Robert F. St. Peter, M.D. Kansas Health Institute

1. Getting Obesity on the Public Policy Agenda at the State LevelNACCHO-ASTHO Meeting • July 14, 2005 Robert F. St. Peter, M.D. Kansas Health Institute

3. Obesity is certainly a public health problem but Is it also a public policy problem?

4. Intended Audiences • Legislature • Governor • Public health (local and state) • Schools • Private sector • Philanthropies

5. Public 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

6. Approach to Obesity as a Public Policy Issue • Get attention of policy makers • Frame it as a public policy issue • Create framework for policy interventions • Present options from other states • Identify local preferences

7. Approach to Obesity as a Public Policy Issue • Get attention of policy makers • Frame it as a public policy issue • Create framework for policy interventions • Present options from other states • Identify local preferences

8. Raising the Profile • Series of forums and brownbag discussions • Data collection in schools • Statewide survey with emphasis on minority populations • Visits by key CDC personnel • IOM regional conference in July

9. Approach to Obesity as a Public Policy Issue • Get attention of policy makers • Frame it as a public policy issue • Create framework for policy interventions • Present options from other states • Identify local preferences

10. Obesity as Public Policy • Health care costs • Unique role of schools • Potential for bias & discrimination • Disparities among racial and ethnic minorities

11. Health 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

12. Adult Obesity Prevalence (BMI ≥30), 1998-2000 Source: Finkelstein, Fiebelkorn and Wang, 2004

13. Unique 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

14. Bias and Discrimination • Employment • Education • Health care • Housing

15. Affects Disparities Among Racial and Ethnic Minorities

16. Approach to Obesity as a Public Policy Issue • Get attention of policy makers • Frame it as a public policy issue • Create framework for policy interventions • Present options from other states • Identify local preferences

17. Providing 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

18. Providing a Framework (cont.)

19. 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

20. Approach to Obesity as a Public Policy Issue • Get attention of policy makers • Frame it as a public policy issue • Create framework for policy interventions • Present options from other states • Identify local preferences

21. Analysis of Legislative Approaches in States • KHI assessed state legislation between 1999 and 2003 • Identified 79 initiatives • 30 states • Up-tick after 2001 SG report

22. Types 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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24. Kansas Health Institute, 2004

26. 2005 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

27. 2005 Kansas Legislature (cont.) • Bills that did not become law: • HB 2137 regulated offerings in school vending machines • HB 2208 created a 13member 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

28. 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: • Nutrition • Nutrition education • Physical education • Physical activity • Health education

29. 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 School Nutrition and Physical Activities Policies Study

30. Kansas Health Institute Healthier Kansans through informed decisions