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Transforming the Environment in New York City to Reduce Chronic Disease

Transforming the Environment in New York City to Reduce Chronic Disease. November 18, 2013 Stella Yi, PhD MPH Research & Evaluation Unit Bureau of Chronic Disease Prevention and Tobacco Control New York City Department of Health and Mental Hygiene syi@health.nyc.gov. Presentation Outline.

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Transforming the Environment in New York City to Reduce Chronic Disease

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  1. Transforming the Environment in New York City to Reduce Chronic Disease November 18, 2013 Stella Yi, PhD MPH Research & Evaluation Unit Bureau of Chronic Disease Prevention and Tobacco Control New York City Department of Health and Mental Hygiene syi@health.nyc.gov

  2. Presentation Outline • Introduction • Innovative Initiatives • Active Design and Physical Activity • Trans Fat Restriction • Calorie Labeling • National Salt Reduction Initiative • Closing Remarks

  3. The Epidemiologic Transition Source: Vielrose E. Oxford, Pergamon Press Inc. 1965, Data for 1960-2000 from World Population Prospects, 1996 revision.

  4. Life Expectancy at Birth, NYC and United States, 2001 to 2010 Source: Prepared Dec 11, 2012. Bureau of Vital Statistics, New York City Department of Health & Mental Hygiene; http://s3.documentcloud.org/documents/537407/life-expectancy-charts.pdf

  5. Physical Activity Levels Among Adults in New York City and the U.S. U.S.: 11% NYC: 29% Source: Bartley et al. Epi Data Brief, Feb 2013. http://www.nyc.gov/html/doh/downloads/pdf/epi/databrief22.pdf

  6. People Are Eating Out More Source: Food Consumption (Per Capita) Data System, USDA, Economic Research Service

  7. Eating Out Is Associated with Obesity • Calorie intake increasing – 200 calories/day from 1977 to 1996. • Children consume 2X calories in restaurant meals compared to meals at home • ~1/3 of our calorie intake comes from food prepared outside the home Sources: Guthrie et al. JNEB 2002; Zoumas-Morse et al. JADA 2001

  8. Most Salt Intake in U.S. Adults Comes from Processed Foods 12% Processed foods 77% While eating 6% 5% Mattes, RD. Donnelly D. Relative Contributions of Dietary Sodium Sources. Journal of American College Nutrition, 1991, 10:383-393.

  9. Frieden’s Health Impact Pyramid: Modern Interpretation of the Geoffrey Rose Approach Source: Frieden AJPH 2010

  10. Active Design and Physical Activity

  11. Fit City Conferences

  12. Active Design Guidelines • Extraordinary collaboration between city agencies, AIA, private architects, academics and public health • Download here: www.nyc.gov/adg

  13. Trans Fat restriction

  14. Restricting Trans Fat in NYC Restaurants Source: Angell et al. Ann of Internal Medicine 2009 • NYC was the first city to implement restriction of trans fat • December 2006: • Health Code amendment passed • Phased in over 18 months • Applied to all NYC restaurants and mobile vending commissaries

  15. Impact of Trans Fat Reductions Sources: Angell et al. Ann of Internal Medicine 2009; Angell et al. Ann of Internal Medicine 2012 November 2008: Trans fat use had decreased from 50% to <2% June 2009: Decrease of 2.4 g of trans fat per purchase at NYC fast food restaurant November 2013: FDA announced proposal to reduce trans fat from the food supply

  16. Calorie Labeling

  17. Enacting Calorie Labeling in NYC • July 2008: Enforcement begins • Restaurants that are part of chain with ≥15 locations nationwide required to post calorie information Subway Menu Board, 2007

  18. Impact of Calorie Labeling • October 2008: Calorie labeling did not decrease calories purchased overall • Reductions in those who saw and used labeling • Nationally calorie labeling will be required at restaurants with ≥20 locations Source: Dumanovsky et al. AJPH 2010

  19. The National Salt Reduction Initiative

  20. National Salt Reduction Initiative Strategy • Set Targets: 2012 and 2014 target for packaged and restaurant food categories • Invite Commitments: 28 food companies are committed to the NSRI • Monitor changes: Changes in sodium in foods and in population intake using 24-hour urine collections

  21. Preliminary Results and Evaluation of the NSRI • March 2011: Heart Follow-Up Study 2010 results release • Baseline sodium intake in NYC adults using 24-hour urine collections (n=1656) • Mean NYC adult intake is 3,150 mg sodium/day • February 2013: • 21 companies met their sodium targets

  22. Closing Remarks • Chronic disease interventions that make the healthy choice the default choice may be implemented at the policy level. • Cities can be the first step to implementing health initiatives and creating evaluation systems. • Locally initiated health policies can benefit citizens nationwide.

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