9 minute read
Santa Clara County Healthy Brain Initiative
The Lancet Climate Countdown paper (Romanello, 2021) carefully summaries the interwoven issues and healthcare’s future needs to create changes in the underlying social and environmental determinants of health as well. Obstetricians and Gynecologists also now recognize their role in climate change within “the context of women’s reproductive health as a public health issue, a social justice issue, a human rights issue, an economic issue, a political issue, and a gender issue.” (Giudice, 2021)
The Perils of Ignoring History
Considering the state of the environment, with species loss, habitat degradation, extreme weather events and burgeoning epidemics of modern disease (especially in children), we need to rethink our strategy as humans on this planet in order to survive. We are now becoming experts in the law of unintended consequences. Widely adopting a meaningful version of the Precautionary Principle while including human rights, could fundamentally change our economy for the benefit of the environment and indirectly help all of the nine billion humans inhabiting our fragile earth. We can otherwise continue to collectively or individually decide to deny, delay and dismiss the problems. (“The Science for Profit Model”, 2021)
Medicine is Still an Honorable Calling
A unique bond of trust and caring is formed with each doctor patient interaction. To heal and see a life improve is immensely satisfying for both involved. This is a result of a long history of rigorous MD training along with a dedication to the profession of medicine and human kind. Pursuing medicine is a selfless act, but one that now only 10% of physicians recommend to their children. The “Business of Medicine” has now overtaken the “Joy of Medicine”, with crushing administrative burdens that are most obvious to private practitioners. Medicine is still an honorable and rewarding calling. Let’s reform the profession, so we can still “enjoy the journey” as Dr. Abraham Vergese wisely advises. The SCCMA like our sister organization, the CMA, will continue to pursue its mission “to promote the science and art of medicine, protection of public health and the betterment of the medical profession.” Join us in this endeavor.
“I think we learn from medicine everywhere that it is, at its heart, a human endeavor, requiring good science but also a limitless curiosity and interest in your fellow human being, and that the physician-patient relationship is key; all else follows from it.” ~ Dr. Abraham Vergese, Stanford Professor and author of Cutting for Stone
REFERENCES:
The search for animals harbouring coronavirus — and why it matters. Scientists are monitoring pets, livestock and wildlife to work out where SARSCoV-2 could hide, and whether it could resurge. March 2, 2021. https://www.nature.com/articles/d41586-021-00531-z
COP26: What was agreed at the Glasgow climate conference? Nov 15, 2021. BBC News. https://www.bbc.com/news/science-environment-56901261
Nearly 1 in 5 Healthcare Workers Have Quit Their Jobs During the Pandemic Medical workers cited COVID-19, poor pay and burnout as reasons for layoffs, resignations. Oct 4, 2021. Morning Consult. https://morningconsult.com/2021/10/04/health-care-workers-series-part-2-workforce/
What we know about the Omicron variant. CNN. Nov 27, 2021. https://www.cnn.com/2021/11/26/health/omicron-variant-what-we-know/index.html
The Perils of Ignoring History: Big Tobacco Played Dirty and Millions Died. How Similar Is Big Food? Milbank Q. 2009 Mar; 87(1): 259–294. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2879177/
The Monsanto Papers: Poisoning the scientific well.Int J Risk Saf Med. 2018;29(3-4):193-205. https://pubmed.ncbi.nlm.nih.gov/29843257/
For Decades, Polluters Knew PFAS Chemicals Were Dangerous but Hid Risks from Public. Environmental Working Group. Teflon Documents https://www.ewg.org/pfastimeline/
Exxon Knew about Climate Change almost 40 years ago. Scientific American. Oct 26, 2015. https://www.scientificamerican.com/article/exxon-knew-about-climate-change-almost-40-years-ago/ The Science for Profit Model—How and why corporations influence science and the use of science in policy and practice. Legg et al. . PLOS One. June 23, 2021. https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0253272
Wingspread Conference on the Precautionary principle: http://www.sehn.org/wing.html
The 2021 report of the Lancet Countdown on health and climate change: code red for a healthy future. The Lancet. Vol 398, issue 10311. Oct 20, 2021. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(21)01787-6/fulltext
Climate change, women’s health, and the role of obstetricians and gynecologists in leadership. International Journal of Gynecology and Obstetrics. Giudice LC et al. Oct 25, 2021. https://obgyn.onlinelibrary.wiley.com/doi/full/10.1002/ijgo.13958
By Ethan Giang, MPH, TTS
Healthy Brain Initiative Lead, Healthy Communities Branch Santa Clara County Public Health Department
Funded by the California Department of Public Health Alzheimer’s Disease Program, Santa Clara County Public Health Department (SCCPHD) is one of six local health jurisdictions in California to be awarded the Healthy Brain Initiative. It is a 2-year project that aims to build and raise awareness of brain health, Alzheimer’s Disease and Related Dementias (ADRD), and cognitive decline risk reduction, education and messaging. Our department goal is to integrate cognitive health as a key component of public health’s prevention framework to prevent chronic diseases and injuries of our aging population. At SCCPHD, we envision all adults thrive in healthy, equitable, and supportive communities that ensure optimal health and promote aging in place.
In Santa Clara County, the older adult population is growing rapidly. About 1 in 4 residents is over the age of 55. By 2050, it is projected that about 1 in 4 will be over age 65. The racial and ethnic demographic distribution of the older adult population is also anticipated to shift from predominately White to increasingly Asian/Pacific Islander and Hispanic/Latinx, while the African American population will remain relatively the same.
It is estimated that over 35,300 county residents living with Alzheimer’s disease or a related dementia. By 2040, that number will grow to over 82,300. In 2019, Alzheimer’s disease was the 5th leading cause of death among all residents in the county. Based on the 5-year rate (2015-2019), the age-adjusted death rate due to the disease is 16.4 deaths per 100,000 residents. The death rate of Alzheimer’s disease among female is 17.7 deaths per 100,000 residents compared to 14.2 deaths per 100,000 residents for their male counterparts. There are some health disparities when looking at Alzheimer’s disease among the African American population. The death rate due to the disease is higher among African Americans (24.7 deaths per 100,000 residents) than White (17.6), Latinx (16.8), and Asian/Pacific Islander (13.1) residents.
In addition, 1 in 10 county residents regularly provides care or assistance to someone who has a long-term illness or disability. Residents ages 55-64 comprised the greatest percentage (16%) of caregivers. Caregiving was most frequently provided to a parent. Among caregivers, nearly half (48%) have an annual household income of less than $50,000. Also, paid and unpaid caregivers are more likely to be women ages 50 or older. Caregiving does take a toll on the health and wellness of caregivers in which the emotional stress of providing care is high or very high,
leading to higher rates of depression, physical illness, and social isolation. Caregivers also named stress (30%) and financial burden (26%) as the two greatest difficulties of their caregiving role. Overall, the data represents a small portion of the burden and the impact among families and caregivers of people living with dementia.
From this evidence, the Santa Clara County Healthy Brain Initiative (SCCHBI) takes a deliberate approach to eliminating health disparities within priority populations by: 1) Meaningfully engaging communities with the greatest disparities in cognitive health and caregiving; 2) leveraging partnerships with multisector agencies serving these communities; 3) embedding culturally and linguistically appropriate activities into the SCCHBI work plan; 4) and designing countywide health approaches to uplift all communities. This approach is carried out through an array of resources and services such as in-person and online Brain Health Series workshops (Brain Health & Aging, Dementia Friends, and MIND Diet) at Santa Clara County Senior Nutrition Program sites, distribution of cognitive health education resources and materials, virtual learning/training opportunities on ADRD and caregiver resources for health and service providers, and health education campaigns to raise awareness of brain health and cognitive decline risk reduction education in multiple languages.
The challenge of addressing cognitive health and caregiving is complex, and the public health agencies face many demands for their expertise and support that often exceed available resources. Much of the SCCHBI workplan spans the entire populous of Santa Clara County (focusing on adults and older adults) but there are priority populations with which funded partners (Alzheimer’s Association Northern California and Nevada & Roots Community Health Center, South Bay) promote brain health and provide cognitive decline risk reduction education. As an emerging issue, brain health is an integral component of public health because our department’s goal is to protect and improve the overall health and wellness of our community within a racial and health equity framework.
The vision of the SCCHBI is to advance cognitive health through community education, participation, and partnerships. The intent is to bring our core essential services (data-driven approach, outreach and education, partnership engagement, and policy development) and risk reduction focused framework into the field of dementia with our internal and external partners by strengthening our data systems of cognitive decline and caregiving among aging population. Another component of the SCCHBI is the opportunity to leverage the current work at SCCPHD Healthy Communities Branch and in the community regarding cognitive health and risk factor reduction: diabetes prevention, proper nutrition, physical activity, and tobacco avoidance.
To promote optimal health, we integrate cognitive decline risk reduction education and messaging across all PHD programs via the informational infographic Stay Sharp – A Healthy Brain at Any Age—a health fact sheet of brain health risk and protective factors and healthy habits to reduce the risk of cognitive health decline with tailored messages for general and priority populations. This infographic also contains chronic disease and injury prevention tips. Stay Sharp – A Healthy Brain at Any Age is available in English, Spanish, Vietnamese, and Chinese.
Over the two-year period, the SCCHBI collaborating agencies have been engaged the public to join the movement of becoming a Dementia Friend in partnership with the County of Santa Clara Social Services Agency’s Seniors Agenda. More than 200 people from a diverse group of community members, partners, and stakeholders are part of the Dementia Friends USA. To strengthen our partnership with the Health & Hospital System (hospitals, behavioral health services, social services agencies), the SCCHBI has been successful in hosting several symposiums and webinars to deliver healthcare and service providers education on brain health, cognitive health assessment screening, and ADRD diagnosis, and opportunities to improve care for those they serve through these annual presentations. On the policy level, we will collaborate with the County Senior Care Commission, County Board of Supervisors, and the County Executive Office to establish a County Dementia Plan and Caregiver Resource Hub. Both of which are emerging needs in public policy. Through these collaborations, the SCCHBI strives to educate policymakers about cognitive health and impairment, the impact of dementia on caregivers and communities, and the role of public health in addressing this priority work.
By June 30, 2022, the SCCHBI hopes to transform the county to be an age- and dementia-friendly environment where community members, policymakers, and stakeholders recognize risk factors and signs of ADRD, promote cognitive health, and engage in adopting a healthy lifestyle, system and policy changes to reduce behavior, social and environment risk factors associated with ADRD. We aim to manifest strong support of public engagement in chronic disease and injury prevention, brain health, and commitment to a sustainable healthy lifestyle. Healthcare providers and staff will have integrated culturally tailored education on brain health and screening of ADRD to improve care of patients. Most importantly, impacted communities, family members, caregivers, and people living with ADRD will have equitable access to high-quality chronic disease and injury prevention resources, including brain health and cognitive decline risk reduction and health and wellness services.
