APHN ProgramCulture Of Health

Leading cause of death in the United States and in Hawaii are cardiovascular disease, cancer, cerebrovascular disease, stroke, accidents, diabetes, chronic obstructive lung disease, suicide. Not a single infectious disease in the group. What happened? What is the link between all of those? All of those are caused by societal factors. By indolence, not exercising, eating too bloody much, and by societal cues to do all of these. So again I had another colleague of mine who helped me do the obesity census. Her name is Susan (Forester?). I wrote a bunch of editorials (about cancer?), because remember diet and physical inactivity and tobacco use relate to the two leading causes, both cancer and cardiovascular disease. So if you do upstream intervention we created the whole concept of downstream disease and upstream interventions.

You make the healthy choice the easy choice. Traditionally the unhealthy choice has been the easy choice. But what public health folk are trying to do now, and this is as much medicine as giving people a tablet or doing anything else that seems to be very medical, is making the healthy choice the easy choice, whether it's on tobacco use, whether it's on tobacco control, whether it's on exercise, whether it's on the foods they eat, fruits, vegetables all of that is public health intervention.

Segue to what are we doing in Kauai for all of this. we do way upstream intervention the wholesale intervention I talked of that Joan and Tony and I and others try to do in the public health movement today. It's very simple. how do you prevent tobacco use? You have smoke-free beaches, you have smoke-free homes, you have smoke-free cars. You prevent a risk event from happening and you prevent the disease that is caused by that risky behavior. For exercise we have this gorgeous path by the sea it's called Ke Ala Hele Makalae. It was created by our current mayor Bernard Carvalho and our previous mayor and a whole bunch of people. Thomas Noyes, the entire Kauai Path group, Doug Hague, the head of building codes. A lot of people involved in the development of the path. And yet the path was developed as a recreational effort by Parks and Recreation, by others.
You have the walking path that goes up from here to Kapaa Middle. It goes up to Kapaa Elementary.

You want to have them exercise in schools. Tell them to walk to school. Well they can't walk because they can't access Ke Ala Hele Makalae from here. How do you address that? There's a street up the road connecting the highway, Kuhio Highway to Kapaa High, Kapaa Elementary. Goes to Mailehuna. You need a path, a bike path.

Have safe routes to schools. That's why we're building, the Health Department, working with county in building that with the Pentagon and the Department of Transportation. It's, these are all health interventions believe it or not. The built environment is a classic example.

Health is not determined by giving out pills and just doing immunizations. Health is by creating an environment which promotes health, which encourages people to exercise, which encourages people to eat well.