Issue Category: Public Health Funding

New Report Places 25 States and DC in High Performance Tier on 10 Public Health Emergency Preparedness Measures

As Threats Increase, Annual Assessment Finds States’ Level of Readiness for Health Emergencies is Improving in Some Areas but Stalled in Others

February 5, 2020

(Washington, DC) – Twenty-five states and the District of Columbia were high-performers on a three-tier measure of states’ preparedness to protect the public’s health during an  emergency, according to a new report released today by Trust for America’s Health (TFAH). The annual report, Ready or Not 2020: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, found year-over-year improvement among 10 emergency readiness measures, but also notes areas in need of improvement. Last year, 17 states ranked in the report’s top tier.

For 2020, 12 states placed in the middle performance tier, down from 20 states and the District of Columbia in the middle tier last year, and 13 placed in the low performance tier, the same number as last year.

The report found that states’ level of preparedness has improved in key areas, including public health funding, participation in healthcare coalitions and compacts, hospital safety, and seasonal flu vaccination. However, other key health security measures, including ensuring a safe water supply and access to paid time off, stalled or lost ground.

Performance Tier States Number of States
High Tier AL, CO, CT, DC, DE, IA, ID, IL, KS, MA, MD, ME, MO,
MS, NC, NE, NJ, NM, OK, PA, TN, UT, VA, VT, WA, WI		 25 states and DC
Middle Tier AZ, CA, FL, GA, KY, LA, MI, MN, ND, OR, RI, TX 12 states
Low Tier AK, AR, HI, IN, MT, NH, NV, NY, OH, SC, SD, WV, WY 13 states

 

The report measures states’ performance on an annual basis using 10 indicators that, taken together, provide a checklist of a jurisdiction’s level of preparedness to prevent and respond to threats to its residents’ health during an emergency. The indicators are:

Preparedness Indicators 
1 Incident Management: Adoption of the Nurse Licensure Compact. 6 Water Security: Percentage of the population who used a community water system that failed to meet all applicable health-based standards.
2 Cross-Sector Community collaboration: Percentage of hospitals participating in healthcare coalitions. 7 Workforce Resiliency and Infection Control: Percentage of employed population with paid time off.
3 Institutional Quality: Accreditation by the Public Health Accreditation Board. 8 Countermeasure Utilization: Percentage of people ages 6 months or older who received a seasonal flu vaccination.
4 Institutional Quality: Accreditation by the Emergency Management Accreditation Program. 9 Patient Safety: Percentage of hospitals with a top-quality ranking (“A” grade) on the Leapfrog Hospital Safety Grade.
5 Institutional Quality: Size of the state public health budget, compared with the past year. 10 Health Security Surveillance: The public health laboratory has a plan for a six-to eight-week surge in testing capacity.

Four states (Delaware, Pennsylvania, Tennessee, and Utah) moved from the low performance tier in last year’s report to the high tier in this year’s report. Six states (Illinois, Iowa, Maine, New Mexico, Oklahoma, Vermont) and the District of Columbia moved up from the middle tier to the high tier. No state fell from the high to the low tier but six moved from the middle to the low tier. Hawaii, Montana, Nevada, New Hampshire, South Carolina, and West Virginia.

“The increasing number of threats to Americans’ health in 2019, from floods to wildfires to vaping, demonstrate the critical importance of a robust public health system. Being prepared is often the difference between harm or no harm during health emergencies and requires four things: planning, dedicated funding, interagency and jurisdictional cooperation, and a skilled public health workforce,” said John Auerbach, President and CEO of Trust for America’s Health.

“While this year’s report shows that, as a nation, we are more prepared to deal with public health emergencies, we’re still not as prepared as we should be. More planning and investment are necessary to saves lives,” Auerbach said.

TFAH’s analysis found that:

  • A majority of states have plans in place to expand healthcare capacity in an emergency through programs such as the Nurse Licensure Compact or other healthcare coalitions. Thirty-two states participated in the Nurse Licensure Compact, which allows licensed nurses to practice in multiple jurisdictions during an emergency. Furthermore, 89 percent of hospitals nationally participated in a healthcare coalition, and 17 states and the District of Columbia have universal participation meaning every hospital in the state (+DC)  participated in a coalition. In addition, 48 states and DC had a plan to surge public health laboratory capacity during an emergency.
  • Most states are accredited in the areas of public health, emergency management, or both. Such accreditation helps ensure that necessary emergency prevention and response systems are in place and staffed by qualified personnel.
  • Most people who got their household water through a community water system had access to safe water. Based on 2018 data, on average, just 7 percent of state residents got their household water from a community water system that did not meet applicable health standards, up slightly from 6 percent in 2017.
  • Seasonal flu vaccination rates improved but are still too low. The seasonal flu vaccination rate among Americans ages 6 months and older rose from 42 percent during the 2017-2018 flu season to 49 percent during the 2018-2019 season, but vaccination rates are still well below the 70 percent target established by Healthy People 2020.
  • In 2019, only 55 percent of employed people had access to paid time off, the same percentage as in 2018. The absence of paid time off has been shown to exacerbate some infectious disease outbreaks . It can also prevent people from getting preventive care.
  • Only 30 percent of hospitals, on average, earned top patient safety grades, up slightly from 28 percent in 2018. Hospital safety scores measure performance on such issues as healthcare associated infection rates, intensive-care capacity and an overall culture of error prevention. Such measures are critical to patient safety during infectious disease outbreaks and are also a measure of a hospital’s ability to perform well during an emergency.

The report includes recommended policy actions that the federal government, states and the healthcare sector  should take to improve the nation’s ability to protect the public’s health during emergencies.

Other sections of the report describe how the public health system was critical to the vaping crisis response, how health inequities put some communities at greater risk during an emergency, and the needs of people with disabilities during an emergency.

Read the full text report

New National Data Present a Mixed Picture: Some Drug Overdoses Down but Others are Up, and Suicides Rates are Increasing

(Washington, DC – January 30, 2020) Newly released mortality data from 2018 show the first increase in Americans’ life expectancy since 2014, and the first decline in the rate of drug overdose deaths, including opioid overdoses, since 2012. The year also saw an increase in suicide and in overdose deaths involving synthetic opioids, cocaine, and psychostimulants (a category that includes drugs like methamphetamine, amphetamine, and methylphenidate). The topline trends on mortality and opioids—released by the National Center for Health Statistics on January 30—are heartening after years of alarming trends, but suicides continue to rise, and drug overdoses remain a major public health issue that requires vigilance from policymakers to ensure sustained gains.

Key findings from today’s reports:

  • Life expectancy: American’s life expectancy was 78.7 years in 2018, compared with 78.6 years in 2017. Life expectancy in the United States peaked in 2014 at 78.9 years.
  • Suicide deaths: 48,344 Americans died from suicide in 2018, a rate of 14.2 deaths per 100,000. That’s a rate 2 percent higher than 2017 when 47,173 Americans died from suicide (14.0 deaths per 100,000).
  • Overall drug overdoses deaths: 67,367 Americans died from drug overdoses in 2018, a rate of 20.7 deaths per 100,000. This is a rate 5 percent lower than over 2017 when 70,237 Americans died of drug overdoses (21.7 deaths per 100,000). Even with the decline, the 2018 rate of drug overdoses is still 74 percent higher than 2008.
  • Opioid overdose deaths: 46,802 Americans died from opioid overdoses in 2018, a rate of 14.6 deaths per 100,000. That’s a rate 2 percent lower than 2017 when 47,600 Americans died of opioid overdoses (14.9 deaths per 100,000). Even with the decline, the rate of opioid overdose deaths has more than doubled in the last decade.
  • Synthetic opioid overdose deaths: 31,335 Americans died from synthetic opioid overdoses in 2018, a rate of 9.9 deaths per 100,000. That’s a rate 10 percent higher than 2017 when 28,466 Americans died of synthetic opioids overdoses (9.0 deaths per 100,000). The rate of synthetic opioid overdose deaths has increased almost 900 percent over the last five years.
  • Cocaine overdose deaths: 14,666 Americans died from cocaine overdoses in 2018, a rate of 4.5 deaths per 100,000. That rate is 5 percent higher than 2017, when 13,942 Americans died of cocaine overdoses (4.3 deaths per 100,000). The rate of cocaine overdose deaths has increased by almost three-fold over the past five years.
  • Psychostimulant overdose deaths: 12,676 Americans died from psychostimulants in 2018, a rate of 3.9 deaths per 100,000. That’s a rate 22 percent higher than 2017, when 10,333 Americans died from psychostimulant overdoses (3.2 deaths per 100,000). The rate of psychostimulants overdose death has increased by more than three-fold over the past five years.Additional annual data (1999-2018) and state-level data on drug overdose death can be found below.“While we have some cause for celebration, now is not the time to become complacent,” said Benjamin F. Miller, PsyD, chief strategy officer, Well Being Trust. “It’s been important to focus on harm reduction and saving lives—but policy and investments must go further to reduce what’s driving despair and prevent substance misuse issues and suicidal ideation from developing in the first place. No one policy will solve this crisis we’re facing as a country—what is need is a comprehensive, actionable framework for policy makers.”“These new data suggest efforts to reduce opioid deaths are starting to take hold, particularly by reducing inappropriate opioid prescribing and expanding treatment options,” said John Auerbach, President and CEO of the Trust for America’s Health. “These data show we can make a positive difference when we adopt evidence-based approaches and expand the available resources.   But we need to expand that approach to prevent suicides and address all forms of substance misuse.  That requires a comprehensive approach that pays attention to the upstream root causes, like childhood trauma, poverty and discrimination,”Over the last four years, Trust for America’s Health (TFAH) and Well Being Trust (WBT) have released as series of reports on “deaths of despair” called Pain in the Nation: The Drug, Alcohol and Suicides Epidemics and the Need for a National Resilience Strategy, which include data analysis and recommendations for evidence-based policies and programs that federal, state, and local officials.

 

Drug Overdose Deaths, 1999-2018 (Rates age-adjusted)

Year Deaths Deaths per 100,000
1999 16,849 6.1
2000 17,415 6.2
2001 19,394 6.8
2002 23,518 8.2
2003 25,785 8.9
2004 27,424 9.4
2005 29,813 10.1
2006 34,425 11.5
2007 36,010 11.9
2008 36,450 11.9
2009 37,004 11.9
2010 38,329 12.3
2011 41,340 13.2
2012 41,502 13.1
2013 43,982 13.8
2014 47,055 14.7
2015 52,404 16.3
2016 63,632 19.8
2017 70,237 21.7
2018 67,367 20.7

Source National Vital Statistics System, National Center for Health Statistics

 

2018 Drug Overdose Deaths by State

State Deaths Deaths per 100,000
Alabama 775 16.6
Alaska 110 14.6
Arizona 1670 23.8
Arkansas 444 15.7
California 5348 12.8
Colorado 995 16.8
Connecticut 1069 30.7
Delaware 401 43.8
DC 254 35.4
Florida 4698 22.8
Georgia 1404 13.2
Hawaii 213 14.3
Idaho 250 14.6
Illinois 2722 21.3
Indiana 1629 25.6
Iowa 287 9.6
Kansas 345 12.4
Kentucky 1315 30.9
Louisiana 1140 25.4
Maine 345 27.9
Maryland 2324 37.2
Massachusetts 2241 32.8
Michigan 2591 26.6
Minnesota 636 11.5
Mississippi 310 10.8
Missouri 1610 27.5
Montana 125 12.2
Nebraska 138 7.4
Nevada 688 21.2
New Hampshire 452 35.8
New Jersey 2900 33.1
New Mexico 537 26.7
New York 3697 18.4
North Carolina 2259 22.4
North Dakota 70 10.2
Ohio 3980 35.9
Oklahoma 716 18.4
Oregon 547 12.6
Pennsylvania 4415 36.1
Rhode Island 317 30.1
South Carolina 1125 22.6
South Dakota 57 6.9
Tennessee 1823 27.5
Texas 3005 10.4
Utah 624 21.2
Vermont 153 26.6
Virginia 1448 17.1
Washington 1164 14.8
West Virginia 856 51.5
Wisconsin 1079 19.2
Wyoming 66 11.1

Source National Vital Statistics System, National Center for Health Statistics

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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. @HealthyAmerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org @WellBeingTrust

TFAH Statement on 5th Circuit Ruling on ACA

December 19, 2019

Yesterday, the U.S. Court of Appeals for the Fifth Circuit ruled the Affordable Care Act’s individual mandate is unconstitutional and directed the lower court judge, who has already ruled against the entire law, to determine how the latest ruling impacts the rest of the law.

Trust for America’s Health’s CEO John Auerbach issued the following statement:

“While millions of Americans wait in limbo as Texas v. U.S. continues through the courts, it’s important to remember how much is at stake. Millions of Americans could lose health coverage.  Health insurance is a critical determinant of health. It is impossible for the nation to tackle our leading health crises – from the opioid crisis to infectious disease outbreaks – without access to high quality health care for everyone.

There are also major implications for public health. If the entire law is overturned, it would gut the nation’s investment in public health by eliminating over $15 billion over the next 10 years (FY2021-FY2030) for the Centers for Disease Control and Prevention (CDC) and other public health agencies. The Prevention and Public Health Fund, a dedicated funding stream specifically designated for public health and prevention, funds programs in every state to expand immunizations, prevent suicide, modernize laboratory and epidemiology services to detect and contain disease outbreaks, prevent childhood lead poisoning, and prevent diabetes and other chronic conditions.

The decision also threatens the requirement that insurers cover recommended clinical preventive services without cost-sharing. These provisions have meant that an estimated additional 71 million Americans now have access to vaccines, tobacco cessation services, blood pressure and diabetes screenings and other life-saving services previously inaccessible to them.

Overturning the law would have a profound effect on the health of every American, regardless of where they live.  Every state has benefited from investments in public health and prevention.  Millions of Americans have gained access to health coverage and access to preventive services.”

New Maps Track Laws Related to Tobacco Pricing Strategies and Syringe Service Programs in US

(Philadelphia, Pa – Novermber 19, 2019)  Two new maps published to LawAtlas.org today — syringe service programs (SSPs) and tobacco pricing strategies — offer a comprehensive look at US laws that address tobacco pricing strategies and access to clean syringes through syringe service programs.

“States have a vital role to play in promoting the health and well-being of their residents. These datasets, along with other resources produced under the Promoting Health and Cost Control (PHACCS) in States initiative, will provide decisionmakers, advocates, and other key stakeholders with the evidence and business case for the adoption of policies that have been shown to improve community health,” said Adam Lustig, MS, Manager and Co-Principal Investigator of the PHACCS initiative.

The maps are the first two legal data resources in a new series created and maintained by the Center for Public Health Law Research at Temple University’s Beasley School of Law (CPHLR)  with the Trust for America’s Health (TFAH).

Researchers from the Center used the scientific policy surveillance process in collaboration with experts from TFAH to provide states with detailed information about the current state of US laws that could be used to improve community health through cost-saving policy changes.

“You must first measure a policy to understand its impact on health and cost. These maps give policymakers, advocates, practitioners and other stakeholders a comprehensive look into what these laws say and how the nuanced characteristics differ across the US,” said Lindsay Cloud, JD, Director of the Policy Surveillance Program at CPHLR. “The policy surveillance process we use is the gold standard for legal research because it creates objective, detailed legal data that can be used for evaluation and provides a clear visual to identifying gaps and areas for policy improvement.”

The project will include 13 datasets on a variety of public health topics through the end of 2020, ranging from universal pre-kindergarten and school nutrition standards, to housing and economic policies like the Earned Income Tax Credit and paid sick and family leave laws. The laws displayed were in effect as of August 1, 2019.

The two datasets released today, on syringe service programs and tobacco pricing strategies, represent two of the harm reduction-focused datasets in the series.


Syringe Service Programs

Syringe service program (SSP) policies authorize the legal sale and exchange of sterile syringes, and are one of the most effective and scientifically-based methods for reducing the spread of HIV and Hepatitis. This legal map identifies where SSPs have been explicitly authorized by the law, legal exemptions for individuals who access SSPs if they’re in possession of paraphernalia if stopped by law enforcement, and additional services an SSP must provide directly or through referrals.

Some key findings from this dataset include:

  • 31 states have passed laws that explicitly authorize SSPs. This number has nearly doubled since 2014 (18 states as of August 1, 2014).
  • In four of the 31 states – Delaware, Florida, Hawaii, and Maine – the law requires a one-for-one exchange of syringes.
  • In three states – Colorado, Georgia and Ohio – SSPs are also required to provide HIV and Hepatitis screenings.


Tobacco Pricing Strategies

Tobacco use and exposure to second-hand smoke are leading causes of preventable death in the US. One strategy to decrease tobacco use and promote quitting is to increase the price of tobacco products. This legal map details US laws that apply taxes or set pricing limits for tobacco products, like traditional cigarettes, e-cigarettes, and others.

Some key findings from this dataset include:

  • All 50 states and the District of Columbia tax cigarettes.
  • All 50 states and the District of Columbia have taxes on non-cigarette tobacco products.
  • 14 states and the District of Columbia also tax e-cigarettes, either by taxing the device, the liquid, or both.
  • 31 states and the District of Columbia prohibit selling cigarettes, non-cigarette tobacco products, or both below cost.
  • 32 states preempt local taxation of tobacco, either through explicit prohibitions on local tobacco taxation or through general limitations on the power of local governments to impose their own excise taxes.

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. Learn more at www.tfah.org

The Center for Public Health Law Research at the Temple University Beasley School of Law supports the widespread adoption of scientific tools and methods for mapping and evaluating the impact of law on health. Learn more at http://phlr.org

 

 

Adolescent Suicide Up 87 Percent Over Last Decade; LGBT and American Indian/Alaskan Native Teens at Highest Risk

Vaping among teens also increasing at an alarming rate.

(Washington, DC and Oakland, CA – October 29, 2019) – Adolescent suicides have spiked over the last decade and substance misuse including vaping is exacting a heavy toll on teens according to a report released today by Trust for America’s Health (TFAH) and Well Being Trust (WBT).

The report, Addressing a Crisis: Cross-Sector Strategies to Prevent Adolescent Substance Misuse and Suicide finds that, while progress has been made in reducing some risky behaviors, adolescent suicide and substance misuse rates remain high and in some cases are climbing. The report calls for the expansion of evidence-based and cross-sector strategies in order to save lives.

Suicide rates among 12- to 19-year-olds have increased 87 percent between 2007 and 2017 (when the most recent data is available) – making suicide the second leading cause of death among adolescents. In 2017, 7.4 percent of high schoolers nationwide attempted suicide within the preceding 12 months – a 17 percent increase from the previous year. Nearly 3,000 12- to 19-year-olds died by suicide in 2017.

“We know strategies that are proven to work and can improve mental health and well-being among our young people,” said Benjamin F. Miller, PsyD, chief strategy officer, WBT. “From Zero Suicide to Youth Mental Health First Aid to LifeSkills Training programs and dozens of other initiatives, there are solutions out there – why this is not the first question of every Presidential debate, prioritized in Congress, and in every state legislature is beyond me. Our country has failed to devote the time, energy, and resources to our youth.”

An additional area of concern threatening youth well-being is vaping—with rates of use among adolescents climbing dramatically. In just one year, 2017 to 2018, e-cigarette use by high school students increased by 78 percent and by 48 percent among middle school students. More teens are also reporting vaping marijuana.

While there is some good news – rates of illicit or injection and prescription drug use among adolescents have declined or held steady among 12- to 17-year-olds since 2002 – but those rates are still too high and cause serious harm and disruption to young lives. In 2017, 5,455 young people between the ages of 15 to 24 died due to a drug overdose.

Alcohol use among adolescents has also declined. Past month alcohol use among 12- to 17-year-olds declined from 18 percent in 2002 to 10 percent in 2017 and lifetime alcohol use among high school students has declined from 82 percent in 1991 to 60 percent in 2017.

Substance misuse and suicide disproportionately affect adolescents from certain population groups

Of additional concern are large disparities in substance misuse rates and suicide based on teens’ race, ethnicity, socioeconomic status, sexual orientation/gender identification or where they live.  Most striking is the high risk for substance misuse and suicide-related behaviors among gay, lesbian and bisexual adolescents.  Forty-eight percent of gay, lesbian and bisexual adolescents report considering or attempting suicide as compared to 13 percent of their heterosexual peers.  These high rates of suicide risk for sexual minority teens are likely due to stressors they experience including discrimination, bullying, violence and family rejection, according to the report.

American Indian/Alaskan Native teens experience the highest rates of suicide among any race and ethnicity in the United States: 16 suicides per 100,000 15- to 19-years-olds in 2016 – a rate 60 percent higher than the national average for all teens.  The high rates of substance misuse and suicide among American Indian/Alaskan Native teens are likely associated with the historical and intergenerational trauma experienced by their community as well as the lack of education and economic opportunities typically available to them.

Solutions do exist and need implementation

Adolescence is a critical juncture in teens’ lives. This report highlights the many opportunities to set youth on healthy pathways be increasing the life circumstances that protect them from harm.

The report highlights dozens of evidence-based programs in place in communities across the country that help reduce risk and build protective factors in teens’ lives  by strengthening families, providing counseling and mentorship, teaching social and emotional skills, fostering connectedness, particularly in schools, and working across sectors. Most importantly, addressing the factors that create or reduce risk for substance misuse or mental health issues will not only reduce negative impact on teens’ health, it will also improve outcomes in other sectors such as high school graduation rates or involvement with the juvenile justice system.

“Adolescence is a challenging time when the impact of poverty, discrimination, bullying and isolation can be intense,” said John Auerbach, President and CEO of Trust for America’s Health. ” Fortunately, there are policies and programs that can reduce some of these circumstances and the risks associated with them by strengthening teens’ coping and emotional skills – skills that can improve their health and lead to their succeeding in school.”

Recommendations for programs and policy actions

The report includes recommendations for policy actions at the federal, state and local level.

Among the specific recommendations are:

  • The federal government and state legislatures should create and/or scale up policies that support families including increases to federal and state earned income tax credits and programs that provide access to health insurance and affordable housing.
  • Congress should increase funding for substance misuse and suicide prevention including Project AWARE and the Garrett Lee Smith State/Tribal Youth Suicide Prevention and Early Intervention Grant program.
  • States should expand Medicaid services in schools using flexible models such as school-employed providers, school-based health centers and telehealth.
  • Congress should increase investments in the Centers for Disease Control and Prevention’s Division of Adolescent and School Health.
  • All youth-serving systems should adopt trauma-informed and culturally competent policies and practices and should engage youth leaders in program development.
  • Federal, state and local efforts to improve school safety should include strategies to prevent school violence by investing in safe and supportive school environments and mental health services.
  • Public and private funders should incentivize strategies that address common risk/protective factors across all adolescent serving sectors.

The report is part of the TFAH/WBT Pain in the Nation publication series, launched in 2017 and examining substance misuse and suicide trends and evidence-based policies and programs in an effort to promote a comprehensive approach to solving the nation’s deaths of despair crisis. The report series is designed to focus attention on the need for national resilience strategy.

 

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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. Twitter: @healthyamerica1

Well Being Trust is a national foundation dedicated to advancing the mental, social, and spiritual health of the nation. Created to include participation from organizations across sectors and perspectives, Well Being Trust is committed to innovating and addressing the most critical mental health challenges facing America, and to transforming individual and community well-being. www.wellbeingtrust.org. Twitter: @WellBeingTrust.

 

 

 

U.S. Obesity Rates at Historic Highs – Nine States Reach Adult Obesity Rates of 35 Percent or More

 Report Calls for Sugary Drink Taxes, Expanded SNAP and WIC Nutrition Support Programs and a built environment that encourages physical activity to Help Address Health Crisis

(Washington, DC – September 12, 2019) – Nine U.S. states had adult obesity rates above 35 percent in 2018, up from seven states at that level in 2017, an historic level of obesity in the U.S., according to the 16th annual State of Obesity: Better Policies for a Healthier America report released today by the Trust for America’s Health (TFAH).

The report based in part on newly released data from the Centers for Disease Control and Prevention’s Behavioral Risk Factor Surveillance System (BRFSS), and analysis by TFAH, provides an annual snapshot of obesity rates nationwide.  The State of Obesity series and this report were made possible by funding from the Robert Wood Johnson Foundation.

Obesity has serious health consequences including increased risk for type 2 diabetes, high blood pressure, stroke and many types of cancers. Obesity is estimated to increase national healthcare spending by $149 billion annually (about half of which is paid for by Medicare and Medicaid) and being overweight or obese is the most common reason young adults are ineligible for military service.

Obesity rates vary considerably between states with Mississippi and West Virginia having the highest level of adult obesity in the nation at 39.5 percent and Colorado having the lowest rate at 23.0 percent.

For the first time, adult obesity rates were above 35 percent in nine states in 2018: Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota and West Virginia.

As recently as 2012, no state had an adult obesity rate over 35 percent and within the last five years (2013 and 2018) 33 states had statistically significant increases in their rates of adult obesity.

“These latest data shout that our national obesity crisis is getting worse,” said John Auerbach, President and CEO of Trust for America’s Health. “They tell us that almost 50 years into the upward curve of obesity rates we haven’t yet found the right mix of programs to stop the epidemic.   Isolated programs and calls for life-style changes aren’t enough.  Instead, our report highlights the fundamental changes that are needed in the social and economic conditions that make it challenging for people to eat healthy foods and get sufficient exercise.”


Differential Impact Amongst Minority Populations

The report highlights that obesity levels are closely tied to social and economic conditions and that individuals with lower incomes are more at risk. People of color, who are more likely to live in neighborhoods with few options for healthy foods and physical activity, and, are the target of widespread marketing of unhealthy foods, are at elevated risk.

As of 2015-2016, the latest available data, nearly half of Latino (47 percent) and Black adults (46.8) had obesity while adult obesity rates among White and Asian adults were 37.9 percent and 12.7 percent respectively.  Incidence of childhood obesity was highest amongst Latino children at 25.8 percent while 22 percent of Black children had obesity, 14 percent of White children had obesity and 11 percent of Asian children had obesity.


What Could Work?

While the obesity rates are alarming, there are new data offering the promise of policies that combat the epidemic, namely promoting healthier food for children through revamped WIC food packages and fostering behavior change through taxes on sugary drinks.

  • Obesity rates for children enrolled in WIC (Special Supplemental Nutrition Program for Women, Infants and Children) continue to decline, from 15.9 percent in 2010 to 13.9 percent in 2016. In 2009, the USDA updated WIC food packages to more closely meet recommended national dietary guidelines including the addition of more fruits, vegetables and whole grains and reduced fat levels in milk and infant formula. A Los Angeles County study published this year found that 4-year-olds who had received the revised WIC food package since birth had reduced risk for obesity.
  • A number of U.S. cities and the Navajo Nation have passed local taxes on sugary drinks that are showing promise as a means to change consumers’ beverage habits. Studies of a 1-cent per ounce tax in Berkeley, California and a 1.5 cent per ounce tax in Philadelphia, Pennsylvania found that the consumption of sugary drinks decreased significantly after the tax was imposed.

“Policies such as these are proving effective in changing behavior. But, no single solution – however promising – is sufficient.  Obesity is a complex problem and will need multi-sector, multi-factor solutions,” said TFAH’s Auerbach.

“Creating the conditions that allow people to more easily make healthy choices is central to preventing obesity, as is prioritizing investment in those communities most affected by the crisis,” Auerbach said.


Recommendations for Policy Action

The report includes 31 recommendations for policy action by federal, state and local government, across several sectors, designed to improve access to nutritious foods and provide safe opportunities for physical activity, while minimizing harmful marketing and advertising tactics.

Among the report’s recommendations for policies to address the obesity crisis are:

  • Expand the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) to age 6 for children and for two years postpartum for mothers and fully fund the WIC breastfeeding Peer Counseling Program.
  • Increase the price of sugary drinks through excise taxes and use the revenue to address health and socioeconomic disparities.
  • Ensure that CDC has enough funding to grant every state appropriate funding to implement evidence-based obesity prevention strategies (currently, CDC only has enough funding to work with 16 states).
  • Make it more difficult to market unhealthy food to children by ending federal tax loopholes and business costs deductions related to the advertising of such foods to young audiences.
  • Fully fund the Student Support and Academic Enrichment program and other federal programs that support student physical education.
  • Encourage safe physical activity by funding Safe Routes to Schools (SRTS), Complete Streets, Vision Zero and other pedestrian safety initiatives through federal transportation and infrastructure funding.
  • Ensure that anti-hunger and nutrition-assistance programs, like the Supplemental Nutrition Assistance Program (SNAP), WIC, and others follow the Dietary Guidelines for Americans and make access to nutritious food a core program tenet.
  • Strengthen and expand school nutrition programs beyond federal standards to include universal meals, flexible breakfasts and eliminate all unhealthy food marketing to students.
  • Enforce existing laws that direct most health insurers to cover obesity-related preventive services at no-cost sharing to patients.
  • Cover evidence-based comprehensive pediatric weight management programs and services in Medicaid.

 

State by State rates of adult obesity – highest to lowest

Tie: Mississippi and West Virginia (39.5%), 3. Arkansas (37.1%), 4. Louisiana (36.8%), 5. Kentucky (36.6%), 6. Alabama (36.2%), 7. Iowa (35.3%), 8. North Dakota (35.1%), 9. Missouri, (35.0%),  10. – Tie: Oklahoma and Texas (34.8%), 12. – Tie: Kansas and Tennessee (34.4%), 14. South Carolina (34.3 %), 15. – Tie: Indiana and Nebraska (34.1%), 17. Ohio (34.0%), 18. Delaware (33.5%), 19 – Tie: Michigan, North Carolina (33.0), 21. Georgia (32.5%), 22. New Mexico (32.3%), 23. Wisconsin (32.0%), 24. Illinois (31.8%), 25. – Tie: Maryland and Pennsylvania (30.9%), 27. Florida (30.7%), 28 – Tie: Maine and Virginia (30.4%), 30. Tie: Minnesota and South Dakota (30.1%), 32. Oregon (29.9 %), 33. New Hampshire (29.6%), 34. Three-way Tie: Alaska, Arizona and Nevada (29.5%), 37. Wyoming (29.0%), 38. Washington (28.7%), 39. Idaho (28.4%), 40. Utah (27.8%), 41. Rhode Island (27.7%), 42. New York (27.6%), 43. Vermont (27.5%), 44. Connecticut (27.4%), 45. Montana (26.9%), 46. California (25.8%), 47. – Tie: Massachusetts and New Jersey (25.7%), 49. Hawaii (24.9%), 50. District of Columbia (24.7%), 51. Colorado (23.0%).

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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. Twitter: @healthyamerica1

 

 

 

 

Tasas de obesidad en Estados Unidos con altos récords históricos

Nueve estados alcanzan tasas de obesidad en adultos superiores al 35 por ciento

El Reporte demanda por Impuestos para las Bebidas Azucaradas, Programas Ampliados de Apoyo Nutricional SNAP y WIC y un entorno que fomente la actividad física para ayudar a abordar la crisis de salud

(Washington, DC) – 12 de septiembre de 2019 – Nueve estados de EE. UU. Tenían tasas de obesidad en adultos superiores al 35 por ciento en 2018, en comparación con siete estados en ese nivel en 2017, un nivel histórico de obesidad en los EE. UU., Según el 16 ° Estado anual de Obesidad: mejores políticas para un informe más saludable de América publicado hoy por el Trust for America’s Health (TFAH).

El informe basado en parte en datos recientemente publicados del Sistema de Vigilancia del Factor de Riesgo del Comportamiento (BRFSS, por su sigla en ingles) de los Centros para el Control y la Prevención de Enfermedades, y el análisis realizado por TFAH, proporciona las tasas de obesidad anuales en todo el país. La serie El estado de la obesidad y este informe fueron posibles gracias a el financiamiento de la Fundación Robert Wood Johnson.

La obesidad tiene graves consecuencias para la salud, incluido un mayor riesgo de diabetes tipo 2, presión arterial alta, accidente cerebrovascular y muchos tipos de cáncer. Se estima que la obesidad aumenta el gasto nacional en atención médica en $ 149 billones anuales (aproximadamente la mitad de lo cual es pagado por Medicare y Medicaid) y el sobrepeso y la obesidad es la razón más común por la que los adultos jóvenes no son elegibles para el servicio militar.

Las tasas de obesidad varían considerablemente entre los estados, con Mississippi y West Virginia con el nivel más alto de obesidad en adultos en la nación con 39.5 por ciento y Colorado con la tasa más baja con 23.0 por ciento.

Por primera vez, las tasas de obesidad en adultos superaron el 35 por ciento en nueve estados en 2018: Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, Dakota del Norte y Virginia Occidental.

No muy lejos atrás en el 2012, ningún estado tenía una tasa de obesidad en adultos superior al 35 por ciento y en los últimos cinco años (2013 y 2018) 33 estados tuvieron incrementos estadísticamente significativos en sus tasas de obesidad en adultos.

“Estos últimos datos indican que nuestra crisis nacional de obesidad está empeorando”, dijo John Auerbach, presidente y director ejecutivo de Trust for America’s Health. “Nos dicen que casi 50 años después de la curva ascendente de las tasas de obesidad todavía no hemos encontrado la combinación correcta de programas para detener la epidemia”. Los programas aislados y los llamados a cambios en el estilo de vida no son suficientes. En cambio, nuestro informe destaca los cambios fundamentales que se necesitan en las condiciones sociales y económicas que hacen que sea difícil para las personas comer alimentos saludables y hacer suficiente ejercicio “.

Impacto diferencial entre las poblaciones minoritarias

El informe destaca que los niveles de obesidad están estrechamente vinculados a las condiciones socioeconómicas. Las personas con ingresos más bajos están más en riesgo. Las comunidades de color, que tienen más probabilidades de vivir en vecindarios con pocas opciones de alimentos saludables y actividad física, y que a menudo son el objetivo de una comercialización generalizada de alimentos poco saludables, también tienen un riesgo elevado.

A partir de 2015-2016, casi la mitad de los adultos latinos (47 por ciento) y los adultos negros (46.8) tenían obesidad, mientras que las tasas de obesidad entre adultos blancos y asiáticos fueron de 37.9 por ciento y 12.7 por ciento respectivamente. La incidencia de obesidad también fue más alta entre los niños latinos con un 25.8 por ciento, mientras que el 22 por ciento de los niños negros tienen obesidad, el 14 por ciento de los niños blancos tienen obesidad y el 11 por ciento de los niños asiáticos tienen obesidad.

¿Qué podría funcionar?

Si bien las tasas de obesidad son alarmantes, hay nuevos datos que ofrecen la promesa de políticas que combaten la obesidad, como promover alimentos más saludables para los niños a través de paquetes de alimentos renovados de WIC y fomentar el cambio de comportamiento a través de impuestos sobre las bebidas azucaradas.

  • Las tasas de obesidad para los niños inscritos en WIC (Programa Especial de Nutrición Suplementaria para Mujeres, Bebés y Niños) continúa disminuyendo, de 15.9 por ciento en 2010 a 13.9 por ciento en 2016. En 2009, el Departamento de Agricultura de los Estados Unidos (USDA, por su siglas en inglés) actualizó los paquetes de alimentos de WIC para cumplir más estrechamente con las recomendaciones nacionales. pautas dietéticas que incluyen la adición de más frutas, verduras y granos integrales y niveles reducidos de grasa en la leche y la fórmula infantil. Un estudio del condado de Los Ángeles publicado este año encontró que los niños de 4 años que habían recibido el paquete de alimentos WIC revisado desde su nacimiento habían reducido los riegos de padecer obesidad.
  • Varias ciudades de EE. UU. Y la Nación Navajo han aprobado impuestos locales sobre las bebidas azucaradas que se muestran prometedoras como un medio para cambiar los hábitos de bebidas de los consumidores. Los estudios de un impuesto de 1 centavo por onza en Berkeley, California y un impuesto de 1,5 centavos por onza en Filadelfia, Pensilvania, encontraron que el consumo de bebidas azucaradas disminuyó significativamente después de la imposición del impuesto.

“Políticas como estas están demostrando ser efectivas para cambiar el comportamiento. Pero, ninguna solución única, por prometedora que sea, es suficiente. La obesidad es un problema complejo y necesitará soluciones multisectoriales y multifactoriales “, dijo Auerbach de TFAH.

“Crear las condiciones que permitan a las personas tomar decisiones saludables con mayor facilidad es fundamental para prevenir la obesidad, al igual que priorizar la inversión en las comunidades más afectadas por la crisis”, dijo Auerbach.

Recomendaciones para la acción política

El informe incluye 31 recomendaciones para la acción política del gobierno federal, estatal y local, en varios sectores, diseñado para mejorar el acceso a alimentos nutritivos y proporcionar oportunidades seguras para la actividad física, al tiempo que minimiza las tácticas perjudiciales de marketing y publicidad.

Entre las recomendaciones del informe para las políticas para abordar la crisis de obesidad están:

  • Ampliar el Programa Especial de Nutrición Suplementaria para Mujeres, Bebés y Niños (WIC) a los 6 años para niños y durante dos años después del parto para las madres y financiar completamente el Programa de Orientación de Pares de WIC para la lactancia materna.
  • Aumentar el precio de las bebidas azucaradas mediante impuestos especiales y utilizar los ingresos para abordar las disparidades socioeconómicas y de salud.
  • Asegurarse de que los CDC tengan los recursos suficientes para otorgar a cada estado fondos apropiados para implementar estrategias de prevención de la obesidad basadas en evidencia (actualmente, los CDC solo tienen fondos suficientes para trabajar con 16 estados).
  • Hacer que sea más difícil comercializar alimentos no saludables para los niños al poner fin a los vacíos fiscales federales y las deducciones de costos comerciales relacionados con la publicidad de dichos alimentos para el público joven.
  • Financiar completamente el programa de Apoyo al Estudiante y Enriquecimiento Académico y otros programas federales que apoyan la educación física del estudiante.
  • Fomentar la actividad física segura mediante la financiación de Rutas Seguras a las Escuelas (SRTS), Complete Streets, Vision Zero y otras iniciativas de seguridad para peatones a través de fondos federales de infraestructura y transporte.
  • Asegurar de que los programas contra el hambre y la asistencia nutricional, como el Programa de Nutrición Suplementaria (SNAP), WIC y otros, sigan las Pautas dietéticas para estadounidenses y hagan del acceso a alimentos nutritivos un principio básico del programa.
  • Fortalecer y expandir los programas de nutrición escolar más allá de los estándares federales para incluir comidas universales, desayunos flexibles y eliminar todo el mercadeo de alimentos poco saludables para los estudiantes.
  • Hacer cumplir las leyes existentes que ordenan a la mayoría de las aseguradoras de salud que cubran los servicios preventivos relacionados con la obesidad sin costo compartido para los pacientes.
  • Cubrir el manejo del programa integral del peso pediátrico basado en evidencia y servicios en Medicaid.

Tasas de obesidad adulta por estado, de mayor a menor:

1. (Empatados): Mississippi and Virginia Occidental (39.5%), Arkansas (37.1%), 4. Louisiana (36.8%), 5. Kentucky (36.6%), 6. Alabama (36.2%), 7. Iowa (35.3%), 8. Dakota del Norte (35.1%), 9. Missouri, (35.0%), 10. – Empatados: Oklahoma and Texas (34.8%), 12. – Empatados: Kansas and Tennessee (34.4%), 14.  Carolina del Sur (34.3 %), 15. – : Indiana and Nebraska (34.1%), 17. Ohio (34.0%), 18. Delaware (33.5%), 19 – Empatados: Michigan, Carolina del Norte (33.0), 21. Georgia (32.5%), 22. Nuevo Mexico (32.3%), 23. Wisconsin (32.0%), 24. Illinois (31.8%), 25. – Empatados: Maryland and Pennsylvania (30.9%), 27. Florida (30.7%), 28 – Empatados: Maine and Virginia (30.4%), 30. Empatados: Minnesota and Dakota del Sur (30.1%), 32. Oregon (29.9 %), 33. New Hampshire (29.6%), 34. Empatados: Alaska, Arizona and Nevada (29.5%), 37. Wyoming (29.0%), 38. Washington (28.7%), 39. Idaho (28.4%), 40. Utah (27.8%), 41. Rhode Island (27.7%), 42. Nueva York (27.6%), 43. Vermont (27.5%), 44. Connecticut (27.4%), 45. Montana (26.9%), 46. California (25.8%), 47. – Empatados: Massachusetts and Nueva Jersey (25.7%), 49. Hawaii (24.9%), 50. Districto de Columbia (24.7%), 51. Colorado (23.0%).

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Trust for America’s Health es una organización sin fines de lucro y no partidista que promueve la salud óptima para cada persona y comunidad y hace de la prevención de enfermedades una prioridad nacional. WWW.tfah.org