getting obesity on the public policy agenda at the state level naccho-astho meeting july 14, 2005...

Getting Obesity on the Public Policy Agenda at the State Level

NACCHO-ASTHO Meeting • July 14, 2005

Getting Obesity on the Public Policy Agenda at the State Level

NACCHO-ASTHO Meeting • July 14, 2005

Robert F. St. Peter, M.D.

Kansas Health Institute

Obesity is certainly a public health problem

but

Is it also a public policy problem?

Intended AudiencesIntended Audiences

LegislatureGovernorPublic health (local and state)SchoolsPrivate sectorPhilanthropies

Public OpinionPublic Opinion Americans recognize problem is increasing Understand link to health problems Ambivalent about role of government

Favorable towards awareness and education Oppose junk food taxes, intrusion on individual

freedoms Some exception for childhood obesity

Healthier school lunches More physical education/activity Health education

Approach to Obesity as a Public Policy Issue


Get attention of policy makersFrame it as a public policy issueCreate framework for policy

interventionsPresent options from other statesIdentify local preferences

Raising the ProfileRaising the Profile

Series of forums and brownbag discussions

Data collection in schoolsStatewide survey with emphasis

on minority populationsVisits by key CDC personnelIOM regional conference in July

Obesity as Public PolicyObesity as Public Policy

Health care costsUnique role of schoolsPotential for bias &

discriminationDisparities among racial and

ethnic minorities

Health Care Costs of ObesityHealth Care Costs of Obesity 6% of adult health care expenditures Expenditures 36% higher for obese v. non-obese Projections of 1 out of 4 health care dollars by

2020 $657 million annual expenditures-KS

$138m for Medicare $143m for Medicaid

Cost to business $13 billion annually-US $8b in direct health care costs $2.4b in sick leave $1.8b for life insurance $1b disability insurance

Cost shift to non-obese

Kansas US

Total pop. 19.6% 20.0%

Medicare pop. 19.8% 20.7%

Medicaid pop. 28.4% 29.6%

Adult Obesity Prevalence (BMI ≥30), 1998-2000

Source: Finkelstein, Fiebelkorn and Wang, 2004

Unique Role of SchoolsUnique Role of Schools Reaches young people and has preventive

advantage Link between learning and health Nutrition education

4 hours/yr in middle school (median, US) 5 hours/yr in high school

Physical education Declining participation in daily physical activity

School food environments USDA food programs Competitive food availability Vending contracts

Bias and DiscriminationBias and Discrimination

Employment Education Health care Housing

Affects Disparities Among Racial and Ethnic MinoritiesAffects Disparities Among

Racial and Ethnic Minorities

Providing a FrameworkProviding a Framework

Call to Action to Prevent and Decrease Overweight and Obesity (Satcher, DHHS 2001) Promote recognition Assist balancing healthful eating with

regular physical activity Effective, culturally appropriate

interventions Encourage environmental change Engage public-private partnerships

Providing a Framework (cont.)Providing a Framework (cont.)

Providing a Framework (cont.)Providing a Framework (cont.)

Policy suggestions and actions Schools and youth-serving organizations Work sites and employer programs Community support programs, services

and policies Community design for healthy eating

and active living Food industry and food marketing Health care system Communication and public advocacy

Source Raymond and Moon, 2003

Analysis of Legislative Approaches in StatesAnalysis of Legislative Approaches in States

KHI assessed state legislation between 1999 and 2003

Identified 79 initiatives30 statesUp-tick after 2001 SG report

Types of Legislative InitiativesTypes of Legislative Initiatives

Commemorative/advisory resolutions Advisory commission/studies Insurance regulation School food programs Nutrition education Physical education/activity for children Adult physical activity Other

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Kansas Health Institute, 2004

2005 Kansas Legislature2005 Kansas Legislature

Bills enacted: SB 154 creates guidelines on nutritional

standards, physical activity and wellness education

SCR 1604 requires Kansas Department of Education to study policies on school nutrition and physical activity and report to the 2006 legislature

2005 Kansas Legislature (cont.)2005 Kansas Legislature (cont.)

Bills that did not become law: HB 2137 regulated offerings in school

vending machines HB 2208 created a 13 member task

force to study obesity and at-risk populations and develop state plan

HB 2417 created a 30 member council that would recommend a comprehensive state plan to increase prevention and management of obesity

Kansas School Nutrition and Physical Activities Policies Study

Kansas School Nutrition and Physical Activities Policies Study Response to SCR 1604 Funding from conversion foundation for

analysis No new funding to Dept of Ed for programs Data collected at district and school level Will address topics of:

1. Nutrition2. Nutrition education3. Physical education4. Physical activity5. Health education



NUTRITION

Open campus Lunchroom policies A la carte options Food and beverage

vending Financial issues

impacting sustainability of reimbursable food program

PHYS. ACTIVITY AND EDUCATION

Curriculum Staff adequacy and

training School day structure

related to accommodating PA/PE

Frequency and duration

Kansas Health InstituteKansas Health Institute

Healthier Kansans through informed decisions

getting obesity on the public policy agenda at the state level naccho-astho meeting july 14, 2005...

Documents

public policy issue

public policy problem

public policy agenda

public health problem

health care costs of

kansas health institute

nonobese slide

health care dollars