NY Governor Paterson Proposes Tax to Fight Childhood Obesity

In a commentary recently posted on CNNhealth.com,  New York's Governor Paterson describes why he included a proposed tax on sugared beverages in the state budget he submitted last week. "What smoking was to my parents' generation, obesity is to my children's generation. Nearly one out of every four New Yorkers under the age of 18 is obese. In many high-poverty areas, the rate is closer to one out of three." 

Paterson cites a study by Harvard researchers found that each additional 12-ounce soft drink consumed per day increases the risk of a child becoming obese by 60 percent. For adults, the association is similar. He believes that in order to succeed in reducing childhood obesity we must reduce consumption of sugared beverages.  He estimates that an 18% tax on sodas and fruit drinks that are less than 70% juice will reduce consumption by 5%. This tax would bring in an estimated $404 million annually, which could be used to fund programs to help reduce the almost $6.1 billion the state spends on health care related to adult obesity -- the second-highest level of spending in the nation.

Paterson acknowledges that his proposed tax may be unpopular, but he points to the benefit to public health from high cigarette taxes. Last month, the Centers for Disease Control and Prevention reported that, for the first time in generations, fewer than 20 percent of Americans smoked. Lung cancer rates have finally begun to decline. As a result, we are all healthier.

 Paterson says, "Just as the cigarette tax has helped reduce the number of smokers and smoking-related deaths, a tax on highly caloric, non-nutritional beverages can help reduce the prevalence of obesity."

It's not perfect, but it's a step in the right direction.

Burger King Introduces Unhealthy Behavior to "Burger Virgins"

The marketing folks at Burger King might think they have come up with an oh so clever way to trump Mickie D in the burger wars. I'm referring to recent TV spots featuring "burger virgins" in far off lands (like Transsylvania) who are introduced to the Whopper and then asked to compare it to a Big Mac. Are we supposed to be influenced in a positive way by these ads? If members of the Hmong tribe prefer the Whopper to the Big Mac, should we care? I think what we should care about is the tragic commentary these ads make about our willingness to export our unhealthy eating habits to these poeple, when we as a nation have so much more to offer.

Did The Press Give Your Kid Measles?

Dan Blankenhorn, over at ZDNet Healthcare posted this provocative question on his blog. He reports that according to Tammy Boyce, a research fellow at the King's Fund in England. excessive media coverage of the possible like between vaccines and autism had prompted unhealthy behavior among parents of young children. She sees a direct correlation between the rise in media coverage and rise of measles in England. That's because a growing number of parents are refusing to allow their children to receive the standard MMR (mumps, measles and rubeblla) vaccine. While the research that touched off this fear of vaccines (conducted by Andrew Wakefield) has been discredited, the media seem intent on keeping the debate alive, and therby fueling concern among parents about vaccine safety.

When Ms. Boyce was asked in in interview with The Economist if the press had learned anything from what has happened, she answered, "No, on balance I don't think they have."

AN UNHEALTHY AMERICA: The Economic Burden of Chronic Disease

In October 2007, the Milken Institute published an eye-opening report authored by Ross DeVol and Armen Bedroussian. (You can find it in the Reports section of their website) It provides a comprehensive state-by-state look at the impact of chronic disease in America, what will happen if we continue our unhealthy behavior, and charts new courses to save lives and increase productivity and economic growth.

The authors don't waste any time pointing out the magnitude of the problem we face. Here is an excerpt from their introduction to the report: "More than half of Americans suffer from one or more chronic diseases. Each year millions of people are diagnosed with chronic disease, and millions more die from their condition. By our calculations, the most common chronic diseases are costing the economy more than $1 trillion annually—and that figure threatens to reach $6 trillion by the middle of the century. Yet much of this cost is avoidable. This failure to contain the containable is undermining prospects for extending health insurance coverage and for coping with the medical costs of an aging population. The rising rate of chronic disease is a crucial but frequently ignored contributor to growth in medical expenditures."

To quantify the potential savings from healthier lifestyles and plausible but modest advances in treatment, the authors compared a“business-as-usual” baseline scenario with an optimistic scenario that assumes reasonable improvements in health-related behavior and treatment. The major changes contemplated here are weight control combined with improved nutrition, exercise, further reductions in smoking, more aggressive early disease detection, slightly faster adoption of improved therapies, and less-invasive treatments. The impacts of these factors vary widely by condition—gains against diabetes depend largely on reductions in obesity, while colon cancer advances depend heavily on wider early screening. A complete description of the assumptions on which these scenarios are based can be found in the full report.

Across the seven diseases, the optimistic scenario would cut treatment (direct) costs in 2023 by $217 billion (figure ES-1). And the cumulative avoidable treatment costs from now through
2023 would total a whopping $1.6 trillion. Note that this would be a gift that keeps on giving, saving hundreds of billions annually in the years beyond 2023.

California Has a Plan For Fighting Unhealhty Behavior

The CA Department of Public Health, through its Network For a Healthy California, has developed Take Action!, a free 10-week web-based program for employees of California businesses that will empower them to adopt and maintain a healthy lifestyle. Why are they doing this? Consider this quote from the introduction to the Take Action! Program Overview (which you can download by clicking the previous link): California residents have gained 360 million pounds of excess weight in the past ten years, a rate that is among the fastest in the country. A third of our children, one in four teens, and over half of all adults are already overweight or obese.

The impact of this extra weight? According to the CA Department of Health, "rates of chronic disease and disability associated with poor diet and inactivity continue to escalate year after year and are costing California $28 billion annually."

The Take Action! plan is a wellness plan that has great potential to improve health and productivity because of one key ingredient that many similar plans lack: SIMPLICITY. The plan provides two paths to better health: 1. include more fruits and veggies in the diet, 2. increase regular physical activity. The plan realizes that asking people to embrace both paths at the same time is not likely to achieve the desired outcome. So it simply asks participants to just pick one, and be willing to follow the guidelines in the plan for that path. The plan provides a week by week guideline for employers to maximize the plan's effectiveness.

If you are in a position to introduce a wellness plan into your workplace, definitely check out Take Action!

How's This For Unhealthy Behavior?

Dr. Stanley Feld M.D.,FACP,MACE over at Repairing The Healthcare System has be posting a multi-part series on the war on obesity. In part 12 of the series he summarizes the keynote speech by Dr. Ken Cooper during World Diabetes Day in Dallas TX.  Here are some astonishing stats presented by Dr. Cooper.

Estimated obesity rates for children 6 to 11 years old have increased from 15.1% in 1999 to 18.8% in 2004. The Department of Health and Human Services estimates that 20% of children and youth in the U.S. will be obese by 2010.

Washington D.C. was first in the nation with 22.6% of children age 10-17 being obese. 

Texas was sixth with 19.1% of children 10-17. Forty-two percent of fourth graders and 39% of eight graders were obese in 2004. A shocking 70% of these children will become obese adults and one in three will develop diabetes.

In order to save the healthcare system we must have a national WAR ON OBESITY.

Microsoft Examines "Cyberchondria"

Microsoft researchers have just published the results of a study of health-related web searches based on anonymous data and interviews with Microsoft employees. Basically the study points out that over-reliance on web-based content for self-diagnosis can be just as unhealthy as not taking any interest in symptoms of possible illness. The study suggests that self-diagnosis by search engine frequently leads searchers to conclude the worst about what ails them. They found that searching for a particular symptom such as "headache" could just as easily lead people to pages describing a serious condition such as brain tumor, as those describing a benign condition such as caffeine withdrawal.

The problem that the researchers see is that current search engine technology is unable to prioritize results most likely to be relevant to the searcher's intent. A better alternative could be provided by a personal health record that can provide health advice based on an individual's actual health history. By using the PHR as the first point of inquiry about a health question, it could be possible to use the person's health profile as a filter to present information relevant to their current health condition.

Cyberchondriacs and Health Info-entials are Early Adopters of Healthy Behavior

Harris Interactive coined the name Cyberchondriacs to describe individuals who go on-line regularly to search for health information. Edelman, in their recently available Health Engagement Barometer (http://engageinhealth.com) uses Health Info-entials to describe individuals who claim to be highly involved with health issues and actively seek and share health information.

According a Harris poll of 1,010 US (http://www.harrisinteractive.com/news/newsletters_healthcare.asp) adults conducted in July, 2008, 150 million Americans claim to go online to obtain health information. While this is a big number (66% of all adults and 81% of those who are online) it represents a decrease from the 160 million reported just a year ago. When Harris began measuring the number of people going online for health information in 1998, they reported 54 million. Here are a few highlights that describe Cyberchondriac behavior in 2008:

• 25% go online often for health info.
• They average 4.8 online searches per month for health info.
• 86% believe the info they get online is reliable
• 47% discuss the info they obtain online with their doctors
• 49% go online to seek info as a result of discussions with their doctors
  
  The Edelman study is based a much larger and more diverse population totaling 5,183 adults distributed approximately evenly among the US, UK, Germany, Russia and China. They found that one in five of those surveyed were Health Info-entials. It is interesting to note that they ranged from 35% in China to 13% in UK. Here are the top five ways Info-entials want companies and organizations involved in health to engage with them:
  Help me address health issues that affect me personally
  Communicate both positive and negative news to me
  Inform me about health conditions that I am concerned about
  Inform me about risks and benefits of their products and services
  Communicate openly and transparently
  
  It is interesting to note that a well designed interactive Personal Health Record could easily satisfy this wish list.
  
  
  

Can Preventive Care Change Unhealthy Behavior?

Dana Blankenhorn over at ZDNET Healthcare posed a provocative question on his blog: “Is preventive care a silver bullet against rising health care costs?” If individuals have access to the knowledge they need to make the right decisions, will they in fact take greater responsibility to maintain their health and thus avoid many preventable illnesses? It seems that any proposal to reform healthcare in America is counting on it. As an example, here is an excerpt from “Call to Action, Health Reform 2009” written by Senate Finance Committee chairman Max Baucus (D. MONT.)

“The Baucus plan would immediately refocus our health care system toward prevention and wellness, rather than on illness and treatment. Those who are uninsured ― and therefore less likely to receive preventive care and treatment for major conditions ― would be given a “RightChoices” card that guarantees access to recommended preventive care, including services like a health risk assessment, physical exam, immunizations, and age and gender appropriate cancer screenings recommended by the U.S. Preventive Services Task Force.”

We agree with Sen. Baucus that focusing on prevention and wellness is an essential part of meaningful reform. But there is no silver bullet unless there is a significant shift in people’s attitudes about their own health. What if individuals could be given a custom health plan based on their genes and family history? As Blankenhorn asks in his blog, “Will we follow it? And what will following it cost, as opposed to waiting for your stroke, having a good time, and then dieing suddenly in middle age?”

Unhealthy behavior is a way of life in Huntington W. Virginia.

A recent CDC study of U.S. health claims that this out of the way college town has the dubious distinction of having the poorest health ranking in the country. Nearly half the adults in the five county metro area of Huntington are obese, far higher than the national average. Huntington also leads in 6 other illness measures including heart disease and diabetes. It even tops the percentage of adults who have lost all their teeth (half of them have). This is in sharp contrast to another out of the way college town—Burlington VT—ranked by the CDC as the healthiest city in America in 2008.

Huntington and Burlington share similar attributes of both being college towns and both having overwhelming white populations of English, Irish or German ancestry. But there the similarities end. Burlington is younger, better off financially (8% living at federal poverty level vs. 19% in Huntington) and better educated (40% have at least a college degree vs. 15% in Huntington). These differences, coupled with regional cultural differences help to explain why Huntington’s adult population is not only unhealthy but has little motivation to improve.

In Huntington, high unemployment and the high poverty level combine to make even basic health care services unaffordable. In Burlington, IBM, the area’s largest employer, influences good health through its insurance plans and well funded wellness initiatives. In Huntington, many people think of exercise and healthy eating as luxuries. In Burlington they are considered the norm.

While the poor health rating for the Huntington area is a terrible distinction, the locals rarely talk about it. In fact, follow up surveys showed that most people weren’t aware of it. And when made aware, most saw little reason to change their behavior.

Huntington is a perfect candidate for applying behavioral economics to change the health status of a population. By identifying biases that lead to bad health decisions, health providers and community agencies can exploit these biases by making the healthiest choices the ones that follow the path of least resistance. For example, fast food is a major food supply for residents who believe they can’t afford to buy healthier food. Fast food restaurants could apply behavioral economics by substituting bottled water for soda as the default beverage with a combo meal. The soda would be available only on request.

Gabe d'Annunzio

Truth in Comedy

My favorite comedian is Brian Regan and if you watched the above video you'll see "truth in comedy" certainly exists as he tackles his high cholesterol and feelings of inferiority when visiting his doctor.

But as Carol Burnett once said "comedy is tragedy plus time." And our country is heading for tragedy with regards to health care. It's not just that people don't listen to their doctors - they also aren't going - especially if they perceive it's more important to fill their cars with gas and put food on the table vs. paying for prescriptions or doctors visits. In a recent article in the WSJ (Consumers Cut Health Spending as Economic Downturn Takes Toll 9.22/Vanessa Furhmans)

As the credit crunch threatens to throw the economy into a deep slump, Americans are already cutting back on health care... Health policy experts say patients short term care cutbacks could lead to more medical problems and higher spending down the road.

Here are some more alarming statistics from this article.

According to National Association of Insurance Commissioners, 11% of consumers surveyed said they scaled back on prescription drugs to save money. And 22% said the economy is causing them to go to the doctor less often.

The truth is unless people change their behavior and play an active role taking care of their own health, there will always be a health care crisis (sicker people = increased health costs for everyone). Yet, as organizational behavior specialists would say you can't change behavior without metrics. In other words, Brian Regan and others might decide to do something about their high cholesterol if they had incentives to do so. People might make the choice to fill their prescriptions if they were less costly. And they would certainly take their meds if they knew not taking them would cause them to pay a higher premiums on their health care. The bottom line is - incentives change people's behavior - and as Ruth Buzzy would say - "That's the Truth."