Obesity and Public Policy:Options and Opportunities

Jeffrey Levi, PhDExecutive Director

Trust for America’s HealthNovember 4, 2006

21st Century Public Health: Broader Agenda, Multiple Leadership Styles

• Protecting Health– “Traditional” view of public health – protecting people

from things they cannot control

• Promoting Health– Requires combination of governmental, non-

governmental, and voluntary action

• Provision of Preventive and Curative Quality Health Care Services– Engagement of the health care system

Public Attitudes

• Public distinguishes between infectious disease control and preparedness on the one hand, and chronic disease prevention on the other.– The public views staying healthy primarily as the responsibility of

the individual. – They respond more to messages that include them as an active

partner and participant in their own health. – Government’s role: provide education for healthier choices and

research the causes and cures for diseases.– Poll in 2005: How important is it for government to focus on

• Chemical terrorism (74%)• Preparing for a biological terrorist attack (70%)• Decreasing diseases related to obesity like diabetes (54%)

– What does this mean in terms of policy? – NYC debate: regulate trans fats vs. calorie information

Public and Policy Maker Education

• Personal responsibility AND societal responsibility– Create the context that permits people to make responsible

choices• Barriers to access (healthy food, physical activity)

– Economic– Physical– Environmental

– Public health must engage a broad range of policy makers and programs not normally part of public health

• Requires collaborative vs. authoritative decision making style• We need to have a common framework for success that

addresses individual concerns (focus on BMI vs. eating healthier and moving more) and health outcomes (modest weight loss and/or increases in physical activity) result in major health improvements and cost savings.

F as in Fat

• Annual summary of obesity in the US

– State-by-state obesity rates– Overview of research– Overview of model programs– Overview of state policies– Recommendations for action

Chronic Disease Directors: Barriers to Success

• Insufficient funds to support serious and sustained strategic efforts.

• Lack of political prioritization.• Difficulties in combating perceptions that obesity

is only an “individual” concern.• Not enough “translation” of research to support

practical, on-the-ground application of science into policies and programs.

• The need to establish other ways to measure “success” and behavior change in addition to weight loss and BMI.

Chronic Diseases, Chronically Underfunded

• CDC chronic diseases budget faces three-year cumulative cut of 8.9%.

• CDC chronic diseases budget is approximately $3 per person/year in the US – less than a dinner at McDonald’s.

• Division of Nutrition and Physical Activity spends $0.14 per person.

All sectors have a role to play

• Schools

• Employers

• Communities

• Food industry

Government Can Lead• Government has a responsibility to provide

individuals and other sectors with the information, the expertise, and sometimes the resources they need to take on obesity.

• Clear and consistent recommendations based on sound research.

• Long-term commitment to translate many isolated successes into a national strategy, with the funding to make it work.

Obesity Requires a Government-wide Response

• All agencies of government must be involved, not just public health agencies

– At federal level: HHS, Agriculture, Education,Transportation, VA, etc.

– At state and local level: Health, Environment, Transportation, Education, Zoning, etc.

Relying on obesity policy at the state and local levels

• Tobacco as organizing model– Change the social context– Change the environment (in different ways)

• North Carolina Obesity Summit (funded by the Robert Wood Johnson Foundation and The Duke Endowment)– Ongoing work with Healthy Carolinians, Inc.

and the North Carolina Alliance for Health

What Can Funders Do?

• Support the multi-stakeholder dialogue that will be critical to change the social context of obesity policy.

• Support the establishment of broad-based local coalitions that can move a public health-based obesity agenda forward.

• Support efforts to promote a science agenda that assesses interventions in real world environments with real world resource levels for those interventions.

• Support the communications work that helps people understand the role of all sectors in moving the agenda.

• Support a non-stigmatizing, health outcomes based approach.

Source: Behavioral Risk Factor Surveillance System, CDC.

19961991

Obesity Trends* Among U.S. AdultsBRFSS, 1991, 1996, 2004

(* BMI 30, or about 30 lbs overweight for 5’4” person)

No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

2004