The Obesity Crisis: Solutions Northeastern University School of Public Policy & Urban Affairs Open Classroom Series Food & American Society: An Urban Perspective April 11, 2012 Allison F. Bauer Program Director The Boston Foundation

Spending Mismatch: Health Care vs. the Determinants of Health * Source: NEHI estimates from McGinnis et al (2002) and U.S. National Health Expenditures Healthy People in a Healthy Economy

State Budget FY’01 – ’10: In MA – and the US – health care costs are crowding out investment in the basic determinants of health Mass. State Budget

MA is among best in adult obesity; lags in childhood rate 1Mississippi44.4% 2Arkansas37.5% 3Georgia37.3% 4Kentucky37.1% 5Tennessee36.5% 10Illinois34.9% 15Ohio33.3% 20Texas32.2% 25Virginia31.0% 30Massachusetts30.0% 35New Hampshire29.4% 40Wisconsin27.9% 41Idaho27.5% 42Colorado27.2% 43Vermont26.7% 44Iowa26.5% 45North Dakota25.7% 47Connecticut25.7% 49Oregon24.3% 50Utah23.1% 51Minnesota23.1% STARK REALITY: MA ranks 30th, at 1 in 3 children overweight or obese Healthy People in a Healthy Economy

Neighborhood Focus: Healthy Dorchester Healthy People in a Healthy Economy

Geographically Targeted Grants to Address Food Access: Dorchester Neighborhood of Boston Healthy People in a Healthy Economy

7 The Boston Foundation Health Portfolio: From Statewide Policy Change to Targeted Local Impact Neighborhood: Healthy Dorchester Bowdoin Street Health Center ReVision Urban Farm Sportsmen’s Tennis & Enrichment Center Boston Natural Areas Network Greater Boston Food Bank City of Boston Playworks Goldberg Civic Engagement Initiative Boston Schoolyards Initiative CHAMPS BOKS Statewide Policy Healthy People/Healthy Economy Initiative (NEHI) Mass Public Health Association Greater Boston Interfaith Organization (GBIO) Mass in Motion (DPH) Healthy People in a Healthy Economy

8 Socioeconomic Factors Changing the Context to make individuals’ default decisions healthy Long-lasting Protective Interventions Clinical Interventions Counseling & Education Largest Impact Smallest Impact Examples Poverty, education, housing, inequality Immunizations, brief intervention, cessation treatment, colonoscopy Fluoridation, trans fat, smoke-free laws, tobacco tax Rx for high blood pressure, high cholesterol, diabetes Eat healthy, be physically active CDC “Health Impact Pyramid” Shifting our Emphasis