Author Archives: Carley Riley

Transforming Communities to Reduce Stress and Improve Health

Jul 8, 2014, 9:00 AM, Posted by Brita Roy, Carley Riley

Brita Roy, MD, MPH, MS, is a Robert Wood Johnson Foundation (RWJF)/U.S. Department of Veterans Affairs Clinical Scholar, and Carley Riley, MD, MPP, is an RWJF Clinical Scholar. 

You awake to the sound of your alarm, not feeling as rested as you’d hoped. Hurriedly bathing and dressing, you then grab a breakfast bar and stumble over your long-neglected bicycle to climb into your car, joining other anonymous drivers enduring their morning commutes.

Unfortunately, these sorts of mornings, all too common to Americans, create negative stress and worsen health. Under time constraints and other pressures, stressed individuals engage in less healthy behaviors: eating more unhealthy foods, exercising less, smoking more, and sleeping less than their less stressed counterparts. And the persistent assault of low-grade stressors, such as air and noise pollution, constant rush, lack of nature, and social isolation repeatedly trigger our bodies’ stress responses, promote persistent low-level inflammation, and subsequently undermine our cardiovascular and overall health.

Beyond these familiar stressors, emerging research is showing how the nature of our communities and our relationships within them—our social environment—also influence our health. We are learning that living in neighborhoods in which residents do not know or trust each other increases negative stress levels. And how living in communities in which residents do not have confidence in their government or do not believe they can affect change to better their lives also creates stress.

We have greater understanding of how people living in neighborhoods with high crime and violence rates experience more chronic stress. And we are finding that living and working in environments in which we feel powerless augments the negative health effects of stress. 

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A Call for Better Measures: The Well-Being of a Population is Consequential

Feb 7, 2014, 9:00 AM, Posted by Brita Roy, Carley Riley, Cary Gross

Cary Gross, MD, is a professor of medicine and co-director of the Robert Wood Johnson Foundation (RWJF) Clinical Scholars Program at Yale University. Carley Riley, MD, MPP, is an RWJF Clinical Scholar and Brita Roy, MD, MPH, MS, is an RWJF/U.S. Department of Veterans Affairs Clinical Scholar. This post is part of the “Health Care in 2014” series.

file Cary Gross

As a new year begins, we are inundated with information summarizing the prior year: the top 10 movies, most newsworthy moments, and worst Hollywood breakups. Yet the topic that draws the most attention is the economy and our financial health. We gather a tremendous amount of information to assess this. The Census Bureau randomly selects 60,000 households each month, unleashing a swarm of 2,000 field representatives to track down the selected participants and assess their employment status. The Bureau of Labor Statistics surveys 500,000 businesses to estimate job creation. Approximately 5,000 “consumers” are surveyed each month to gauge their confidence. And so on.

file Carley Riley

So there you have it: we know that in 2013, the unemployment rate decreased from 7.9 percent to 6.7 percent, about 2.1 million new jobs were created, consumer confidence increased, and the Dow Jones index rose by 26.5 percent. Certainly, the health of the national economy is important, but is this the type of health that really matters most? When envisioning a healthy life, many people think about the sort of health that allows us to engage in enjoyable activities, maintain strong interpersonal relationships, and feel that our lives have purpose. A full assessment of health—of individuals, communities, and the country—should assess these dimensions.

file Brita Roy

Aren’t we already awash in data about health and well-being? Yes and no. There are abundant data concerning insurance status, prevalence of diseases, and utilization of health care. Additionally, large national survey efforts through the Centers for Disease Control and Prevention gather information on disease risk factors and health behaviors.  But well-being is not captured by these data. Well-being is a comprehensive construct accounting for interwoven facets—such as physical, mental, and social health—that together comprise a global assessment of true health. It refers to a positive state of health that allows for the pursuit of meaningful activities, formation of a cohesive social network, planning for the future, and coping with, overcoming, and even growing from negative events.

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