1. 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

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. KansasUS 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

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. 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

23. ↑ ↑

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 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

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. Kansas School Nutrition and Physical Activities Policies Study 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

30. Kansas Health Institute Healthier Kansans through informed decisions

31. History of SB 154 As originally written:  Directed the state board of education to prescribe nutritional standards for all foods and beverages made available to students in Kansas public schools during the school day.  Directed all Kansas public school districts to comply with the standards, unless a waiver is granted by the state board of education. As amended by the Senate Public Health and Welfare Committee:  Directed the state board of education to consult with other state agencies, private foundations and other private entities when developing the standards.  Added physical activities and wellness education to the list of items to consider. As amended by the House Education Committee and signed by Governor.  Changed the standards to guidelines.  Removed the language requiring all public school districts to comply with the standards.  Instead, directed all public school districts to consider the guidelines when establishing a wellness policy.

32. Public School Legislation that failed in 2005 HB 2137 would have regulated food choices available at school.  All food products offered in vending machines at elementary and middle schools must be healthy food alternatives.  Fifty percent of vending machine food offered at high schools must be healthy food alternatives.  No teacher should use candy as a reward or incentive.

33. Public School Legislation that failed in 2005 SCR 1604 would have requested the Kansas Department of Education to study the following items and report suggested improvements to the 2006 legislature.  School food programs  Other food available on school premises  Classes on health and physical activities intended to promote healthy bodies and physical fitness

34. Comprehensive Statewide Plan Two bills that did not become law would have outlined a statewide plan to reduce obesity.  HB 2208 created a 13 member task force to:  Analyze the extent and consequences of obesity, as well as identify populations at highest risk.  Deliver a report to the Governor and Legislature on January 15, 2007, that would recommend an integrated, statewide plan to prevent and reduce obesity.  HB 2417 created a 30 member council to:  Submit a report prior to the 2007 session that would recommend a comprehensive state plan to increase prevention and management of obesity.