Issue Category: Obesity/Chronic Disease

States Can Improve Residents’ Health and Reduce Healthcare Spending by Adopting Policies Outside of the Healthcare Sector, New Report Shows

February 21, 2019

Policies that can improve health and save money include: Pre-K and school nutrition programs, syringe access, tobacco and alcohol taxes, paid family leave, the Earned Income Tax Credit and rapid rehousing.

(Washington, DC) — States can improve their residents’ health and well-being, and lower healthcare costs, by implementing a range of policies in sectors beyond healthcare, according to a new report, Promoting Health and Cost Control: How States Can Improve Community Health and Well-being through Policy Change, released today by Trust for America’s Health (TFAH).

The new report analyzes state action on 13 policies outside the healthcare sector that have a long-term impact on health and an evidence base showing their effectiveness. They include: tobacco and alcohol taxes, syringe access programs, universal pre-K and rapid rehousing laws, among others. The wide policy lens of the report, which covers numerous sectors, including taxation, employment, education, housing and transportation, underscores the many economic and social factors beyond medical care that influence health.

In the context of the longest decline in life expectancy since World War I, and, insufficient resources dedicated to preventing health problems before they arise, this new report serves as an urgent call to state policymakers to take concrete steps to improve residents’ health. The report was made possible by financial support from the Robert Wood Johnson Foundation and Kaiser Permanente.

“In the current environment, states have an even more vital role to play in promoting the health and well-being of their residents,” said John Auerbach, President and CEO of Trust for America’s Health. “Our goal in creating this report is to provide state public health officials and policymakers the evidence and business case for the adoption of policies that have been shown to improve community health.”

Policies Analyzed in the Report Number of States with the Policy
Universal Pre-K program* 10 (incl. DC)
School breakfast program 31 (incl. DC)
School lunch program 20
School competitive foods (snacks and drinks) 28 (incl. DC)
Syringe access programs 27 (incl. DC)
Smoke-free laws** 29 (incl. DC)
Tobacco taxes*** 51 (incl. DC)
Alcohol taxes*** 51 (incl. DC)
Complete streets 30 (incl. DC)
Housing rehabilitation loan and grant programs**** 40 (incl. DC)
Rapid re-housing laws 9 (incl. DC)
Earned income tax credit 30 (incl. DC)
Paid sick leave 12 (incl. DC)
Paid family leave 7 (incl. DC)
Fair hiring protections (ban the box) 34 (incl. DC)

The economic benefits of these policies can be substantial. For example:

  • Pre-K education programs can generate $4.63 in benefits to participants, taxpayers, and others in society for every $1 spent on such programs.
  • Expanding syringe exchange programs could return $7.58 for every $1 invested in the long run, by lowering HIV rates and reducing treatment costs. There is no evidence such programs lead to higher drug use.
  • Rapid re-housing programs, which focus on getting homeless individuals into stable housing before addressing other challenges, can reduce hospital admissions and jail bookings. One pilot study found that such an approach saved more than $36,000 in treatment costs per person over the course of a year, nearly twice what the program cost.

“While the healthcare sector plays an important role in providing health services when someone gets sick, many of the factors that keep people healthy are outside the healthcare system and involve where people live, work, play and learn,” said Adam Lustig, Manager of the Promoting Health and Cost Control in States initiative and one of the report authors.  “This report gives state policymakers a menu of evidence-based policies that have been shown to improve individual and community health.”

“I encourage all state policymakers to read this important report.  Doing so will give them access to proven solutions to the challenge of run-away healthcare spending yet so little improvement in health outcomes. To improve Americans’ health, we have to think beyond the healthcare sector and about the many factors that impact health,” said Anand Parekh, MD, MPH, Chief Medical Advisor, Bipartisan Policy Center and a member of the Promoting Health and Cost Control in States Advisory Board.

To create the report, TFAH reviewed approximately 1,500 evidence-based programs and strategies.  The 13 policies ultimately included in the report all:

  • Have a strong health impact and economic evidence of that impact, such as cost avoidance or reduction.
  • Focus on prevention at the population health level, i.e., are designed to prevent illness or injury at the community level rather than the individual level.
  • Focus on primary prevention, preventing an injury or illness rather than treating it.
  • Can be implemented by state legislative action.

The findings show dramatic variability in how states approach these health-promoting policies. For instance, all 50 states plus DC institute tobacco and alcohol taxes. But only nine states and DC have laws in place to encourage universal pre-K programs, which have been shown to set children up for better health later in life. Universal pre-K programs are state funded programs that support pre-K for nearly 50 percent or more of the state’s 4-year-olds. Only six states and DC support paid family leave, even though data show such policies support maternal and child health, and, can save employers money in the long run.

“Action is imperative,” said Auerbach.  “As a nation, we spend trillions of dollars a year on healthcare and yet Americans are getting less healthy.  The solution is two-fold: direct more spending to prevention efforts and address the social determinants of health instead of their impact after someone is sick.”

Notes:
*states that support state-funded pre-K to nearly 50% or more of the state’s 4-year-olds.
**comprehensive smoke-free as per the American Lung Association
*** rates vary, and higher taxes are generally more effective
**** many states fund such programs in the absence of statewide legislation

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  www.tfah.org

Countering Childhood Obesity in Georgia

Countering Childhood Obesity in Georgia

Georgia Shape, a statewide multifaceted initiative, seeks to advance the health and well-being of children by utilizing a cross-sectors approach to tackle childhood obesity in the state.

By cultivating strong relationships with institutions throughout the State, Georgia Shape has been able to focus on upstream interventions, namely providing time in each students’ day for physical activity. Upstream interventions refer to programs and policies that impact the root causes of health or social conditions.

Through the development of community-wide interventions, particularly Georgia Shapes’ ‘Power Up for 30’ program, rates of childhood obesity in Georgia have started to  decrease. The Center for Disease Control and Prevention recognizes school based programs to increase physical activity, such as ‘Power Up for 30’, as one of fourteen non-clinical community-wide interventions that can lead to cost-effective and cost-saving health outcomes within five years.

How It Took ‘Shape’

After the implementation of the 2009 Georgia Student Health and Physical Education Act (SHAPE), Georgia Shape was created to end the increasing rates of obesity among children in the state. In 2011, the Governor declared childhood obesity prevention as the number one public health priority and state leaders understood the importance of bridging the efforts of multi-sector partners to bolster the goals set forth by SHAPE. A governing council comprised of experts from a variety of disciplines was established to ensure that multiple perspectives were considered. Through the utilization of an obesity systems modelling program, factors contributing to obesity were identified, including a substantial lack of physical activity.

The overall goal of Power Up for 30 is to promote and protect the health of all children by incorporating 30 minutes of physical activity before, during, or after each school day. In collaboration with researchers, the Georgia Department of Public Health developed a comprehensive model to strategically focus and measure the health and economic impacts of school-based programs to increase physical activity.

The Power Up for 30 Model

Implementation of ‘Power Up for 30’ in schools relied on the support and acceptance of school superintendents and educators. Georgia Shape was promoted throughout elementary schools with messaging tailored to the interests of teachers and administrators to help garner support and establish applicability for the intervention. Tailored messages emphasized the benefits school principals, physical education teachers, and classroom teachers each prioritized including improved attendance and discipline, improved health, and improved academic performance. By identifying perceived barriers in each school, program developers were able to mold ‘Power Up For 30’ to fit each school’s specific environment and/or needs and assist teachers and administrators in achieving their respective goals.

School Based Activity Programs Increase School Based Activity Programs Decrease
●     School attendance

●     Academic performance

●     Concentration and attention in the classroom

●     Scores on State competency tests

●     Physically activity in the classroom

 ●     Childhood Obesity

●     Number of students receiving discipline

●     Negative health outcomes

Shape encouraged the utilization of physically active academic lessons as both a supplement to physical education in schools and to complement student learning. Former teachers served as subject matter experts to ensure the design of the program incorporated the realities of what would work in the classroom. Furthermore, the former teachers lent their knowledge of the unique needs of specific communities, which helped increase the programs ability to fit the diverse norms of different school environments.

In order to measure the effects of the intervention, the program assessed health knowledge, classroom physical activity time, time spent doing moderate to vigorous activity during physical education, availability of before school activity programs, and student aerobic capacity and BMI. For each school, data was compiled to discern the best available strategies for increasing physical activity within their individual environments. Buy-in and engagement was created at the individual school levels by training at least one administrator, one physical education teacher, and one classroom teacher to lead the ‘Power Up for 30’ program in their respective schools. Cultivating within-the-school leaders for the Power Up 30 program was a key to its success.

Success and Sustainability

At the beginning of 2012 the Power Up for 30 program launched across 40 Georgia elementary schools. ‘Power Up for 30’ expanded from a 5-county pilot program to a statewide approach by the 2013-2014 school year. As of 2016, more than 880 schools enlisted in Power Up for 30. Initially an elementary school pilot, ‘Power Up for 30’ is now embedded into Georgia’s elementary school educational curriculum and augmented to incorporate a middle school pilot.

Georgia Shape’s success in large part is due to its more than 120 partnerships and its sustainable and adaptable practices. Through utilizing evidence-based and sustainable models such as online training modules, low or no cost resources, free training, and continuous technical support, the Power Up for 30 program supports the implementation needs of all schools and educators. Assistance from public and private sector partners, such as the Georgia Department of Education, Department of Child and Family Services, the CDC, and corporate sponsors have been vital to Georgia Shapes’ achievements in tackling childhood obesity and protecting the health of every child.

For more information visit:

http://georgiashape.org/

(December 2018)

The State of Obesity 2018

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Report emphasizes urgent need to increase evidence-based obesity prevention programs to prevent disease and potentially save billions in healthcare spending

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Findings include:

  • Adult obesity rates vary considerably from state to state, with a high of 38.1 percent in West Virginia and a low of 22.6 percent in Colorado. No state had a statistically significant improvement in its obesity rate over the past year.
  • Adult obesity rates are at or above 35 percent in seven states; for the first time in Iowa and Oklahoma, and at least the second time in Alabama, Arkansas, Louisiana, Mississippi, and West Virginia.
  • Six states — Iowa, Massachusetts, Ohio, Oklahoma, Rhode Island, and South Carolina — saw their adult obesity rates increase significantly between 2016 and 2017.
  • Adult obesity rates are between 30 and 35 percent in 22 states and 19 states have adult obesity rates between 25 and 30 percent.
  • Over the past five years (2012 – 2017), 31 states had statistically significant increases in their obesity rate and no state had a statistically significant decrease in its obesity rate.
  • There continue to be striking racial and ethnic disparities in obesity rates. In 31 states, the adult obesity rate among Blacks is at or above 35 percent.  Latino adults have obesity at a rate at or above 35 percent in eight states.  White adults have obesity rates at or above 35 percent in one state. Nationally, the adult obesity rates for Latinos, Blacks and Whites are 47.0 percent, 46.8 percent and 37.9 percent respectively.

State by State rates of obesity among adults: 1 = highest rate of obesity, 51 = lowest rate

  1. West Virginia (38.1%), 2. Mississippi (37.3%), 3. Oklahoma (36.5%), 4. Iowa (36.4%), 5. Alabama (36.3%), 6. Louisiana (36.2%), 7. Arkansas (35.0%), 8. Kentucky (34.3%), 9. Alaska (34.2 %), 10. South Carolina (34.1%), 11. Ohio (33.8%), 12. Indiana (33.6%), 13. North Dakota (33.2%), 14. Texas (33.0%), 15. Tie Tennessee and Nebraska (32.8%), 17. Missouri (32.5%), 18. Kansas (32.4%), 19. Michigan (32.3%), 20. North Carolina (32.1%), 21. Wisconsin (32.0%), 22. South Dakota (31.9%), 23. Delaware (31.8%), 24. Tie Pennsylvania and Georgia (31.6%), 26. Maryland (31.3%), 27. Illinois (31.1%), 28. Virginia (30.1%), 29. Rhode Island (30.0%), 30. Arizona (29.5%), 31. Oregon (29.4%), 32. Idaho (29.3%), 33. Maine (29.1%), 34. Wyoming (28.8%), 35. Tie Minnesota, Florida and New Mexico (28.4%), 38. New Hampshire (28.1%), 39. Washington (27.7%), 40. Vermont (27.6%), 41. New Jersey (27.3%), 42. Connecticut (26.9%), 43. Nevada (26.7%), 44. Massachusetts (25.9%), 45. New York (25.7%), 46. Tie Montana and Utah (25.3%), 48. California (25.1%), 49. Hawaii (23.8 %), 50. District of Columbia (23.0%), 51. Colorado (22.6 %).

NOTE to reporters: See full report at TFAH.org/ObesityReport2018 and StateofObesity.org for state-by-state obesity rates, data interactives, priority policy summaries, and briefs for all 50 states.

“Obesity is a complex and often intractable problem and America’s obesity epidemic continues to have serious health and cost consequences for individuals, their families and our nation,” said John Auerbach, president and CEO of Trust for America’s Health. “The good news is that there is growing evidence that certain prevention programs can reverse these trends.  But we won’t see meaningful declines in state and national obesity rates until they are implemented throughout the nation and receive sustained support.”

Obesity is a problem in virtually every city and town, and every income and social sector.  But its impact is most serious in communities where conditions make access to healthy foods and regular physical activity more difficult, such as lower income and rural areas, including many communities of color.

The national costs of obesity are enormous.  Obesity drives an estimated $149 billion annually in directly related healthcare spending, and an additional $66 billion annually in lowered economic productivity. Also, one in three young adults is ineligible for military service, owing to being overweight, posing a national security vulnerability.

Evidence-based programs, policies and practices to reverse the obesity trend are known but need widespread implementation.

“Obesity is a major challenge in nearly every state and our role as public health leaders is to ensure we’re doing everything we can to address it,” said John Wiesman, president of the Association of State and Territorial Health Officials (ASTHO) and secretary of health at the Washington State Department of Health. “Our goal at the state level is to work across sectors to advocate for and implement evidence-based policies that encourage active healthy living and support healthy and safe communities that provide access to healthy foods, physical activity, and clinical preventive services.”

Recommendations

The report offers 40 recommendations for federal, state and local policymakers; the restaurant and food industries; and the healthcare system, including:

  • Support and expand policies and programs aimed at addressing obesity at the federal, state and community levels, including programs in the Centers for Disease Control and Prevention’s (CDC) Division of Nutrition, Physical Activity and Obesity, and community health programs like the Racial and Ethnic Approaches for Community Health program (REACH), and programs that focus on school health in CDC’s Division of Population Health.
  • Maintain and strengthen essential nutrition supports for low-income children, families and individuals through programs — like the Supplemental Nutrition Assistance Program (SNAP) and the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in the U.S. Department of Agriculture (USDA) and expand programs and pilots to make healthy food more available and affordable through the program.
  • Maintain nutrition standards for school meals that were in effect prior to USDA’s interim final rule from November 2017, as well as current nutrition standards for school snacks.
  • States should ensure that all students receive at least 60 minutes of physical education or activity during each school day.
  • Medicare should encourage eligible beneficiaries to enroll in obesity counseling as a covered benefit, and, evaluate its use and effectiveness. Health plans, medical schools, continuing medical education, and public health departments should raise awareness about the need and availability of these services.
  • Food and beverage companies should eliminate children’s exposure to advertising and marketing of unhealthy products.
  • Hospitals should no longer sell or serve sugary drinks on their campuses; they should also improve the nutritional quality of meals and promote breastfeeding.

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Trust for America’s Health is a nonprofit, nonpartisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  www.tfah.org

TFAH Applauds Passage of Senate Farm Bill

(Washington, D.C., June 29, 2018) – John Auerbach, president and CEO, of Trust for America’s Health (TFAH) today made the following statement regarding Senate passage of “Farm Bill” legislation (the Agriculture Improvement Act – Senate amendment to H.R. 2) to reauthorize key federal agricultural and nutrition programs.

“The Trust for America’s Health is pleased the U.S. Senate has completed work on Farm Bill legislation that will support and promote good nutrition and improved health outcomes. By rejecting the approach taken by the House, the Senate bill largely protects and strengthens the Supplemental Nutrition Assistance Program (SNAP), which serves as a critical lifeline to millions of American children and families that otherwise lack the means to access adequate nourishment and make healthy food choices.

In addition to increases in funding to the Food Insecurity Nutrition Incentive Pilot, the Senate bill includes a Harvesting Health pilot that would help to further promote linkages between health care providers and anti-hunger and nutrition improvement activities.

According to TFAH’s State of Obesity report, roughly two out of every three adults or one out of every three children is either obese or overweight. Obesity remains both a significant public health crisis and a national security issue-being overweight or obese is the leading cause of medical disqualifications for military service, with nearly one-quarter of applicants being rejected for exceeding the weight or body fat standards. Additionally, obesity translates to higher health care costs and poor quality of life.

Many efforts are underway that encourage SNAP recipients to make healthy food choices; for example, incentive programs to use SNAP benefits at farmers’ markets. Such efforts, combined with other prevention programs and policies, have been shown to be effective. We must now continue to invest in and scale such approaches to help Americans eat healthier. SNAP and other Farm Bill programs will be critical to turning the tide against this longstanding health problem.

TFAH looks forward to continuing to work with Congress through the conference process as it develops a final Farm Bill that will lead us in the right direction, towards improving the health and prosperity of all Americans.”

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Trust for America’s Health is a non-profit, non-partisan organization dedicated to saving lives by protecting the health of every community and working to make disease prevention a national priority.

Separating parents and children at US border is inhumane and sets the stage for a public health crisis

(Washington, D.C., June 15, 2018) — “The Trump administration’s policy of separating parents and children at the U.S.-Mexico border will have a dire impact on their health, both now and into the future.

“As public health professionals we know that children living without their parents face immediate and long-term health consequences. Risks include the acute mental trauma of separation, the loss of critical health information that only parents would know about their children’s health status, and in the case of breastfeeding children, the significant loss of maternal child bonding essential for normal development. Parents’ health would also be affected by this unjust separation.

“More alarming is the interruption of these children’s chance at achieving a stable childhood. Decades of public health research have shown that family structure, stability and environment are key social determinants of a child’s and a community’s health.

“Furthermore, this practice places children at heightened risk of experiencing adverse childhood events and trauma, which research has definitively linked to poorer long-term health. Negative outcomes associated with adverse childhood events include some of society’s most intractable health issues: alcoholism, substance misuse, depression, suicide, poor physical health and obesity.

“There is no law requiring the separation of parents and children at the border. This policy violates fundamental human rights. We urge the administration to immediately stop the practice of separating immigrant children and parents and ensure those who have been separated are rapidly reunited, to ensure the health and well-being of these children.”

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Trust for America’s Health is a non-profit, non-partisan organization that promotes optimal health for every person and community and makes the prevention of illness and injury a national priority.  Twitter: @HealthyAmerica1