HRSA/MCHB 2005 FEDERAL/STATE PARTNERSHIP MEETING

PUBLIC HEALTH ACROSS the LIFESPAN

Get Healthy California: Governor’s Plans and Activities for Obesity Prevention

SUSANN J. STEINBERG: I’m glad that you said the limited funds because we spent much of yesterday afternoon complaining about that. I have a--was that me? Oh, I thought, you know, they always say that I project well but that was really--the staff should be here now. Anyway, I have a very brief video to show you at the beginning while they’re setting up the laptop and so on, so if my technical help back there would start the video then--it’s very, very brief.

VIDEO: (Inaudible) patient Cheryl. She’s five feet, 155 pounds, Type 2 diabetes, high blood pressure, fairly typical for an overweight woman in her 60’s. What’s so upsetting is (inaudible) nutrition, and Cheryl is 12.

ANNOUNCER: Too many calories and not enough physical activity are destroying the health of our children. So make sure that your kids eat lots of fruits and vegetables and get at least an hour of physical activity every day.

UNKNOWN SPEAKER: Childhood obesity, don’t take (inaudible).

ANNOUNCER: A message from the California Department of Health Services.

UNKNOWN SPEAKER: If five kids at school came down with killer disease. There’d be a huge outcry. Well, I have five fourth graders who are obese, it’s ruining their health and nobody acts like anything’s wrong.

ANNOUNCER: Too many calories and not enough physical activity can greatly increase the child’s risk of Type 2 diabetes and high blood pressure. So make sure your kids eat lots of fruits and vegetables and get at least an hour of physical activity every day.

UNKNOWN SPEAKER: Childhood obesity, don’t take it lightly.

ANNOUNCER: A message from the California Department of Health Services.

Spanish video.

SUSANN J. STEINBERG: That’s it. California ’s been addressing the obesity epidemic for several years actually. As you saw this morning we were one of the first states that got involved in the Fit WIC program several years ago. In 1991 Department of Health Services through a Leaders Encouraging Activity and Nutrition program or a LEAH program started working on nutritional activities, environmental factors and so on that have to do with the obesity epidemic. We have in California something that I think all of us who work in maternal child adolescent health have come to recognize. In California through our--as we fondly call him, our Governator, we have leadership from the top. Part of what we have is a very strong effort on the part of the governor’s office to work in California on the obesity problem to form partnerships and so on. You know that in your states unless you have that kind of leadership any of the programs or partnerships you try to carry through you’re, sort of, as someone said yesterday, swimming upstream.

California ’s problem, the big picture and when we use the term big in a sense we’re talking about actually big. California ’s vision is 10 Steps to Healthy Living. We’ve accomplished some of this by policies and legislation, private partnerships, government action, DHS programs. Many of those are conducted through the MCAH program, other agencies and envisioning change--what we call envisioning change and what is the caliber of the problem in California and you can see here on this slide 60% of the adults are overweight or obese. While there are equal portion of adult men and women who are obese, 22%, the data also reveals that there is a greater portion of men, 46%, compared to women, 30%, who are overweight in California. Here we’re looking at overweight and obesity in California adults by ethnicity and we can see that the over weighing and obesity problem is a problem across all ethnic groups with the exception of perhaps the Asian population in California for obesity but certainly they share in the issue of overweight.

We heard this morning Dr. van Dyck talk briefly about the overweight and or the weight issues related to pregnancy and our data indicates that the pre-pregnancy body mass index of our population in California we see that normal weight is 52% of the population, however, the remaining population of 48% are either obsess, overweight or even of more concern or of as much concern are those that are under weight when they enter their pregnancy.

The prevalence of overweight among low-income children in California, you can see the graphs here. In California this graph indicates that the prevalence of overweight for children less than five is higher for California than compared to the nation’s average. According to Trust for America ’s Health issue report October 2004 California ranks number two in the nation with the highest proportion of low-income overweight children in the two to five year age range. Here we look at the prevalence of overweight of low-income children by specific age groups and we see that in all age groups as well as the total general that we are above the 2010 target goal.

Now, what are the costs in California --estimated costs in California of the overweight and obesity? Looking at the different components that we heard about a bit this morning the inactivity, obesity and overweight--a conservative estimate I think is, is 28 billion. So what we see is that this is costly not only to the individual and the individual’s well being and the individual’s health but it’s also costly to the state and to society in general. Now, I mentioned at the beginning one of the things that will make any program--that you have in your state more successful is if you have significant support--from the top.

Our governor you can see here the picture--I don’t know if the--no, the arrow doesn’t work but you can see the picture of our governor and his wife in the center and in September the governor had a summit on health, nutrition and obesity. The governor asked that we in California in the Department of Health Services help him right a vision for California, Ten Steps Toward Healthy Living, and these are the 10 steps that have been outlined for California. When I first, sort of, looked at these I thought to myself, this is motherhood and apple pie. It all sounds good but how do we put it actually in action? Part of what happened in the summit that the governor had that I mentioned to you is that he’s a very charismatic sort of man and has a lot of networking connections and so on and so he has been able to pull into partnership with the department and with California generally a group of very influential private partners. We have the California Association of Health Plans are part of his conglomerate of partners which includes Blue Cross, Health Net, The American Academy of Pediatricians have taken part in this and made commitments related to the goals and missions.

The Lewis Group of Companies and this is an interesting thing because we’ve heard about the environmental components or the environmental issue that may be related to the obesity problem and situation. The Lewis Group of Components are actually a real estate and a housing construction, community construction group who are looking at the whole issue of the environmental aspect of obesity. He has partnerships with Kraft Food and their commitment is to work on more healthier foods and snacks through their Kraft organization. Obviously he has been able to pull in the entertainment industry which was his prior job before becoming our governor and they have been very cooperative in doing little bits and little sounds bites similar to the ones we saw here, launching a multi year public education campaign involving high profile entertainers. Yahoo! Has developed daily messages to propagate and get healthy California public education messages out.

The West Field Shopping Centers which is an organization that owns many large shopping centers and malls in California have made a commitment to promote health choice retailers in their mall food courts and in mall restaurants, introduce West Field Fitness Blast which is a mall based program that engages shoppers in healthy living seminars. They actually have seminars that people who are shopping can go into different areas in the mall and have seminars on healthy living, healthy eating, exercise and they’ve promoted walking in the malls for folks before the mall shops open. I think in many other states I think they’re doing the same kind of thing. Opening the malls early in the morning and so on so that folks can walk safely in their malls.

What you also need is--you remember one of the things we talked about is legislative support and the governor has gotten legislative support and has actually signed off on these bills along with some other bills that preceded this on the issue of nutrition particularly related to schools and I think that you have some examples of the actual legislation. The last time I gave this talk I didn’t bring that and people who wanted to go back and say, what was actually said in your legislation? Senate Bill 12 requires the sale of all foods on elementary school grounds to comply with certain nutritional standards requires an individual food item sold to a pupil during morning or afternoon breaks in an elementary school to meet specific standards. SB965 expands the school soda ban to high schools. There was a previous bill that band soda in elementary schools. Now, this is not been an easy situation because the schools as you probably know gain much of their financial support for their ancillary programs, sports programs, band and so on from the profits obtained from the sale of foods through the vending machines and soda and so on. So the school districts themselves and certain other groups were not very enthusiastic about this because it meant that the support for some of the programs--the financial support would not be there. Senate Bill 281 request the Department of Health Services and the Food and Drug Administration in California or the representative of the Food and Drug in California in consultation with The State Department of Education and The State Board of Education to develop a program that encourages schools to provide fruits and vegetables to pupils. The school lunch program for low-income students who meet the criteria for school meal programs, we’ve looked at in California those programs being sure that the programs are in fact providing healthy choices for the kids who are taking part in this. MCH has aligned with the governor’s vision.

We had no choice actually but I think it was an appropriate vision that the governor has and one of our states priorities as we heard a little bit this morning when there was some discussion by Dr. van Dyck about the five-year needs assessment and state priorities. California is one of the states that did in fact have obesity and physical activity or lack of physical activity as one of their priorities.

In California the way we did our needs assessment which probably many of you did the same way we from our counties and jurisdictions we asked them to identify their needs assessment and to supply us with some data that they had on a local level to support why they thought this was a need assessment or one of their needs. Forty-five of the 55 reporting local health jurisdictions listed obesity as a problem and 29 of 55 reported local health jurisdictions had identified issues related to breast feeding and we heard this morning the relationship and I’m not going to go too much into that discussion, the relationship between breast feeding and obesity and prevention of obesity.

MCH in California has several different programs under the umbrella. The Black Infant Health Program where we provide a variety of modules in our program to reach men, our male involvement program, social empowerment and support, case management and outreach and one of the important features of that program over the last few years has been particularly in the social empowerment compotation of the program is having women in the program, sort of, start from the basics learning how to utilize food stamps, how to utilize their WIC choices, actually taking them into grocery stores that have volunteered at low times of activity to take the women through a shopping, kind of, excursion and talk with them about food choices.

Our regional perinatal program. This monitors the perinatal programs, our (inaudible) and so on in California making sure that women are delivering in the appropriate place depending on whether they may have a vulnerable pregnancy or baby. Our perinatal programs because they’re already in the hospitals have become very much involved in training the hospitals and the hospital staff on initiating and encouraging breast-feeding. What we found in California is that many women go into the hospital for their delivery having made the choice to breast feed but come out of the hospital not breast feeding, so something is happening in that period of time in the hospital that is not encouraging women to follow through with their desire breast feed. So our regional perinatal outreach folks who are already in the hospital are working with the hospitals on making them--we don’t want to say baby friendly hospitals because we get into a little issue with that because of the formula manufactures who provide some financial incentives to hospitals and so on, so we call them breast feeding friendly hospitals.

Our California Diabetes and Pregnancy Program that we have which we call Sweet Success has been very successful in women both prior to their pregnancy, women with diabetes prior to their pregnancy women who are diabetic during their pregnancy with gestational diabetes and post partum in helping them to control their weight, helping them to control their diabetes.

Our adolescent family life program has been very active and we believe and I suppose it’s no surprise to anyone that the sooner that we can get young people thinking about their health, their nutrition, and their physical activity the more likely we are to initiate long term life changes and habits that they will follow. And part of what we did we worked with our teens and the teens came up with a nice cookbook which they helped and worked with some of our programs in developing and it was, sort of, something they developed on their own looking at the kinds of foods that teens like and how you can produce those foods or make those foods in a way that would still remain healthy.

The breast feeding promotion, I’ve already talked about. One of the things we’ve also initiated is a report card for hospitals. We send out to the hospitals and I think you may have a boilerplate letter that we send out to the hospitals telling them where they place with other hospitals in California in promoting exclusive breast-feeding in patients who deliver in their hospitals. And we send them out a report card and we say this is how you placed as compared with other hospitals and so on in your area and in the state generally.

We have many collaborative activities with a variety of different groups in The Department of Health Services as well as groups outside the department of health services and I have the nutritionists who works with us in our programs. She always likes to throw these terms at me. We have PANCC, PANP, COPI and all of these kinds of things that we’ve identified that are all part of California ’s different programs working on obesity. PANCC which I never can remember so I’m going to read it off is Physical Activity and Nutrition Coordination Committee and this committee has been working since 2001 in trying to incorporate across the state different kinds of ideas to work on obesity. And it’s brought in policy changes. It was through this committee that some of the writing for those legislative proposals that you all have came out of this committee. They helped the legislators in writing their proposed legislations bills.

I think here again no surprises. The issue as many of the issues we face in maternal child health fall under a big umbrella of societal kinds of issues. So starting at the very top we have society in general that has to get involved in this program that we have to educate about the dangers of obesity and so on.

Obesity obviously is and overweight is an issue with our smoking campaigns and our alcohol programs, we can survive without smoking. We can survive without alcohol but eating is something that we pretty much need to do everyday. So it’s not so easy to control some of these things because you can’t just say I’m not going to eat anymore as you can say I’m not going to smoke anymore. But the kind of responsibility for making these changes goes down from society to the individual level. I think it’s impractical for us to tell the individual, you know, change your eating habits and begin a physical activity program and put all of the burden of responsibility on the individual. Certainly the individual has a responsibility but also society, the community organizations whatever organizations we’re in and our interpersonal relationships and our support systems all have a responsibility to work on that problem.