State Category: Alabama

New Data Show Sixteen States Have Adult Obesity Rates at 35 Percent or Higher Up From 12 States in 2019

Social and economic factors linked to obesity were exacerbated by COVID-19 pandemic

(Washington, DC – September 15, 2021) – In 2020, 16 states had adult obesity rates at or above 35 percent, up from 12 states the previous year. These and other emerging data show that the COVID-19 pandemic changed eating habits, worsened levels of food insecurity, created obstacles to physical activity, and heightened stress, all exacerbating the decades long pattern of obesity in America.

State of Obesity 2021: Better Policies for a Healthier America, released today by Trust for America’s Health (TFAH) is based in part on newly released 2020 data from the CDC’s Behavioral Risk Factors Surveillance System and analysis by TFAH. It provides an annual snapshot of rates of overweight and obesity by age, race/ethnicity and state of residence for U.S. adults. In the report, TFAH calls for addressing the social determinants of obesity, for example, by ensuring access to no cost healthy school meals for all students, a program started during the pandemic.

Obesity is associated with a range of diseases, including type 2 diabetes, heart disease, stroke, arthritis, sleep apnea, and many types of cancers. Obesity is estimated to increase healthcare spending by $149 billion annually (about half of which is paid for by Medicare and Medicaid). Furthermore, obesity is one of the underlying health conditions associated with the most serious consequences of COVID-19 infection, including higher risk of hospitalization and death.

Since the start of the pandemic, 42 percent of adults in the U.S. experienced weight gain, according to a Harris Poll conducted in February 2021. The average self-reported weight gain amongst U.S. adults was 29 pounds.

Sixteen states have adult obesity rates at or above 35 percent

Obesity rates vary considerably between states and regions of the country. In 2020, Mississippi had the highest adult obesity rate at 39.7 percent, followed by West Virginia at 39.1 percent and Alabama at 39 percent. Colorado had the lowest adult obesity rate nationally at 24.2 percent.

Nationally, 16 states now have adult obesity rates at or above 35 percent.  New to this list are Delaware, Iowa, Ohio, and Texas. The twelve states that continue to have adult rates above 35 percent are: Alabama, Arkansas, Indiana, Kansas, Kentucky, Louisiana, Michigan, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia.  (See state rates chart).

As recently as 2012, no state had an adult obesity rate above 35 percent.

Systemic inequities and socioeconomic factors contribute to higher rates of obesity among certain racial and ethnic populations. According to the latest available national data – from the 2017 – 2018 National Health and Nutrition Examination Survey (NHANES), Black adults had the highest level of adult obesity nationally at 49.6 percent; driven in large part by an adult obesity rate among Black women of 56.9 percent.  Hispanic adults have an obesity rate of 44.8 percent. White adults have an obesity rate of 42.2 percent. Asian adults have an obesity rate of 17.4 percent.

“The epidemic of obesity is an urgent problem in the U.S. and has worsened during the COVID-19 pandemic. What is needed are transformational policies and bold investment in programs that reduce health inequities and address the social and economic conditions that are barriers to access to affordable, healthy food and physical activity,” said J. Nadine Gracia, MD, MSCE, President and CEO of Trust for America’s Health.

Rising obesity rates are also a problem among children and adolescents.  According to the 2017 – 2018 NHANES data nearly 20 percent (19.3 percent) of U.S. children ages 2 to 19 have obesity. These data more than tripled since the mid-1970s and Black and Latino youth have substantially higher rates of obesity than do their white peers.

Policies to Address the Obesity Crisis

Solving the nation’s obesity crisis will require increased investment and bold policy action. Recommendations within this report focus on two principles: 1) the need for multi-sector, multi-disciplinary approaches, and 2) an intentional focus on those population groups that experience a disproportionate risk for obesity.  Policymakers will not be able to reverse obesity trends without addressing the social, economic and environmental conditions at the root of the crisis.

The report includes policy recommendations – actions to be undertaken by federal, local and state government, the education sector, the healthcare sector and the food industry – including:

  • Increase funding for CDC’s National Center for Chronic Disease Prevention and Health Promotion. This investment should include at least $125 million in FY2022 for CDC’s Division of Nutrition, Physical Activity and Obesity and $102.5 million in FY2022 for CDC’s Racial and Ethnic Approaches to Community Health to ensure sufficient and equitable funding for obesity prevention programs in all 50 states.
  • Make healthy school meals free for all students as a step to end child hunger and ensure access to healthy foods. Protect the recent expansion of the Supplemental Nutrition Assistance Program (SNAP) benefits and enhance access to the Special Supplemental Nutrition Program for Women, Infants and Children (WIC).
  • Close tax loopholes and eliminate business-cost deductions related to the advertising of unhealthy food and beverages to children.
  • Increase the price of sugary drinks through an excise tax, with tax revenue allocated to local efforts to reduce health and socioeconomic disparities and obesity prevention programs.
  • Ensure that every resident has safe and convenient access to walking and biking trails, and that all students have safe routes to walk or bike to school. State and local education agencies should prioritize physical activity during the school day.
  • Expand access to health insurance including through the extension of Medicaid and by making marketplace coverage more affordable. Insurance plans should cover all U.S. Preventive Services Task Force “A” or “B” recommendations for obesity prevention programs with no cost-sharing to the patient.

 Report: State of Obesity 2021: Better Policies for a Healthier America

 

 

On the 20th Anniversary of the September 11th Terror Attacks the Nation is Better Prepared but Still not Fully Prepared for Public Health Emergencies

(Washington, DC – September 6, 2021) – On the 20th anniversary of the September 11th attacks on the World Trade Center and the Pentagon, Trust for America’s Health (TFAH) reflects on the nation’s strong progress in preparedness for public health emergencies, as well as the major challenges that still exist, including those illuminated by the COVID-19 pandemic.

In 2002, following the first anniversary of this tragedy and the subsequent anthrax attacks, TFAH released its first analysis of the response and limitations of the public health system, Public Health Preparedness: Progress and Challenges Since September 11, 2001. From this report, TFAH’s Ready or Not: Protecting the Public’s Health from Diseases, Disasters and Bioterrorism report series was developed.  The 2021 Ready or Not report highlights the urgent need for federal, state, and local policymakers to prioritize the nation’s health security as we work toward ending the COVID-19 pandemic and preparing for extreme weather, the health impacts of climate change, future pandemics, and other emerging threats.

“The COVID-19 pandemic, the devastating wildfires, and the unfolding impacts of Hurricane Ida are only the most recent reminders of the need to strengthen our nation’s health security,” said J. Nadine Gracia, MD, MSCE, TFAH President and CEO. “The 20th anniversary of September 11th is an important milestone to mark the progress we have made in the past two decades: we have built a public health preparedness enterprise from the ground up, including a dedicated public health emergency workforce. But we must make additional and sustained investments in public health infrastructure and workforce, and we must ensure equity is at the center of preparedness, response, and recovery efforts.”

TFAH recommends the following policy actions to strengthen the nation’s emergency response capacity:

  • Federal, state, and local governments should bolster public health infrastructure investments. Congress should enact the Public Health Infrastructure Saves Lives Act and make annual investments in public health infrastructure to build the workforce and systems that have been chronically neglected for decades.
  • Congress should invest in modernizing public health data systems. Modern and sustainable public health data systems and the collection of complete and disaggregated demographic data will facilitate a more effective and equitable public health response during future emergencies.
  • Public health and government leaders must be equipped to deliver effective public communications and counter misinformation. Misinformation, such as inaccurate social media messaging, has been a significant barrier to developing a proactive public health response during the COVID-19 pandemic and has increased vaccine hesitancy. Congress must fund research and implementation of public health communications and messaging, grounded in the best available science, to counter misinformation.
  • Equity should be an explicit and foundational component of preparedness and response at all levels of public health. The COVID-19 pandemic has highlighted that health inequities are exacerbated during emergencies. Health departments and policymakers should build the health equity workforce, partner with, and provide resources to trusted community organizations, and incorporate equity leadership into all emergency planning and response.
  • Federal and state lawmakers should invest in policies and capacity to improve social and economic conditions in communities and advance equity and resilience. People at highest risk during disasters and those who have the hardest time recovering are often those with unstable or unhealthy housing, limited access to transportation, and people who live in low-income communities – circumstances often rooted in longstanding systemic inequities. Congress should invest in the Center for Disease Control and Prevention (CDC) efforts to address the social determinants of health. Lawmakers and employers should advance policies and promote multisector efforts to ensure access to healthy, affordable housing; promote economic mobility through living wage and paid sick and family leave policies; eliminate poverty; address food security; and improve transportation.

This month, the nation commemorates the thousands of lives lost during the 9/11 attacks, continues to mourn the hundreds of thousands of lives lost to COVID-19, and honors the heroic efforts of first responders, the public health workforce, and healthcare workers. As we reflect and move forward, we must commit to preventing and preparing for public health emergencies in ways that ensure that everyone’s health and well-being are protected during times of crisis.

 

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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.

New Report Outlines Role of Social Determinants in Americans’ Health

Calls for Adoption of Policies Shown to Improve Health Outcomes, Control Healthcare Spending, and Create Health Equity

(Washington, DC – July 29, 2021) – America’s chronic disease and health disparities crisis require policy interventions targeting structural racism and the social determinants of health, concludes a report released today by Trust for America’s Health.

The report, Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity, reviews five policy areas: access to healthcare, economic mobility, affordable housing, safe and healthy learning environments for children, and health-promoting excise taxes. Based on an extensive review of the evidence, the report recommends federal and state-level policies in each issue area to improve health outcomes, advance health equity and reduce healthcare spending.

Today, nearly half of all Americans have at least one chronic disease, and that number is growing. In addition, the COVID-19 pandemic starkly illuminated the ways in which social and economic conditions and inequities– often deeply rooted in communities due to historical and current day structural racism and discrimination – greatly increase health risks and burdens for certain populations groups, including many communities of color. According to the CDC, hospitalization rates during the height of the COVID-19 pandemic were 3.3 times higher for American Indian/Alaska Natives and approximately 3 times higher for Blacks and Latinos as compared to the hospitalization rate for whites.

“The COVID-19 pandemic put a spotlight on the role that social and economic conditions play in health and gives policymakers an opportunity to build an improved social supports and public health system,” said J. Nadine Gracia, MD, MSCE, President and CEO of Trust for America’s Health. “Focusing solely on individual behavior will not solve America’s health crisis. Building healthy and thriving communities and advancing health equity require improving the social and economic conditions that shape health. Only then will everyone have a fair and just opportunity to enjoy optimal health.”

The social determinants of health are factors beyond traditional healthcare that significantly impact health including where you are born, live, work, play, go to school, and age. Data show that these factors impact a wide range of quality-of-life outcomes and health risks. For example, where you live, has a measurable impact on overall health status and longevity.  Furthermore, inequities limit access to health resources and educational and economic opportunities that can lead to poor health.

Policy decisions can drive improvements in the social conditions in communities or they can perpetuate inequities. Policies do not need to be deliberately discriminatory to exacerbate inequities. For example, tying school funding to local property taxes leaves schools in lower income communities with fewer resources than higher income neighborhoods.

The report identifies policies that, if implemented, can create the conditions in people’s lives that support optimal health.  Recommended policy actions in each category includes:

Goal: Supporting Access to High-Quality Healthcare Services

Recommendation: Adopt Medicaid Expansion.  States that have adopted Medicaid expansion experienced the largest reductions in the number of uninsured persons. In 2018, the uninsured rate among low-income, non-elderly adults in states that expanded Medicaid eligibility was about half that of the uninsured rate in states that did not expand the program. Increased access to healthcare saved lives and was associated with a reduction in total state spending on traditional Medicaid.

Goal: Promoting Economic Mobility

Recommendation: Expand the Earned Income Tax Credit. The earned income tax credit (EITC) is a tax credit offered to eligible low-income workers to enhance their economic security. EITC policies, both federal and state, help lift millions of working families out of poverty and reduces the severity of poverty for millions more.

Goal: Ensuring Access to Affordable Housing

Recommendation: Expand the Low-income Housing Tax Credit Program. Decades of research has demonstrated a connection between safe and secure housing and good health.  The low-income housing tax credit (LIHTC) provides tax incentives to encourage developers to build affordable housing. Since the LIHTC program was created approximately 3 million quality homes have been developed to serve working families, older adults, people with disabilities and those at risk of homelessness. Despite this success, the need for affordable housing remains high across the country.

Goal: Promoting Safe and Healthy Learning Environments for Children

Recommendation: Increase access to high-quality early childhood education programs. Research demonstrates the many ways in which safe and supportive school environments put children on healthy developmental pathways. High-quality early childhood education programming, such as Head Start and pre-K can have long-lasting positive impacts on children throughout their lives. Early childhood education centers and schools are also critical sources of nutrition for millions of children through the National School Lunch and School Breakfast Programs and provide access to healthcare for millions of students via school-based health centers.

Goal: Using tax policy to encourage healthy choices

Recommendation: Tax unhealthy products, like tobacco and sugar-sweeten beverages. Such taxes can be a win-win for localities, encouraging healthy choices and raising local revenue that can be reinvested in health-promoting and prevention programs.

Report:  Leveraging Evidence-Based Policies to Improve Health, Control Costs, and Create Health Equity

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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

 

TFAH Applauds Surgeon General’s Call for Whole-of-Society Approach to Correcting the Problem of Health Misinformation

(Washington, DC – July 15, 2021) – Trust for America’s Health (TFAH) applauds the Surgeon General’s Advisory on Building a Healthy Information Environment and his call for a whole-of-society approach to correcting the problem of health misinformation.

“As the COVID-19 pandemic has illustrated, access to accurate health information empowers people and protects their health, while health misinformation risks lives.  TFAH is committed to working with all partners and allies to combat health misinformation,” said J. Nadine Gracia, MD, MSCE, TFAH President and CEO.

 

 

 

TFAH Applauds Court’s Decision Preserving the Affordable Care Act

Decision strengthens the nation’s healthcare system, protects healthcare access for 31 million Americans and will help address health disparities

(Washington, DC — June 17, 2021) – Trust for America’s Health applauds today’s Supreme Court’s decision in California v. Texas for the ways in which it protects healthcare access for 31 million Americans and will help address the nation’s health disparities.

“Access to affordable healthcare is fundamental to individual health. It is also fundamental to achieving health equity. While as a nation we still have a lot of work to do to achieve good health for every individual, today’s court decision keeps us moving in the right direction – it will save lives,” says John Auerbach, President and CEO of Trust for America’s Health.

According to the U.S. Department of Health and Human Services, 31 million people have gained health insurance through the Affordable Care Act (ACA) including many who lost employment and health coverage during the COVID-19 pandemic.[i]  Since the ACA, rates of people without health insurance have decreased in every state, with states that expanded Medicaid experiencing the largest reductions.[ii]

The ACA is transformative legislation in at least three ways: the number of Americans who can now access medical care when they are ill or to deal with chronic conditions (78 percent of U.S. adults 55 and older have at least one chronic condition);[iii] the illness it prevented as millions of Americans gained access to preventive care and screenings and other life-saving services previously inaccessible to them;[iv] and the ways in which it resulted in improved access to healthcare for people of color, reducing – although not eliminating – longstanding healthcare access disparities.

Prior to the ACA, non-Hispanic Black Americans were 70 percent more likely to be uninsured than were whites and the uninsured rate for Hispanics was nearly three times the uninsured rate for whites.[v] Once the ACA was in place, Hispanics had the largest decrease in uninsurance rates, falling from 32.6 percent to 19.1 percent between 2010 and 2016. Uninsurance rates also fell for Asian and Black Americans by 8 percent during the same period.[vi]

Medicaid expansion states experienced significant coverage gains and reductions in uninsured rates among the low-income population broadly and within specific vulnerable populations.[vii] According to the Center on Budget and Policy Priorities, expanding Medicaid coverage to low-income adults led to significant benefits to those individuals and families including improved access to care, improved health outcomes and increased financial stability – including a reduction in medical debt per person gaining coverage via the expansion.[viii] A study by the National Bureau of Economic Research found states that expanded Medicaid had an estimated 19,200 fewer adult deaths (ages 55 to 64) between 2014 and 2017 than did states that did not expand Medicaid.[ix]

The decision also has major implications for public health by protecting over $16 billion in funding over the next 10 years (FY 2022-FY 2031) for the Centers for Disease Control and Prevention (CDC) and other public health agencies. The Prevention and Public Health Fund, a dedicated funding stream created by the ACA and specifically designated for public health and prevention, funds approximately 11 percent of the CDC’s budget. These funds are put to work in every state to expand immunizations, prevent suicide, modernize laboratory and epidemiology services to detect and contain disease outbreaks, prevent childhood lead poisoning, and help smokers quit.

Also preserved are the requirement that insurers not refuse coverage due to preexisting conditions, the provision disallowing annual or lifetime limits on essential care, and the requirement that insurers cover recommended clinical preventive services without cost-sharing: all essential to Americans’ health.

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[i] HHS, HHS Press Office. New HHS Data Show More Americans Than Ever Have Health Coverage Through the Affordable Care Act. June 5, 2021. New HHS Data Show More Americans than Ever Have Health Coverage through the Affordable Care Act | HHS.gov

[ii] ibid

[iii] CDC, National Center for Health Statistics. Percentage of U.S. Adults over 55 with Chronic Conditions. https://www.cdc.gov/nchs/health_policy/adult_chronic_conditions.htm

[iv] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[v] Buchmueller TC, Levinson ZM, Levy HG, Wolfe BL. Effect of the Affordable Care Act on racial and ethnic disparities in health insurance coverage. Am J Public Health. 2016;106(8):1416–21

[vi] Garfield R, Orgera K, Damico A. The uninsured and the ACA: a primer—key facts about health insurance and the uninsured amidst changes to the Affordable Care Act [Internet]. San Francisco (CA): Henry J. Kaiser Family Foundation; 2019 Jan 25.  https://www.kff.org/uninsured/report/the-uninsured-and-the-aca-a-primer-key-facts-about-health-insurance-and-the-uninsured-amidst-changes-to-the-affordable-care-act/ Google Scholar

[vii] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.

[viii] Center on Budget and Policy Priorities. The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion. October 21, 2020. The Far-Reaching Benefits of the Affordable Care Act’s Medicaid Expansion | Center on Budget and Policy Priorities (cbpp.org)

[ix] Madeline Guth, et al. The Effects of Medicaid Expansion Under the ACA: Updated Findings from a Literature Review. March 17, 2020.