University at Buffalo - The State University of New York

Published: July 6, 2006

By KEVIN FRYLING
Reporter Staff Writer

What good is it to say "eat right" to someone who can't afford nutritious food? Or whose neighborhood doesn't have a supermarket?

These were among the questions raised by Maurizio Trevisan, dean of the School of Public Health and Health Professions, during his June 29 UBThisSummer lecture, "Health and Society: The Determinates of Health of Individuals and Populations."

TREVISAN

"If you live on the lower East Side of Buffalo, you have no access to supermarkets," Trevisan pointed out. Dependence on corner stores results in a diet high in canned and processed foods, with little fresh fruit or vegetables, he said.

"We have focused too much on the medical approach. We have focused too much on the individual, he said, explaining that socioeconomic, cultural and environmental factors often are greater determinants of health than individual decisions regarding diet and exercise. These factors include housing, work environment, education, employment rates, agricultural and food production, health care services and water and sanitation.

People assume medical advances are more influential on health than environmental changes, Trevisan said, but in some situations, this is not the case. Citing the historic drop in tuberculosis deaths, he said the chief reason for the decline was not antibiotics, but sanitations reforms.

Moreover, said Trevisan, "Social class makes a big difference in the chances of survival in a disaster."

According to statistics from the 1995 heat wave in Chicago, people with air conditioners were at 70 percent less risk of death than those who did not have the means to purchase them. Access to other air-conditioned locations or transportation also mitigated the risk factors. Furthermore, the chance of death was twice as high for people who lived alone and eight times higher for those confined to bed, he said.

In a famous example, Trevisan pointed out that the risk of death on the cruise ship Titanic was lowest for rich men and women, but highest for poor women. "The weaker the portion of the population, the higher the effect," he said.

Trevisan added that economic disparities within communities also put the poor at great risk. Recent research has found that low-income individuals living in high-income neighborhoods possess a more than four times higher risk of mortality. The lowest risk was for low-income individuals living in low-income neighborhoods.

"Being poor in a rich neighborhood is worse than being poor in a poor neighborhood," said Trevisan. "If you're poor and surrounded by rich people, you're at significant risk."

However, the numbers are not true in reverse, he noted. High-income individuals are at no greater risk than their neighbors in low-income communities, he said, adding that the reasons behind these results are not yet clear.

Trevisan also discussed obesity in the United States, citing statistics that show that individuals' weights—especially among youth—have skyrocketed in the past 20 years. There now are children who are diagnosed with type-two diabetes, he pointed out.

"Most likely, life expectancy will be lower for this generation," he said.

Trevisan said that in his view, fast food has been turned from a health issue into a political one. He said lawmakers lack the "political will" to take on fast food companies and that there is a perception it's easier to produce more drugs to reduce cholesterol than deal with the root of the problem.

He also discussed UB research that examines the influence of neighborhood design on children's health. The joint project between the School of Medicine and Biomedical Science and the School of Architecture and Planning is headed by faculty members Leonard Epstein and James Roemmich, professor and assistant professor of pediatrics, respectively, and Samina Raja and Li Yin, assistant professors in the Department of Urban and Regional Planning. The research has revealed that neighborhoods with many parks and short streets with frequent intersections have a positive impact on physical exercise in boys, but not girls. The research also finds that the more televisions there are in a household, the more "couch potatoes" are produced in that household, according to Trevisan.

There are a number of challenges to public health, said Trevisan. One is the definition of "normality." Health practices are not common across cultures, he explained. For example, cholesterol levels near 250 were seen as the norm in Finland until studies revealed much lower levels in such nations as Japan. Moreover, Trevisan, a native of Naples, Italy, pointed out that on average, Italians walk more than Americans.

Another challenge is that the field of public health does not receive the support it deserves, he said. "We place no value on public health, except in times of crisis," said Trevisan, who predicted a further drop in attention to the field as current fears on such issues as bioterrorism fade.

He came back to his point about the overemphasis on individual treatment to the detriment of social solutions to health problems.

"We have focused too much on the 'medicalization' of society," he stressed.