[Music] this joa is heavy as I was how loud are you about 280 18 plus% of our children right now are obese if you go with the flow in America today you will end up overweight or obese as 2third of Americans do I don't want to be fat for the rest of my life I've got diabetes sleep apnea high blood pressure I get dizzy when I get up everything's hurting [Music] though if we don't now take this as a really serious urgent National priority we are all of us individually and as a nation going to pay a really serious [Music] price so here in the South Bronx this is the lowest income County in New York state we have the highest rates of obesity uh and this map is showing in the neighborhood we're in now more than 30% of the people being obese very high prevalence of diabetes just a short distance away here in Manhattan the Upper East Side where it's the highest income neighborhood in the city uh we have very low prevalence of obesity very low prevalence of diabetes 2third of adults Citywide are overweight or obese but in the darkest areas on this map over close to 90% in some cases of adults are overweight or obese and you can see in the areas that are lighter around University City lower rates of obesity and look at all the healthy food sources yeah so all the produce cars the supermarkets the farmers markets and when you go back to these areas that have higher rates of obesity you see many fewer sources of healthy food there has been a recognition of the seriousness of obesity as an issue for the whole country but if you look at the state of Tennessee in Nashville which is where where we're located it is a crisis level here I mean we rank at the bottom about one out of 10 adults is walking around with diabetes if you look at people who have not graduated from high school it's one out of five the red spots in this particular map are the where the the highest rates of of of poverty art we know that in this area almost one out of every three children is considered to be overweight or uh obese and this is an area as you were saying with poverty the average household income is less than $25,000 for a family of four Orange County California is an extremely wealthy County one of the wealthiest counties in the United States Orange County has a very high number of parks and Parks space in fact per 1,000 residents in Orange County there are 41 Acres of parks in open space but not in Santa [Music] [Laughter] [Music] Ana this red circle reflects the proportion of kids that are overweight or obese look at the difference between that Circle and this tiny little circle in Irvine and all of this yellow which reflects relatively High rates of wealth right next door to these Deep Pockets of poverty overweight and obesity so what is happening here is that we have data that can document that not everybody have the same resources to fight diseases and at the end the epidemics are reduced to the pockets of [Music] poverty us formally and welcome everyone [Music] I want to take the committee on a just a very brief Journey from the uh perspective of a local public health practitioner so the death certificate is actually a pretty good source of data can tell what somebody died of you can tell what age they were when they died you can tell what their race ethnicity is and you can tell where they lived and those four pieces of data can tell you a lot about patterns of death in a community [Music] where you live matters and it matters a lot another way of putting this is does your ZIP code matter more than your genetic code this is Baltimore Maryland where they have a census track down uh near the Inner Harbor with the life expectancy of 62 years and another life expectancy up in Northern Baltimore 82 years of 20-year life expectancy difference this is kyoga County Cleveland where we thus far have found the greatest disparity in in life expectancy this is Huff an inner city neighborhood with the average life expectancy of 64 years and 8 miles down the road is Lind Hurst with a life expectancy of close to 90 years understanding what drives that disparity is going to help us understand what is driving the chronic disease epidemic it's going to help us understand the tools and strategies to get underneath the Obesity epidemic obesity is the primary driver of chronic disease the big contributor to diabetes cardiovascular disease stroke and some cancers and so with our health care costs at over 2 trillion dollar our nation's costs are enormous in a low-income neighborhood there's a different food environment not only do people make less money they're surrounded by lower quality food it's difficult to get fresh vegetables and they're more stressed and so it brings up this question of what degree of free will do people really have when they're in a certain controlled environment and until we can understand that there are large social and economic forces that predict obesity we're never going to solve the epidemic there is a design there is an urban design that is making people sick there is an urban design that is making people obese overweight there is a design that is making people develop chronic [Music] diseases there's no healthy places in my neighborhood the most that we have is like Chinese McDonald's uh KFC with all the burger joints and Deals and 99 cent this and it's 99 cent everywhere if I have $3 you go buy two burgers for 99 cents each and a soda for us it's more accessible to go to the fast food I got a family of five kids and it's hard to just do it on the cheap food you know there's limited resources I'm going to pick what I can afford to feed my family you know to get to the grocery store and to find the healthier foods then to have to prepare those foods and and the expense it's almost out of the picture for someone in my situation if you are uh confined to living in a particular neighborhood because of the amount of money that you make obviously the choices that are in that neighborhood are going to be your only choices so the same populations where people have food insecurity where people worry about about where they're going to have the money to get their next meal are the same populations where we're seeing the highest obesity rates I may live in community if I'm low income in this country where there are food deserts where there aren't amenities that give me access to fresh vegetables fruits and other high quality foods and the streets that I may want to go exercise on may be crime R there may be cars or freeways or there may not be Parks so here I am trying to exercise personal responsibility and I can't be healthy so if they ever tell you you don't have any options for eating well you you should definitely come to my neighborhood cuz you have the McDonald's right there you have the subway Fried Chicken then you can go get a coffee or a donut Dunkin Donuts if you're still hungry you can go to the Wendy's right there this is junk food heaven when you see food even pictures of food it makes you feel hungry in poor neighborhoods there are many more posters and and billboards and you know Outdoor advertising for food that you don't see in wealthy neighborhoods people here have two or three jobs to pay the rent to pay for a Metro Car you know they don't have time to cook home in a low-income neighborhood there are more convenience stores in fact two to four times as many small convenience stores that predominantly sell foods that are high sugar fat salt hello hi go into a poor neighborhood anywhere in America in a small store what do you see there chips soda candy these are products that are made from sugar uh they're made from wheat they're made from corn and they have an enormous shelf life a year or more these are products that have a very large profit margin you see this is my downfall right here the Honey Buns two for a dollar cheap cow are unhealthy calories you can easily in Bodega and South Bronx get 1,300 calories for a little more than $2 you can get more than you need for an entire day for less than $3 2 lit soda you might get a special offer of 99 and the water why is it more [Music] expensive we can't really make a dent in the Obesity epidemic if we don't start making a dent in the disparities between the low income and the high income communities we have to understand that in a very lowincome Community there are much more profound challenges and we have a much greater obligation as a society to create changes in that environment there's a societal not just responsibility but I think investment issue here um because everyone benefits from everyone else being healthy more people are unhealthy that's less economic productivity it's more healthcare costs a variety of other costs that everyone has to take on what type of nation can live without a Workforce that is healthy so what diabetes and obesity is doing to this nation is crippling the workforce but beyond that crippling the families and the individuals and the communities [Music] my [Music] we are city with a high population density uh and so there are mobile vendors all over the city and there are more people who want to vend than there are available permits and so we said we could take advantage of that um what came out of that was the idea of the green carts what we did was we raised the cap on the total number of mobile vendors in the city but only for vendors who were willing to sell fresh fruits and vegetables according to our specifications and only if they sold them in underserved neighborhoods people are strolling by they're seeing this healthy food here and that competes with all the advertising you're seeing for junk [Music] food all my customers come every day every day my strawberri is the number one sell of strawberries everybody loves strawberries it's not too expensive it's cheap and it's fresh that that's the best part it's very fresh this doesn't last in my house we eat like two bags day oh can I have some cherries the biggest changes in health will happen by us creating a world where people naturally behave in a health your way thank you bye okay bye kids I'm responsible for a city of 8.3 million people every one of those people I consider to be my patient as a doctor um and of all the health problems I deal with this is the one problem is getting worse uh obesity and diabetes we haven't solved it yet there's a lot of things we're working on here uh each one I think can contribute to the solution but we haven't reversed it yet and so I'm always trying to understand better the nature of the problem and trying to see where is The Leverage where can we make changes uh that can really turn things around how are you I'm doing well how youing I'm doing well good [Music] you have issues of poverty certainly of crime uh but also lack of options and so then you get a proliferation of bad [Music] options that's a market yeah that's a small market deide and see what kind of they're mostly about mobile phones yeah I don't think they have too much food it's so they sell water sugar sweeten and Beverages and hot dogs where would you buy a salad along here yeah uh I don't think you would so uh food choices okay Chinese store right right and jumbo Stakes that would be it yeah see the yellow sign all the yellow it's really and all the way down too so folks are bombarded and if this is all you have there nothing else to buy yeah nothing else to buy if you don't have a car yeah and there's no big market right in your neighborhood I mean how many groceries can you carry on the try in many neighborhoods in Philadelphia unfortunately you you literally do have what we refer to as these food deserts and so the uh the alternative I'll go to the store you know two blocks down the street unhealthy products prices too high limited choices and I'll just deal with it and the outcome is bad [Music] Health I've got um two bananas and an apple 125 if you're in this area this bag is 25 cents if you go to City Line Avenue and a vending machine this bag will be 75 cents on up and it won't be marked 25 so it starts with the the company right they charge a little more in the neighborhoods where they can make up for the cost and they keep it cheap here and move product is there anything that you're able to sell that's on the healthier side that competes pricewise with this no not at all for 25 cents nothing kids they know no vegetable or fruit you know they may know apples and oranges but I mean I tell you I had a kid the other day I was eating in here and he asked me what that was I was eating broccoli fresh broccoli you know raw broccoli dipping it some of the kids are raised on this stuff it's chips candy soda you know this is a big part of these kids diet and you can see it reflects in their [Music] waistline every community may not be able to have a supermarket but we want to work with the stores that are already in neighborhoods to help them sell healthy products we've had a great response no this is really really pretty I mean we are very excited I wanted to comment on these labels because this is actually this is a traffic light right assemble something really easy for people they can just look at the colors go especially easy for kids to remember [Music] yeah I got married and moved into this community in 1973 when I moved here I realized that there was no Supermarket when you talk to people and say I don't have a supermarket in my area oh my god well where do you go I did not want to move I just wanted to make a difference and I wanted to make a [Music] change they made this happen uh and they pushed the political Community they pushed their neighbors they pushed uh the uh business community and convince folks that this could not only happen but work all of us on our time volunteering struggling blood sweating tears to make this [Music] happen this used to be Barren land weed overgrown concrete debris short dumping all kinds of stuff going on here uh and over the course of about a year and a half uh this entire section was transformed into what we see now brand new Supermarket they haven't had a supermarket in this community in 30 [Music] years all righty okay we are shopping I have to get some broccoli broccoli down here yes so then we are doing color greens it's like heaven I can come over here and get fresh vegetables it's marvelous it's convenient market mean everything for this [Music] neighborhood having the tools and resources right here in the community that's when you're making progress exactly what I'm looking for to watch this entire Community transform itself was just it really was incredible I've never seen anything like it it's best project I've ever been involved in in my life I know I [Music] know there are many small programs at different levels that we can use to chip away at the problem over time step by step we'll put in place systems and interventions that'll make it easier for people to be physically active and will change our food environment in ways so that people eat healthier we need more people to participate in decisions that are being made about investing in open space and Parks investing in grocery stores farmers markets and education of our kids around healthy eating and healthy diets I'm one of those people who believes we can reverse this trend and we do that not as individuals we do that together with other people in [Music] communities [Music] [Music]