The Skinny on Childhood Obesity

Yesterday, Michelle Obama led the White House Childhood Obesity Summit.  The meeting was a follow-up to her (much-needed) Let's Move Campaign she announced in February.  We all know childhood obesity is a problem and the first lady is getting some national discussions started on how to combat this public health epidemic within the next generation.  Both Health and Human Services (HHS) Secretary Kathleen Sebelius and Surgeon General Regina Benjamin have also stated their plans to help Americans stop the obesity epidemic.

One of the leading health policy journals, Health Affairs, released their special March 2010 issue (Vol 29, No 3), with the theme: Child Obesity: The Way Forward. In this issue, there are a number of great articles discussing implications of childhood obesity and potential next steps to combat it.


Regarding costs, John Cawley's article on "The Economics of Childhood Obesity," mentioned two interventions shown to be not just effective, but cost-effective in youth.  One is the Coordinated Approach to Child Health (CATCH) and the other is Planet Health (cost-effective for females).  He argues that we need to use policies and incentives to promote cost-effective interventions and to find other cost-effective measures to stop this problem costing us $14.1 billion in outpatient care and $237.6 billion in inpatient care each year (direct costs).  


So, what can we do and what's being done? Thomas Frieden, director of the Centers for Disease Control and Prevention (CDC) was the lead author on an action agenda, "Reducing Childhood Obesity Through Policy Change: Acting Now To Prevent Obesity," in the Health Affairs issue.  Recommendations include: food and beverage taxes, zoning policies, banning ads, counterads, increasing exposure to healthy foods, increasing physical activity, and decreasing sedentary behavior.  However, the food and beverage taxes would likely need to be pretty high as a study released last week in Health Affairs revealed soda taxes at 4% have no effect on consumption.  However, if the tax revenues are used to fund cost-effective interventions for childhood obesity, there is still potential benefit in these increased taxes, also noted by the authors.    The authors also called to duty: federal, state, and local governments, parents, the food industry, and businesses to act.


Additionally, issue and policy briefs were released in Washington DC.  The Senate Health, Education, Labor and Pensions (HELP) Committee started a series of hearings on child obesity and how to address the epidemic, with the first in the series being the Health Affairs hearing on March 2.  A number of stakeholders convened to begin discussions on what can be done, the built environment, and food policy. You can view the Health Affairs Issue Briefing here.  Aside:  One of the speakers was Debbie Chang, Vice President of Policy & Prevention for Nemours.  I consulted with Dr. Cynthia Minkovitz and the Johns Hopkins Women & Child Health Policy Center (WCHPC) on a policy scan last year regarding current policies practiced by youth-serving organizations to promote healthy eating and physical activity.  It's exciting to be a part of positive change for our nation.


What are your thoughts on the best way to fight childhood obesity?  What is the largest barrier to stopping the epidemic?

Health Affairs, 29, no. 3 (2010): 357-363

The theme issue for Health Affairs was supported by the Robert Wood Johnson Foundation.
Photo of Michelle Obama courtesy of Evan Vucci/Associated Press.

Health Efficiency

It's a fact. The United States is not a "leader" in health information technology. But we are trying to say "goodbye" to our old ways of paper records (see photo). We may be able to learn a lot of Denmark, a country that started using electronic health records (EHRs) a year ago. Telemedicine is also greatly utilized in Denmark (an example of Telemedicine can be found here). If the US wants to focus on efficiency in our health care system (we do), then perhaps we should follow our Scandinavian friends' example (Sweden and Norway are also using EHRs).

To quote the 2008 report by the Healthcare Information and Management Systems Society (HIMSS), "healthcare information technology (IT) is a sleeping giant." On top of that, healthcare IT is significantly behind most other sectors (e.g. banking and telecommunications). The report also mentions that Denmark was able to save roughly $120 million per year by using electronic medical records. The Commonwealth Fund will also be publishing a study later this month, which concludes the Danish information system is the most efficient in the world.

US policymakers are studying the Danish system and seeing if it is possible to follow their example as we overhaul our current healthcare system. Although it is used in some US hospitals and clinics, EHRs only exist in the minority of hospitals--about 10%, or about 17% of physicians use EHRs. Compatibility across and within systems needs significant improvement in the US though. However, last week, two large health systems and users of EHRs--Kaiser Permanente and the Department of Veterans' Affairs--announced communication is possible across the two systems (hooray!).

Of course, electronic health records (EHR) aren't without some concerns. Privacy is one of them. Even though the majority of physicians think EHRS will save time and money while improving patient care, many are still worried about possible security breaches. This is one area HIT policymakers will have to focus on while moving forward with the United States' journey to advanced HIT and EHR.

What do you think about the United States and its expanding role into electronic health records using health information technology? I must say that I, for one, am looking forward to the day that I do not have to fill out my prior medical history (AGAIN) at every doctor's appointment I ever make. Have it all in one electronic record would sure be nice.

5 Months Until Health Reform?

I took a quick look today at Kaiser Health News (KHN), the new nonprofit news organization devoted to health care policy and politics.  They just rolled out today, June 1st, 2009.  I added a quick link in my bookmarks also.  KHN will be a great, high-quality resource for stories on things like health reform, health care costs, insurance, aging, health IT, and quality and delivery of care issues.  I urge you to take a look.

Regarding the title of this post, "5 Months Until Health Reform?," an interview was done with White House health care czar, Nancy-Ann DeParle and she estimates that Obama will have a health reform bill on his desk by Thanksgiving.   DaPerle is asked about her thoughts on financing, and the answere appear unclear, although she does state her opinion that health reform will not be funded primarily with taxes and that a scaled back version of health reform (e.g. scaling uninsured number to half) is not an option right now.  Full reform is the focus.  Also see the KHN article, "Big, Small or Nothing At All? Three Scenarios For Health Reform."  

What are your thoughts on health reform?  What about Kaiser's new health news, KHN?

You can view the press releases for KHN here:  11-19-2008 and today's roll-out 6-1-2009.

Obama & Health Care: Most Likely Outcomes

Obama has some hefty challenges awaiting him in the White House for sure.  The rough economy and war overseas will have to be immediate priorities in January.  Health care reform is also in that list of top priorities.  Last week, Johns Hopkins School of Public Health (JHSPH) held their 4th event in the Universal Healthcare Series, "Moving Toward Universal Healthcare:  Alternative approaches to reform in the US."  Harvard's Dr. David Himmelstein was among the speakers, whom pointedly noted that we've had plenty of opportunities for reform, which have failed (think Clinton's 1992 effort and many multiple state attempts).  He pointed out that now is our opportunity for reform.  

In today's issue of The Lancet, Nellie Bristol discusses Obama's plans for our country and the world's health (Obama's plans for US and global health care).   Many project the following are most probable and feasible Obama's immediate administration:  reversal of Bush's ban on stem cell research, expansion of State Children's Health Insurance Program (SCHIP), reversal in "Mexico City policy" (aka global gag rule), and the establishment of a comparative effectiveness group (similar to UK's National Institute for Health & Clinical Excellence).  

To expand on probable immediate actions, Obama is likely to remove some of the restrictions Bush placed on stem cell research (to only use existing stem-cell lines).  Secondly, SCHIP was vetoed by Bush last year after approval from both houses of Congress.  Most likely coverage will be expanded by $35 billion to $60 billion (paid by cigarette taxes).  Children make up 20% of the US uninsured population (Kaiser Foundation).  Expansion of SCHIP appears likely.  Next, the Mexico City policy (global gag policy) requires NGOs to agree to neither "perform nor actively promote abortion as a method of family planning in other nations."  It was enacted by Reagan in 1984, overturned by Clinton, and put back into place by Bush.   Finally, the comparative effectiveness group would look at evidence-based medicine and the Medicare system for physician reimbursements to give guidelines for clinical practice.  

What will be the long-term results though?  Will we move away from employer-based health insurance?  Will we cover all Americans?  Will we have better preventive care and can we improve health outcomes with new policy reform?  How much will we spend on global health, when the US needs the health improvement also?  

It's certainly an interesting time to be near Washington DC and in the field of Health Policy & Management.  Be sure to advocate and put full pressure on local representatives to push for health care reform (there is also currently a $1m media campaign targeted at newly elected officials to "keep their promises" for health care reform).  

If we don't reform US health care now, (when) will we?