Vegans are more likely to suffer broken bones, study finds
Vegans and vegetarians often have nutrient deficiencies and lower BMI, which can increase the risk of fractures.
24 November, 2020
Credit: Jukov studi via Adobe Stock
- The study found that vegans were 43% more likely to suffer fractures than meat eaters.
- Similar results were observed for vegetarians and fish eaters, though to a lesser extent.
- It's possible to be healthy on a vegan diet, though it takes some strategic planning to compensate for the nutrients that a plant-based diet can't easily provide.
<p>Non-meat diets may help you maintain healthy cholesterol, body weight, and blood-sugar levels. But these diets, particularly veganism, may also boost your risk of suffering broken bones, according to a new study published in <a href="https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-020-01815-3" target="_blank">BMC Medicine</a>.</p><p>While the causes aren't totally clear, the researchers suggested it might stem from vegans not consuming enough calcium and protein, or from having a lower body mass index (BMI), which leaves the body more vulnerable to fractures.</p><p>The study is the largest to date on the relationship between fractures and non-meat diets. The researchers examined data from the long-running EPIC-Oxford study, which issued health surveys to nearly 55,000 people in the U.K. between 1993 and 2001, and followed up with them in 2010. </p><p>For the recent study, the researchers collected additional follow-up data in 2016 using National Health Service records. To study the relationship between diet and fracture risk, they sorted participants into four groups: meat eaters, fish eaters, vegetarians, and vegans. </p><p>After controlling for variables like physically activity, sex, smoking, dietary supplement intake, and alcohol use, the study found that vegans had a 43 percent increased risk of any kind of fracture compared to meat eaters. The increased risk for vegetarians was 9 percent.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDgwNjU5OC9vcmlnaW4ucG5nIiwiZXhwaXJlc19hdCI6MTY0OTA1NDkyN30.if3oiMGzMJs25S5_qGO_NetVfJ_juYlgrMQKvG13xoA/img.png?width=980" id="5177c" class="rm-shortcode" data-rm-shortcode-id="4b6244ab7f711f53c87f32f7e7cb45af" data-rm-shortcode-name="rebelmouse-image" />
Comparison of fracture cases by diet group
Credit: Tong et al.
<p>The results showed that vegans were especially vulnerable to hip fractures, suffering 2.3 times more cases than meat-eaters. Vegetarians and pescatarians were also more likely to suffer hip fractures, though to a lesser extent.</p><p>One explanation may be that non-meat eaters consume less calcium and protein. Calcium helps the body build strong bones, particularly before age 30, after which the body begins to lose bone mineral density (though consuming enough calcium through diet or supplement can <a href="https://ods.od.nih.gov/factsheets/Calcium-Consumer/" target="_blank">help offset losses</a>). Lower bone mineral density means higher risk of fracture.</p><p>Protein seems to help the body absorb calcium, <a href="https://www.bonejoint.net/blog/did-you-know-that-certain-foods-block-calcium-absorption/#:~:text=Historically%2C%20nutritionists%20have%20warned%20that,may%20increase%20intestinal%20calcium%20absorption." target="_blank" rel="noopener noreferrer">when consumed in normal levels</a>. The recent study, along with past research, shows that people who don't eat meat tend to have lower levels of both protein and calcium. When the researchers accounted for non-meat eaters who supplemented their diets with calcium and protein, fracture risk decreased, but still remained significant.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDgwNjYzMy9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NDQ5NTA0NX0.Bv3xDHpgkjGHJoXQhrYYKbZAiQ50oN8KzGJozI4SwD4/img.jpg?width=980" id="72fcc" class="rm-shortcode" data-rm-shortcode-id="c375cf2bd55d73ccaca466fd2aa3cb02" data-rm-shortcode-name="rebelmouse-image" alt="fruit and vegetables" />
Credit: Pixabay
<p>Another explanation is body mass index (BMI). Non-meat eaters tend to have a lower BMI, which is associated with higher fracture risk, particularly hip fractures. In the new study, vegans with a low BMI were especially likely to suffer hip fractures. That might be because having more body mass provides a cushioning effect when people fall.</p><p>Still, the study has some limitations. For one, White European women were overrepresented in the sample. The researchers also didn't collect precise data on the type of calcium or protein supplementation, diet quality or causes of fractures.</p><p>Another complicating factor: Producers of vegan products, such as plant-based milk, are increasingly fortifying foods with nutrients like calcium and protein, so modern vegans are potentially at lower risk of deficiency.</p><p>The researchers wrote that their findings "suggest that bone health in vegans requires further research."</p>Staying healthy on a vegan diet
<p>So, does a vegan diet necessarily lead to worse bone health? Not necessarily. But it's safe to say that people who don't consume meat, dairy and eggs should be extra vigilant about consuming enough essential nutrients. That can be harder than it seems.<br></p><p>One major reason is that the body generally has an easier time absorbing nutrients from animal foods than plant-based products. So, while a salad could contain the same amount of calcium as a glass of milk, the body absorbs more calcium when you drink milk. What's more, there are some molecules and <a href="https://www.healthline.com/nutrition/7-nutrients-you-cant-get-from-plants#5.-Docosahexaenoic-acid-(DHA)" target="_blank">nutrients you simply can't get from plants</a>.</p><p>As such, many vegans round out their diets with supplements, including zinc, iron, iodine, long-chain omega-3s, and vitamins D, K-2, and B-12, to name a few. If you're on a vegan diet or considering making the switch, it's probably best to consult a dietician, and to make sure you maintain a <a href="https://www.cdc.gov/healthyweight/assessing/bmi/adult_bmi/english_bmi_calculator/bmi_calculator.html" target="_blank" rel="noopener noreferrer">healthy BMI</a>.</p>
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Zebrafish give new insight to sound sensitivity in autism
These tiny fish are helping scientists understand how the human brain processes sound.
24 November, 2020
Credit: peter verreussel / Adobe Stock
- Fragile X syndrome is a genetic disorder caused by changes in a gene that scientists call the "fragile X mental retardation 1 (FMR1)" gene. People who have FXS or autism often struggle with sensitivity to sound.
- According to the research team, FXS is caused by the disruption of a gene. By disrupting that same gene in zebrafish larvae, they can examine the effects and begin to understand more about this disrupted gene in the human brain.
- Using the zebrafish, Dr. Constantin and the team were able to gather insights into which parts of the brain are used to process sensory information.
<p>Associate professor Ethan Scott and Dr. Lena Constantin <a href="https://www.sciencedaily.com/releases/2020/11/201110102527.htm" rel="noopener noreferrer" target="_blank">recently carried out a study</a> using zebrafish that carry the same genetic mutations as humans with "Fragile X" syndrome and autism. During their research, they discovered the neural networks and pathways that produce hypersensitivities to sound in both zebrafish and humans. </p><p><strong>What is Fragile X syndrome? </strong></p><p><a href="https://www.cdc.gov/ncbddd/fxs/facts.html" rel="noopener noreferrer" target="_blank">Fragile X syndrome</a> (commonly referred to as FXS) is a genetic disorder caused by changes in a gene that scientists call the "fragile X mental retardation 1 (FMR1)" gene. This gene typically makes a protein called fragile X mental retardation protein (FMRP) that's needed for typical brain development. The brains of people with FXS do not make this protein, and if it is there, it's abnormal. </p><p><strong>What is autism? </strong></p><p><a href="https://www.cdc.gov/ncbddd/autism/facts.html" rel="noopener noreferrer" target="_blank">Autism spectrum disorder</a> (ASD) is a developmental disability that can cause significant social, communication, and behavioral challenges. People with ASD may communicate, interact, behave, and learn in different ways than most other people. A current diagnosis of ASD now includes several conditions that were previously diagnosed separately such as autistic disorder, pervasive developmental disorder, and Asperger syndrome.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDgwMzcyNC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY1NDA1NDMyMn0.pHKAuK2ziH1Nkb2VgPbXxRnvFx8R8QrL5HqmuU8xP8I/img.jpg?width=1245&coordinates=0%2C432%2C0%2C432&height=700" id="6565d" class="rm-shortcode" data-rm-shortcode-id="d966113bd917d2b6503e2b86dc1c5632" data-rm-shortcode-name="rebelmouse-image" alt="zebrafish swimming in a tank" />
By disrupting a specific gene in Zebrafish, we're able to better understand the same disruption of that gene in humans with FXS or autism.
Credit: slowmotiongli on Adobe Stock
<p>"Loud noises often cause sensory overload and anxiety in people with autism and Fragile X syndrome -- sensitivity to sound is common to both conditions," <a href="https://www.sciencedaily.com/releases/2020/11/201110102527.htm" target="_blank">Dr. Constantin explained to Science Daily</a>.</p><p><strong>How do zebrafish relate to humans with autism? </strong></p><p>According to the research team, FXS is caused by the disruption of a gene. By disrupting that same gene in zebrafish larvae, they can examine the effects and begin to understand more about this disrupted gene in the human brain. </p><p>The thalamus, according to Dr. Constantin, works as a control center, relaying sensory information from around the body to different parts of the brain. The hindbrain then coordinates different behavioral responses. Using the different sound tests, the team was able to study the whole brain of the zebrafish larvae under microscopes and see the activity of each brain cell individually. </p><p>According to Dr. Constantin, the research team recorded the brain activity of zebrafish larvae while showing them movies or exposing them to bursts of sound. The movies stimulated movement, a reaction to the visual stimuli that was the same for fish with the Fragile X mutation and those without. However, when the fish were given a burst of white noise, there was a dramatic difference in the brain activity of the fish with the Fragile X mutation.<br></p><p>After seeing how the noise radically affected the fish brain, the team designed a range of 12 different volumes of sound and found the Fragile X model fish could hear much quieter volumes than the control fish. </p><p>"The fish with Fragile X mutations had more connections between different regions of their brain and their responses to the sounds were more plentiful in the hindbrain and thalamus," <a href="https://www.sciencedaily.com/releases/2020/11/201110102527.htm" target="_blank">said Dr. Constantin</a>.</p><p>Essentially, the fish with Fragile X mutation had more connections between the regions of their brain and so their responses to the sounds were more notable. </p><p><strong>Understanding how this gene disruption works in zebrafish will give us a better understanding of sound hypersensitivity in humans with FXS or autism.</strong> </p><p>"How our neural pathways develop and respond to the stimulation of our senses gives us insights into which parts of the brain are used and how sensory information is processed," Dr. Constantin said.</p><p>Using the zebrafish, Dr. Constantin and the team were able to gather insights into which parts of the brain are used to process sensory information. </p><p>"We hope that by discovering fundamental information about how the brain processes sound, we will gain further insights into the sensory challenges faced by people with Fragile X syndrome and autism."</p>
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Hyperbaric chambers used to reverse aging in "Holy Grail" study
Researchers from Israel reversed two key processes involved in aging.
21 November, 2020
Credit: Adobe Stock
- Israeli scientists reversed two major processes involved in aging.
- Their new therapy counteracted the shortening of telomeres and the accumulation of old and dying cells.
- The study participants underwent oxygen treatments in hyperbaric chambers.
<p>Scientists from Israel carried out a study that might prove groundbreaking in the human quest to slow the biological march of time. Researchers used oxygen treatments in hyperbaric chambers to stop blood cells from aging, actually making them grow younger.</p><p>The scientists devised a novel program that uses high-pressure oxygen in a pressure chamber to reverse two key processes that stem from aging. They were able to counteract the shortening of telomeres, which are protective regions at the ends of every chromosome, and the body's aggregation of old and poorly-functioning cells. </p><p>As we get older, our cells continue to divide, while the telomeres keep getting shorter. If they become too short, the cells stop replicating (becoming "senescent") and eventually die. This results in genetic aging. Analyzing the study participant immune cells, the researchers saw a lengthening in 38 percent of the telomeres, while the senescent cells decreased by 37 percent. This is similar to the cellular state of their bodies 25 years earlier, the researchers noted.</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5OTAzNi9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYyMjAyMzc5N30._RJpTC0ebp8iSbmV8HX06oMxfbLzPu8Z8jjpV9k5J6k/img.jpg?width=980" id="2e091" class="rm-shortcode" data-rm-shortcode-id="99487cb8d6c51659a3ac74585c7cf4d9" data-rm-shortcode-name="rebelmouse-image" />
The pressurized chamber involved in the study.
Credit: Shamir Medical Center
<p>The study involved 35 healthy people over 64 years old, who underwent 60 hyperbaric sessions in 3 months. With the air pressure in the chamber twice that of normal, the subjects would breathe pure oxygen, saturating their blood and bodily tissues.</p><p>The research team was led by Professor Shai Efrati from <a href="https://en-med.tau.ac.il/school-of-medicine" target="_blank">Tel Aviv University</a>, who is also the Founder and Director of the <a href="https://www.shamir.org/en/unique-pages-default-aspx/the-sagol-center-for-hyperbaric-medicine-and-research/" target="_blank" rel="noopener noreferrer">Sagol Center</a> of Hyperbaric Medicine at the Shamir Medical Center, as well as Dr. Amir Hadanny, the Sagol Center's Chief Medical Research Officer.</p><p>In a <a href="https://aftau.org/news_item/tau-study-finds-hyperbaric-oxygen-treatments-halt-aging-of-blood-cells-and-reverse-aging-process/" target="_blank">press release</a>, Professor Efrati explained that their team has been working on hyperbaric research and therapy for many years, looking to develop treatments based on exposing patients to varying concentrations of high-pressure oxygen. One of their achievements was in improving aging people's brain functions. The current study was focused on seeing if the aging process could be slowed down at the cellular level in healthy adults. </p>
What are telomeres?
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="03cf30f4eb7cdd7bca57c79e38f5d64c"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/U0fRAr-ZHCo?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p style="margin-left: 20px;">"Today telomere shortening is considered the 'Holy Grail' of the biology of aging," Professor Efrati elaborated. "Researchers around the world are trying to develop pharmacological and environmental interventions that enable telomere elongation. Our HBOT protocol was able to achieve this, proving that the aging process can in fact be reversed at the basic cellular-molecular level."</p><p>Dr. Hadanny added that, previously, lifestyle changes and a great deal of exercise were required to achieve some impact on the shortening of telomeres. But in their "pioneering" study, "only three months of HBOT were able to elongate telomeres at rates far beyond any currently available interventions or lifestyle modifications." </p><p>While more research is required to expand upon these results, you can check out the promising study published <a href="https://www.aging-us.com/article/202188/text" target="_blank">in the journal Aging</a>.</p>
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Researchers 3D bioprint realistic human heart model for the first time
A new method is able to create realistic models of the human heart, which could vastly improve how surgeons train for complex procedures.
20 November, 2020
Credit: Carnegie Mellon University College of Engineering
- 3D bioprinting involves using printers loaded with biocompatible materials to manufacture living or lifelike structures.
- In a recent paper, a team of engineers from Carnegie Mellon University's College of Engineering developed a new way to 3D bioprint a realistic model of the human heart.
- The model is flexible and strong enough to be sutured, meaning it could improve the ways surgeons train for cardiac surgeries.
<p>A team of engineers has created a new method for 3D bioprinting realistic, full-sized models of the human heart. The development could improve how surgeons train for complex procedures, and it could represent a milestone on the road toward 3D bioprinting functional human organs.</p><p>3D-printed organs aren't a new development. But current techniques produce models that don't feel or behave like real organs, because the printing materials are either too stiff or too soft. To create better models, Adam Feinberg, a professor of biomedical engineering at Carnegie Mellon University, and his colleagues used a technique called FRESH, or Freeform Reversible Embedding of Suspended Hydrogels.</p>
<span style="display:block;position:relative;padding-top:56.25%;" class="rm-shortcode" data-rm-shortcode-id="a770da243d0d4028ea1dab0cac121247"><iframe type="lazy-iframe" data-runner-src="https://www.youtube.com/embed/4NUGQTFH5dI?rel=0" width="100%" height="auto" frameborder="0" scrolling="no" style="position:absolute;top:0;left:0;width:100%;height:100%;"></iframe></span><p>The technique, described in a paper published in <a href="https://pubs.acs.org/doi/full/10.1021/acsbiomaterials.0c01133" target="_blank" rel="noopener noreferrer">ACS Biomaterials Science & Engineering</a><em>, </em>uses a specialized 3D bioprinter to print soft biomaterials in a gelatin bath of hydrogel. During the printing process, the hydrogel bath helps support the delicate organ model, preventing it from collapsing. Once printed, the team applies heat to the model, causing the leftover hydrogel to melt away.</p>
<p>Using MRI scans of a real human heart, the team was able to 3D bioprint an accurate replica made from alginate, an affordable biomaterial that's derived from seaweed. Alginate, which has been used in <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5642828/" target="_blank">tissue engineering</a> and wound dressing <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7226066/" target="_blank">for more than a decade</a>, has properties similar to real cardiac tissue, and it's flexible and strong enough for surgeons to suture. That makes it an ideal material to use in training scenarios on organ models.</p><p style="margin-left: 20px;">"We can now build a model that not only allows for visual planning, but allows for physical practice," Feinberg said in a <a href="https://engineering.cmu.edu/news-events/news/2020/11/18-3d-printed-heart.html" target="_blank">statement</a>. "The surgeon can manipulate it and have it actually respond like real tissue, so that when they get into the operating site they've got an additional layer of realistic practice in that setting."</p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5Nzc0MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMzE3MzUyN30.HeX0RSpmFOA_AMNXMhVNhXVj7S2TKt0skaznuEA_jkk/img.jpg?width=980" id="5a4c1" class="rm-shortcode" data-rm-shortcode-id="120a93d4ad116b7873dad31169dcf369" data-rm-shortcode-name="rebelmouse-image" />
Modeling incorporates imaging data into the final 3D printed object.
Credit: Carnegie Mellon University College of Engineering
<p>The FRESH technique isn't currently able to 3D bioprint models onto which real cells can grow and form a functional heart, but similar methods may someday make that possible. If scientists can print functional human hearts, it could help the healthcare industry finally meet the demand for heart transplants, which <a href="https://nyulangone.org/news/nyu-langone-addresses-demand-heart-transplants-has-never-been-higher#:~:text=the%20Transplant%20Institute.-,The%20demand%20for%20heart%20transplants%20has%20never%20been%20higher.,rise%20by%20some%2050%20percent." target="_blank">far exceeds supply</a>.</p><p style="margin-left: 20px;">"While major hurdles still exist in bioprinting a full-sized functional human heart, we are proud to help establish its foundational groundwork using the FRESH platform while showing immediate applications for realistic surgical simulation," said Eman Mirdamadi, lead author on the paper, in a statement.</p><p>In the meantime, the team behind the FRESH technique hopes to use it to generate models for other organs, like kidneys and liver. </p>
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COVID-19 amplified America’s devastating health gap. Can we bridge it?
The COVID-19 pandemic is making health disparities in the United States crystal clear. It is a clarion call for health care systems to double their efforts in vulnerable communities.
19 November, 2020
Credit: Joe Raedle/Getty Images
- The COVID-19 pandemic has exacerbated America's health disparities, widening the divide between the haves and have nots.
- Studies show disparities in wealth, race, and online access have disproportionately harmed underserved U.S. communities during the pandemic.
- To begin curing this social aliment, health systems like Northwell Health are establishing relationships of trust in these communities so that the post-COVID world looks different than the pre-COVID one.
<ul class="ee-ul"></ul>
<p>In the last 100 years, we've made incredible advances in health care, advances that would be viewed as miraculous to any previous generation. To pick one example, the<a href="https://ourworldindata.org/life-expectancy" target="_blank"> U.S. life expectancy</a> in 1950 was 68.2 years. We've since added 10 years to that average. Social programs have helped the young and elderly, two of the most health-vulnerable populations, receive unprecedented levels of care and attention. And telemedicine has decoupled many Americans' health support and monitoring from brick-and-mortar hospitals, expanding access to care.</p><p>Yet, despite these advances and despite handily<a href="https://www.brookings.edu/research/a-dozen-facts-about-the-economics-of-the-u-s-health-care-system/" target="_blank"> outspending other OECD nations on health care</a>, the United States preserves vast health disparities. As James Madara, CEO and executive vice president of the American Medical Association,<a href="https://www.ama-assn.org/about/leadership/america-s-health-care-crisis-much-deeper-covid-19" target="_blank" rel="noopener noreferrer"> </a>wrote on the organization's site: "The U.S. health system that exists today is a hodgepodge of ideas, programs, and regulations that is both extraordinarily expensive and highly inefficient. And despite its size and technological advancements, our health system is beset by tremendous gaps and inequities that favor some groups while unfairly disadvantaging others."</p><p>Our current predicament has its origins in tectonic sociohistorical forces that have shifted and fractured the health care landscape. For those at the peaks, access to superior care, education, resources, and social networks serve to protect their health. For those in the canyons, the ground continues to weather away with each past and ongoing crisis—consider, for example, the disproportionate fallout from<a href="https://diabetes.diabetesjournals.org/content/60/11/2667" target="_blank" rel="noopener noreferrer"> </a><a href="https://www.salon.com/2013/09/29/ronald_reagans_shameful_legacy_violence_the_homeless_mental_illness/" target="_blank" rel="noopener noreferrer">the dissolution of the Mental Health Systems Act</a>.</p><p>Then came COVID-19.</p>
COVID-19 deepens U.S. health disparities
<p>Communities on the pernicious side of America's health disparities have their unique histories, environments, and social structures. They are spread across the United States, but they all have one thing in common.</p><p>"There is one common divide in American communities, and that is poverty," said <a href="https://www.northwell.edu/about/leadership/debbie-salas-lopez" target="_blank">Debbie Salas-Lopez, MD, MPH</a>, senior vice president of community and population health at Northwell Health. "That is the undercurrent that manifests poor health, poor health outcomes, or poor health prognoses for future wellbeing."</p><p>Social determinants have far-reaching effects on health, and poor communities have unfavorable social determinants. To pick one of many examples, <a href="https://www.npr.org/2020/09/27/913612554/a-crisis-within-a-crisis-food-insecurity-and-covid-19" target="_blank" rel="noopener noreferrer">food insecurity</a> reduces access to quality food, leading to poor health and communal endemics of chronic medical conditions. The U.S. Centers for Disease Control and Prevention has identified some of these conditions, such as obesity and Type 2 diabetes, as increasing the risk of developing a severe case of coronavirus.</p><p>The pandemic didn't create poverty or food insecurity, but it exacerbated both, and the results have been catastrophic. A study published this summer in the <em><a href="https://link.springer.com/article/10.1007/s11606-020-05971-3" target="_blank">Journal of General Internal Medicine</a></em> suggested that "social factors such as income inequality may explain why some parts of the USA are hit harder by the COVID-19 pandemic than others."</p><p>That's not to say better-off families in the U.S. weren't harmed. A <a href="https://voxeu.org/article/poverty-inequality-and-covid-19-us" target="_blank" rel="noopener noreferrer">paper from the Centre for Economic Policy Research</a> noted that families in counties with a higher median income experienced adjustment costs associated with the pandemic—for example, lowering income-earning interactions to align with social distancing policies. However, the paper found that the costs of social distancing were much greater for poorer families, who cannot easily alter their living circumstances, which often include more individuals living in one home and a reliance on mass transit to reach work and grocery stores. They are also disproportionately represented in essential jobs, such as retail, transportation, and health care, where maintaining physical distance can be all but impossible.</p><p>The paper also cited a positive correlation between higher income inequality and higher rates of coronavirus infection. "Our interpretation is that poorer people are less able to protect themselves, which leads them to different choices—they face a steeper trade-off between their health and their economic welfare in the context of the threats posed by COVID-19," the authors wrote.</p><p>"There are so many pandemics that this pandemic has exacerbated," Dr. Salas-Lopez noted.</p><p>One example is the health-wealth gap. The mental stressors of maintaining a low socioeconomic status, especially in the face of extreme affluence, can have a physically degrading impact on health. <a href="https://www.scientificamerican.com/index.cfm/_api/render/file/?method=inline&fileID=123ECD96-EF81-46F6-983D2AE9A45FA354" target="_blank" rel="noopener noreferrer">Writing on this gap</a>, Robert Sapolsky, professor of biology and neurology at Stanford University, notes that socioeconomic stressors can increase blood pressure, reduce insulin response, increase chronic inflammation, and impair the prefrontal cortex and other brain functions through anxiety, depression, and cognitive load. </p><p>"Thus, from the macro level of entire body systems to the micro level of individual chromosomes, poverty finds a way to produce wear and tear," Sapolsky writes. "It is outrageous that if children are born into the wrong family, they will be predisposed toward poor health by the time they start to learn the alphabet."</p>Research on the economic and mental health fallout of COVID-19 is showing two things: That unemployment is hitting <a href="https://www.pewsocialtrends.org/2020/09/24/economic-fallout-from-covid-19-continues-to-hit-lower-income-americans-the-hardest/" target="_blank" rel="noopener noreferrer">low-income and young Americans</a> most during the pandemic, potentially widening the health-wealth gap further; and that the pandemic not only exacerbates mental health stressors, but is doing so at clinically relevant levels. As <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7413844/" target="_blank" rel="noopener noreferrer">the authors of one review</a> wrote, the pandemic's effects on mental health is itself an international public health priority.<blockquote>We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights.</blockquote>
Working to close the health gap
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yNDc5MDk1MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxNTYyMzQzMn0.KSFpXH7yHYrfVPtfgcxZqAHHYzCnC2bFxwSrJqBbH4I/img.jpg?width=980" id="b40e2" class="rm-shortcode" data-rm-shortcode-id="1b9035370ab7b02a0dc00758e494412b" data-rm-shortcode-name="rebelmouse-image" />Northwell Health coronavirus testing center at Greater Springfield Community Church.
Credit: Northwell Health
<p>Novel coronavirus may spread and infect indiscriminately, but pre-existing conditions, environmental stressors, and a lack of access to care and resources increase the risk of infection. These social determinants make the pandemic more dangerous, and erode communities' and families' abilities to heal from health crises that pre-date the pandemic.</p><p>How do we eliminate these divides? Dr. Salas-Lopez says the first step is recognition. "We have to open our eyes to see the suffering around us," she said. "Northwell has not shied away from that."</p><p>"We are steadfast in improving health outcomes for our vulnerable and underrepresented communities that have suffered because of the prevalence of chronic disease, a problem that led to the disproportionately higher death rate among African-Americans and Latinos during the COVID-19 pandemic," said Michael Dowling, Northwell's president and CEO. "We are committed to using every tool at our disposal—as a provider of health care, employer, purchaser and investor—to combat disparities and ensure the <a href="https://www.northwell.edu/education-and-resources/community-engagement/center-for-equity-of-care" target="_blank" rel="noopener noreferrer">equity of care</a> that everyone deserves." </p><p>With the need recognized, Dr. Salas-Lopez calls for health care systems to travel upstream and be proactive in those hard-hit communities. This requires health care systems to play a strong role, but not a unilateral one. They must build <a href="https://www.northwell.edu/news/insights/faith-based-leaders-are-the-key-to-improving-community-health" target="_blank" rel="noopener noreferrer">partnerships with leaders in those communities</a> and utilize those to ensure relationships last beyond the current crisis. </p><p>"We must meet with community leaders and talk to them to get their perspective on what they believe the community needs are and should be for the future. Together, we can co-create a plan to measurably improve [community] health and also to be ready for whatever comes next," she said.</p><p>Northwell has built relationships with local faith-based and community organizations in underserved communities of color. Those partnerships enabled Northwell to test more than 65,000 people across the metro New York region. The health system also offered education on coronavirus and precautions to curb its spread.</p><p>These initiatives began the process of building trust—trust that Northwell has counted on to return to these communities to administer flu vaccines to prepare for what experts fear may be a difficult flu season.</p><p>While Northwell has begun building bridges across the divides of the New York area, much will still need to be done to cure U.S. health care overall. There is hope that the COVID pandemic will awaken us to the deep disparities in the US.</p><p>"COVID has changed our world. We have to seize this opportunity, this pandemic, this crisis to do better," Dr. Salas-Lopez said. "Provide better care. Provide better health. Be better partners. Be better community citizens. And treat each other with respect and dignity.</p><p>"We need to find ways to unify this country because we're all human beings. We're all created equal, and we believe that health is one of those important rights."</p>
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