Public Health and the Elderly

Posted on January 19, 2010. Filed under: Family Therapy, Health | Tags: , , , |

A test of a people is how it behaves toward the old. It is easy to love children. Even tyrants and dictators make a point of being fond of children. But the affection and care for the old, the incurable, the helpless are the true gold mines of a culture.~Abraham J. Heschel

The field of family therapy has not fully explored the area of mental health issues with elderly or their caregivers.  There are some wonderful family therapists that work with aging adults yet there is not a lot of literature to help guide therapists.  This post is not a critique of the family therapy field.  Nor will it highlight all the key public health areas that affect healthy aging.  Instead, I will use the next few posts to highlight just a few public health issues that therapists could address with families.

The Center for Disease Control and Prevention published a report in 2007 called The State of Aging and Health in America.  This report examined 15 key health indicators across four areas; Health Status, Health Behaviors, Preventive Care and Screening, and Injuries.  In 2008, the CDC updated this report with the State of Mental Health and Aging in America.  This report examined 6 key indicators that included Social and Emotional Support, Life Satisfaction, Frequent Mental Distress, Current Depression, Lifetime Diagnosis of Depression, and Lifetime Diagnosis of Anxiety Disorder.  If you are a researcher in the field of gerentology, these reports are vital to your research but there are some very interesting facts here for clinicians.   Here are some interesting points:

  • Adequate social and emotional support is associated with reduced risk of mental illness, physical illness, and mortality.
  • Life satisfaction is the self-evaluation of one’s life as a whole, and is influenced by socioeconomic, health, and environmental factors.
  • Life dissatisfaction is associated with obesity and risky health behaviors such as smoking, physical inactivity, and heavy drinking.
  • Older adults with frequent mental distress were more likely to engage in behaviors that can contribute to poor health, such as smoking, not getting recommend amounts of exercise, or eating a diet with few fruits and vegetables
  • Anxiety, like depression, is among the most prevalent mental health problems among older adults. The two conditions often go hand in hand, with almost half of older adults who are diagnosed with a major depression also meeting the criteria for anxiety.

There are three points that should be stressed.  First, the vast majority of the elderly are doing well.  Many aging adults report feeling supported, being satisfied with life, and do not struggle with depression or anxiety.  Next, it is important to stress that this is a population based survey.  This means that clinical and non-clinical aging adults were surveyed.  Since we work with clinical populations, we should expect to see more reports of depression, anxiety, and lack of social support.  Lastly, we know that racial & ethnic health disparities occur across the life span & they can have a cumulative effect.  One way to improve health for aging minority adults is to improve health for minority groups. The State of Aging and Health in America reported, “The care of older adults who are chronically ill, poor, and members of an ethnic community is an increasingly urgent health priority” (p.3).

When family therapists are doing an initial interview, collecting information for an assessment, or doing a genogram we need to make sure that we are asking how aging adults in the family are doing (regardless of who the “client” is).  While the vast majority of the elderly have a positive outlook and social support, we need to make sure that those who do not get the help they need.  Below are a list of public health resources for additional information.  My next post will focus on caregivers and public health.  Please leave a comment, share a story, or offer some new resources.  Take care.



Administration on Aging

Center on an Aging Society

Center for Disease Control and Prevention

Center for Medicare & Medicaid Services

National Institute of Aging

US Department Health and Human Services

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Should Environmental Justice be Part of Family Therapy?

Posted on January 10, 2010. Filed under: Environmental, Family Therapy, Health, Pollution, Public Health | Tags: , , , , |

This post is an addendum to my “Is it ADHD or Expose to Toxins?”  I was reminded by a friend at the Adler Institute of Social Exclusion that exposure to pollution or toxins do not occur evenly throughout the population.  Poor people and ethnic minorities are more likely to be exposed to pollution and toxins.  Within the public health sphere, there is a term called Environmental Justice.  The EPA has a page devoted to Environmental Justice and the EPA defines it as:

Environmental Justice is the fair treatment and meaningful involvement of all people regardless of race, color, national origin, or income with respect to the development, implementation, and enforcement of environmental laws, regulations, and policies. EPA has this goal for all communities and persons across this Nation. It will be achieved when everyone enjoys the same degree of protection from environmental and health hazards and equal access to the decision-making process to have a healthy environment in which to live, learn, and work.

Environmental justice is an important piece of addressing health disparities.  I will discuss some of the key issues of environmental justice and then highlight what family therapists can do to address issues of environmental injustice.

Environmental justice is rooted in the civil rights movement of the 1960’s as black leaders become concerned about the connection between their communities and environmental risks (Click HERE for a timeline).  Community leaders were concerned about what they termed environmental racism.  Environmental racism occurs when policies, regulations, and/or practices that put people of color or low income communities at risk for being exposed to toxins.  There are many historical examples but all we need to do is to look at Hurricane Katrina and Dickson, TN to see that issues of environmental injustice are still around.  Some other startling facts from a United Church of Christ 2007 report (they have done some remarkable work in this area):

  • More than 870,000 of the 1.9 million (46 percent) housing units for the poor, mostly minorities, sit within about a mile of factories that reported toxic emissions to the Environmental Protection Agency (p. 4).
  • More than 600,000 students in Massachusetts, New York, New Jersey, Michigan and California were attending nearly 1,200 public schools, with largely African Americans and other children of color, that are located within a half mile of federal Superfund or state­identified contaminated sites (p. 4).
  • Neighborhoods with a hazardous waste facility in Arizona, California and Nevada are majority Hispanic or Latino. Other states with very large disparities in Hispanic or Latino percentages include Colorado, Connecticut, Florida, Illinois, Kansas and Utah (p. 58-59).
  • While Race and SocioEconomic Status are important variables in predicting the location of a hazardous waste site, Race appears to be more important (p. 62).  Indicating that hazardous waste sites are located in middle class and affluent Black neighborhoods.

While these issues are usually addressed by community organizations, family therapists should inquire about exposure to toxins to understand possible causes or contributors to psychological, behavior, or emotional problems.  These issues should be part of every intake form.  We might be “treating” ADHD when in fact someone has lead poisoning.  And while family therapists cannot change the SES circumstances of our clients, we can provide information on how their housing or community is connected to their health (read physical and mental).

In a previous post I highlighted some questions that family therapists can ask about toxins in the environment.  Here are some other things that family therapists can do:

  • Use the EPA’s website as a source of information about the communities that your clients live in.  Go to the EPA’s Where You Live website and click on the region where your clients reside.  This will give you information about the EPA’s work in your region.
  • Go the Environmental Justice Geographic Tool to see what issues are in the neighborhoods of your clients.  Once you get the region you will need to choose which features you would like to explore.  Here is a link to what Utica, NY looks like.  I chose all the regulated sites (Click on the +) and Schools under Places.
  • If you learn about a possible exposure (e.g., lead, mercury) have them contact their health care provider immediately OR their local Public Health Office. You can locate federally funded health care sites from here by clicking HERE.

I have just touched the surface of this issue.  There are some great resources out there for people wanting to learn more about Environmental Justice.  I will list some resources below and let me know if you have more.  Please leave a comment, concern, or story.  I will respond to all of them.  As always, take care.



Democracy Now: Interview with Dr. Robert Bullard

Environmental Justice Resource Center at Clark Atlanta University (EXCELLENT SITE.  This is really all you need to see what the current key issues are).

Interagency Working Group (11 federal agencies and several White House offices working to integrate environmental justice into its individual programs)

National Black Environmental Justice Network

Pollution Issues: Environmental Racism

Social Science Research Council: Toxic Soup Redux

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January is Cervical Cancer Month

Posted on January 7, 2010. Filed under: Family Therapy, Health, Public Health | Tags: , , , |

I am going to stray away from my current thread on Housing Quality and discuss an important public health issue for women.  January is Cervical Cancer month for the National Cervical Cancer Coalition.  The National Cancer Institute (NCI) estimates that there will be over 11,000 new cases of cervical cancer and over 4,000 women will die from this cancer.  Many women will not have symptoms which is why the NCI recommends women getting their first pap smear within 3 years of first experience of sexual intercourse or at the age of 21.  This type of cancer is easily detected and has a high cure rate if detected early. In addition, there are preventive measures that women can take to decrease their chances of developing cervical cancer.

And while the population cure rate is high for cervical cancer, there are some racial and economic disparities associated with cervical cancer. According to the American Cancer Society (ACS), NCI, and Garner (2003):

  • Cervical cancer has a higher incidence in Latinas, (twice the rate of non-Hispanic women).
  • African American women develop Cervical Cancer 50% more than non-Hispanic women and twice as likely to die from it.
  • Women from lower socioeconomic backgrounds get diagnosed at later stages and have a higher mortality.
  • Vietnamese women have the highest incidence.
  • Immigrant women have low rates of screening related to language barriers, mistrust of medical system, and cultural beliefs (e.g., modesty).

These disparities can be contributed to lack of access to care, mistrust of the healthcare system, patient cultural beliefs, or providers not asking the right questions.

As mental health practitioners we have the unique opportunity to inform our clients, their families, our communities about issues that directly affect their care.  As we work with our clients this month, I ask that we ask  questions to raise awareness.  We can ask women if they talk to their health care provider about cervical cancer.  We can ask women when they had their last pap smear.  We can inform women that January is Cervical Cancer month and give them resources for them to explore these issues (listed below).  We can ask men in relationships with women to raise this issue with their partners.  We can ask parents to talk to their daughters about the importance of early detection and preventive measures.  As noted above, we might be working with women who don’t have access to health care or don’t trust their health care.  The Center for Disease Control and Prevention (CDC) has the National Breast Cancer and Cervical Cancer Early Detection Program so that underserved women can have access to care.  Click on the early detection program link to find a local program.

Again, these questions usually don’t take much time and if they do maybe you stumbled upon an important therapeutic issue.  These questions also convey a wholistic approach to our clients.  That we are interested in the range of their experiences that can affect their lives.  I look forward to any comments, suggestions, or stories that you might want to share.  Take care.



American Cancer Society: Learn about Cervical Cancer

Center for Disease Control and Prevention Cervical Cancer Page

Cervical Cancer: What Vietnamese Women Should Know

Garner, E.I.O. (2003). Cervical cancer: Disparities in Screening, Treatment, and Survival. Cancer Epidemiology, Biomarkers & Prevention March 2003 12; 242s

General Information About Cervical Cancer (Healthcare Provider Version)

General Information About Cervical Cancer (Patient Version)

General Information About Cervical Cancer (Patient Version-Spanish)

National Breast Cancer and Cervical Cancer Early Detection Program

National Cancer Institute: Cervical Cancer Home Page

National Cancer Institute: Cervical Cancer Home Page in Spanish

National Cervical Cancer Coalition Home Page

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