Prevention Matters

By voice vote, the U.S. Senate Thursday night confirmed Dr. Regina Benjamin to serve as Surgeon General. Benjamin, 53, was the first black woman to head a state medical society, received the Nelson Mandela Award for Health and Human Rights and just last fall received a MacArthur Foundation "genius grant." In the wake of Hurricane Katrina, she rebuilt her rural health clinic in Bayou La Batre, Ala., which serves 4,400 patients who would be hard-pressed to find care elsewhere.

Benjamin was nominated by President Barack Obama in July, but a month later Republicans put a hold on all health nominees because the administration had imposed a "gag rule" on companies offering Medicare Advantage to seniors. Those companies were sending out information to customers telling them that a Democratic healthcare reform proposal would cut benefits. The Department of Health and Human Services issued a memo in mid-October telling companies they can provide information about legislation that affects them if their customers agree to receive such information.

But Senate Majority Leader Harry Reid (D-NV) blasted Republicans on Thursday for holding up the nomination of Benjamin and other nominees for reasons "completely unrelated to their qualification." In Benjamin's case, concern had been expressed about holding up the confirmation of one of the nation's leading spokespersons on public health when the H1N1 epidemic was spreading.

Partnership for Prevention and Trust for America’s Health (TFAH) has launched a new ad campaign entitled "Health Care vs. Sick Care."

"Americans don't just want a health system that treats them when they're sick. They want a health system that works to help them stay well,” said Rob Gould, PhD, President and CEO of Partnership for Prevention. “We hope Congress recognizes what we say in this ad: that real health reform starts with prevention."

“This ad campaign conveys how health reform provides a once-in-a-lifetime chance to transform our health care system from a sick care system to one that emphasizes prevention and wellness,” said Jeff Levi, PhD, Executive Director of TFAH. “The evidence is clear that prevention is the key to better health, and that well-designed and well-implemented disease prevention programs could spare millions of Americans from needless suffering.”

The ad stresses the importance of including prevention as a central pillar of health reform. It features visuals of people riding bikes, juxtaposed with an individual in a wheelchair, underscoring that real health care must involve keeping people healthy in the first place, instead of just focusing on treating them after they get sick.

The ad copy reads:

“Americans are not as healthy as they could be or should be. High rates of preventable diseases, like heart disease, stroke, and type 2 diabetes are one of the biggest reasons the U.S. has skyrocketing health care costs. We will continue to struggle with health care costs until we do a better job of keeping people healthier. Smart, strategic investments in proven prevention programs can have a real payoff in dollars, workforce productivity, and quality of life. With an investment of $10 per person per year in proven community-based program to increase physical activity, improve nutrition, and prevent smoking and other tobacco use, the country could save more than $16 billion annually within five years. That’s a return of $5.60 for every $1 invested. REAL Health Reform Starts with Prevention. Visit www.healthyamericans.org/prevention to learn more about how a Prevention and Public Health Fund and National Prevention Strategy should be the centerpiece of health reform.”

The return on investment figures in the ad were from TFAH’s Prevention for a Healthier America: Investments in Disease Prevention Yield Significant Savings, Stronger Communities, published in July 2008 and based on a literature review by The New York Academy of Medicine and an economic model by the Urban Institute.

Key prevention and public health provisions in the House Tri-Committee bill (the America's Affordable Health Choice Act of 2009) and Senate Health, Education, Labor and Pensions draft health reform bill (the Affordable Health Choices Act) include:

• The creation of a National Prevention and Wellness Strategy (House) or a National Prevention and Health Promotion Strategy (Senate) that clearly defines prevention objectives and offers a plan for addressing those priorities; and

• The establishment of a Public Health Investment Fund (House) or a Prevention and Public Health Fund (Senate), which would be financed through a mandatory appropriation to support expansion of public health functions and services that surround, support, and strengthen the health care delivery system. The Fund would support core governmental public health functions, population level non-clinical prevention and wellness programs, workforce training and development, disparity issues, and public health research to improve the science base of prevention efforts.

• First-dollar coverage of clinical preventive services provided by Medicaid, with deductibles and co-pays prohibited.

The ad is available on TFAH’s Web site at: www.healthyamericans.org and additional information about prevention and public health in health reform is available at www.healthyamericans.org/prevention.

Additional information about the Partnership for Prevention’s ongoing REAL Health Reform Starts with Prevention initiative is available on their Web site at http://www.prevent.org/ .

Americans for Nonsmokers' Rights has developed some new tools for its Smokefree Casinos campaign. A 4-page backgrounder includes information about NIOSH's report on environmental tobacco smoke and casino dealers, current smokefree gaming laws, quotes from supportive poker champions, and more.

The heart attack gap between men and women is narrowing in good and bad ways for women. Two new studies show that the number of heart attacks is rising among middle-aged women and falling among men, but the risk of death after a heart attack is improving more for women than for men.

Could an Internet search engine be used to improve early detection of the flu epidemic? The folks at Google say the answer appears to be "yes." That's because there are more flu-related searches during flu season, more allergy-related searches during allergy season, and more sunburn-related searches during the summer. Below is an overlay of how past flu activity has tracked with Google's estimates based on flu-information seeking on the web:

BEST

Soccer-Players Kick off World Cup Anti-Malaria Fight



WORST

Many cancer survivors who smoke not advised about quitting

USA Today ran a front page story on Oct. 26 detailing the growing controversy posed by electronic cigarettes. Proponents claim the cigarette alternative is safe and shouldn’t be regulated. Public health officials want the Food and Drug Administration (FDA) with its new authority over tobacco products, to test and regulate e-cigarettes. Electronic cigarettes are battery-operated devices that turn nicotine and other chemicals into a vapor inhaled by the user. The smokers’ argument is “no smoke, no problem.” Not so easy say others. Potential dangers not known, so we can’t give it a pass.

Diane Canova Managing Senior Fellow
& Senior Program Officer
Partnership for Prevention

Healthy-lifestyle discounts "are critical to health reform and must become the norm for health insurance,” Sami Beg, associate medical director of U.S. Preventive Medicine, said in a letter to The Washington Post.

Beg expressed support for rewarding “people who adopt healthy behaviors, such as enrolling in smoking cessation or nutrition classes and participating in physical activities that lead to healthier weight over time.”

A new study commissioned by Partnership for Prevention finds that too little attention is paid to improving the delivery of clinical preventive services to adolescents by addressing problems unique to that population. The review article in the American Journal of Preventive Medicine also finds that most of the clinical preventable services that are recommended for adolescents  don’t have good evidence to support their effectiveness.

Among the unique problems:
• The time typically allocated for routine adolescent exams is quite short and is unlikely to be extended, given Medicaid’s recent reductions in preventive visit reimbursements relative to other services.
• Many clinicians feel that adolescents are less likely to heed their recommendations because they believe adolescents are less interested in their long-term health than adults and more likely to engage in risk behaviors.
• Delivery of clinical services to adolescents tends to be driven by tradition, expert opinion, and the very limited needs of particular required preventive visits (e.g., school or sports physicals)

“We need to encourage both more clinical effectiveness research on clinical preventive services for adolescents and changes in the ways medical practices serving adolescents approach improving delivery rates,” said Leif I. Solberg, MD, the study’s chief author who is Associate Medical Director for Care Improvement Research, HealthPartners Medical Group. “It’s important that healthcare providers use every medical encounter, not just ‘well-child visits,’ which not all adolescents receive regularly, to address their clinical preventive services needs.”

CNN's Mary Snow reports that New York Gov. David Patterson is open to revisiting the so called "fat tax" on soda.

A number of new tools have been added to The US Public Health Service's Clinical Practice Guidelines for Treating Tobacco Use and Dependence since it was released in June 2008. At the same time, some additional guideline-related information is now available online. As with all guideline materials and information, they are in the public domain and can be used without obtaining permission from the US PHS. These new materials and tools include:

1) A 20-page “quick reference guide” for clinicians that summarizes key guideline findings in a short, easy-to-use guide.

2) A PowerPoint presentation containing every data table and recommendation in the 2008 guideline to aid policymakers, researchers and others who may need this information for presentations.

3) A 30-40 minute PowerPoint presentation that summarizes key findings in the 2008 guideline for people who wish to give a presentation on the guideline.

4) A tool for health systems that are interested in incorporating the guideline recommendations into clinical practice, summarizing key strategies and opportunities.

5) An updated poster for clinician offices.

6) A new Guideline addition and corrections section. This new section now provides clinicians with a link to the recent update by the FDA on the use of bupropion and varenicline and a correction to Table 6.22 from page 102.

These new tools and other materials, including the full Guideline and references, are available online at: http://www.ahrq.gov/path/tobacco.htm#Clinic  and http://www.surgeongeneral.gov/tobacco/. While all of the materials are on the AHRQ website, some of these materials are still being added to the Surgeon General’s website.

Additionally, a free, one-hour CME program sponsored by the University of Wisconsin School of Medicine and Public Health on treating tobacco dependence has been updated based on the 2008 guideline. The program is currently accredited for physicians (up to Category 1 CME credit), nurses (one ANCC contact hour), and pharmacists (one ACPE contact hour). The CME program is available on Medscape at http://cme.medscape.com/viewprogram/17710 .

Finally, the Guideline panel wants to alert you to two recent publications. First, the U.S. Preventive Services Task Force recently reaffirmed its recommendation that using evidence-based cessation interventions in adults and pregnant women can lead many to quit using tobacco products and improve their health. The Task Force’s recommendations were published in the April 21, 2009 issue of the Annals of Internal Medicine and are available on the AHRQ Web site at http://www.preventiveservices.ahrq.gov/. Second, John Hughes has recently published an article in Addiction that describes the high rate of concordance between two independent entities that have examined the smoking cessation literature: the 2008 PHS Guideline and relevant Cochrane Collaboration analyses (Hughes JR. "How confident should we be that smoking cessation treatments work?" Addiction 2009; published online August 4, 2009 (http://www3.interscience.wiley.com/cgi-bin/fulltext/122538766/HTMLSTART  ).

Partnership for Prevention President Robert J. Gould today issued the following statement regarding a New York Times article about a report that breast cancer screening may be leading to overtreatment similar to that resulting from prostate cancer screening:

“The US Preventive Services Task Force has never recommended screening for prostate cancer, but it has recommended mammograms and has modified those recommendations as necessary. The proper use of screening remains an invaluable tool in breast cancer detection and treatment and in saving lives. A woman’s personal physician is the expert best equipped to help her decide what procedures should be employed in her individual circumstances. This important public discussion about screening should not discourage anyone from consulting their doctor.”

A study proving the health benefits of smoking bans was named Partnership for Prevention’s “Best Prevention Idea of the Week,” while the fine print attached to some corporate cause-marketing campaigns was named “Worst Prevention Idea of the Week.”
The Best/Worst Idea awards are a regular feature of Prevention Matters, the blog of Partnership for Prevention. Each week, Partnership for Prevention's staff will choose the designees based on nominations of items in the previous week's news submitted by members, staff and the public at large. To submit a nomination or for more information, contact Damon Thompson at dthompson@prevent.org.


BEST
Smoking bans cut nonsmokers’ heart attack risk
http://bit.ly/2ZsDUj

Corporate Cause-Marketing Full of Fine Print
http://bit.ly/1L8vm0

Companies engaging in cause-oriented marketing are not always as generous as their products may make them seem. A recent Daily Finance article details the hurdles consumers must overcome to ensure that two cents of their pink-packaged Swiffer purchase actually reach the cause the pink box implies: according to a Procter & Gamble spokeswoman, the company will only make a two-cent donation to the National Breast Cancer Foundation if a consumer uses a coupon from Procter & Gamble's brand saver coupon book, which was distributed in newspapers on Sept. 27. Without the coupon, the limited-edition pink packaging on the Swiffer is simply designed to draw awareness to the cause. Meanwhile, stores contain many products with pink coloring and "generic" pink ribbons whose producers are not bound to the same legal checkmarks.

Nearly 25 years ago, the FDA banned the sale of turtles with a carapace length of less than four inches to reduce turtle-associated Salmonella transmission, especially among young children who love to pick up handle the tiny pets. The ban apparently has been flouted, because turtles are still available on pet store shelves and have been linked to disease outbreaks.

During a 2007 outbreak, youngsters who handled a small turtle were at a 41-fold increased risk of contracting Salmonella, compared with controls (95% CI 6.9 to unbounded), the CDC's Julie R. Harris, PhD, and colleagues reported online in Pediatrics.

"Small turtles continue to be sold and pose a health risk, especially to children," the researchers said. "And many people remain unaware of the link between Salmonella infection and reptile contact."

Today we’re talking with Dr. Kelly Brownell, a professor and director of the Rudd Center for Food Policy and Obesity at Yale University. Dr. Brownell led a group of prominent researchers who published an article in the Sept. 17 issue of the New England Journal of Medicine that made a strong public health case for a tax on sweetened sodas and other beverages. The study has generated considerable debate and, while Congress has not yet incorporated such a proposal into health reform legislation that is currently being drafted, Dr. Brownell has continued to press for such steps to be taken at the federal and state levels. To listen to this podcast, click on the media player below. If you don't see a media player, click here.

The Internet can be a great source of information about the pandemic H1N1 flu, but it's also the mother lode of swine flu scams, the FDA is warning.In a news release, the agency said it recently purchased and analyzed several products that purported to be oseltamivir (Tamiflu), one of two antiviral drugs thought to be effective against the pandemic flu.

"One of the orders, which arrived in an unmarked envelope with a postmark from India, consisted of unlabeled, white tablets taped between two pieces of paper," the agency said. Analysis showed the tablets contained talc and acetaminophen, but no oseltamivir, the FDA said. The Web site disappeared shortly after the order was placed. The agency said it bought four similarly advertised products from other Web sites. These did contain some oseltamivir, but were not approved for use in the U.S. Several Web merchants did not require a prescription, and none of the drugs arrived quickly enough to treat someone infected with the pandemic flu or with an immediate exposure to the virus.

The Washington Post's David Hilzenrath warns that expanded wellness incentives being considered by Congress could give employers and insurers a way to establish health plans that discriminate on the basis of pre-existing conditions.


"President Obama and members of Congress have said they are trying to create a system in which no one can be denied coverage or charged higher premiums based on their health status," Hilzenrath writes. "The insurance lobby has said it shares that goal. However, so-called wellness incentives could introduce a colossal loophole. In effect, they would permit insurers and employers to make coverage less affordable for people exhibiting risk factors for problems such as diabetes, heart disease and stroke."

Currently, incentives based on health factors are capped at 20 percent of the premium paid by employer and employee combined. Legislation passed by Senate health and finance committees would increase the limit to 30 percent, and it would give government officials the power to raise it to 50 percent.

"A single employee whose annual premiums cost him and his employer the national average of $4,824 could have as much as $2,412 on the line," Hilzenrath writes. "At least under the health panel's bill, the stakes could be higher for people with family coverage. Families with premiums of $13,375 -- the combined average for employer-sponsored coverage, according to a recent survey -- could have $6,688 at risk."

Such concerns led Paychex, a payroll management company, to structure a program that provide incentives for employee participation in wellness programs without pegging them to biometric targets.

"Employees could be doing everything right and still not achieve the desired outcome. And so then you're holding them accountable for something that may not be achievable," said Jake Flaitz, the company's director of benefits.

In a recent blog post, noted economics journalist Merrill Goozner says one reason the America lags behind other countries in terms of life expectancy because it seeks to increase longevity primarily through investing in technology to extend life rather than investing to prevent premature deaths.


"Why has our technological faith failed us?" asks Goozner, a former Chicago Tribune journalist and author of The $800 Million Pill: The Truth Behind the Cost of New Drugs. "The answer is simple. Increased longevity has nothing to do with extending the natural human lifespan. Societies increase longevity by eliminating premature mortality. Technology is one means to that end, but it is probably the least efficient  method. It’s definitely the most expensive."

Goozner says dramatic increases in longevity in the early 20th century resulted mostly from better sanitation that reduced infectious disease deaths, while gains after World War II came from better housing, better heating, less burdensome work, and more leisure. In more recent years, he says, cleaner air, less smoking, and better diets have played a bigger role than medical interventions in extending life.

While medical technology saves lives and "even performs miracles in some cases," Goozner says, "...the truth is that investment in technology will never bring the U.S. up to the longevity standards of other advanced industrial countries. Why? Because our misplaced faith has distracted us from tackling the real and enduring determinants of ill-health in our society– poverty, income inequality, social insecurity, and status anxiety, the hallmarks of our increasingly dysfunctional social order. There’s a vast literature on the social determinants of health. Alas, it has gone unnoticed and unremarked in the current health care reform debate."

A new Institute of Medicine report further clinches the case for linking second-hand tobacco smoke to cardiovascular disease.  An IOM committee found that data consistently demonstrates that secondhand-smoke exposure increases the risk of coronary heart disease and heart attacks and that smoking bans reduce this risk. Given the prevalence of heart attacks, and the resultant deaths, the committee found smoking bans can have a substantial impact on public health.

"The IOM study underscores the 2006 declaration by Surgeon General Richard Carmona that when it comes to second-hand smoke, 'the debate is over, the evidence is clear,'" said Partnership for Prevention President Robert J. Gould.

"Most importantly, the report clearly re-iterates that the damage from second-hand smoke does not require years of exposure," he continued. "The effects are immediate, and smokefree laws quickly reduce heart attacks among non-smokers.

"The science cannot and must not be ignored," Gould said. "We hope policymakers and employers across the country will take immediate action to protect the public from detrimental effects of second-hand smoke in all public spaces and workplaces. We also hope that citizens wll take this science 'to heart' and make their homes tobacco free."

Partnership for Prevention is a membership organization of business, nonprofit and government leaders working to make evidence-based disease prevention and health promotion a national priority.  A year ago, Partnership assembled a naitonal working group that issued a call to action (www.acttiontoquit.org) to provide smokers who want to quit with accress to a comprehensive range of evidence-based cessation treatment.

"Since smokefree policies encourage tobacco users to make quit attempts, it is important for such policies to be accompanied by improved access to a wide range of evidence-based treatments," Gould said. "Quitting smoking is very difficult for most people, and not all treatments work the same for all people,"

A Virginia program offering “Drive-through” flu shots were named Partnership for Prevention's "Best Prevention Idea of the Week," while the spread of fake malaria drugs was named “Worst Prevention Idea of the Week.”

http://www.myfoxdc.com/dpp/news/virginia/300_Get_Drive_Through_Flu_Shots_092609

The Wall Street Journal reports that recently issued federal guidelines may throw a monkey wrench into the plans of employers who have or are planning to establish wellness rewards programs. The guidelines, aimed at protecting genetic information, prohibit health plans and employers from offering any financial rewards to any worker for participating in a health risk assessment that requests information about their family medical history.

Employers whose health plans aren't in compliance can face fines of up to $500,000. The rules apply to group health insurance with plan years beginning on or after Dec. 7. Employers and insurers have until Jan. 5 to submit comments, which means they could yet be revised.

Worksite programs help employees lose weight, according to a systematic review published in the October issue of the American Journal of Preventive Medicine. On the basis of strong evidence of their effectiveness, the U.S. Task Force on Community Preventive Services (Task Force) recommends worksite programs intended to improve diet and/or physical activity behaviors for reducing weight among employees. These programs include various approaches to support behavior change, such as informational and educational activities, behavioral and social strategies, and policy and environmental approaches.

People living in "healthy neighborhoods" that provide easy opportunities for exercise and healthy eating were less likely to be diagnosed with type 2 diabetes in a five-year cohort study, after controlling for such factors as age, income, race, and education. "The strength of the association was considerable and equivalent to a reduction in type 2 diabetes incidence associated with a BMI of 5 [points] lower in this sample," Amy Auchincloss, PhD, MPH, of Drexel University in Philadelphia, and colleagues wrote in the Oct. 12 Archives of Internal Medicine. The analysis covered participants in Baltimore, the Bronx borough of New York City, and the North Carolina county that includes Winston-Salem.

A new Facebook application has been launched to help educate, motivate and mobilize people to prevent the spread of Human Papillomavirus (HPV). “Fact Check: HPV” (http://www.hpvfactcheck.org/) allows users to take an interactive, educational quiz about HPV, find additional resources, and commit to take action, while even allowing concerned friends to anonymously share the application with peers. The application was developed by Partnership for Prevention and the University of Maryland’s College of Information Studies with input from the School of Public Health. The project was funded by the Fund to Prevent Cervical Cancer.

Partnership Executive Vice President Corinne G. Husten, MD, MPH, tells the New York Times that some workplace wellness incentive programs that tie an employee's health insurance premiums to targets such as weight have raised concerns among some health and prevention advcocates.

“Actually, achieving a target is not necessarily within someone’s control,” says Husten, noting that genetic predisposition is a factor in many conditions like heart disease and diabetes, and the environment also plays a role. “If you live in a neighborhood with only convenience stores and fast-food, you don’t necessarily have access to the food that will help you to eat healthier,” she adds.

Provisions in health care legislation under consideration in Congress would allow employers and insurers to offer premium discounts of as much as 50 percent to employees in workplace wellness programs who meet specific health targets, such as keeping their weight, cholesterol and blood pressure within healthy ranges. Under current law, discounts for meeting these kinds of health targets can be no greater than 20 percent of the total premium. An amendment passed by the Senate Finance Committee would raise that cap to 30 percent and permit the secretaries of Health and Human Services, Labor and Treasury to increase the cap to 50 percent at their discretion. A similar provision appears in a Senate Health, Education, Labor and Pensions Committee bill.

Don't have time to read the health reform bills working their way through Congress? Try listening to them! Voice actors Diane Havens and Kathleen Keesling have set up a website called http://www.hearthebill.org/ as a public service for those who want to know exactly what the health care bill contains.

In the case of the House bill - HR3200 - it took nearly three weeks of 12-hour days for the site’s creators to pull together the entire bill, which was divided into 62 files which were read by 50 volunteer professionals working in home studios in locations as far flung as Colorado and the United Kingdom. The final product runs nearly 24 hours


They have since added the chairman's mark of the Senate Finance Committee bill as well as modifications made on Sept. 22. They are still recruiting volunteers for future recordings as the bills progress.

North Carolina is poised to become only the second state to penalize state employees by placing them in a more expensive health insurance plan if they're obese. Smokers will feel the drag of higher costs, too, as North Carolina and South Carolina state employees who use tobacco are slated to pay more for health insurance next year.

State workers who don't cut out the Marlboros and Big Macs will end up paying more for health insurance. Tobacco users get placed in a more expensive insurance plan starting in July and, for those who qualify as obese, in July 2011. Some state employees, though, are criticizing the planned changes.

Kim Martin, a sergeant at Piedmont Correctional Institution in Salisbury, said: "If they're going to hold us accountable. Pay for a gym membership or part of a membership. Give us an incentive, a way to combat it."

A recent blog posting by Partnership's Alyson Hazen Kristenson on propsals to tax soft drinks elicited an online comment by the American Beverage Association (the original post and the ABA's comment can be read online here). Needless to say, they were against a soda tax, and repeated the industry's recent assertions that taxes don't educate consumers.

Their comment drew the following response from Partrnership President Robert J. Gould:

Dear American Beverage Association,


We appreciate having an association whose members' sales total $110 billion a year drop by our humble blog. But the points you offered were a bit hard to swallow. The next time you want to engage in a discussion with a group that is dedicated to evidence-based prevention, you should consider bringing along some facts.

Here are a few facts:

1. To your claims that taxes don’t help educate people, we’d respond that they have often been a very important tool in helping to steer people to education programs about healthy lifestyles. For example, in the year after the state of New York nearly doubled its cigarette tax in 2007, calls to the state's smoker's quitline increased from 9,900 calls a month to 23,100 calls a month. Nationally, after Congress increased federal tobacco taxes effective April 1, the American Lung Association reported that its quitline had received 553,000 calls by the end of May - nearly equal to the 591,000 calls it received in all of 2008.

2. The environment in which people make decisions can greatly influence the outcome of those decisions. When unhealthy choices provided within an environment are cheaper or cost the same as healthy alternatives, there is less incentive to try healthy alternatives. However, by increasing the price of the unhealthy choice, you change the environment in a way that not only discourages unhealthy behavior but also provides an incentive to try healthier alternatives.

3. A review article in the Sept. 16 edition of the The New England Journal of Medicine stated: ”The science base linking the consumption of sugar-sweetened beverages to the risk of chronic diseases is clear,” and then went on to cite the findings of numerous studies. The authors offered a “conservative” estimate that an excise tax of 1 cent per ounce would lead to a minimum reduction of 10% in calorie consumption from sweetened beverages, “a reduction that is sufficient for weight loss and reduction in risk.”

4. And as for your assertion that a tax on beverages “won’t make a dent in paying for improved healthcare or addressing obesity,” the NEJM article predicts a 1 cent per ounce tax would raise $14.9 billion in the first year alone. That amounts to around one-sixth of the estimated annual costs of the health reform bill being crafted by the Senate Finance Committee. I’d call that a pretty good-sized dent.

Even so, there are actually some points upon which we can agree: 1) obesity is a serious and complex problem that requires thoughtful and comprehensive solutions, and 2) education, exercise and balanced diets are critical to solving this problem.

It’s not necessary to raise taxes on all your members’ products to put such incentives into play. According to your web site, the industry’s single-serve bottled water products already account for 19.3 percent of sales and diet sodas accounted for four of the industry’s top 10 carbonated soft drinks and another 19 percent of that market. Any changes produced by a tax would not leave your members high and dry, but instead would help them grow the markets for their healthier alternatives.

Whether or not the tax would “make a dent” in improving the health care system, $14.9 billion a year would certainly be enough to fund precisely the type of public education effort that you say is needed to persuade people to pursue exercise and a balanced diet.

Could we count on you to support such a proposal? If so, we’d love to meet with the beverage industry to discuss it. If you don’t mind, we’ll supply the drinks.

Robert J. Gould, Ph.D.
President and CEO
Partnership for Prevention

Wondering if swine flu's bad enough to require a doctor's attention? An interactive Web site may help you decide, using the same type of triage calculations that doctors at Emory University use. Microsoft Corp. unveiled the site Wednesday at http://www.h1n1responsecenter.com . Type in your age - it's only for people over 12 - and answer questions about fever, other symptoms and your underlying health. Microsoft licensed the self-assessment tool from Emory, which based it on what the Centers for Disease Control and Prevention has determined are key risks factors for a bad flu outcome. A large insurer tested the tool against more than 2,500 records of patient visits for flulike symptoms in Colorado, and only two people deemed low-risk were hospitalized within the following two weeks.

In a first-of its-kind study, epidemiologists at the University of Pennsylvania School of Medicine found that, on average, guns did not protect those who possessed them from being shot in an assault. In fact, the study estimated that people with a gun were 4.5 times more likely to be shot in an assault than those not possessing a gun. The study was released online this month in the American Journal of Public Health, in advance of print publication in November 2009.

The Washington Post has hit the nail square on the handle. A front-page, above the fold article in the Oct. 6 edition proclaimed: "U.S. Losing Ground on Preventable Deaths; Despite High Medical Spending, Results Trail Other Wealthy Countries." It noted that "nations that dramatically lowered their preventable death rates focused on challenges such as controlling diabetes and reducing hospital-acquired infections."

Sounds promising so far... What was the conclusion?

"The U.S. doesn't take primary care seriously," said Mark Pearson, head of the health division at the Organization of for Economic Cooperation and Development.

But could it possibly have anything to do with the fact that the U.S. takes population-based prevention even less seriously? As in only devoting about 5 percent of health care spending to it?

The headline above the story's inside jump page declared: "U.S. Preventable-Death Rate Confounds Medical Reform Efforts."

Indeed. Our guess is that it will continue to confound them as long as it is viewed as entirely a medical problem.

"Health care in Colonial America looked nothing like what we’d consider medicine today, but the debates it triggered were similar. The danger of smallpox and the high cost of its prevention led to divisive questions about who should pay, whether everyone deserved equal access, and if responsibility lay at the feet of the individual, the state, or the nation." Andrew M. Wehrman fuses the past with the present in a Boston Globe article.

An ordinance to restrict fast-food chain restaurants in South Los Angeles is unlikely to cut obesity, say researchers at Rand Health. In a study published in Health Affairs, the researchers found that the South Los Angeles region has no more fast-food chain establishments on a per capita basis than other parts of the city, but rather many more small food stores and other food outlets. They said these small food stores and outlets are more likely to be the source of high-calorie snacks and soda consumed substantially more often by residents of South Los Angeles as compared to other parts of the city.

The New York Times reports that a start-up company led by Adam Bosworth, former head of the Google Health team, plans to become the newest entrant to the online consumer health business. Bosworth and his San Francisco-based company, Keas (pronounced KEE-ahs) Inc. Keas is at the forefront of the effort to combine advanced Web and database technologies so it can personalize health education. Using the Keas system, for example, a person with Type 2 diabetes might receive reminders, advice on diet and exercise, questions and prompts presented on the Web site or delivered by e-mail or text messages — all personalized for the person’s age, gender, weight and other health conditions. Keas' major partners include Google Health and Microsoft HealthVault.

A new poll published in Health Affairs Blog indicates the American public’s support for the major health legislation being debated in recent weeks has fallen to 27%, with 59% opposed. Yet it suggests that incoporating just one proposed amendment - tort reform - raises support for the bill to “too close to call” (44% for, 46% against). The second biggest boost would come from eliminating the individual mandate, and the third from adding a public option. Several combinations of two amendments would yield plurality or majority support.

The Robert Wood Johnson Foundation RWJF) says it will support an independent evaluation of part of an industry effort to help reduce obesity.  A coalition of more than 40 retailers, non-governmental organizations and food and beverage manufacturers announced on Oct. 5 the launch of the Healthy Weight Commitment Foundation (HWCF), a national, multi-year effort designed to help reduce obesity—especially childhood obesity—by 2015. The HWCF will promote ways to help people achieve a healthy weight through energy balance. It focuses on three critical areas—the marketplace, the workplace and schools.

RWJF will fund an independent group of scientists who will define the measures that will be used to track progress of the marketplace program and determine whether it is making a significant difference for the nation’s children.

U.S. schools have cut back on certain "less nutritious" foods and drinks, the CDC reports. The CDC today released new survey data on the percentage of students in public secondary schools who cannot buy candy, salty snacks, fruit drinks that aren't 100% juice, sports drinks, and soda at school.
The percentage of students who couldn't buy candy or salty snacks increased in the 40 states that participated in the survey, from 46% in 2002 to 64% in 2008. The percentage of secondary school students who couldn't buy soft drinks at school rose in all 34 states that tracked that from 2006 to 2008, while 23 of those states have also nixed sales of sports drinks to students.

Mississippi and Tennessee -- home to some of the nation's highest rates of adult obesity -- made the biggest gains in the percentage of secondary school students who can't buy candy, salty snacks, and soft drinks at school.

The surprising results of AIDS vaccine trials in Thailand were named Partnership for Prevention's "Best Prevention Idea of the Week," while the failure by all 50 states to meet fruit and vegetable consumption targets was named “Worst Prevention Idea of the Week.”

In the U.K., episodes of The Simpsons are to be sponsored by the government to tackle obesity in the run-up to Christmas. Health bosses hope their trailers depicting a plasticine family based on Homer, Bart and Marge will strike a chord with viewers. The characters, designed by Wallace and Gromit creators Aardman Animations, will be seen on the Simpsons couch scoffing junk food before it is replaced by fruit and veg.
The £640,000 campaign runs on Channel 4. Public Health Minister Gillian Merron said: "It is an engaging way to get the message to families about ways of improving their diet."

The Washington Post's Rob Stein writes: "Doctors, nurses and other health-care workers in Indiana and Tennessee will receive the first doses of swine flu vaccine Monday as the federal government launches the most ambitious vaccination campaign in U.S. history."

The campaign's goal is to inoculate at least half the U.S. population against the new H1N1 virus. The federal government has spent $2 billion to purchase about 250 million doses of vaccine and has pledged to buy enough to immunize every American if there is enough demand. But public opinion surveys indicate that Americans are undecided about the vaccine.

 

The Robert Wood Johnson Foundation's Paul Tarini says consumer product companies and retail chains a source for "big innovation" in health and health care that are worth watching.

"Think Procter & Gamble, Best Buy and Wal-Mart," Tarini writes in RWJF's "Pioneering Ideas" blog. "When you move the focus from detection and treatment to prevention and wellness, there are lots of opportunities to develop products and services and relationships that improve health, extend life and don’t require medical professionals.

"I can imagine a whole bunch of consumer products and services that focus on wellness. And once established in that market, it’s not too big a step for these companies to begin to offer products and services that do require medical professionals…it’s already happening with minute clinics."

The Robert Wood Johnson Foundation has published research on efforts by California school districts to encourage healthy eating and physical fitness among its students.


Findings from online surveys and focus groups, as well as interviews with school board members, leaders of state associations of school boards, state directors of nutrition and school wellness advocates
identified the following as the most significant barriers to effective school wellness policies:

• Inadequate funding, such as for staff and facilities, to implement and monitor a policy.
• Competing priorities and lack of time.
• Lack of support from students, parents and the community.
• A need for tools and training.

America has "turned a blind eye or, worse yet, taken the wrong path" to combat the obesity epidemic for too long and the country is now approaching a tipping point, two former Surgeons General say in an op-ed appearing in the Atlanta Journal-Constitution.
"The burdens caused by the obesity epidemic are unsustainable," Drs. David Satcher and Richard S. Carmona write. "Unless we do something now, the cost burden of obesity — currently nearly $150 billion each year — will be an ever-tightening yoke around the neck of future generations of Americans."

Satcher and Carmona say political debates over health reform fail to recognize that "obesity is not a simple matter of personal lifestyle choice."

"People do not become overweight or obese all on their own," they write. "The reality is that their communities may not include safe places to exercise. Their incomes may not allow them to purchase healthy food. Their workplaces may not offer a wellness program. Genetics can also be a reason why some people become overweight or obese more easily than others and struggle unsuccessfully to lose pounds..."

"The data is in and the truth is that we cannot wait any longer," they say. "Helping Americans make healthier choices and enjoy a better quality of life can no longer be compromised by political bickering or continued inaction. Instead it must be a national priority."