Lowering Cancer Risk by Improving the Environment

April 12, 2017 | by Josh Jenisch

“What if the way we care for the hungry turns them into the sick?”
April - Minority Month - Tim Tim Alderson
That was the question Tim Alderson asked himself a few years ago as he considered the prepackaged, calorie-dense meals often fed to the needy.
 
Alderson, who leads the food justice arm of the Episcopal Diocese of Los Angeles, knew that providing food isn’t always synonymous with providing nutrition.
 
So, with the blessing of Bishop Jon Bruno, Alderson founded Seeds of Hope, a program that turns unused and underutilized church property into small farms that feed the undernourished and provides health and wellness education to those who work the soil.
 
“At the time, the bishop was a patient at City of Hope where he was being treated for and was ultimately cured of leukemia,” Alderson said. “Having just been told that he was ‘metabolically clear’ he began thinking about how to invest the five years he had left until mandatory retirement. He wanted to do something especially meaningful.”
 
That “something meaningful” turned out to be Seeds of Hope, designed to give underserved communities control of their own health by providing access to inexpensive foods. He says the idea was simple: Use the 210 institutions that make up the Diocese of Los Angeles and turn available space within those institutions into a vertically integrated food system.
 
"Each of these institutions has at least some space to grow food," said Alderson. "Everywhere access to nutrition is a problem generally in poorer neighborhoods the diocese has facilities where it can be distributed.”
 
The program is especially helpful considering poorer neighborhoods served by the diocese also are places where the social and physical environment conspire to create other problems, like chronic disease.
 
Environment has a direct association with overall health and cancer risk. Without access to affordable, nutritious foods, obesity rates rise in certain communities — and obesity is linked to an increased risk of cancer.
 
Alderson has seen this firsthand.
 
“Environment absolutely affects people’s health,” he said. The negative stuff in life crime, poor health, poor nutrition all of it runs downhill toward the lower end of the socioeconomic spectrum. It’s a precarious existence.
 
"Many of these folks are working multiple jobs to try to make ends meet and they’re still dealing with food insecurity. To stretch their money, they depend on fast food and prepackaged food, neither of which are the building blocks of good health.”
 
Seeds of Hope is a shining example of literal “grassroots” activism, empowering the community to take back its health by changing its physical environment. Currently the organization is growing and distributing food in over 100 communities across the six-county diocese.
 
The ‘Built’ Environment
 
Like Alderson, City of Hope researchers are working to change the physical, or “built,” environment.   
  
Kimlin Tam Ashing, Ph.D., is a professor and director of CCARE, City of Hope’s Center of Community Alliance for Research & Education, established to improve health care access, disease diagnosis and treatment outcomes for ethnic minorities and others living in lower socioeconomic communities.  
April - Minority Month - Ashing White BG Kimlin Tam Ashing, Ph.D.
“We understand that there are associations between environment and cancer,” she said. “We can clearly see the relationship between poverty and poor health outcomes, for example. And although we don’t always understand the exact mechanism of that relationship, that doesn’t mean we can’t act.”
 
CCARE’s goal, in part, is to positively impact health by making substantive changes to community environments.
 
“As a society, we need to create environments that support health and well-being,” said Ashing. “At the same time we’re teaching people to eat healthier or exercise more, we need to be addressing the built environment: better education, affordable homes, access to low-cost, high-nutrition foods and safe places to be physically active and play.
 
"How can we tell people to eat more vegetables when the nearest place selling them is 20 miles away? How can we tell them to exercise when the park is run down and unsafe?”
 
To that end, the CCARE team works with healthy food retailers to encourage them to accept EBT cards, California’s version of food stamps, and place healthy food in more visible areas of the store. When large-scale change is necessary, the team teaches community members to lobby on their own behalf.
 
“Health policy is dictated by the government,” said Ashing. “Communities need to make their voices heard. Why do you think there are sunshades in parks? Why do you think they don’t serve soda in [California] schools? It’s because people stood up and said, ‘Enough.’”
 
Noe Chavez, Ph.D., a community psychologist at City of Hope, said that in addition to big community-changing initiatives, it’s important to remember that a real difference can be made by working with individuals, too.
April - Minority Month - Noe 2 Noe Chavez, Ph.D.
“A person’s environment isn’t just their city or town,” he said. “It’s a collection of external forces that impact their way of life. People in CCARE do a great job targeting the whole person. They understand that there are all sorts of needs, not just health needs. They understand the problems facing an individual housing, income, etcetera and then they marshal the resources needed to deal with all of it.”
 
Chavez said that many at City of Hope share CCARE’s whole-person approach.
 
“There is great support for local communities here,” he said. “They have backpack drives for schoolkids. They put together Easter baskets. The nurses even raise money so that they can travel to impoverished countries and train the nurses there.”
 
The Education Environment
 
While a lack of resources can be devastating, Ashing said that the situation is compounded by a lack of culturally and community responsive health education.
 
“Even if we can’t change the built environment, we can still offer people information about choices,” she said. “If we can’t change context, we can influence choice, and we can propel families into community advocacy.”
 
CCARE’s “Eat, Move, Live” program links City of Hope with cities and school districts to implement obesity, diabetes and cancer prevention programs largely nutrition and exercise-based in a school setting.
 
“The programs are conducted in culturally and linguistically sensitive manner, which is why they’re successful,” said Ashing.
 
Alderson, with Seeds of Hope, has had similar success with his educational outreach efforts. A shining example, in El Monte, California, is the organization's work with the Cleaver Family Wellness Clinic.
 
“We don’t just distribute fresh fruits and vegetables there," he said. "We’ve built a teaching kitchen inside of it. So you come and pick up your vegetables, then attend a cooking class to see how to prepare them — and the City of Hope CCARE team is about to begin offering its 'Eat, Move, Live' program there.”
 
Success for Ashing is something that can be scientifically measured lower BMI, lower weight, lower blood pressure. For Alderson, the evidence is more anecdotal (though a quantitative study in partnership with City of Hope in the works).
 
“We see the change,” said Alderson of the people served by Seeds of Hope programs. “We hear about the changes they’ve made with regard to cooking and eating. We see them losing weight. We see the impact.”
 
But Ashing and Alderson realize there is a lot more work to be done.
 
“It is a bidirectional partnership,” said Ashing. “We talk to each other; we work side by side. We’re moving in the right direction, but the need for policy changes is clear. Education, health, housing and safe environments these aren’t just privileges, they’re fundamental human rights.”
 
For Alderson, knowledge that he is making a difference is reassuring.
 
“There’s a story about a man walking along a deserted shoreline,” he said. “All of a sudden, he comes upon a boy on the beach surrounded by thousands of starfish. One by one, the boy picks up the starfish and tosses them into the sea. The man says, ‘Young man, why are you doing this? There are thousands of these creatures, you cannot possibly make a difference.’ The young boy tosses another starfish into the sea and looks up at the man, ‘I made a difference to that one,’ he says.”
 
 
Stories of Hope is a monthly series that explores important issues in health care. To commemorate National Minority Health Month, we are dedicating the entire month of April to health care disparities.

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