Social Determinants of Cardiovascular
Disease: Food Justice & Active Living
to Prevent CVD
Filipino American Cardiovascular Health
July 8-9, 2011, Washington DC
Executive Director: Rod Lew, M.P.H
Email: rodlew@appealforhealth.org
Website: www.appealforcommunities.org
Overview
• Describe risk factors for cardiovascular diseases
• Describe role of policy change and social
determinants in eliminating health disparities
• Describe APPEAL framework for addressing
policy change on tobacco, healthy eating and
active living for AAs and NHPIs.
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CVD and Risk Factor Prevalence
• Cardiovascular disease (CVD) is one of the leading
causes of death among AA&NHPIs. In 2007, it
accounted for about one in four deaths among
AA&NHPIs (24.4%).
• Asian Americans appear to be at greater risk for CVD
at lower body mass index (BMI) than other ethnic
groups.
• Filipinos have the 2nd highest CVD rates among Asian
American subgroups according to self-reported
national data.
• Although the prevalence of obesity is low within the
adult Asian population, Filipino adults (14%) were
more than twice as likely to be obese as Asian Indian
(6%), Vietnamese (5%), or Chinese adults (4%).
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Percentage of Asian Adults Who Were “Current Smokers”, 2004-2006
25
20
15
10
5
0
Chinese
Filipino
Asian Indian
Japanese
Vietnamese
Korean
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Percentage of Asian Adults with Selected Health Conditions, 2004-2006
40.0
35.0
30.0
Overweight
25.0
Obese
20.0
Heart Disease
Hypertension
15.0
10.0
5.0
0.0
Chinese
Filipino
Asian Indian Japanese Vietnamese
Korean
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Winnable Battle
At least 80% of premature heart disease,
stroke, and type 2 diabetes could be
prevented through healthy diet,
regular physical activity
and avoidance of tobacco products.
- WHO, 2009
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Will “Fixing” the Individual Work?
• Historically, the public health response to
preventing and controlling cardiovascular
disease (CVD) and type 2 diabetes has focused
on “fixing” the patient by addressing behavioral
risk factors, such as increasing physical activity
and improving dietary intake.
• The responsibility for health condition placed on
individual, thereby resulting in “blaming the
victim.”
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Limitations of Behavioral Change
• Traditional behavior change strategies have had some
positive, but limited effects and will not likely be sufficient
to eliminate these health disparities at the population
level.
• Ex. the Traditional Hawaiian Diet (THD) showed that
while majority of the participants successfully realized
short-term weight loss and improvements in health,
longer term weight loss was a challenge.
• Participants attributed this to difficulties in accessing
fresh and affordable produce and the lack of a
supportive environment for healthy eating.
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Results from Tobacco Industry
Documents 1988-1995
• AAPI market important due to
population growth and geographic
clustering
• AAPIs had “predisposition to smoking”
and increased consumer purchasing
power
• High percentage of AAPI retail
business owners
• Philip Morris’ PUSH, PULL and
CORPORATE GOODWILL strategies
Tobacco’s Impact on
AAs and NHPIs
• Sacred Use of
Tobacco
• History of Tobacco’s
Commercialization
• Heavy Targeting by the
Tobacco Industry
• Disparities in
Resources and
Capacity
• Tobacco as a Social
Justice Issue
Per Capita Cigarette Consumption United
States 1900 to 1999
Source: Tobacco Use - United States, 1900-1999. MMWR November 5, 1999; 986-993
Place Matters:
The Food Environment
Studies have shown that food environment influences health:
• Availability of food outlets that sell nutritious and affordable
food is a big factor in promoting healthy diet among
individuals and reducing obesity and diabetes risk.
• Lower income neighborhoods that are commonly populated
by communities of color have fewer grocery stores, greater
abundance of fast food outlets and convenience stores.
• Those who live near an abundance of fast-food restaurants
and convenience stores compared to grocery stores and fresh
produce vendors, have a significantly higher prevalence of
obesity and diabetes.
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Race/Ethnicity Matters
• When controlling for SES, the differences in health
status between blacks and whites are reduced, but
within each level of SES, blacks still tend to have worse
health status than whites.
• Race as a lived experience and social construction tends
to have an effect on health, independent of SES.
• Social stigma of being black, and the internalization of
society’s ideology toward blacks result in expectations
(on the part of blacks) of rejection and discrimination,
anxieties, and “reactions that affect the functioning of
marginalized groups.
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Image Source: World Health Organization
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Social Determinants of Health
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What are the food environments surrounding Filipino Americans?
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Strategic Framework for Healthy Eating and Active Living Policy Work among Asian Americans,
Native Hawaiians and Other Pacific Islanders
Inputs
Guiding
Principles
Community
Readiness
Advocates
Communities
Strategic
Planning
Community
Capacity
Building
Leadership
Development
Community
Participation
Policy
Mainstream
Institution
Policy
Legislative
Policy
Corporate
Policy
Community
Competence
Environment
Assessment
and Data
Community
Mobilization
and Organizing
Prioritization
and GoalSetting
Infrastructure
Development
Partnerships
Resources
Community
Empowerment
Time
Long Term
Outcomes
4-Prong Policy
Change Model
Community
Coalitions
Leaders
Short Term and
Intermediate
Outcomes
Programs
Cessation
Prevention
Greater access to
healthy nutrition,
higher levels of
physical activity
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Health Parity
and
Health Justice
APPEAL Network
APPEAL began the PROMISE (tobacco control)
and NAPNEHD (healthy eating and active living)
networks to eliminate health disparities in the
diverse AA and NHPI communities by focusing on
environmental and policy change.
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NAPNEHD Local Affiliates
• Coalition for Asian American Children &Families (New
York)
– Collaborates with 6 Coalition Partners to serve the Filipino, Nepali
& South Asian, Southeast Asian, other Pan-Asian communities
• Coalition for a Tobacco Free Palau (Republic of Palau)
– Collaborates with the Palau National Olympic Committee, the
Palau Medical Commission (for sports), and the Palau Softball
Federation to serve Palau’s sporting community
• Washington Asian Pacific Islander Community Services
(Seattle)
– Collaborates with 25 partners to serve the Cambodian, Chinese,
Filipino, Korean, Lao, Samoan and Vietnamese communities.
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APPEAL’s Leadership
Experience
APPEAL Leadership Summits
(1997, 1999, 2000, 2004)
APPEAL Youth Leadership
Summits (2002, 2004)
National Latino Leadership Summit
(2002)
National Cross Cultural Leadership
Summit (2004)
Washington Cross Cultural
Leadership Institutes (2004, 2005)
Leadership and Advocacy to
Advance Minnesota’s Parity for
Priority Populations (2005-7)
600 Fellows Trained
“APPEAL trainings are intense, in-depth, refreshing, and understands
and embraces the diversity and cultural perspectives of the
participants. And most of all you feel good… because for the first time
my history, cultural, and experiences -- were allowed at the table.”
- Brandie Flood, Center for Multicultural Health
Impact of Leadership
Development
• Individual: Increased knowledge and skills
• Community: Mobilization, capacity building and
interventions
• Policy/Systems: Funding, representation and
legislation
• Cross Cultural: Increased collaboration,
empowerment and parity
A Movement ?
APPEAL’s 4- Prong
Policy Change Model
1. Need to advocate within our priority
populations where tobacco is not a high priority
2. …within the mainstream tobacco control
movement where priority populations are not a
high priority
3. …with policymakers where neither tobacco nor
priority populations are a priority
4. …against the tobacco industry where priority
populations are one of the high priorities
2011 APPEAL Policy Recommendations
• Fund data platform that provides consistent and
standardized organization of disaggregated local and
regional AA and NHPI population data.
• Fund the replication of model programs and policy
initiatives for AA and NHPI communities including
capacity building initiatives.
• Increase the representation of AA and NHPIs on key
national and regional decision-making bodies.
• Monitor and regulate the tobacco and agri-food industry
including food conglomerates and fast food companies
that target AA and NHPI communities with unhealthy
food products.
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Participate in Our Upcoming HEAL Webinar, “Building
Communities Around Healthy and Responsible Food”
on July 21, 2011!
• Visit our website www.appealforcommunities.org for more
information.
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