Task Force Releases Report on Childhood Obesity

To rollback childhood obesity in one generation.

Ambitious goal - to get the prevalence of childhood obesity down to 5% by 2030. No society has ever succeeded in undertaking such an enormous task - one that is complicated by deeply ingrained norms around diet and exercise, a well-financed commercial industry (not only fast/junk food, but also when it comes to diet and weight loss), and a general distrust of government-led initiatives.

The White House Task Force on Childhood Obesity released its report (commissioned by President Obama on February 9, 2010) and it combines the best evidence for tackling weight gain among our nation's kids.

It quickly lays out the facts: our children are fatter than ever and it is impacting their health.

Update: MA School Nutrition Bill

It took a little investigating (and some decoding) to figure it out: the School Nutrition Bill passed the House!

Thanks for calling and/or writing your Legislators. It does make a difference. I know there was a lot of movement on the ground Thursday morning among advocates for school wellness and nutrition policy even though I couldn't join them.

You can access the legislative history of the newly numbered bill (HB 4441) at the Massachusetts website. Each Amendment was adopted in turn, with a few hiccups (i.e. "referred to House Rules" and "Rules Suspended") along the way.

Need a little more information about what took place yesterday?? ...

Contact Your MA Legislator for School Nutrition!

Tomorrow may be a historic day for school nutrition in Massachusetts!

This Thursday, the Massachusetts House plans to vote on House Bill 4438 (previously HB 2092), also known as the School Nutrition Bill. This would be a milestone in Massachusetts school nutrition history, as no previous bill has set standards for the types and quality of food sold in school besides the VERY minimal federal regulations.

If you want our schools to be healthier places for our kids, then contact your legislator by TOMORROW!

You can find out more about the School Nutrition Bill and the Local Farm Products Bill (HB 2017), which will *hopefully* also be incorporated in the final document, at the Massachusetts Public Health Association website.

To find out who your State Representative is and how to contact them click here.

This is what I wrote to my Representative...

Mammography Screening Myths Exposed

The US Preventive Services Task Force (USPSTF) released "new" mammogram guidelines this week. The guidelines have received major backlash from the American Cancer Society and many cancer survivors.

Below is are some of the mammography screening myths floating around:

Mandated H1N1 Vaccination: Right or...Oh, so Wrong?

A good friend and former colleague inspired this post (thanks Joanne) after realizing how media attention to mandated H1N1 vaccination among health workers has grown in the past few weeks. NPR, Time, the New York Times, ABC News all are covering what is an unprecedented move to require health care workers to be vaccinated against swine flu.

While many hospitals and clinics are requiring employees to get vaccinated, the state of New York is requiring all health care workers with patient contact to receive the H1N1 vaccine or face job loss; resistance to this mandate among health care workers has been overwhelming. Fear of side effects and privacy issues top health workers' concerns. However, an August poll shows a vast majority of the public to be supportive of these vaccine requirements among healthcare employees.

There seem to be several streams of thought regarding this issue:

1. Vaccination of all health care workers is needed to protect the public against swine flu spread by providers who come into contact with sick patients
2. Mandatory vaccination is needed to protect other patients in the hospital setting with compromised immune systems (meaning they easily can come down with an illness, like the flu).

But many nurses object, saying that they have never gotten flu in past seasons, so why now? Why this flu shot? Additionally, opponents to mandatory vaccination highlight the fact that the vaccine is not effective 100% of the time. Nurses also worry about the potential side effects of vaccination, particularly whether it would cause them to get sick with the flu.

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?

Research and Policymaking Merge in Public Health

How does a State know whether fluoridating its water supply will prove cost-effective in reducing tooth decay and its related health costs of their residents? Are mass media campaigns effective in discouraging smoking among young people?

These questions and others are posed in a Fall 2008 report by the Council of State Governments entitled "State Policy Guide: Using Research in Public Health Policymaking". 

The report indicates strong support for State governments to begin making public health decisions based on empirical evidence rather than the influence of lobbyists or in the interest of political expediency. The challenge of making evidence based decisions is directly addressed in the report, as is the need to distinguish public health policies directed at the population (i.e. community) level from medical care policies, which focus on treating or preventing disease in individual patients. 

Rating scales to evaluate the evidence for particular interventions are provided, as well as a step-by-step guide to drafting and reviewing proposed legislation on public health policy. 

I wonder how much attention to evidence-based policy making is currently happening at the local and State level. Have other sectors of government (apart from health) been making evidence-based policies or is this something new altogether?

It is imperative that we elect and promote individuals with a strong ability to identify and critique the public health literature so that informed public health policies can be implemented. At the least, we must expect our policymakers to surround themselves with people who are public health experts and can inform the content that goes in to the legislation. This guide is a good first step -- a call to action of sorts. 

Next Steps:

• Are evidence-based public health policies being made in your State? 
• What are the risks/rewards of being the first State to adopt a new public health policy? Can these decisions still be evidence-based?
• Who will keep local and State governments accountable for their public health policies?

Fast Food and Obesity: A Causal Relation??

The New York Times reported on a recent Working Paper that examined changes in obesity among high-school students and excessive weight gain during pregnancy before and after a fast-food outlet opened in several cities across the United States. What did they find? Check out my blog post at Society and Health. 

What the Stimulus Means for Public Health

President Obama passed the Stimulus Bill (a.k.a. the American Recovery and Reinvestment Act) on Monday. Immediately, I got an email from APHA announcing how pleased they were "with the $1 billion investment in disease prevention and wellness activities...[and]with the inclusion of $2 billion to improve community health centers and expand services and $500 million for the training of primary care providers." Additionally, I received an email sent from the Director of Nutrition Policy at the Center for Science in the Public Interest who praised the inclusion of funding for community-based prevention and wellness programs, equipment for the National School Lunch Program to help schools prepare healthier meals, and increased support for WIC recipients. 

You make ask, "why is public health part of this stimulus plan?" or even argue that it has no place in it. I disagree.  Maintaining the health of our nation during this economic crisis must be a priority. Healthy workers are productive workers, just as healthy mothers have healthy babies. Healthy babies grow into healthy adults.

Just as the education system will suffer greatly as a result of budget cuts and spending freezes, so will those serving in public health see their budgets shrink and their resources dwindle. Thankfully, the education system will receive $100 billion in investment through the Stimulus Bill (see Nicholas Kristof's Sunday column for his take on this). The $3 billion for public health pales in comparison to that amount. Nonetheless, I think that the public health priorities included in this bill will speak volumes for the types of activities that the administration will pursue in the coming months and years.

It is worth noting that what is good for education is also good for public health. Higher educational attainment is associated with lower risk of disease and death for most health problems. Reducing disparities in education may serve to improve the public's health more than any technological innovation in medicine (e.g., electronic medical records) could hope to. I hope we do not lose focus of the fundamental causes of poor health, to do so would be a tragic misstep.

Changes to WIC Nutrition Standards: Which State is Next?

Even if you have never received WIC assistance, you have most likely heard of the government program if you worked as a cashier in a grocery store. WIC is the name given to the government food program for low-income pregnant women and young mothers called the Special Supplemental Nutrition Program for Women, Infants, and Children. 

The program was created in 1974. It provides vouchers for foods considered to provide for the nutrition needs of nursing/pregnant women and their baby or infant under age 5.  For example, white bread, whole milk, and cheese are commonly bought WIC items. However, as nutrition science has evolved, those in the field of public health and policy realized that WIC was promoting many foods that were likely contributing to obesity and overweight. 

In 2005 the Institute of Medicine (IOM) and other agencies began writing reports on changes in dietary patterns among women using WIC, as well as changes in what is known to provide adequate nutritional benefits without creating other potential health problems  such as overweight, diabetes, digestive problems, etc. (As an aside, the recommendations of the IOM are in a book called WIC Food Packages that can be found here, but appallingly costs $36.  An 8-page brief report can be found in pdf, here.).

Numerous recommendations were given by the IOM committee including 

• increasing the vouchers for fresh fruits and vegetables
• reducing cheese vouchers from 4 lbs/month to 1 lb/month
• offering only whole grain breads, rice, and cereals to certain food packages
• allowing the purchase of jarred baby foods
• restricting the amount of juice that can be bought.
  

Nearly a full four years later (read January 2009), Delaware and New York have been among the first to adopt new WIC nutrition standards. New York, rather than using the IOM report standards, chose to adopt dietary guidelines set forth by the CDC. Among the changes for WIC recipients are ability to purchase whole grain breads and cereals, canned or dried beans, and jarred baby foods, as well as cash value checks for buying fresh fruits and vegetables. According to a Robert Wood Johnson Foundation announcement, WIC will begin changing its nutrition standards to align more closely with federal dietary recommendations in - RWJF says October 2010, but the Food and Nutrition Service website shows an implementation date of October 2009.

This is a great success for public health; it is a change that will affect millions of lives not just in the short term, but also in terms of long-term health outcomes. It is another example of persistence and hard work paying off. Now the question is -- how will States adopt the new standards? Will there be uniform change? And will there be regular evaluation and updating of nutrition standards, or will these last another 30-40 years?