Improving Community Health: A Q&A With N.Y. Times' Jane Brody

Jun 18, 2013, 11:30 AM

file Jane Brody, New York Times

Jane Brody is the Personal Health columnist for The New York Times. She joined the newspaper in 1965 as a specialist in medicine and biology after receiving degrees in biochemistry and writing for multiple college newspapers, as well as for the Minneapolis Tribune. With her column she has seen and reported on almost 50 years in the evolution of personal and community health.

NewPublicHealth recently spoke with Brody about her take on the state of community health—and what we can all do to improve it.

NewPublicHealth: Over the years, what efforts have you seen that you think have been most effective at improving community health?

Jane Brody: Well, I think one of the most exciting things that’s happened in New York City, and possibly in other cities as well, is getting better food to people who live in food deserts. For example, collecting food that would otherwise be wasted and bringing it to communities where people get free food that is healthy, fresh, and they even have demonstrations of recipes. In fact, I got one of my favorite recipes—it’s a green bean frittata—from one of their demonstrations that I attended just to see how it all worked out.

We’ve also, as you’ve no doubt heard, been putting in all of these bike lanes and we now have introduced the Bike Share Program, which is not inexpensive, but it does at least give more people an opportunity to get off their butts and get out of their cars and maybe even not even use public transportation in some cases, but to get some exercise to and from work, which is wonderful. I remember during one of the transit strikes that we had in New York City, I rode my bicycle from Brooklyn to Times Square where I work, over the bridges and stuff, and it was just wonderful because I got my exercise in at the same time as I got to work and I didn’t have to spend an extra hour exercising. There have been improvements. We have, of course, public pools that are only open in the summer, but in summer is better than no public pools and nobody has to pay anything for a public pool, which is really great.

NPH: What are ways you've noticed policy changes lead to individual and community health?

Brody: That’s a hard question, because I think that legislation has definitely pushed people to make some changes that are really good for them and good for the community. Of course, the most significant one has been the reduction in cigarette smoking. I’ve been a science and health reporter since 1963 and in January 1964 was the first Surgeon General’s report on smoking and health. I remember when I interviewed people who were smokers in the wake of that report, the most common response I got when I asked them what they’re going to do in the face of that new information, was oh, by the time I get lung cancer, they’ll know how to cure it—and of course that has yet to happen all these decades later and it may never happen that we know how to cure lung cancer. The better part of valor, of course, is to prevent lung cancer for as many of them as we can, and about 75 percent of the cases can be totally prevented by not smoking.

But what has really pushed people to quit were both laws and internal regulations like people saying you can’t smoke in my house or employers saying you can’t smoke in the workplace. And the workplace changes really came about because employers were afraid of lawsuits from the people who got sick because they were exposed to other people’s smoke. That’s certainly what happened on the airlines. The change in airline smoking rules did not come about because they wanted to protect the public; it came about because they were afraid of lawsuits from the flight attendants who were sitting back there with all the smokers and being exposed. But that change has been so phenomenal, I mean, it has really made a humongous difference in health statistics and in the healthiness of the air that everybody is breathing.

NPH: Does it take too long for some of these initiatives to trickle down to lower income communities or do you see that in New York, while it may start in one place, it is really spreading out to help improve the health of everyone in the city?

Brody: Well, I see that people are doing all sorts of things based on what they learned about their own lives and their own health. For example, I recently wrote about a woman who used to be, in her youth, a Rockette and remained a dancer and choreographer for many, many years and then decided that she wanted to do something really important that would have more of an impact on the health limits of the community. She became a registered dietitian and has created a food group musical that she takes to schools in disadvantaged communities and teaches the kids about nutrition, about healthy eating, and then has them put on a performance about all the foods groups and what you should be eating. Through repetition, they are exposed over and over and over again, and I went to one of these schools and I was just blown away by what the kids have told me.

For example, one little boy—now, these are just eight year olds and what do they care about nutrition—told me that now all the bread we have in our house is whole grain bread and another person told me that their house switched from whole milk to 1% milk, which is a darn size better than whole milk. It may not be skim, but it’s much, much better. So these kinds of things are happening and we really have to make it a societal norm. One of the sadnesses, I think, is who is smoking now. The lower economic groups are the ones who are the highest rate of smoking and that has not changed enough, although it will eventually, but it has not happened fast enough and it hasn’t happened in enough places yet.

NPH: Are there things that we can do to speed it up so that with the next initiative, you might be able to have changes that occur faster or save more lives?

Brody: The very most important thing to do—and I think our mayor has tried to do this—is to forbid the sale of cigarettes to people under 21. There’s no question that the vast majority of people who smoke started in their teen years. We have to not let teens smoke. Giving them health messages doesn’t have any meaning to them. I don’t know if you remember the ads that were used some years back with fashion models that were designed to show how disgusting cigarettes were. And I think we need to get that to the kids, we need to get kids to understand that this is not a socially acceptable habit, that it’s ugly, it looks ugly, it makes you ugly. You know, my husband smoked for 50 years and he finally quit when he saw his two beautiful young nieces smoking, age 14 and age 20. He knew how bad it was, it’s just that he started when he was 11 years old and these are the people we need to reach. We need to reach young people—younger than most adults realize are the ones who we have to influence. And he quit smoking. He made a deal with these two young women to quit if they would quit and he did. After 50 years he quit smoking and after many, many prior attempts that failed.

NPH: What else have you seen impacting community health?

Brody: One of the [other] issues in the city has been labeling menus. I remember I was in Starbucks shortly after New York said that food chains with more than a certain number of outlets had to list the calories for all of the fare that they offered. And I was in a Starbucks in an affluent neighborhood and I heard a young woman say, I don’t need to know that there are 400 calories in this drink that I’m about to get — it’s just ruining it for me. And I said to myself, well, you’re ruining your own health by drinking this junk. You really need to start thinking about what it is you’re putting in your body and this is one way to help you think about it. It has to come from many, many different directions. There’s no one method that’s going to make a change, but look at the changes that have occurred.

It has to be a really top-down, comprehensive approach to eating and exercise that we’ve yet to come to grips with. And one of the big sadnesses is the loss of physical education in our schools.

In fact, I think we need to talk about schools in general. We put the onus on parents and parents are not always the best people to motivate children to do the right thing. If we fail to make physical activity and healthy eating a part of a child’s upbringing and lifestyle and if we don’t bring it out in the schools, we’re never going to make any significant progress with our next generation. And the loss of physical education in so many schools because we’re now concentrating on standardized testing — it’s truly appalling, it should not happen.

NPH: Do you think individuals could focus more on the changes they make as individuals, which, if multiplied, could create healthier communities?

Brody: Well, that’s absolutely true, but the thing is we have to establish this as a societal norm before all the groups—all the socioeconomics and educational groups—sign on to it. Usually these changes start with the upper social economic groups and they filter down. I do see people taking other children, not their own children, to the park to play and certainly that’s important. It’s important that kids get out, they’ve got to get away from those electronics, they have got to get out there and move and use some of that energy. Why do we think we have all these hyperactive kids, I mean, they can’t pay attention and they’re restless because they need to move, children need to move, grownups also need to move — everybody needs to move.

I guess I do think that individual changes can make a difference, but it can’t be to the exclusion of establishing a broader environmental change. New York City is a very privileged environment because people walk. People use their feet to get from one place to another, and unfortunately, in many, many, many communities outside of the city there are no sidewalks. Where do you walk if there are no sidewalks? I mean, I’ve traveled around the country, I’ve been in many, many towns where there was no safe place to walk and I would go up to the hotel desk and say, where can I do an exercise walk. And they’d say, well you know we have a workout room. But I don’t want a workout room, I want to get outside. And we really need to establish this as this is what people do if you want to be human; if you are human, you have to do this and the more people who do it the better.

This commentary originally appeared on the RWJF New Public Health blog.