Thursday , August 5 2021

Manuel Franco, principal investigator of the Heart Healthy Hoods project



Manuel Franco is determined to improve urban health, involving citizens. The epidemiologist has shown that citizens themselves can formulate public policy recommendations with researchers and municipal councils. Access to a cheap and healthy diet, the proximity to parks where exercise and active transportation can change our lives.

The team Manuel FrancoProfessor of Epidemiology at the University of Alcalá in Madrid and the Johns Hopkins School of Public Health, analyzes what characteristics of cities are more or less healthy and what could be done to optimize health in cities.

His Heart Healthy Hoods project was funded by the European Research Council to study how urban characteristics relate to chronic diseases.

In these works, mainly quantitative, they applied the participative methodology of citizen science Photovoice. The main idea is that not only researchers, but also citizens, provide information to help decide which are the most interesting interventions to improve cities.

The first Photovoice of Franco's team was made in Villaverde -District of southern Madrid, with low socioeconomic levels. So they continued to study how the city relates to physical activity in Chamberí -District of the center of Madrid, with a high socio-economic universe.

What are the differences in relation to the urban environment and physical activity between the two districts?

It is very interesting that in both districts lack of parks to be able to use them as a place of physical activity. While the problem in Chamberí is that there are very few, in Villaverde there is not that there are few but that they are in bad condition.

"Having citizenship to improve urban health gives you information that without your help you would not know"

Another factor analyzed was the use of public resources of sports centers. In Chamberí the problem is that the center is packed, there is a huge waiting list and it is relatively expensive; and in Villaverde the prices are very high and families can not always take it.

Citizenship is very interesting from the point of view of the urban health because it gives you information that without your help you would not know.

Is the translation of the results for the policies closer?

We study how it is built and who lives in the city, what resources exist and what are the norms and behaviors in relation to cardiovascular health. And it's the neighbors themselves who tell us.

Being a participatory process in which citizens collaborate with us, sometimes it never ends because new ideas always appear. And we came up with a very interesting procedure – which we published last year with the Villaverde project – in which citizens project public policy recommendations along with researchers and local politicians.

Collaboration between society, researchers and technicians and policy makers is key to improving the health of the population and reduce inequalities, as we published with colleagues from Barcelona and Asturias for the 2018 Report of the Spanish Society of Public Health and Health Administration.

How can you O small actions in the city Can they change people's health?

The issue of urban health is being increasingly worked around the world. We are getting a lot of data on diet, physical activity, alcohol, and smoking.

There are very interesting evidences from other countries that show how you are transported (so-called active transport) is directly related to body weight and risk of chronic diseases.

In the HeartHealthyHoods (HHH) study in Madrid, we have just published an article about how the dynamism of neighborhoods in social and demographic terms affects the risk of diabetes. O diabetes Currently, it is one of the most important metabolic diseases, in addition to increasing the risk of having other associated pathologies (renal or cardiovascular).

Therefore, studying diabetes in cities is very important for what this means for the people affected, for the difficulty of controlling it and for our health system.

And the importance of regulating eating habits?

In 2013 I published an article on British Medical Journal, conducted in Cuba on how to reduce weight throughout the population by five kilos could reduce mortality by one-third due to coronary heart disease.

"Society itself can make regulations to make health food more accessible and accessible"

This paper looked at the relationship between weight changes and coronary heart disease, stroke and diabetes in Cuban citizens during the last 30 years and revealed that population interventions can be very effective in preventing cardiovascular disease and diabetes. .

This teaches us, on the one hand, how society can make regulations to make accessible and accessible healthy foods and less the unhealthy. If you buy fruits and vegetables every day, cook at home and follow a Mediterranean diet, it is much cheaper than buying weeds.

But not all people have the ability to cook or know what it is mediterranean diet. This is still very complex, but it is where we need to go; there are more and more agents involved and more scientific interest in this.

In addition, there is an increase in physical activity. And this has to do directly with transportation, parks, streets and with the availability of places to walk, run, ride a bike …

The key, then, is how we spend the energy?

These things are essential to the health of the population, especially in urban centers. And that has to do with what we publish about Cuba. From 1991 to 1995, the country suffered a terrible economic crisis. Thus, the Cubans began to depend on themselves to move, due to the practical cancellation of public and private means of transportation.

At the same time and in a gradual and sustained manner, the caloric intake per capita (from 3,000 calories a day to 2,200). As a result, there was a generalized weight loss.

The exceptional thing about the job is the comparison with the later years when the crisis ended and the Cubans gained weight again. In those years (between 1995 and 2010), the population increased its weight by an average of nine kilos and the prevalence of diabetes has skyrocketed since 1997. It was a rebound effect. Weight gain was related to increased mortality from coronary heart disease.

Manuel Franco explains the importance of making healthy food more accessible and accessible. / SYNC

In the end, it's a matter of education, right?

We do not have to come to a blockade or an economic crisis to achieve improvements. What we should do is to organize ourselves better as a society to optimize our diet and physical activity.

There has been a lot of talk about how epidemiology Much progress has been made with tobacco since the 1960s when it began to be identified as an individual and very clear cause of lung cancer first, and then cardiovascular disease and many other cancers. The difference with tobacco is that we can not live without being fed. Therefore, all this kind of regulation is much more difficult.

"Around schools and parks in Madrid there are many establishments where junk food is very accessible"

How is Spain in the availability of healthier food and in promoting physical activity?

We are not very advanced yet and it is a fundamental factor. For example, we know that, just as in tobacco, the best way to regulate consumption of something is its price. There is already evidence of the effect of increased taxes on sugary drinks in a country as important and as large as Mexico, which was a major consumer and had high rates of diabetes and obesity.

There, it has been shown that the increase in taxes on sugary drinks decreases consumption, especially in vulnerable populations (like the younger one, which usually has more economic limitations). This has a very large impact on public health.

Are there measures to regulate what is eaten?

London is starting to regulate in the areas close to schools and institutes what type of establishments can be opened. Now there can be no junk food in about half a mile (about 800 meters). We do not do this in Spain and the situation in Madrid is very clear. Around the schools and parks there are many establishments where this type of food is available and is very accessible.

Cities can also regulate what is consumed not only in schools but also in workplaces. In large buildings, many people eat what is in the machines vending. But why do they always have to be shattered? Right now there are some healthy ones. And it could be regulated that there was a percentage of healthy, compulsive foods, or even 100%. I have no doubt that this is the way.


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