A model for disease prevention and health promotion | Wayne Giles | TEDxChicagoSalon

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what determines health

my parents grew up in the new york city

area and when i was about three years of

age

we moved to the philadelphia suburbs

my parents were working with a real

estate agent and they noted that that

agent was only showing them homes

in certain communities and so they ended

up partnering with a local minister and

his wife

who were both caucasian and the minister

and his wife

actually posed as individuals who were

looking for a home

and it was through this parade that my

parents found the home

where i grew up my mother

was also a diabetic and as a child i

would frequently go with her

to see her physician and i was always

fascinated

by the interactions that she had with

her provider

she would frequently get her blood

sugars measured and when she did

her blood sugars would frequently be in

the high 200s

to 300s a normal is about 120.

on the way home we would frequently talk

about the interaction that she had with

her physician

and i would talk to my mother about her

blood sugars and i would say to her

gee mom your blood sugars seem awfully

high

my mother in a very loving and caring

way

would reassure me and tell me that for

her

her blood sugars were actually pretty

good

my mother ended up passing away from

diabetes at the age of 44

and i was 19 at the time and i remember

wondering if this was some sort of

anomaly

or not i went on to medical school and

completed residencies in both preventive

medicine

and internal medicine and during my

training

i would frequently see patients with

heart disease

and emphysema and cancer and many of

these patients continued to smoke

i would talk with them about their

encounters that they had with their

physicians

and i would ask them if their physicians

had ever talked with them

about not smoking and all too often

the answer to that question was no

you know today only eight percent of

people

are receiving the important clinical

preventive services

they need and are recommended for them

eight

percent wouldn't it be great if instead

of that

we could focus more on prevention and

health promotion

if we could spend more time with our

patients to understand their risk

factors

but the reality is how we are trained

and how we are reimbursed as physicians

we are rewarded to treat disease not to

prevent disease

i ended up going to the cdc where i

spent over 20 years

researching racial and ethnic

disparities

in heart disease and diabetes and cancer

and through that work i learned that my

mother's death

in reality was not some sort of an

anomaly

but for too many individuals in black

and brown communities

they're dying at a younger age for heart

disease and diabetes

and cancer i also did some research into

my mother's childhood

and i learned very soon that what she

was experiencing

and that she experienced a number of

stressors as a child

and these stressors had a huge impact on

her health and well-being

they were stressors like poverty and

housing

and food insecurity you know data from

the adverse childhood experiences study

shows that physical abuse by itself

can increase the risk of heart disease

by up to 50 percent

this is not just true in black and brown

communities but it's true

in immigrant populations veterans and

the population

overall another patient that i

frequently think about

is a woman by the name of mrs means she

was 36

she was overweight she had diabetes much

like my mother

and also hypertension and arthritis as

well

during one particular visit she was she

wanted to talk with me

about losing weight and i got really

excited during that visit and

was almost jumping out of my seat with

excitement

because of my interest in health

promotion and prevention

and so i said to her mrs means we can

work together to make something work for

you

i said i want you to start out really

slowly and i want you to go outside and

walk

up and down your block there was a brief

period of silence and then mrs means

said to me

you know dr giles it's not safe for me

to walk in my community

and i immediately came back with a

response

and i said no problem mrs means we can

make it work

i want you to go to the mall and walk

for 10 or 15 minutes at the mall

again there was this brief period of

silence she had a bewildered look on her

face

and then she said dr giles for me to go

to the mall i've got to take three buses

and it's going to take me 45 minutes

each way

that's not going to work for mrs means

the last person i want to talk about is

go to today

and talk about my uncle tommy wiggfall

tommy is an amazing individual he loves

his cosmopolitan at the end of the day

he loves sports he's a huge tennis and

track fan

and he loves the new york giants every

sunday he's in his man cave

which has all this new york giants

paraphernalia

throughout the room tommy also smoked

for a number of years

and he has a little bit of emphysema and

heart disease and diabetes

as well the second week of march of this

year

he developed a cough that cough got

progressively worse

he developed shortness of breath he went

into

he went to the hospital and on april 1st

seven days before his 75th birthday

he passed away from the ravages of kovid

covid19

as i think about each of these

individuals

i wonder is there something that we

could have done differently

could academic institutions and the

community come together

and you know the reality is this is a

model

that has worked throughout the decades

in north korea finland in the 1970s

a group of women were concerned because

their husbands were dying from heart

disease

at a young age they went to the

government and demanded

that the government do something

differently and the government act

asked academic institutions and the

community to come together

they developed a program and through

this program they saw

dramatic declines in smoking and

cholesterol levels

and most importantly they saw declines

in heart disease as well

more recently in the 1990s the centers

for disease control and prevention

created a program called reach racial

and ethnic

approaches to community health this

program

funded academic institutions such as my

own at the university of illinois at

chicago

and community groups to come together to

address

race disparities and through the program

we've seen

improvements in fruit and vegetable

consumption

physical activity and smoking

most recently because of the impact

that covid19 has had on black and brown

communities

here in the city of chicago mayor

lightfoot has created a racial

ethnic rapid response team

that team has included academic

institutions

community-based organizations chicago

department of public health

and the mayor's office together we're

looking and using

hyperlocal data to target

prevention and communication messages

and

also to target testing to high impact

communities

and through this program we've seen

dramatic declines

in mortality and cases of covet 19.

our work is clearly not completely done

but we've seen dramatic

improvements what if

my uncle tommy wiggfall had had such a

program in his community

that could have educated him about the

importance

of avoiding crowds and wearing a mask

what if mrs means had had such a program

in her community

and they had worked to create safe

places to be physically active

and what if my mother had had such a

program

that could have helped her to manage her

diabetes so that she knew glucoses of

290

were not good for her the reality

is this is a model that has worked

throughout the decades

we need to scale this model up to

improve health

and well-being all we need is the will

to make it happen