State Category: Iowa

New Report Measures States’ Emergency Preparedness and Makes Recommendations About How to Strengthen the Nation’s Public Health System

Sustained Investment in Public Health Infrastructure and Preparedness is Needed to Protect Lives During Disease Outbreaks and Natural Disasters

(Washington, DC – March 23, 2023) – As infectious disease outbreaks and extreme weather events threaten the health of more Americans, a new report shows the need for strengthened national and state public health emergency preparedness.

Ready or Not 2023: Protecting the Public’s Health from Diseases, Disasters, and Bioterrorism, released today by Trust for America’s Health, measures states’ readiness to respond to a spectrum of health emergencies and to provide ongoing public health services. The report gives federal and state health officials and policymakers actionable data and recommends policies to improve the nation’s emergency preparedness at a time when health emergencies are increasing. During 2022, the U.S. surpassed 1 million deaths due to COVID-19 and saw decreasing rates of routine vaccinations and increasing prevalence of health misinformation.  In addition, the past year was the eighth consecutive year the U.S. experienced 10 or more billion-dollar weather-related disasters.

The report tiers states and the District of Columbia into three performance levels for health emergency preparedness: high, middle, and low. This year’s report placed 19 states and DC in the high-performance tier, 16 states in the middle performance tier, and 15 states in the low performance tier.

High Tier – 19 states & DC

CO, CT, DC, DE, FL, GA, KS, ME, MD, MA, MS, NJ, NC, OH, PA, UT, VT, VA, WA, WI

Middle Tier – 16 states

AK, AL, AR, CA, IA, ID, IL, IN, MO, ND, NE, NH, NY, RI, SC, TX

Low Tier – 15 states

AZ, HI, KY, LA, MI, MN, MT, NM, NV, OK, OR, SD, TN, WV, WY

“Increased and sustained investment in public health infrastructure, emergency preparedness, and health equity will save lives,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Federal, state, and local officials as well as leaders in the healthcare and business sectors should use our findings to identify and address gaps in public health preparedness. Neglecting to do so will mean that the country will not be as prepared as it needs to be for the next public health emergency.”

The report’s findings showed both areas of strength within the nation’s public health system and areas that need attention.

Areas of strong performance include:

  • A majority of states have made preparations to expand healthcare and public health laboratory capacity in an emergency.
  • Most states are accredited in the areas of public health or emergency management. Some states are accredited in both.
  • Most U.S. residents who received their household water through a community water system had access to safe water. However recent water system failures in Jackson, Mississippi and Newark, New Jersey demonstrate the importance of continued attention to the integrity of municipal water systems.

Areas that need attention include:

  • Too few people were vaccinated against seasonal flu last year despite significant improvement in flu vaccination rates in recent years. During the 2021-2022 flu season, 51 percent of Americans ages 6 months or older received a flu vaccine, well short of the 70 percent goal established by Healthy People 2030.
  • Only half the U.S. population is served by a comprehensive public health system. Comprehensive public health systems ensure that necessary health services are available to all residents.
  • Only 26 percent of hospitals in states, on average, earned a top-quality patient safety grade in 2022. Hospital safety scores measure performance on such issues as healthcare-associated infection rates, intensive-care capacity, and an overall culture of error prevention.

The report contains recommendations for policy actions that would create a stronger public health system at all levels, including:

  • The Administration, Congress, and state lawmakers should modernize public health infrastructure, including by investing $4.5 billion annually to support foundational public health capabilities. In addition, Congress should continue to increase funding for the Public Health Emergency Preparedness cooperative agreement and public health data modernization to allow for earlier and more accurate detection of emerging health threats.
  • Policymakers at all levels should act to protect and strengthen public health authorities and should prioritize rebuilding trust in public health agencies and leaders.
  • Congress and state legislatures should invest in effective public health communications, including countering misinformation.
  • Congress and states should ensure first-dollar coverage for all recommended vaccines under commercial insurance and for uninsured people. States should minimize vaccine exemptions for school children, and healthcare facilities should increase rates of vaccination for healthcare workers.
  • Congress and states should provide job-protected paid leave for employees due to illness or family caregiving demands.
  • Congress and states should invest in policies and capacity to address the social determinants of health such as secure housing, access to transportation, and access to healthy food.
  • Congress should fund the entire medical countermeasures (MCM) enterprise, including the distribution and dispensing of MCMs. Congress should also create incentives for new products to prevent and fight antibiotic-resistant infections.
  • Congress and states should strengthen readiness for climate change, extreme weather, and environmental health threats.

Read the full report

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. 

 

 

 

 

 

Improving Americans’ Nutrition Security Requires Legislative Action

Q&A with Dr. Hilary Seligman:

Hilary Seligman, M.D., MAS, is a professor at the University of California, San Francisco, with appointments in the Departments of Medicine, Epidemiology, and Biostatistics. Her research and advocacy work focuses on food insecurity, its health implications, and the needed policy responses.

 

TFAH: Food insecurity is obviously a serious problem in the United States. Can you also talk about the issue of nutrition insecurity and the relationship between the two?

Dr. Seligman: First, it’s important to recognize that the food-security construct always considered access to nutrition, not just calories. But, the sector’s new focus on nutrition security has helped emphasize the importance of providing not just food but food that meets people’s health and nutrition needs. The construct of nutrition security is also strongly related to issues of equity and the massive burden of early mortality in our country that is related to poor diets.


TFAH: Can food banks and charitable food networks address hunger and improve nutrition?

Dr. Seligman: Yes, of course they can, and they must. The charitable food system as a whole has made massive investment and progress in this area over the last decade. What I do want to call attention to though is that the same forces that make it difficult for individuals to afford and prepare healthy food make it difficult for the charitable food system to distribute healthy food. Healthy alternatives almost always cost more, they are often perishable, and they often require more preparation time which can be costly to provide. So, although there has been strong investment and tremendous progress at the system level, there is still a lot to be done. It will always be cheaper to distribute a box of mac and cheese than it will be to distribute a peach.


TFAH: You’ve been a leader in grassroots anti-hunger programs in the San Francisco area, programs like EatSF, a healthy food voucher program. Are these programs making a difference in food insecurity for San Francisco families and children?

Dr. Seligman: EatSF is one of a rapidly growing ecosystem of state and local food voucher programs and produce prescription programs in the U.S. These programs have functioned as a way for local leaders and health systems to say: We see we have this critical problem of nutrition insecurity in our community, this is not acceptable in the richest county in the U.S., and we are going to do something about it. I think that is amazing, and I am privileged to be a part of that movement. But, let’s be honest, the nutrition security problem in the U.S. is not going to be solved by small local programs. We need a systems-based approach. We need better policies to address nutrition security, and we need to rectify the way in which our current policies work better for white people than they do for people who are not white.


TFAH: Can you say more about that? How does current policy work better for white people than for people of color?

Dr. Seligman: SNAP program policies are a good example. In order for able bodied adults to receive SNAP benefits they have to be working. For a myriad of reasons, Black people are less likely to be able to secure employment. They are therefore less likely to be able to meet the work requirements that would allow them to enroll in SNAP, even if they are food insecure.


TFAH: You direct the National Clinician Scholars Program at the UCSF School of Medicine. The goal of the program is to train clinicians to be change-agents in order to improve their patients’ health. Are clinicians and the healthcare system doing enough to address the social determinants of health? Are they well-prepared to treat their patients who have obesity?

Dr. Seligman: Traditionally, healthcare in the U.S. has focused on treating, not preventing, disease in individuals. The evidence is very clear that this is the worst way to approach obesity: first to do it at the treatment stage (when obesity has already developed, rather than to prevent the onset of obesity) and second to do it by attempting to change people’s behaviors, rather than changing the environments that resulted in the onset of obesity to begin with. So, although I hate that we need to be having this discussion at all, we do. We do because the U.S. has completely failed at prevention efforts and at policy and environmental approaches to obesity prevention for decades. So now, what needs to be done? Obesity and poor diets are the biggest drivers of healthcare costs in the country— so the healthcare system has to get involved (whether it is traditionally in their wheelhouse or not), and the best way to do this is by addressing social determinants of health and food environments. It is not a comfortable fit for the healthcare system, but there really is no other choice. And because it is not a comfortable fit and requires a new way of thinking about healthcare and new kinds of engagement and policy change, we have to nurture the next generation of healthcare leaders to be able to tackle these really complicated problems.


TFAH: What are the links between public policy and obesity? What policy actions or changes would you like to see enacted?

Dr. Seligman: Oh, there are so many of them—dozens if not more are being discussed as potential approaches for the next Farm Bill. At the federal level alone, there are policy levers that Congress, USDA, and the FDA have authority over that could help reverse obesity trends. Let’s start with an enormous one: SNAP. Early in my career I worked on health literacy, and I was always challenged by the lack of existing infrastructure to reach people with effective health literacy interventions. Food insecurity is not like that. SNAP works. It reaches almost 50 million people in the U.S. annually. It is available in every county nationwide. It helps families to afford more nutritious food. So, we have the tools, we have the evidence, and we have the infrastructure to solve food insecurity in the U.S. What we lack is the political will. We need to expand SNAP eligibility to all the people who aren’t receiving the food they need but who are not currently eligible for benefits, and we need to raise benefit rates to allow for the purchase of healthy food. If these changes are made, it is very clear to me that they will have a substantial impact on obesity rates and on public health.


TFAH: There  were a number of waivers in federal food programs like SNAP, WIC, and school meals, during the COVID-19 pandemic to better reach individuals and families during the public health emergency. Are there any lessons we can learn from these policy changes?

Dr. Seligman: Yes! The predominant lesson is: these programs work. Food insecurity rates did not increase nearly as much as anticipated during the pandemic, although there were certainly vast disparities in how the pandemic impacted different communities. Why didn’t rates of food insecurity rise as much as anticipated? Because we had the will to do the things we knew—based on a tremendous amount of evidence— would make a difference. When we make it easier for people to enroll in SNAP, more people have access to benefits and food insecurity falls. When we provide money on debit cards to replace the meals not being served in schools, food insecurity falls. When stimulus checks were sent to people across the U.S. in response to the pandemic, low-income households reported that food was the first or second most covered item from the stimulus money.

The really optimistic lesson is that we know how to address hunger, nutrition security, and obesity prevention through good public policy. Now we just have to keep these programs in place as interest in the pandemic wanes.

Additional Resources:

Brief: Legislative Priorities for the 118th Congress

Report:  State of Obesity 2022

Priority Issue: Obesity /Chronic Disease

This interview was originally published as a part of TFAH’s 2022 State Of Obesity: Better Policies for a Healthier America report.

TFAH’s Board Chair and President and CEO, Statement in Honor of Martin Luther King, Jr. Day and the National Day of Racial Healing

“Today’s observation of Martin Luther King, Jr. Day and tomorrow’s National Day of Racial Healing are a time to take action to end racism, heal the impacts of centuries of racial injustice, and promote equity for all people.

As the COVID-19 pandemic has demonstrated, long-standing structural racism within our society causes a disproportionate negative impact on people of color, especially during public health emergencies.

TFAH’s goal is to secure the opportunity for optimal health for everyone and make all communities more resilient. This includes advancing policies that promote health and address the primary drivers of health disparities.

We are committed to continuing to support and advocate for policies that overcome the impacts of racism and advance health equity. Meaningful change will require racial healing, which will in turn necessitate acknowledging the historical and contemporary impacts of racism, building meaningful relationships across communities, and policy change.”

Among TFAH’s policy priorities for promoting health equity in 2023 are the following:

Invest in policies and capacity to address the social determinants of health: Congress should fund the Centers for Disease Control and Prevention’s Social Determinants of Health work to enable communities to work across sectors to address the non-medical drivers of poor health outcomes.

Target the elimination of poverty by implementing living wage policies and expanding the Earned Income Tax Credit at the national and state levels.

Strengthen leadership for health equity and incorporate lessons learned from the COVID-19 pandemic into future preparedness and response capabilities. The White House, Congress, and relevant federal, state, local, tribal, and territorial agencies should continue to implement the recommendations of President Biden’s COVID-19 Health Equity Task Force. The White House should create a permanent health equity infrastructure to implement and ensure accountability for these recommendations and bolster equity leadership and coordination for future health crises.

Provide job-protected paid leave. The pandemic called attention to the fact that paid family, sick, and medical leave protect individual’s and families’ economic security and are important infection-control measures. Congress should enact a permanent federal paid family and medical leave policy and dedicated paid sick days protections, including for preventive services such as vaccination.

Congress and federal agencies should ensure federal funding is reaching localities and organizations that represent and serve communities that encounter disproportionate barriers to good health.

Public health agencies should appoint chief health equity officers who would be part of the response, planning, and activation teams for all emergencies.

Increase access to high-quality healthcare for all by strengthening incentives to expand Medicaid and by making marketplace coverage more affordable for people with low- and moderate-incomes.

Increase funding for programs that promote long-term security and good health for children and families, including programs designed to expand access to affordable housing and Head Start, Early Head Start, and nutrition support programs such as Healthy School Meals for All, the Supplemental Nutrition Assistance Program (SNAP), and the Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC).

For more information, see TFAH’s reports.

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

The National Day of Racial Healing, is sponsored by the W.K. Kellogg Foundation. According to the Foundation, the day is a time to contemplate our shared values and create a blueprint for #HowWeHeal from the effects of racism. W.K. Kellogg Foundation (wkkf.org)

 

 

Trust for America’s Health is a Healthy People 2030 Champion!

As an organization that prioritizes optimal health for all people, Trust for America’s Health (TFAH) is pleased to be recognized as a Healthy People 2030 Champion by the U.S. Department of Health and Human Services (HHS). TFAH shares the Healthy People 2030 vision of a society in which all people can achieve optimal health and well-being across the lifespan. This commitment is reflected in TFAH’s overall vision and mission and within its Age-Friendly Public Health Systems (AFPHS) initiative.  TFAH prioritizes achieving equity in all of our work and promotes optimal well-being for all by focusing on the social determinants of health (SDOH).

TFAH has worked closely HHS leadership, particularly within the Office of Disease Prevention and Health Promotion, which administers Healthy People 2030, to promote stronger collaborations between state departments of health and state aging agencies.

The Age-Friendly Public Health Systems initiative and Healthy People 2030 are well aligned as they share a focus on optimal health in every community. AFPHS’s 6C’s strategy provides a roadmap for state and local health departments to engage in activities that support healthy aging in their communities including:

Connecting and convening multi-sector stakeholders

Coordinating existing supports and services

Collecting, analyzing, and translating relevant data

Communicating important public health information

Complementing existing health promoting programs

Creating and leading policy, systems, and environmental changes

In addition to the Healthy People 2030/AFPHS alignment, TFAH supports the Healthy People 2030 vision in the following ways:

Promoting and increasing access to disease prevention and health promotion activities.

TFAH’s federal advocacy priorities focus on strengthening the public health system so that every state, tribal, local, and territorial health department has the funding and capacity to improve and sustain optimal health for every person and community.

Addressing social determinants of health, eliminating disparities, achieving health equity, and/or promoting well-being.

TFAH is leading advocacy efforts to increase public health’s capacity to fully address the social determinants of health, with a focus on equity and eliminating disparities in health across the lifespan.

Providing training and other necessary resources to adapt or modify disease prevention and health promotion activities to meet the needs of diverse populations, address SDOH, eliminate disparities, achieve health equity, and/or promote well-being.

Many of TFAH’s reports and policy briefs document states where health promotion activities need improvement, as well as feature best practices. In addition, TFAH’s website includes detailed health data on every state and territory including on emergency preparedness, prevalence of chronic diseases and flu vaccination rates.

Developing partnerships across a variety of sectors, including public health, healthcare, government, philanthropy, civil rights, academia, education, community, faith-based, media, business, and technology

TFAH routinely hosts convenings of representatives across sectors including public health, healthcare, government, philanthropy, academia, community, and education. Such convenings have focused on the COVID-19 pandemic, adolescent health, healthy aging, state policies to promote health and control costs, and many other topics.

TFAH looks forward to continuing our strong partnership with the HHS Office of Disease Prevention and Health Promotion and other Healthy People 2030 Champions to create and sustain opportunities for all Americans to live healthfully and productively throughout their lives.

New CDC Data Shows 4 Percent Rise in Suicides in 2021

On September 30, the Centers for Disease Control and Prevention (CDC) released a new report on provisional data on suicide mortality in 2021. The new data shows a 4 percent increase in the national suicide rate—rising from 13.5 deaths per 100,000 population in 2020 to 14.0 deaths per 100,000 population in 2021. In contrast, the national suicide rate declined in both 2019 and 2020, though it had steadily increased over the previous two decades.

The report also includes additional information on suicide by sex, age group, and month. Key takeaways:

  • Suicide rates increased more among males (3 percent increase) than females (2 percent increase).
  • Suicide rates increased for people in nearly all age groups. The only exception was a 2 percent decline for people age 75 and over, though it was not a statistically significant change.
  • The largest statistically significant increase among all sex/age groups was for males aged 15–24, with an 8 percent increase in suicide rate from 2020 to 2021. Females aged 10–14 had the largest percentage increase in suicide rate (15 percent), though the change was not statistically significant due to a relatively small numbers of cases.
  • There were more suicides across all months of 2021 compared with 2020, except in January, February, and July. The largest increase across all the months was an 11 percent increase in suicide rate in October.

The report does not include racial/ethnic or geographic information, nor information on suicide method—all critical pieces to understanding the full picture. For example, data from 2020 showed higher rates of  suicide among American Indian, Black, and Latino people and of suicide by firearm—all in a year when the overall suicide rate declined. The National Center for Health Statistics will likely release final 2021 mortality data, including these additional data points, in December.

“The increase in suicide is devastating,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health (TFAH). “The new data underscores the need for more attention on this issue and action to prevent future suicides—by federal policymakers, the private and non-profit sectors, and every community across the nation. This study is a wakeup call that we continue to face a mental health and substance use crisis, but we can prevent these tragic deaths.”

The most recent Pain in the Nation report from TFAH includes 2020 data and an analysis of longer-term trends, as well as policy recommendations for reducing alcohol, drug, and suicide deaths. The new CDC report reaffirms the importance of many of these recommendations, including to:

  • Strengthen the continuum of crisis intervention programs with a focus on the newly established “988” lifeline.
  • Expand CDC’s comprehensive suicide-prevention efforts, including measures to strengthen economic supports, promote connectedness, and create protective environments.
  • Address the social determinants of health and promote resilience in children, families, and communities, including through economic supports, access to quality childcare, and prevention and early intervention efforts in schools.
  • Build grassroots community capacity for early identification and intervention for individuals with mental health and substance use disorders, including through community-based or non-traditional settings.
  • Limit access to lethal means of suicide, including drugs and firearms, among individuals at higher risk of suicide through state and federal laws, more funding of foundational research, and the adoption of counseling programs in healthcare systems.

 

 

New CDC Data Shows 4 Percent Rise in Suicides in 2021

On September 30, the Centers for Disease Control and Prevention (CDC) released a new report on provisional data on suicide mortality in 2021. The new data shows a 4 percent increase in the national suicide rate—rising from 13.5 deaths per 100,000 population in 2020 to 14.0 deaths per 100,000 population in 2021. In contrast, the national suicide rate declined in both 2019 and 2020, though it had steadily increased over the previous two decades.

The report also includes additional information on suicide by sex, age group, and month. Key takeaways:

  • Suicide rates increased more among males (3 percent increase) than females (2 percent increase).
  • Suicide rates increased for people in nearly all age groups. The only exception was a 2 percent decline for people age 75 and over, though it was not a statistically significant change.
  • The largest statistically significant increase among all sex/age groups was for males aged 15–24, with an 8 percent increase in suicide rate from 2020 to 2021. Females aged 10–14 had the largest percentage increase in suicide rate (15 percent), though the change was not statistically significant due to a relatively small numbers of cases.
  • There were more suicides across all months of 2021 compared with 2020, except in January, February, and July. The largest increase across all the months was an 11 percent increase in suicide rate in October.

The report does not include racial/ethnic or geographic information, nor information on suicide method—all critical pieces to understanding the full picture. For example, data from 2020 showed higher rates of  suicide among American Indian, Black, and Latino people and of suicide by firearm—all in a year when the overall suicide rate declined. The National Center for Health Statistics will likely release final 2021 mortality data, including these additional data points, in December.

“The increase in suicide is devastating,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health (TFAH). “The new data underscores the need for more attention on this issue and action to prevent future suicides—by federal policymakers, the private and non-profit sectors, and every community across the nation. This study is a wakeup call that we continue to face a mental health and substance use crisis, but we can prevent these tragic deaths.”

The most recent Pain in the Nation report from TFAH includes 2020 data and an analysis of longer-term trends, as well as policy recommendations for reducing alcohol, drug, and suicide deaths. The new CDC report reaffirms the importance of many of these recommendations, including to:

  • Strengthen the continuum of crisis intervention programs with a focus on the newly established “988” lifeline.
  • Expand CDC’s comprehensive suicide-prevention efforts, including measures to strengthen economic supports, promote connectedness, and create protective environments.
  • Address the social determinants of health and promote resilience in children, families, and communities, including through economic supports, access to quality childcare, and prevention and early intervention efforts in schools.
  • Build grassroots community capacity for early identification and intervention for individuals with mental health and substance use disorders, including through community-based or non-traditional settings.
  • Limit access to lethal means of suicide, including drugs and firearms, among individuals at higher risk of suicide through state and federal laws, more funding of foundational research, and the adoption of counseling programs in healthcare systems.

 

 

Nation’s Obesity Epidemic is Growing: 19 States Have Adult Obesity Rates Above 35 Percent, Up From 16 States Last Year

Social and Economic Factors Are Key Drivers of Increasing Obesity Rates

(Washington, DC – September 27, 2022) – Four in ten American adults have obesity, and obesity rates continue to climb nationwide and within population groups, according to a report State of Obesity 2022: Better Policies for a Healthier America released today by Trust for America’s Health (TFAH). The report amplifies the importance of the White House Conference on Hunger, Nutrition and Health happening tomorrow. The Conference and the report are intended to spotlight the links between hunger, nutrition, and health, and diet-related diseases including obesity. In addition, they will drive policy action to address food insecurity and health disparities, factors often at the root of diet-related health issues.

The report finds that persistent increases in obesity rates across population groups underscores that obesity is caused by a combination of factors including societal, biological, genetic, and environmental, which are often beyond personal choice. The report’s authors conclude that addressing the obesity crisis will require attending to the economic and structural factors of where and how people live.

Based in part on newly released 2021 data from the Centers for Disease Control and Prevention’s Behavioral Risk Factors Surveillance System, and analysis by TFAH, the report tracks rates of overweight and obesity by age, race/ethnicity, and state of residence. Among the most striking findings are:

Nineteen states have adult obesity rates over 35 percent.  West Virginia, Kentucky, and Alabama have the highest rate of adult obesity at 40.6 percent, 40.3 percent, and 39.9 percent, respectively. The District of Columbia, Hawaii, and Colorado had the lowest adult obesity rates at 24.7 percent, 25 percent, and 25.1 percent respectively.

A decade ago, no state had an adult obesity rate at or above 35 percent.  (See state-by-state rate chart).

National data from the 2017-2020 National Health and Nutrition Examination Survey also included in the report show the following:

  • Nationally, 41.9 percent of adults have obesity.
  • Black adults had the highest level of adult obesity at 49.9 percent.
  • Hispanic adults had an obesity rate of 45.6 percent.
  • White adults had an obesity rate of 41.4 percent.
  • Asian adults had an obesity rate of 16.1 percent.
  • Rural parts of the country had higher rates of obesity than did urban and suburban areas.

Structural and social determinants are significantly influencing the rates of obesity among adults and youth.  Factors such as structural racism, discrimination, poverty, food insecurity, housing instability, and lack of access to quality healthcare are key drivers of the differences in obesity rates across racial and ethnic groups. These systemic barriers make it inappropriate to assign blame to individuals with obesity for their weight. The purpose of this report is to analyze conditions in people’s lives which make them more likely to develop obesity and recommend policies to address those conditions.

Obesity rates are also increasing among children and adolescents with nearly 20 percent of U.S. children ages 2 to 19 having obesity. These rates more than tripled since the mid-1970s and Black and Latino youth have substantially higher rates of obesity than do their white peers.

A special section of the report looks at the relationship between food insecurity and obesity. Food insecurity, defined as being uncertain of having or unable to acquire enough food because of insufficient money or resources, is driven by many of the same social and economic factors that drive obesity including poverty and living in communities with many fast-food establishments but limited or no access to healthy, affordable foods such as available in full-service supermarkets or farmers markets. Being food and nutrition insecure often means families must eat food that costs less but is also high in calories and low in nutritional value.

Obesity is multifactored and involves more than individual behavior

Social and economic factors including experiencing poverty and the impact of long-standing structural racism and health inequities are strongly associated with obesity and are at the root of higher rates of obesity in low-income communities that have fewer resources to support healthy eating and being physically active.

“The continued increase in rates of obesity across all population groups is alarming,” said J. Nadine Gracia, M.D., MSCE, President and CEO of Trust for America’s Health. “Policies and programs to reduce obesity need to be implemented at a systems level. We must advance policies that address the community, institutional, and structural factors that are barriers to healthy eating and physical activity and that exacerbate health inequities.”

Addressing obesity is critical because it is associated with a range of diseases including type 2 diabetes, heart disease, stroke, arthritis, sleep apnea, and some cancers. Obesity is estimated to increase U.S. healthcare spending by $170 billion annually (including billions by Medicare and Medicaid).

The report includes recommendations for policy actions that federal, state, and local policymakers and other stakeholders should take including:

  • Increase funding for the CDC’s National Center for Chronic Disease Prevention and Health Programs to prevent obesity and related chronic diseases. Funding increases need to be sufficient to put proven obesity prevention programs to work in every state and should prioritize those communities where the need is greatest to address health inequities.
  • Make healthy school meals for all students a permanent policy, extend COVID-19 flexibilities that expand nutrition access for students and their families, strengthen school nutrition standards, and increase students’ opportunities for physical activity during the school day.
  • Expand the CDC’s social determinants of health program to address the upstream, structural drivers of chronic disease.
  • Decrease food insecurity and improve the nutritional quality of available food by increasing funding for and participation in nutrition assistance programs such as the Supplemental Nutrition Assistance Program (SNAP), the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), and the Child and Adult Care Food Program.
  • End unhealthy food marketing to children by closing tax loopholes and eliminating business-cost deductions related to the advertising of unhealthy food and beverages to young people.
  • Impose excise taxes on sugary drinks and devote the revenue to local obesity prevention programs and to reduce health disparities.
  • Expand support for maternal and child health, including supporting breastfeeding.
  • Fund active transportation projects like pedestrian and biking paths in all communities and make local spaces more conducive to physical activity such as opening school recreational facilities to community groups outside of school hours.
  • Expand access to healthcare and require insurance coverage with no cost sharing for U.S. Preventive Task Force recommended obesity prevention programs.

Read the full report