School Nutrition Policies, MA on my mind

As I mentioned on Twitter this morning, french fries appear to be the lunch food of choice for students in a popular school in Queens, New York, according to the New York Times. That probably doesn't surprise anyone who works in a school or has visited one during lunch. Unfortunately, I have not.

Nonetheless, my memories of school lunch are not much different. I remember tater tots and pepperoni hot pockets being standard fare. By the time I graduated, there was a salad bar in place; it was not very popular. Occasionally, I opted for the food served as part of the National School Lunch Program (spaghetti comes to mind) and on days of cross-country meets I habitually ate a peanut butter and jelly sandwich, which was a pretty good choice thinking back on it.

Is Extreme Public Health the Answer?

I'm taking off my "reporter" hat for a moment to share some public health talk I've been mulling over lately. You know the uproar over health care reform and the public option? Of course you do! How about the fury and debate over the state and national initiatives to tax soda and other sugar-sweetened beverages? Or the resistance of businesses, "consumer groups" (i.e. backed by the food industry), and others to put nutrition information on menus and point-of-purchase sales in fast food chains and restaurants?

The list goes on and on of public health initiatives that create waves in the ocean endearingly called "status quo."

My question: do public health initiatives have to be extreme to be an effective solution? (I'm going to leave extreme undefined for the moment...but basically, I'm talking about "extreme" as to the degree it causes public reaction, corporate unrest, and resistance). Or, as I asked my mom, "Do you have to be a wacko to get the job done?" I was being facetious, kind of.

My response after much reflection: Yes.

Let's embrace it!

Going to the Park? Walk or Bike!

Just in case you need a little nudge to ride your bike to work or walk to get groceries here's further evidence that "active" transit (i.e. walking or biking to get somewhere) is associated with better health. In the latest American Journal of Preventive Medicine one year of data was taken from a 20-year follow-up study to assess whether walking or cycling compared to only using a car to get around was associated with Body Mass Index (BMI), waist circumference, and fitness.

News Flash

The intersection between the environment and public's health has made recent headlines in the New York Times. I wonder if it is any surprise that conditions related to CAFOs (concentrated animal feeding operations) are implicated in at least one of the public health disasters. Here two of the most interesting (and disturbing) stories I read recently:

• Health Ills Abound as Runoff Fouls Wells - The New York Times reported today that excess cattle manure is contaminating local water systems. The pollution is resulting in a wide-range of health problems including diarrhea, ear infections, and skin rashes. The problem appears to be in the enforcement of laws already on the books. Local communities need more safety mechanisms in place to identify and prevent possible sources of water contamination and to act quickly once a problem is identified.



• Clean Water Laws Are Neglected, at a Cost in Suffering - A Sunday special in the New York Times investigates the problem of contaminated drinking water, beginning with a community in coal country West Virginia. Though legislation is in place (the Clean Water Act and the Safe Drinking Water Act) both are systematically violated resulting in dental caries, skin rashes, and likely far greater medical conditions. Again, regulators are overwhelmed, but urgent action and redress is needed.
  
  
  

Soda Tax To Combat Obesity, Will it Work?

Cigarettes are taxed, alcohol is taxed, why aren't soft drinks taxed?

One huge reason for the dirth of legislation levied against unhealthy foods including sodas is the enormous lobby of the food industry in DC and across the country. Whenever there is serious consideration of restricting access to unhealthy foods (such as in public schools) there is enormous resistance. Big Food has lots of money to manipulate (I mean influence) public opinion so that there is not enough momentum and public support for anti-junk food policies. The sad story is that public health professionals can have nearly the same trouble improving access to healthy, nutritious foods in these same places!!

The lead story of the Business section of today's New York Times was "Tempest in a Soda Bottle: Proposed Tax on Sugary Beverages Debated." It discusses the increased political open-mindedness to the idea of a tax on soft drinks and sugar-sweetened beverages in the US and the likely resistance to such a proposal.

Here's why I think this could be a good idea.

Smoking Outside, A Public Health Threat?

The New York Times has been impressing me recently with its coverage of public health issues. Sure, health care reform makes that coverage pretty much a no-brainer, but today's front page article on the proposal to ban smoking outdoors in New York City definitely peaked my interest. It is part of the "Take Care New York Plan 2012" and includes other public health proposals in addition to banning smoking in public parks and beaches.

New York City has long been an early adopter of public health initiatives, such as eliminating trans-fat from prepared foods, improving menu labeling in fast food chains to include calorie counts, and banning smoking from nearly all indoor spaces.

The proposal, launched by the NYC health commissioner, Dr. Thomas A. Farley, to ban smoking from public, outdoor spaces is not without precendence, as the article points out:

"A number of municipalities — particularly in California — have banned smoking at outdoor parks, playgrounds and beaches. In 2007, Los Angeles extended its smoking ban, which already covered beaches and playgrounds, to include municipal parks. Later that year, Chicago banned smoking at its beaches and playgrounds, though smoking is still allowed in many parks."

Nonetheless, there is much controversy over the need for such a ban. What are its objectives?

Low-Fat Diet Disaster

Saturated fat has historically been the "number one enemy" of dietitians and nutritionists. For decades, popular thought was that the most effective way to lose weight or to prevent weight gain was to eat a diet low in fat. This approach to weight loss and management has had disastrous consequences; however, because of its subsequent timing with the explosion of refined carbohydrates (as opposed to whole grain foods) and sugary beverages.

Indeed, there is little, if no, evidence that eating a diet low in fat will result in weight loss in the long-term. We discussed eating patterns, such as a low-fat diet, in a class I am taking this semester on Obesity Epidemiology with Frank Hu, author of the book by the same title.  In it, he reviews the most current research on the causes of obesity and the health consequences of obesity. Oh, and you thought obesity was itself a disease.

Missing the Health in Health Care Reform

Michael Pollan was preaching to the choir today in his New York Times op-ed piece on "Big Food Vs. Big Insurance." His words were music to my ears:

"...the fact that the United States spends twice as much per person as most European countries on health care can be substantially explained...by our being fatter. ...

That's why our success in bringing health care costs under control ultimately depends on whether Washington can summon the political will to take on and reform a second, even more powerful industry: the food industry."

As excited as I was to hear Obama's rallying cry on health care reform last night, I was disappointed to hear prevention offered as a critical element of reform only one, maybe two, times.  Prevention isn't a sexy or politically inspiring topic, I know. Yet, public health is all about prevention. Public health is about "creating the conditions in which people can be healthy."

The food industry has significantly changed the way Americans (and populations globally) eat. Few countries have been spared. Those that refuse to let huge US-based multinational food manufacturers in, or that limit their reach, have often met much resistance and criticism. Yet, as Barbara Kingsolver would say, these resistant countries are protecting their food culture. They are also consequently protecting their health.

In an effort to get the cheapest, most convenient food we have sacrified quality, nutrition, and health. We have kids in America who are both obese AND malnourished. How have we let that happen?

While I am all in support of health care reform moving forward, it will in no way be a panacea for America's poor health. There are enough players out there who want to profit from sickness, not just the insurance companies. Pollan has brought this to our attention, once again.

Obama Health Care Speech, Meat and Meaning

We know we must reform the system. The question is, 'How?'

- President Obama, Health Care Speech, September 9, 2009

Tonight at 8pm Eastern President Obama made his appeal for passing health care reform. Prescriptions columnist David Herszenhorn had a timely piece in the New York Times this morning, "How to Watch the Obama Speech." Where was Herszenhorn right? Where did he go wrong? This is my attempt at establishing whether, as my journalism professor put it, "it was worth the effort."

Can We Harness New Media for Public Health?

After a year of public health blogging I have numerous questions on the utility and impact of new media on public health. While there is no technical definition of "new media" that I am aware of (please tell me if you have one) this is what I mean by the term:

"Interactive digital media, such as the Internet, as opposed to traditional media such as print and television" (from Wictionary - an example of new media in action).

Other types of new media that I regularly interact with include: Facebook; Twitter; personal and community blogs; Delicious; Yelp; YouTube; LinkedIn; and, of course, my cell phone. A few of these examples fall into the social media category. In other words, it is used to primarily network with others and to build relationships. Others are primarily used for communicating and documenting ideas, activities, and information.

There are a variety of ways to use new/social media...and that brings me to the questions that I just keep on asking myself...

Support Healthier School Lunches TODAY!

Slow Food USA is sponsoring a National Day of Action (today, September 7, 2009) which includes hundreds of "eat-ins" (a.k.a. pot lucks) all across the country. You can log in to their website to sign a petition to improve school lunches, spread the word, or attend an eat-in.

I heard about this too late to attend an eat-in; if I hear of more in the future I will try to get the word out sooner! Labor day was full of activity (including a health care reform rally in the Boston Commons) and you can't be all places at once.

Keep an eye out for the Child Nutrition Act, which has to do with the National School Lunch program and will be up for "reauthorization" at the end of the month. Civil Eats had a recent blog post on the topic which really drives home the urgency and timeliness of this issue!

Banning Peformance-Enhancing Drugs from the Military?

While today's New York Times article is titled "A Focus on the Effects of Dietary Supplements Among Troops in War Zones," the article actually discusses the use performance-enhancing (PE) supplements meant to build  and maintain muscle mass quickly by our U.S. troops.  At first glance I thought the article might talk about Vitamin D or Calcium intake; a poor editorial title choice if you ask me.

These PE supplements have been clearly linked to heart problems and several deaths, and military health experts are concerned that the conditions of deployment (e.g. hot climate, increased stress, high activity) might create a heightened risk for these serious health outcomes.

While performance-enhancing drugs carry with them health risks (many of which have only recently been acknowledged), they also do increase strength, endurance, and help users fight muscle fatigue. It seems to me that these are desirable outcomes for men and women who will be fighting insurgents and charged with strenuous tasks that require peak performance.

This will be a difficult decision for those in the Secretary of Defense. Surveillance of PE supplement use and associated health outcomes should be integrated into the military health system if they are serious about understanding the scope of the problem. 

What do you think should be done?

"Smart Choices" Is Fool's Gold

The New York Times today ran a story today on the "Smart Choices" food labeling campaign that is being heavily endorsed by the biggest food industry players. The program claims to respond to consumers' need to be able to make quick, convenient choices on "healthier" food products. I mean, who has time to read through ingredient lists and nutrition labels? Well...I do. But, I know most people do not. Nonetheless, despite its good intentions, this food labeling system is inherently flawed.

Actually, this is a public health abomination! Walter Willett (whose name often appears on Veritas Health), is actually quoted in the article as saying "These are horrible choices." Enough said.

It is really no surprise to me that the article was titled "For Your Health, Froot Loops." As I've written before, sugary breakfast cereals seem to be constantly popping up in marketing to parents and kids as a nutritious breakfast food. It's as if food manufacturers fear people will find out that highly refined, processed cereals are not that great for them and switch to something that resembles what one might find at a farm somewhere (fruit, eggs, dairy, etc.).

So why am I so upset by this? It's just a few labels, right? Well, not exactly. This is an example of industry exploiting a true (Veritas) public health need. Consumers, parents especially, need to have a more simple, credible system on which to base their food choices. This, as Willett dually notes, is not a credible system.

It is not as though parents are choosing between donuts and Fruit Loops as Eileen Kennedy of the Friedman School of Nutrition Science and Policy is quoted as saying. Indeed, it will be more likely a consumers' choice between Froot Loops and some other "un-labeled" potentially healthier cereal product. One that possibly is unable, or unwilling to pay the annual $100,000 dues for the label.

As Kennedy notes, those products without the "Smart Choices" label will be perceived as nutritionally inferior, and, even worse, that those with the label are good for you. I believe there is a big difference between what is good for you and what is "better" for you...relative to something that is really "bad" for you. Come on, "Cocoa Puffs" do not provide any of the health benefits of cacao and there is no fruit in Froot Loops.

Other questions I have: What must companies do to get the "Smart Choices" label? And why are there such generous guidelines for what products qualify? Since when and who exactly decided that Coco Puffs and Froot Loops (in addition to many other similar products, I presume) are actually smart choices? This statement in the article is telling...

Ten companies have signed up for the Smart Choices program so far, including Kellogg’s, Kraft Foods, ConAgra Foods, Unilever, General Mills, PepsiCo and Tyson Foods. Companies that participate pay up to $100,000 a year to the program, with the fee based on total sales of its products that bear the seal.

Recently, I read that if it requires a label it probably isn't that good for you. Here's to simple criteria. In general, stick to foods that don't require a label to tell you that it is a smart choice.

Health Reform Update: Congress Resumes

What has happened to health reform? 

If you are like me, you are wondering if this "deep sigh" of health reform silence will turn into a coma or a comeback. Will health reform get its much needed second-wind? The New York Times today reported that President Obama hopes to create momentum in Congress for health care reform as senators and representatives return from their roller-coaster of an August recess. Obama will be focusing his speech on bipartisan points of agreement (though it may be up for debate whether any really exist). Here are a few that the article notes:

• Regulation of health insurance companies to eliminate denials in coverage based on medical history or current condition.
• Creation of federal subsidies to make insurance affordable to financially vulnerable, low-income populations.

...Did anyone else notice that this is a fairly short list?

It's no surprise that the Times reporters began comparing this speech to the one given by Bill Clinton 16 years ago. 

On a much brighter note I get to follow this story as it develops over the next few months -- mandated Times reading courtesy of my reporting on politics and policies class. Boy, am I excited!!

Web Resources

Thank you for checking out my favorite web resources for the latest public health information. Just a reminder that this is a work in progress. I would LOVE your feedback. Suggestions?

US Health Care

• Kaiser Family Foundation (health reform, medicaid/care, media, state policy)
• American Public Health Association (health care reform, advocacy)

Food & Nutrition

• Center for Science in the Public Interest (advocacy, health and nutrition)
• California Center for Public Health Advocacy (research, advocacy, obesity, policy)
• Harvard Nutrition Source (nutrition, diet)

Gender-based Violence

• Harvard Humanitarian Initiative (humanitarian assistance, research)
• Family Violence Prevention Fund (family and intimate partner violence)

Social Determinants of Health

• Robert Wood Johnson Foundation (disparities, health reform, childhood obesity)
• The Urban Institute (economic and social policy)

Global Health

• Global Health Council (global health, information dissemination)

NYC Ads Target Sugar-Sweetened Drinks

This is the most eye-catching public health campaign ad that I have seen in a long time that does not have to do with violence. While it specifies cutting back on sodas in the text, the liquid resembles sugar-laden iced team more than Coca-Cola and could apply to a wide range of beverages.

In fact, you can check out the entire ad campaign at the New York City Department of Health website, which shows a series of three ads: one with a bottle of Coke being poured, one using Gatorade, and one with the Snapple (of course, these bottles are not actually branded as such...). You can comment on the posters at the nycHealthy blog here.

The ad was first brought to my attention by Dr. Oz (known for his frequent guest appearances on Oprah) on Twitter who asks whether the ads are "too much?"

Too much of what? The truth?

I love this edgy ad campaign that pushes the boundaries and wakes up America to the food traps that are destroying our health and costing us millions, even billions of dollars health care bills for preventable illness. Sugar-sweetened beverages are low-hanging fruit with lots of empirical evidence to support their limited consumption. I wonder whether this campaign will be extended to other States and regions, as well.

Way to go NY City Department of Health!!