Expert in social disparities speaks at Missouri Health Policy Summit

Saturday, October 31, 2009 | 12:01 a.m. CDT; updated 1:37 a.m. CDT, Saturday, October 31, 2009

COLUMBIA — Not living close to a supermarket can be hazardous to your health.

"People living in communities ... that do not have a supermarket are 25 to 46 percent less likely to have a healthy diet compared to people with the greatest access," said Darcy Freedman, assistant professor in social disparities at the University of South Carolina. "These data suggest that where you are, where you live, where you work, where you play, has an impact on obesity and related health issues."

Freedman presented this research at the Seventh Annual Missouri Health Policy Summit, which drew about 250 medical professionals and congressional representatives from eight states to the Hilton Garden Inn conference center Friday. Her speech was one of three on the implications of health care reform for state policy.

Through her research in Nashville, Tenn., Freedman said she found that access to food stores was limited in low-income Nashville communities. She said convenience stores were the most prevalent food store available to members of poorer communities.

"Seventy percent of the stores in these communities were convenience stores, such as the discount cigarette store and the discount beer market, cigarette store," she said.

Freedman focused on social determinants, such as income, and where one lives and works as conditions that can cause a person to develop certain diseases.

"There's a significant and long history of evidence suggesting that social determinants are fundamentally associated with health outcomes," she said.

Among these is diabetes.

Freedman showed a graph correlating the lack of access to health foods in low-income urban areas and high obesity rates in those communities.

She then said more than 60 percent of the convenience stores and local markets in the area did not sell fresh fruits, fresh vegetables, lean meats, low-fat milk products or whole-grain breads.

According to a fact sheet provided at the summit, which sourced the Centers for Disease Control and Prevention, 82 percent of high-school students and 80 percent of adults in Missouri consumed fewer than five fruits and vegetables a day.

The statistics show that physical inactivity and unhealthy eating habits contribute to a number of chronic diseases, such as some cancers, cardiovascular disease and diabetes, and that chronic diseases are among the most costly, prevalent and preventable health problems in the U.S.

The most prevalent of these in Missouri in 2005 was heart disease, the CDC statistics show, which caused 27 percent of all Missouri deaths.

The CDC statistics also showed that 63 percent of Missourians were overweight or obese in 2007.

Former Senate Majority Leader Tom Daschle, who spoke earlier in the morning, said prevention is one of the major goals of health reform. He said the three major initiatives to improve primary care, wellness and prevention are to increase reimbursement rates for primary care physicians by 5 percent, increase incentives to improve quality care and increase availability for medical school students who want to practice primary care.

This could be accomplished, Daschle said, by helping pay for primary-care students' education, given they serve in underserved communities after graduation.

"What we're trying to do is to reduce costs in the longer term," he said.

Brad Hall, manager of chronic disease and nutrition programs for the Missouri Department of Health and Senior Services, said he attended the summit out of curiosity.

"I'm curious to hear all the different aspects of health reform ... and how health reform will affect my programs and public health in general," he said.

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