Why should we become more engaged in civil society? For health, that's why!

I am an intense believer in the social determinants of health and looking at health problems through a social-ecological lens (i.e. determinants of health exist at multiple social levels of influence and are not just attributable to the individual or to the healthcare system). I think this is why I’ve also gotten incredibly interested in politics – from this perspective, government policies can influence population and environmental health.  An interesting social determinant of health, social capital, has made me realize how we as individuals can collectively make a difference in shaping the quality of our shared spaces, and potentially overall community health – through influencing policies and working with government.

Social capital, a concept originating from the work of Robert Putnam, among others, embodies the norms of reciprocity (gift giving with the expectation of receiving), social and civic participation and trust in society. Another, complimentary view is that social capital refers to the network of social relationships that provide access to resources. Regardless of the definition, when you have more of these things you have more social capital (sometimes called cohesion). Although both definitions are relevant, I am speaking more to the former definition in the discussion that follows.

Richard Wilkinson was the first to introduce social capital to studies on health. He found that societies that are more socially cohesive, with smaller income gaps (more egalitarian) have higher life expectancies and lower infant mortality rates. Other authors have found that societies with higher levels of income inequality and lower social cohesion have higher levels of crime and violence and higher mortality rates. At a more local level, it has been found that residents who are more involved in the community tend to be happier where they live, regardless of the physical quality of their homes.  Some studies have even found that as the level of social cohesion in an area increases, the prevalence of obesity decreases. 

Social capital is complex – these studies show how it may influence health. An obvious explanation is that it improves the quality of our immediate social and physical environments, as well as society at large. One caveat is that social capital itself can be shaped by many different factors operating at many different levels of social organization (e.g. at the neighbourhood/community, region, province, and country level), which thus impacts the quality of our spaces. Social capital therefore, is not a one-way street, rather an intricate web of interaction.

Open space in question, complete with dog

    

My plan is to add to social capital and hopefully improve the quality of my neighbourhood, by becoming more civically engaged. I’ve read a lot lately about how greenspace can potentially be beneficial for mental and physical health, and how it is also good for the environment (I have blogged a bit about this too). I enjoy being outdoors in natural areas – it makes me happy – and I also have a dog, with no back-yard.  Unfortunately there are no dog parks or interesting greenspaces within walking distance of my home.  I often take my dog to an open space close by. It’s a piece of land that separates two suburban neighbourhoods, with trees and a man-made marsh that was constructed to deal with street water runoff. Other neighbourhood residents also bring their dogs, kids toboggan down the banks of the marsh in the winter, and residents of houses bordering the space often use it as their personal dumping ground (a pet-peeve of mine discussed in a previous post). There is no landscaping and the space is never maintained.

Neighbours like to use it as their own personal dump

I would really like to have this space converted into a dog-friendly park (that is maintained), with perhaps a community composter (since everyone dumps their s**t anyway), and even a community vegetable garden. Although, my partner brought to my attention that probably dog parks and food don’t mix – I’ll have to think the vegetable garden through a little bit more…

I really had no idea how to go about making this happen until I read an interesting post on the City of Gatineau’s website:  

“Ville de Gatineau is revising its land use and development plan. Would you care to share your thoughts about how your neighbourhood or the city should develop? This is the time! This revision will extend over three years, with meetings scheduled to start this spring!”

This first meeting for my area is this June the 6^th. I plan to go to see how I can voice my ideas and connect with others who may share my view and/or be able to help me. This will be the first time (other than voting in various elections) that I am involved in the running of my community. I’ll keep you updated as to how this pans out. And I urge everyone else to do the same. Finally, I will not be a hypocrite, especially with respect to my own research!  

      

Leal C, & Chaix B (2011). The influence of geographic life environments on cardiometabolic risk factors: a systematic review, a methodological assessment and a research agenda. Obesity reviews : an official journal of the International Association for the Study of Obesity, 12 (3), 217-30 PMID: 20202135

Home cookin', leftovers, and your health

CC image: Kathleen Franklin

Home cooking is where it’s at. In my view, getting people to cook at home with wholesome foods is one way to combat the obesity epidemic.  And of course, home cooked meals *can* taste great; that’s chef-dependent of course. Foods prepared outside of the home are higher in calories, fat, and sodium, and a recent meta-analysis found that children and adolescents who eat shared family meals at least 3 times per week are less likely to be overweight or eat unhealthy foods than children who eat fewer shared meals. There are two main problems with home cooking, aside from the multitude of barriers to actually being able to cook (e.g. time/work schedule, knowledge and skills). Rather, these are outcomes of cooking that I will discuss based on a recent experience.

First, we waste a whole lot o’ food. Research in the UK has shown that 2.2 million tonnes of food is thrown away due to cooking, preparing, or serving too much. That’s just food that we’ve managed to work with – it doesn’t include fresh produce, meats/fish, dairy, etc. In the US, 30% of all food is thrown away each year.

All of this waste is obviously costly, as we’re paying for food that we don’t eat. In the case of the US, this amounts to US$48.3 billion! But food waste is also harmful to the environment. Rotting food releases methane, one of the most potent greenhouse gases. A UK research group estimates that if food were not left to rot in landfills, this would be the greenhouse gas equivalent of removing 1 in 5 cars from the road.  And we can’t forget all of the fertilizers, pesticides, and energy going into growing/raising food that we just toss into the trash.

Okay, home cooking is great but waste is bad. What do we do? Eating your leftovers is one way to get the best of both worlds. Hang on though, leftovers need to be handled and stored properly in order to avoid illness. I have a dietetics bachelor’s degree but am the worst for food safety (probably because more often than not I don’t get sick). I’m the one that leaves the ham sandwich in the car in 30 degree weather (that’s Celsius) all day and then eats it unperturbed on the way home from work.  Or leaves a defrosting tenderloin on the top shelf in the fridge or even out on the counter for the entire day (both no-no’s).

 But the other day, I did get sick – not badly mind but enough to make me realize that food safety does matter if I want to avoid having to take a day off of work. My significant other thought he was doing a service (which he was) by bringing home leftovers from a conference at work. It was some sort of pasta with a béchamel sauce and chicken.  We reheated it in the microwave at home and ate about half of what was brought home. The next day, we both could not stray too far from the toilet…This was no coincidence – same symptoms and the pasta was the only thing we had in common for the previous 24 hours. We threw the rest of it out.

So what went wrong? I can’t say for sure because there are so many things that could have happened, but I’ll touch on a few here. It’s hard for bacteria to grow in foods that are held at temperatures less than 4°C (40°F) or more than 60°C (140°F) – in between is called the ‘danger zone’. When serving prepared hot foods, like this pasta dish, it is imperative that the food be above 60°C. Additionally, time is a factor. Food left out for more than 2 hours is more prone to bacterial contamination. Perhaps the pasta was held in this danger zone – something that caterers should know to avoid, or not thrown out after 2 hours.  My partner may have also taken the pasta and unknowingly left it out for too long. Reheating the pasta at home didn’t seem to do anything. The Canadian Food Inspection Agency (CFIA)  recommends reheating leftovers to 75°C – maybe we didn’t hit that mark.   

  

When other people make your food there is always the possibility that they didn’t adequately wash their hands, or use clean serving utensils or pots/containers. That’s something out of your control but you can ensure that you do these things when you make your own food.  

Other ways to deal with leftovers to prevent illness: 

• Put hot leftovers in shallow containers and place immediately in the fridge. Really hot items can be left out for a bit then put in the fridge after the steam stops. Leave lids off or wrap loosely until food becomes fridge temperature (to avoid explosions)
• A great way to keep leftovers is to freeze them
• Eat leftovers left in the fridge (as opposed to the freezer) within 2 to 3 days
• Throw out uneaten leftovers - i.e. once reheated, don’t keep the left over leftovers
• Thaw frozen leftovers in the fridge or microwave. This is something I need to think about doing – I always thaw my soup at room temperature
• Never refreeze thawed leftovers – they should be eaten or thrown out  
• When reheating leftovers, stop the microwave half-way through and stir the dish in order to ensure even heat distribution (we didn’t do this with the pasta dish)
• The CFIA recommends using a digital thermometer to check food temperatures but I don’t really see this as something that I would do let alone the general public. Maybe… if I get sick again….
• And finally, when in doubt, throw it out!

The more we cook at home, the better for our health. But sometimes we cook too much. Instead of throwing out food, which is bad for the environment and our pocketbooks, think ‘leftovers for lunch’ and perhaps even for a second dinner. But be mindful of how you handle, store, defrost, thaw, and reheat leftovers. 

Other great resources include:

The Food Safety Network http://www.foodsafetynetwork.ca/aspx/public/default.aspx

United States Department of Agriculture: Food Safety and Inspection Service http://www.fsis.usda.gov/factsheets/safe_food_handling_fact_sheets/index.asp

Love Food Hate Waste: tips for reducing household food waste http://www.lovefoodhatewaste.com/

Hammons AJ, & Fiese BH (2011). Is Frequency of Shared Family Meals Related to the Nutritional Health of Children and Adolescents? Pediatrics PMID: 21536618

Quested T, & Johnson H (2009). Household Food and Drink Waste in the UK WRAP

Part 2 Building Design: Fooling people into taking the stairs

I just got back from a conference in Montreal – one on obesity at that. The hotel, the location for the conference, held sessions on floors 1-4 and on sub floors below the lobby – ample opportunity to use the stairs.  There were two main problems: 1) the stairs were confusing – you’d get up to one floor but then couldn’t find the next set of stairs to the next floor and have to walk quite a distance to get to them; and 2) there were escalators in between these floors in plain sight from the main floor lobby, somewhat easy to navigate, and were a brilliant, flashy gold colour. I, more often than not, took the flashy-fancy escalators. 

In my last post, I reflected on how easy it is to be physically inactive nowadays and went on to discuss point-of-decision prompts as a way to get people to use the stairs instead of escalators or elevators. These prompts appear promising, but what if buildings are not designed to make taking the stairs easier or enjoyable, such as was the case at the obesity conference? To answer this, in today’s post I will discuss the recommendations provided by New York City’s Active Design Guidelines to make buildings enjoyable places to walk – and some instances make walking the more convenient form of transportation. The guidelines were developed based on the best available evidence in the literature, as well as on current best practices in architecture and design. So keep in mind that even though these are recommendations there is no guarantee that they’ll work to increase physical activity.  At the same time however, they have direct synergies with sustainability, such as decreasing electricity and building material use (so, in my opinion, are at least worth considering).

There are three main categories of building design recommendations that I’ll touch on in my discussion below: 1) Elevators and escalators; 2) stairs; and 3) supportive design elements. I think that the more recommendations implemented, the more likely that building design will be successful at increasing the physical activity levels of its users.    

Design of elevators and escalators

Mechanized options for travel between floors should be designed to be hard to find, or at least less prominent (not the case for the escalators at my conference). Decreasing their speed can make them less efficient than walking, and save on electricity. Installing the minimum number of elevators required by building codes could also decrease efficiency by increasing volume of users. Other ways to make elevators less efficient than walking include programming them to:

• Be skip-stop (they don’t stop on every floor so you have to get out and walk up a floor);
• Open at each floor (this may not make sense in buildings with 30+ floors);
• Open and close very slowly (which is beneficial for persons with disabilities) 

Design of stairs

Stairs should be the main attraction. They should be visible from the lobby and elevators, and always located close to building occupants (i.e. office areas). One way to draw attention to them is to put the lobby of the building on the second floor, accessible from the ground floor via a grand staircase, with elevators accessible only at the lobby (meaning people have to use the stairs to access the elevators). Point-of-decision prompts can also help (as I discussed in Part I).  A great example of making stairs interesting -maybe a bit extreme and perhaps not sustainable, but cool nonetheless- is the piano stairs:  

Additionally, stairs should:

• Open to and be accessible at each floor (no locked doors);
• Be seen – if stairwells are a must they should be transparent;
• Receive large amounts of natural light;
• Be well ventilated

Canadian Museum of Nature, Ottawa (ON): CC images Michelle Hotchin

In order to improve the overall experience, stairs themselves should be designed for comfort, aesthetics, safety, and ease of maintenance. Art and articulated and unique stair composition can increase interest. Balustrades, handrails and landings can provide architectural points of interest, especially for grand staircases. Floor finishes should be slip resistant and colour or textural contrasts can be used to increase safety. Step height should be comfortable for small children (i.e. not too high), and staircases should be wide enough for groups traveling in opposite directions to safely pass. Finally, stairs should be easy to maintain. Long lasting materials should be chosen that are easy to clean and discourage vandalism or graffiti.   


   

Cooper Union New Academic Building, New York, NY: CC images

Supportive design elements

There are some things that can be included in building design that make being physically active easier and more enjoyable. Change rooms and showering facilities are big ones for me. My work building currently does not have one. I figured it would be quite easy to add a shower – one for men and one for women and no need for change rooms as our washrooms are so large. No dice though, my request was immediately shut down by my organization – citing no money. Always the excuse. I plan to press the issue. Bike parking and storage are also important. In NYC, several laws have been enacted that mandate certain buildings and facilities provide bicycle parking or other accommodation for cyclists. Storage can also prevent damage to building interiors when bikes are brought inside, and also prevent nasty notes from being sent to you when you forget your bike lock. 

Design of building exteriors should also have the pedestrian/cyclist in mind and interestingly can influence building users and non-users alike. Here are a few examples that can enliven, and improve the comfort/convenience and safety of the streetscape:

• Reducing set-backs (space between the road and building) and providing multiple entry points 
• Adding awnings or canopies (to provide shelter from the weather)  
• Porches, stoops, and terraces can add to the social environment and provide ‘eyes on the street’ 
• Paying attention to nearby parks, open spaces and public gathering areas so that the building does not adversely affect them (e.g. minimizing the cast of building’s shadow, and the potential for creating unpleasant wind conditions)

Building in New Orleans (LA): CC image

The design of public buildings (including point-of-choice prompts) has the potential to not only increase physical activity, but also to vastly improve the quality of our shared spaces. Perhaps residential spaces could also be designed to promote physical activity and reduce sedentary behaviour. The hard part is that people generally choose what they live in and where they live.  It is my hope that more and more researchers examine how design of our spaces (from houses to cities) may influence not only obesity but overall health, with high quality epidemiological methods - something that is currently lacking.              

Bloomberg MR, Burney D, Farley T, Sadik-Khan J, & Burden A (2010). Active Design Guidelines: Promoting Physical Activity and Health in Design City of New York