By Milou Fredrix, Emma Carr & Eimear Morrissey
“La Buena Vista: Expanding Horizons of Behavioural Medicine” was the theme of this year’s Society of Behavioural Medicine’s (SBM) Annual Meeting & Scientific Sessions held in San Diego. The conference focused on facilitating the translation of research into real-world practice and policy-making. It aimed to inspire attendees to create a healthier future by tackling critical research questions with the most advanced methods and by encouraging the translation of “actionable” research findings.
Held in sunny San Diego, the conference drew 2,053 delegates, and we were lucky enough to be three of them! It was a busy four days with 251 sessions to attend, 1,205 posters to see and many tweets to read (tweets of the event reached 17.5 million Twitter users). And of course there were the sights and sounds of the city to be explored as well.
An active conference
The meeting was described as an “active conference” and we think Marita Hennessey would have approved of their attempts at making this SBM a healthy meeting. For those willing and able (or mad) each day of the conference began with 6 am yoga practice with the first conference sessions beginning at 7am. Coming from Galway and used to a more
relaxed approach to conferencing (9.30/10am start; see our mHealth Conference in June) we felt that this early beginning to the day may have had a slightly deleterious impact on our health and so chose to forego this particular element of the “healthy meeting”. Thankfully there were other healthy behaviours promoted throughout the event that we could actively engage in. Delegates were encouraged to stand throughout sessions and take the stairs when navigating the beautiful BayFront Hilton hotel. It was unfortunate that none of us delivered an oral presentation because delegates were encouraged to give standing ovations, or ‘active applauses’ for every talk in order to have an opportunity to stand! There was no tea/coffee/lunch provided and delegates were advised to eat in one of the restaurants in the hotel. This resulted in lattes and pastries from Starbucks and posh Hilton burgers and fries. The Starbucks was on the far side of the hotel though, so it did involve some walking to get there. Thus while not a perfectly healthy meeting it is excellent to see attempts being made at engaging with this approach to conferences.
An overwhelming number of presentations gave us an update on research in the areas of diabetes, digital health, chronic pain, physical activity, health behaviour in veterans and many more. A recurring theme throughout the presentations was the role of environment and community in determining health behaviour, the keynotes in particular addressed these issues. Dr Robert Ross highlighted the influence societal and cultural norms can have on health and health disparities while Dr Diez Roux spoke about the impact of the built environment on our health decision making. Dr Goldstein discussed using evidence to change state policy and Col Tracy A. Neal-Walden highlighted the great work being done to improve the health of military and veterans communities.
Dr Robert K Ross
Dr Robert Ross is currently president and chief executive officer of the California Endowment, a private, state-wide health foundation created in 1996 to expand access to affordable, quality health care for underserved individuals and communities, and to promote fundamental improvements in the health status of all Californians. Prior to this appointment he served as director of the Health and Human Services Agency for the County of San Diego and was Commissioner of Public Health for the City of Philadelphia.
Dr Ross focused on the consequences of the invention of ‘crack cocaine’ in the 1980’s and its ongoing effects on American society to illustrate how the wider social environment can impact on health. The increase in drug use and crime in the 1980’s led to schools instigating a zero-tolerance policy for misbehaving youths. This led to a 350% increase in school suspension rates. Data shows that if a student is suspended once, the likelihood of them attending higher education decreases by 70%. The California Endowment initiative Building Healthy Communities has targeted this policy in California and has produced a 27% decrease in suspension rates. Dr Ross talked about the devastating Clinton bill, a reaction to the crack cocaine crisis, which included a “three strikes” rule that meant anyone convicted of a serious violent crime who had two or more prior convictions, was given a life sentence. This law fails to distinguish between dangerous criminals and young people who make mistakes. These reactionary measures helped widen the health disparities in California with the state now spending more on incarceration than it does on education. According to Dr Ross one in seven of all California babies born in 2006 and 2007 was reported for abuse or neglect by age 5, and 25 % of Californians report 2-3 adverse childhood experiences. The Endowment is fighting for health equality and is engaging deeply with 14 disadvantaged communities around California. They are breaking new ground in public health through their 10-year commitment to creating healthy and equitable communities. Dr Ross made clear how wider societal and cultural norms can greatly impact on the health and well-being of communities.
Dr Ana Diez Roux
Dr Diez Roux is Dean and Distinguished University Professor of Epidemiology in the Dornsife School of Public Health at Drexel University. She previously held the post of Chair of the Department of Epidemiology and Director of the Centre for Social Epidemiology and Population Health at the University of Michigan, School of Public Health. Dr Diez Roux was awarded the Wade Hampton Frost Award for her contributions to public health by the American Public Health Association. She has conducted extensive research on the social determinants of population health and the study of how neighbourhoods affect health.
Dr Diez Roux presented research showing that neighbourhood facilities impact health outcomes. The built environment can be a barrier or facilitator to a healthier life. Everything from proximity to supermarkets, selling fresh fruit and vegetables, to access to green areas our environment can impact healthy eating, sleep quality and physical activity. Dr Diez Roux argues that many communities are designed for obesity and diabetes. It’s often easier to drive through cities then it is to walk through them. She provided the example that some green areas even prohibit physical exercise (see image below). Dr Diez Roux called for all researchers and policy makers to help in the translation of this reseach into action; we need to design communities that facilitate healthy living not hinder it.
Dr Harold Goldstein
Dr Goldstein is executive director of the California Centre for Public Health Advocacy, a nonpartisan, non-profit organization that aims to raise awareness about critical public health issues and promote effective health policies. In particular targeting the epidemics of childhood obesity and diabetes by advocating for state and local policies that promote healthy eating and physical activity.
Dr Goldstein opened his talk with a startling statistic: 55% of Californians have pre-diabetes or diabetes. A fact that likely means that this generation of children, could be the first in the history of the Unites States to live shorter lives than their parents. Between 1977 and 2001 per capita calorie intake has increased by 278 calories per day. Sweetened beverages and sodas are responsible for 43% of this increase in calories. In the 1970’s and 80’s companies like Coke and Pepsi made drinking soda a part of pop culture and particularly targeted the youth of America; a legacy which continues today.
The role of policy change in the fight against obesity and diabetes is clear: there must be changes made to the availability of sodas and junk food directly in schools and indirectly through taxation. A great example of people fighting the battle against the great foaming tide of Coca-Cola, Pepsi and others has taken place in Berkeley California. America’s unofficial capital of progressive politics, are calling it the battle against Big Soda. Inspired by Michelle Obama’s campaigns to get underprivileged children to eat fresh food, campaigners have just notched up their first clear victory. A referendum in Berkeley to impose the first sugar tax in the US on soda won 75% voter approval!
See the story of how Berkley stood up for children’s health against one of the world’s most powerful industries here:
Col. Tracy A. Neal-Walden
Colonel Tracy A. Neal-Walden serves as Deputy Director, Psychological Health, Air Force Medical Support Agency, Office of the Surgeon General. She advises and coordinates with senior Air Force leaders, Congressional staff, Health Affairs, AFMOA and the sister Services on psychological health policy matters.
Col. Tracy Neal-Walden works in the Office of the Surgeon General for the US Air Force. In her keynote, she did her best to inform SBM attendees about the inspiring work that is being done to improve the physical and mental health of military and veteran communities. She highlighted how health experts are collaborating across the services, using evidence-based strategies, evaluating the outcomes, and helping millions of people.
Evidence isn’t enough
All keynote speakers gave us one very clear take home message. Our social, economic and political world greatly impacts our food and activity choices. Public policy changes are the only way to make changes to our environment that will facilitate heathy choices. We need to translate our evidence into practice, into policy change. This however is easier said than done and a common thread throughout all three keynotes indicates that this change will not happen by publishing our work in scientific journals. On the contrary, it was contended that scientific evidence isn’t enough. Governments and policy makers, now more than ever, respond to power and pressure rather than data. Research needs to translate into something more. Dr Goldstein told us about the emphasis that was placed on the financial consequences of removing junk food and soda from schools, rather than the reduction of obesity. Researchers need to become advocates or at a minimum work closely with advocates, we need to learn to use the media to create public interest and pressure in order to facilitate change, in order to have our research translate. We left SBM with the sobering thought that no matter the impact factor of the journal we publish in, change will not happen without advocacy.
Dr Goldstein finished his talk with the adage: If you always do what you’ve always done, you always get what you always gotten. If we wish to expand the horizons of behavioural medicine, as the conference was hopefully titled, we need to think outside our academic box in order to translate our research into something meaningful.