Social Determinants of Cardiovascular Disease: Food Justice & Active Living to Prevent CVD

1. Social Determinants of Cardiovascular Disease: Food Justice & Active Living to Prevent CVD Filipino American Cardiovascular Health July 8-9, 2011, Washington DC Executive Director: Rod Lew, M.P.H Email: rodlew@appealforhealth.org Website: www.appealforcommunities.org

2. Overview • Describe risk factors for cardiovascular diseases • Describe role of policy change and social determinants in eliminating health disparities • Describe APPEAL framework for addressing policy change on tobacco, healthy eating and active living for AAs and NHPIs.

4. CVD and Risk Factor Prevalence • Cardiovascular disease (CVD) is one of the leading causes of death among AA&NHPIs. In 2007, it accounted for about one in four deaths among AA&NHPIs (24.4%). • Asian Americans appear to be at greater risk for CVD at lower body mass index (BMI) than other ethnic groups. • Filipinos have the 2nd highest CVD rates among Asian American subgroups according to self-reported national data. • Although the prevalence of obesity is low within the adult Asian population, Filipino adults (14%) were more than twice as likely to be obese as Asian Indian (6%), Vietnamese (5%), or Chinese adults (4%).

5. Percentage of Asian Adults Who Were “Current Smokers”, 2004-2006

6. Percentage of Asian Adults with Selected Health Conditions, 2004-2006

7. Winnable Battle At least 80% of premature heart disease, stroke, and type 2 diabetes could be prevented through healthy diet, regular physical activity and avoidance of tobacco products. - WHO, 2009

8. Will “Fixing” the Individual Work? • Historically, the public health response to preventing and controlling cardiovascular disease (CVD) and type 2 diabetes has focused on “fixing” the patient by addressing behavioral risk factors, such as increasing physical activity and improving dietary intake. • The responsibility for health condition placed on individual, thereby resulting in “blaming the victim.”

9. Limitations of Behavioral Change • Traditional behavior change strategies have had some positive, but limited effects and will not likely be sufficient to eliminate these health disparities at the population level. • Ex. the Traditional Hawaiian Diet (THD) showed that while majority of the participants successfully realized short-term weight loss and improvements in health, longer term weight loss was a challenge. • Participants attributed this to difficulties in accessing fresh and affordable produce and the lack of a supportive environment for healthy eating.

10. Results from Tobacco Industry Documents 1988-1995 • AAPI market important due to population growth and geographic clustering • AAPIs had “predisposition to smoking” and increased consumer purchasing power • High percentage of AAPI retail business owners • Philip Morris’ PUSH, PULL and CORPORATE GOODWILL strategies

11. Tobacco’s Impact on AAs and NHPIs • Sacred Use of Tobacco • History of Tobacco’s Commercialization • Heavy Targeting by the Tobacco Industry • Disparities in Resources and Capacity • Tobacco as a Social Justice Issue

12. Per Capita Cigarette Consumption United States 1900 to 1999 Source: Tobacco Use - United States, 1900-1999. MMWR November 5, 1999; 986-993

13. Place Matters: The Food Environment Studies have shown that food environment influences health: • Availability of food outlets that sell nutritious and affordable food is a big factor in promoting healthy diet among individuals and reducing obesity and diabetes risk. • Lower income neighborhoods that are commonly populated by communities of color have fewer grocery stores, greater abundance of fast food outlets and convenience stores. • Those who live near an abundance of fast-food restaurants and convenience stores compared to grocery stores and fresh produce vendors, have a significantly higher prevalence of obesity and diabetes.

14. Race/Ethnicity Matters • When controlling for SES, the differences in health status between blacks and whites are reduced, but within each level of SES, blacks still tend to have worse health status than whites. • Race as a lived experience and social construction tends to have an effect on health, independent of SES. • Social stigma of being black, and the internalization of society’s ideology toward blacks result in expectations (on the part of blacks) of rejection and discrimination, anxieties, and “reactions that affect the functioning of marginalized groups.

15. Image Source: World Health Organization

16. Social Determinants of Health

18. What are the food environments surrounding Filipino Americans?

19. Strategic Framework for Healthy Eating and Active Living Policy Work among Asian Americans, Native Hawaiians and Other Pacific Islanders Inputs Guiding Principles Strategic Planning Community Capacity Building Short Term and Intermediate Outcomes Long Term Outcomes • Community Participation • Community Competence • Community Empowerment Community Readiness • Advocates • Communities • Coalitions • Leaders • Partnerships • Resources • Time Leadership Development • 4-Prong Policy Change Model • Community Policy • Mainstream Institution Policy • Legislative Policy • Corporate Policy Environment Assessment and Data Community Mobilization and Organizing Prioritization and Goal-Setting Infrastructure Development • Programs • Cessation • Prevention Greater access to healthy nutrition, higher levels of physical activity Health Parity and Health Justice

20. APPEAL Network APPEAL began the PROMISE (tobacco control) and NAPNEHD (healthy eating and active living) networks to eliminate health disparities in the diverse AA and NHPI communities by focusing on environmental and policy change.

21. NAPNEHD Local Affiliates • Coalition for Asian American Children &Families (New York) • Collaborates with 6 Coalition Partners to serve the Filipino, Nepali & South Asian, Southeast Asian, other Pan-Asian communities • Coalition for a Tobacco Free Palau (Republic of Palau) • Collaborates with the Palau National Olympic Committee, the Palau Medical Commission (for sports), and the Palau Softball Federation to serve Palau’s sporting community • Washington Asian Pacific Islander Community Services (Seattle) • Collaborates with 25 partners to serve the Cambodian, Chinese, Filipino, Korean, Lao, Samoan and Vietnamese communities.

22. APPEAL’s Leadership Experience • APPEAL Leadership Summits (1997, 1999, 2000, 2004) • APPEAL Youth Leadership Summits (2002, 2004) • National Latino Leadership Summit (2002) • National Cross Cultural Leadership Summit (2004) • Washington Cross Cultural Leadership Institutes (2004, 2005) • Leadership and Advocacy to Advance Minnesota’s Parity for Priority Populations (2005-7) 600 Fellows Trained

23. “APPEAL trainings are intense, in-depth, refreshing, and understands and embraces the diversity and cultural perspectives of the participants.  And most of all you feel good… because for the first time my history, cultural, and experiences -- were allowed at the table.” - Brandie Flood, Center for Multicultural Health

24. Impact of Leadership Development • Individual:Increased knowledge and skills • Community:Mobilization, capacity building and interventions • Policy/Systems:Funding, representation and legislation • Cross Cultural:Increased collaboration, empowerment and parity A Movement?

25. APPEAL’s 4- Prong Policy Change Model • Need to advocate withinour priority populations where tobacco is not a high priority • …within the mainstream tobacco control movement where priority populations are not a high priority • …with policymakers where neither tobacco nor priority populations are a priority • …against the tobacco industry where priority populations are one of the high priorities

26. 2011 APPEAL Policy Recommendations • Fund data platform that provides consistent and standardized organization of disaggregated local and regional AA and NHPI population data. • Fund the replication of model programs and policy initiatives for AA and NHPI communities including capacity building initiatives. • Increase the representation of AA and NHPIs on key national and regional decision-making bodies. • Monitor and regulate the tobacco and agri-food industry including food conglomerates and fast food companies that target AA and NHPI communities with unhealthy food products.

27. Join Our National Network! Be a Member of Our Network • Keep informed about our activities and join us in our efforts by becoming a member of our network. To sign up, please visit our website at www.appealforcommunities.org ! Join Our Healthy Eating and Active Living Listserv • Send an email to appeal-FALP-subscribe@yahoogroups.com with blank subject line and the message, "subscribe APPEAL FALP (your full email address)”. Participate in Our Upcoming HEAL Webinar, “Building Communities Around Healthy and Responsible Food” on July 21, 2011! • Visit our website www.appealforcommunities.org for more information.

28. Thank You!