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Peter A. Ubel

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Fat Lazy Neighborhoods?

Posted: 10/26/09 01:24 PM ET

If I told you that neighborhoods cause people to develop diabetes, would you believe me? And would that make you more or less willing to see your tax dollars spent researching ways to treat and prevent diabetes?

That is essentially the question my colleagues and I posed to a wide swath of Americans, and a question, we discovered, that polarizes people along political party lines.

What do I mean when I say that neighborhoods can cause diabetes? Well, social scientists have linked neighborhoods to disease. People living, for example, in neighborhoods with poor sidewalk access end up walking less than people in other kinds of neighborhoods, thereby gaining weight and developing diabetes. By a similar token, if a neighborhood is too dangerous for people to exercise outdoors, people become more sedentary and, voila, diabetes predictably ensues in a subset of the population. What's more, some neighborhoods have a terrible supply of grocery stores -- people living in such neighborhoods can easily avail themselves of fast food restaurants, but can't necessarily find fresh produce.

Often when people learn that forces beyond individual control contribute to illness, they become more supportive of public funding to combat those illnesses. In fact, in our study we provided a random subset of research participants with a news story explaining that diabetes is caused by genetics (this is true, by the way -- genes do contribute to diabetes.) People reading this news story -- whether Republican or Democrat -- became more supportive of spending public funds to treat and prevent diabetes.

Then we gave another subset of participants a different news story. This one explained that diabetes is caused by neighborhoods. Once again, hearing about the forces that contribute to diabetes made Democrats more interested in spending money on diabetes research. But the Republicans who read this news story weren't persuaded; in fact, they became less willing to use tax money to tackle the diabetes epidemic.

It is easy to believe that our country is politically polarized simply because people have gravitated toward partisan media outlets. Watch Fox news and you will hear about Tea Party demonstrations; watch MSNBC and you will hear about Gay Rights demonstrations. No surprise that when people receive imbalanced information, they end up with polarized attitudes.

However, our study shows that our nation's political divisions run much deeper than the Glenn Beck/Keith Olbermann divide. In our study, Republicans and Democrats came to starkly different opinions from each other even after receiving identical information about the cause of diabetes. Hearing about neighborhood effects on diabetes brought out compassion among Democrats, but not so much among Republicans. As some of my Republican friends tell me when I talk to them about neighborhoods and illness: "The neighborhood doesn't force people to eat at McDonalds. Even if a neighborhood is dangerous, people can do Pilates in their living rooms if they're motivated."

True enough. Human behavior is ultimately the main cause of diabetes. But no person's behavior is completely under their own control. Social forces can influence people's behavior -- the kinds of social forces that differ across neighborhoods, for example. Sadly, when people think about these other forces, some are more convinced than others, and these divisions run across predictable party lines.

To reduce partisanship in this country, we need to educate more people about the complexity of human nature. I wonder if the 24 hour news channels will find the time to do that!

Our study, led by Sarah Gollust, was published in the October issue of the American Journal of Public Health.

My most recent book is Free Market Madness. Read more of my blogs here.

 
 
 
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HUFFPOST PUNDIT
Tulka2
Solidarity. Courage. Humor.
01:44 AM on 12/17/2009
Had a moment of profound despair reading this essay.

Americans used to care about all Americans. The right wing has been extremely successful in convincing the rich and powerful that the poor and powerless are none of their concern. I think it's been accomplished with the immigration propaganda over at Fox News.

People have PhDs in have to manipulate people. What Freud started to heal broken hearts has now morphed from advertising's brilliance at creating urgent need in every grocery store and now into incredibly artful political propaganda.
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05:28 PM on 11/20/2009
Our number one health care problem is obesity. Americans are notorious for their over indulgent life styles and bring 80% of their health care problems upon themselves. We need an intense national education campaign on diet/exercise then penalize (tax) those who continue to abuse themselves. We can not afford another generation of fat ba$tards. Give a man a fish; you feed him for today. Teach a man about fish; and he'll drop fifty pounds.
09:15 AM on 10/28/2009
Lack of sidewalks may be part of the obesity problem but morbid obesity is more than just being overweight. Our epidemic of morbid obesity may be a form of mental illness. The question of why an increasing percentage of our population including young people are morbidly obese has not been taken seriously by mental health experts. A 5' 6" woman who weighs 350 pounds did not get there by not taking walks. Something else is happening in our society. I think the morbid obesity rate went up as our personal financial debts increased and the two may be related. In any case a society that is killing itself with an epidemic of morbid obesity needs to address the reasons we are eating ourselves to death.
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HUFFPOST PUNDIT
Tulka2
Solidarity. Courage. Humor.
01:48 AM on 12/17/2009
Good comment. Did you notice last week that fact came out that children on Medicare are four times as likely to be prescribed mood altering drugs as children on private insurance? Yeah. And those drugs are likely to have life-long consequences. Common side effects in children are weight gain and high blood pressure.

How many adults are on mood altering drugs now?
HUFFPOST SUPER USER
pkafin
12:39 PM on 10/27/2009
As a physician, this author should know enough to distinguish between type I diabetes and type II diabetes. They are two completely different diseases and there is nothing a type I diabetic has done that has led to his or her disease. It is genetic and it is completely inexcusable to create the impression that folks who are dealing with it are to blame for their situation.

It's understandable when a lay person makes this mistake. However, it is rather odd when a medical professional does so. It makes whatever else he or she may have to say suspect.
HUFFPOST COMMUNITY MODERATOR
JScott
John Galt's last name is McGuffin-Smithee
10:26 AM on 10/27/2009
'I wonder if the 24 hour news channels will find the time to do that! '

Sadly probably not, it would require critical journalistic research and some thought of the part of viewers, perhaps it could be on 'The News Hour' on PBS, but sadly the ones that would need to see it, won't.
07:48 PM on 10/26/2009
these parts...

I am anglophone.
07:48 PM on 10/26/2009
The government need to 'invade' neighbourhoods...
with paid government 'types'...
incessant, friendly, yet not over-friendly neighbours...
who are placed in a neighbourhood to gently
break the barriers that seem to tie us to our homes...

we ALL want to get out...
we ALL want to be friendly...
we ALL want to be fit...

I won't say the word conspiracy...
they don't like it in these part...

but I have fought back...
and go out by myself.
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HUFFPOST COMMUNITY MODERATOR
LisaLisa1234
05:17 PM on 10/26/2009
Dr. Ubel, I'm not a doctor, but shouldn't you indicate that you're talking about Type 2 Diabetes? Especially when you say, "Human behavior is ultimately the main cause of diabetes."
03:07 PM on 10/26/2009
Did you control for economics of the community as your key charachteristics for these communities are generally reflective of lower economic conditions. And while you seem to have blamed the environment the relationship between lower economic conditions and cheap often nutritionally dubious foods being consumned in larger quantities is well established.

In short is it diet or environment and did you control for the variables.
05:25 PM on 10/26/2009
Ummm....No offense AJH but....

The Authors study was about people's attitudes toward....and relative level of compassion FOR diabetes sufferers.....when given differing news stories.

In short, did you read the piece?
tm
02:51 PM on 10/26/2009
Recent issue of Wired had a fascinating article about how people who share certain social habits tend to congregate and influence each other. Obese people who are sendentary tend to have obese, sedentary friends; smokers seek out other smokers (interesting note: it wasn't so much like this in the 60's when there was no stigma against smoking), etc. When a group of people live together in proximity these influences only increase and often in subconscious ways.
05:35 PM on 10/26/2009
"kylennblack"
good points....

Re: "stigma"
I Clearly remember as a small child,
My mother's ire at people who didn't have the courtesy to "cup" their (lit!) ciggarettes in hand
When entering a crowded elevator....
So as not to burn the clothing of others or the ears of small children
(in this case, Me)..........
IMAGINE!
"

regards
tm
02:36 PM on 10/26/2009
Trying to change human nature is like painting hard boiled easter eggs. No mattwr what pretty colors you put on the surface, the egg is still an egg. Most people believe what they want to believe, and many of those continue to believe what they want to believe because they'd rather be right than happy.We need to do a better job of convincing people how being right, in the right way, can make people happy, even if that means abandoning previously held beliefs

And you can apply that to just about every study about human nature that has ever been done.
TryToBeFlexible
MENSA, Gay, Atheist, Believer in justice
01:50 PM on 10/26/2009
When Republicans hear "neighborhood", they think "race". When they think "race", they think "lazy black".

They may receive the same specific information about diabetes and neighborhood, but they filter it through their racial animus.
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HUFFPOST SUPER USER
bknott
My Micro-bio is "empty".
02:35 PM on 10/26/2009
I was thinking the exact same thing. If these Republicans were told that the neighborhoods that affect Diabetes rates were white and middle class (example: suburban sprawl means more people drive and less people exercise) then I bet their answer would change.
05:16 PM on 10/26/2009
Sadly, I agree
01:37 PM on 10/26/2009
Neighborhoods make a huge difference in terms of peoples' health. Where I grew up, I could play outside and ride my bike alone as a child. We had access to fresh fruit and veggies. Although we were not well-off by any stretch of the imagination, my mother could provide us with access to opportunities that enabled us to make healthy choices. Today, too many people lack access to those simple things.

It's stunning how people can point to personal responsibility as the answer to every problem that faces us. Hopefully, in time, more people will come to understand that our choices impact one another. Maybe they'll even grow to be compassionate towards others and grateful for the opportunities they've been provided.

Keep educating people.
05:15 PM on 10/26/2009
Excellent comment. .

Let's just say...if we werent poor when I was a kid then we were very, VERY, working class.

Highly processed foods were simply not affordable..and fast food was a "special treat".

To this day the taste of "instant" mashed potatoes, or a McDonald's hamburger conjures memories of trips to distant sburban relatives homes.

regards
tm
12:55 PM on 10/26/2009
Of course, conservatives who themselves prefer to eat fast food, sit on the couch and gain a lot of weight in many cases do not worry at all about the fact that their habits will likely lead to medical problems and drive up healthcare premiums for everyone else - including those with healthy lifestyles. They are just manifesting their FREEDOM by eating the way THEY choose. They believe that healthy food tastes terrible, so that's the way it is.