to catch interest. The point is get people to take some action towards the health of their community.

The current work on establishing a regional health department for the Lehigh Valley represents an important step toward building a strong system of prevention and health promotion for our region. For more information on this effort, visit RenewLV’s Regional Health Initiative page.

County Health Ranking And What It Means For Us

A new report released by County Health Ranking (CHR) reveals that morbidity numbers are shockingly low in Lehigh County (37 out of 67) and Northampton County (60 out of 67).

Morbidity is a term that refers how healthy people feel in the community while alive. Morbidity numbers capture the Health-related quality of life (HRQoL) and Birth Outcomes within the community. The measures used to assess the HRQoL of the population were self-reported health and number of physically and mentally unhealthy days per month. Birth Outcome was measured using low birth weight (LBW) that represents child’s current and future morbidity.

Lehigh County of Pennsylvania has slipped in overall county health rankings from a ranking of 19 in 2010 to 27 rank in 2011. In regards to morbidity numbers, age-adjusted numbers of poor physically unhealthy days reported in past 30 days have gone up as compared to 2010 numbers and 2 points higher than the average state numbers (3.7 in 2011; 3.5 in 2010; PA rates of 3.5 in 2011). There were no changes in the reported low-birth weight percentages as compared to last year percentages (8.3%); however state percentages were still better at 8.2%. Northampton county, too, has slipped from last year overall ranking of 26 to current ranking of 27 primarily due to increase in morbidity rates. Even though there were no changes in age-adjusted numbers of adults reporting poor health and low-birth weight percent this year from last year numbers (Poor or fair health at 16% in 2010 and 2011; Low birth weight at 8.7% in 2010 and 2011), average number of physically unhealthy days and mentally unhealthy days reported have increased (poor physical health days 3.7 in 2011 and 3.6 in 2010, and poor mental health days 3.8 in 2011 and 3.6 in 2010). Poor mental health days were comparable to state last year; however, this year the numbers are more than the state average.

The above rankings, based on model of population health, clearly depict the need of public health prevention efforts in order to make the community a healthier place to live, work, and play. Apart from morbidity numbers, the report ranks mortality and health factors including healthy behaviors, clinical care, socio-economic factors, & physical environment. Crossroads will be reporting more on CHR in the coming weeks as it has implications on improvement of public health infrastructure in Lehigh and Northampton County.

Proposal to Weaken EPA and What It Means for Latinos

A new report released by The Center for American Progress reveals that Latino communities will be severely impacted by the proposal to weaken the EPA.  Adrianna Quintero over at NRDC Switchboard provides further insight into the potential harm that limits to the EPA would pose. The report shows the reality that many Latinos currently live and work in areas with very poor air quality.

Latino families are disproportionately exposed to some of the most dangerous environmental hazards—and often in their own backyards. Fully 66 percent of U.S. Latinos—25.6 million people—live in areas that do not meet the federal government’s safe air quality standards. This translates into shorter life spans: Latinos are three times as likely as whites to die from asthma. Latino children are also 60 percent more at risk than white children to have asthma attacks.

As the following chart from the report indicates, Allentown-Bethlehem-Easton Latino population of 11.30% made it on the list of one of the 25 most polluted cities in the US.  It is clear that the proposal to weaken the EPA will negatively impact millions of people, especially vulnerable populations.

The report comes to the conclusion that Latinos should support a strong EPA that protects their health to avoid further damage:

Latinos will pay the price for cuts to the EPA. They and their children will be exposed to elevated levels of risk and harm. Dirty air and water mean more visits to the emergency room, more missed days of work and school, and more cases of dangerous and expensive health issues.

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