Obesity Prevention Initiative

• Abstract
• Purpose of health policy or idea
• Characteristics of this policy
• Political and economic background
• Purpose and process analysis
• Expected outcome
• References

Featured in half-yearly report: Health Policy Developments Issue 5

Abstract

California Governor Arnold Schwarzenegger is proposing to allocate $6 million in state funds for a comprehensive anti-obesity initiative coordinated by the state department of human services (DHS). The DHS would coordinate various state agencies and community-based programs to promote anti-obesity initiatives. Although support for the initiative is broad, the proposed $6 million in a lean budget year will be coveted by many existing state programs.

Purpose of health policy or idea

As part of his proposed 2005-2006 California budget, Governor Schwarzenegger has proposed an anti-obesity initiative to help control the state's obesity epidemic. The plan would allocate $6 million to enable the state Department of Health Services to take a leadership role in coordinating comprehensive obesity prevention activities in the state.  By controlling obesity, the state will be able to control comorbidities such as high blood pressure, diabetes, heart disease, and others. Ultimately, this will improve the welfare of the state's residents and save the state money in health care costs.

The initiative plans to fight obesity by having the state coordinate and support a framework of programs that promote healthy eating and physical activity. Some of these programs already exist, and some would be created under the initiative. The specific objectives of the obesity prevention initiative include:

• Improving the nutritional quality of available food and drink, and increasing opportunities for physical activity.
• Increase obesity prevention/treatment services in health insurance programs
• Community planning to foster increased walking, activity
• Workplace changes that support increased physical activity and healthy eating
• Make obesity prevention a statewide priority through education, outreach, and governor's summit on healthy eating and physical activity
• Support Medi-cal's (the state's Medicaid insurance program for the poor) managed care obesity screening, treatment and counseling for children and adults.

In service of these objectives, the DHS in its role as coordinator proposes to administer the proposed $6 million in state funding in the following manner:

• Providing $3.5 million in community action projects/training grants: These grants to community groups would be for projects aimed at making environmental, systemic and policy changes around nutrition and physical activity. DHS would attempt to fund projects that have already undergone an extensive community planning process and are ready for implementation. 
• $1.4 to support Medi-Cal managed care plans obesity prevention efforts: The state would use the money to work with providers and managed care plans to implement systemic changes and specific interventions to help prevent and treat obesity, as well as connecting providers with community obesity prevention resources.
• $500,000 to study obesity causes and solutions in the state: The DHS would contract studies to help them evaluate the causes of obesity, prevalences and trends, as well as monitoring variables that help track the impact of interventions (e.g. the number of children walking to school, using public parks, etc.). The DHS and others would use these studies to help inform policy decisions and design interventions in the future. 
• $150,000 to implement worksite changes: These funds would be used to actually implement worksite changes make healthy choices easy for workers (e.g. opening stairwells, improving the nutritional quality of food sold on site). 
• $150,000 for public awareness campaigning: The state would coordinate all nutrition and physical fitness communications in order to promote awareness and changes in social norms. The state would work with other groups, such as California Endowment, First 5 Commission, CalPERS, and health plans to extend its communications reach.

As coordinator, the DHS would work to promote close collaboration with and support of existing community-based obesity prevention efforts, as well as facilitating collaborative efforts between state agencies (for example, the Department of Health Services, Department of Education, and the Department of Transportation). According to the DHS, collaboration between the various agencies and community groups is currently difficult because resource constraints mean that groups are protective of their resources and do not always have the time and personnel to devote to building collaborations. The plan will theoretically impact all Californians, who, according to the Governor's budget, have collectively gained 180,000 tons in the past decade (an average of 10.7 pounds per person).  It reflects the state's growing interest in taking a leadership role in the fight against obesity.

Main points

Main objectives

Preventing and reducing obesity by providing funding for a comprehensive obesity-prevention program led by the state.

Political and economic background

There has been growing alarm over the problem of obesity in the United States in recent years. 

The United States Centers for Disease Control and Prevention (CDC) has made reducing the prevalence of obesity among adults to less than 15% by 2010 a national health objective. The US Department of health and human services acknowledged the seriousness of the problem in July of 2004 when it changed language in the federal Medicare guidelines to classify Obesity as a disease, thus qualifying it for coverage under Medicare. Beginning in October 2000, CDC began funding anti-obesity programs in selected states through The Nutrition and Physical Activity Program to Prevent Obesity and Other Chronic Diseases. In 2004-2005, 28 states received between $300,000 and $1.5 million each from the CDC to implement anti-obesity programs. 

More than half of California's adults are overweight or obese, and the state's obesity rates have risen faster than the rest of the United States, leading to rapidly rising rates of diabetes, high blood pressure, and other obesity comorbidities.  In addition to being a major threat to public health, obesity has serious health implications. In April of 2005, the California Department of Health Services released a study showing that Obesity costs the state $21.7 billion dollars annually in medical care, workers' compensation and lost productivity. This figure is expected to rise to $28 billion in 2005. 

Although a number of anti-obesity activities have been occurring in California, the state has yet to step forward as a leader in the effort, both financially and organizationally. To date, although the state has put forth a number of nutritionally based policy initiatives to improve nutrition in schools, (for example, limiting the sale of soft drinks in elementary and middle schools [see the April 2004 survey entitled "soda ban"], establishing nutritional standards for food sold in elementary schools, and regulating the sale of a la carte foods) California devoted only minimal state funds for obesity prevention.  Prevention activities have either been organized with federal funds (through federal food supply programs or through some limited funding from the Centers for Disease Control and prevention), or by voluntary efforts by community groups funded by foundations and other private sources.

Existing community-based efforts have often collaborated with the state.  Many of these collaborative efforts have focused around a collaboration known as project LEAN (Leaders Encouraging Activity and Nutrition), which is administered by the Department of Health Services and the independent non-profit Public Health Institute with funding from The California Endowment, The Wellness Foundation, Preventive Health Services Block Grant from the Centers for Disease Control and Prevention, California Department of Health Services, Cancer Research Section, and California Nutrition Network.

Project LEAN was the lead partner in the California Obesity Prevention Initiative (COPI), a planning and capacity building commission established 2000 with funding from the Centers for Disease Control and Prevention (CDC).  The COPI was charged with creating a strategic plan to address obesity prevention in the state, and with creating a framework for collaboration with external partners. Under COPI, the California Department of Health Services (DHS) worked in partnership with the California Obesity Prevention Advisory group, a group that consisted of representatives of over 50 organizations and agencies around the state. COPI developed an action plan called "Reversing the Obesity Epidemic: California's Strategies for Action" which to some extent forms the basis for the current obesity plan. Although COPI represented a fairly significant state effort at developing a cohesive and comprehensive state obesity prevention strategy, their CDC funding was not renewed, and thus, their ability to continue to provide leadership is limited.

Most recently, in March of 2005, the California Endowment, a private foundation, announced a $26 million grant to attack childhood obesity in the state. As part of the initiative, 6 California communities have been selected to receive $1.8 million to implement programs that will improve children's eating habits and encourage physical activity.

Purpose and process analysis

Current Process Stages

	Idea	Pilot	Policy Paper	Legislation	Implementation	Evaluation	Change
Implemented in this survey?

Origins of health policy idea

The new state obesity prevention initiative came out of Governor Arnold Schwarzenegger's office, and is reflective both of the extent of the alarming obesity problem in the state and the governor's personal emphasis on physical fitness (as evidenced by his occupation prior to entering public service). 

Because relatively significant obesity prevention activities have been occurring in California in an ad-hoc way, some legislators have questioned the timing of this initiative, given the state's budget crisis. However, given that obesity rates continue to rise at an alarming rate in the state, it is clear that current activities are insufficient. For Governor Schwarzenegger and his staff, the first step in the solution is to have the state assume a more stable and prominent role in coordinating and driving obesity prevention efforts.  The Governor has expresssed hopes that the relatively modest investment of $6 million will help the state leverage existing community-based and federally funded anti-obesity programs to make successful obesity prevention a reality in the state.

Supporters of the anti-obesity initiative point to similarities to the state's highly successful anti-tobacco campaign. For the anti-tobacco campaign, starting in 1988 the state raised earmarked money through a cigarette tax, and used the funds to create a comprehensive, multi-agency tobacco reduction program. Through a population-based, multi-faceted approach, the state was extremely successful in changing the environment and social norms around tobacco, reducing overall smoking prevalence from 25.8% in 1984 to 16.2% in 2003. The obesity prevention initiative proponents hope that dedicated funds and a clear mission will help the states various agencies collaborate to fight obesity as successfully as they fought tobacco.

Stakeholder positions

While support for the initiative is widespread, the $6 million allocated for it in a lean budget year will be coveted by many other state programs facing cuts.

The California Medical Association, representing the state's physicians, has officially resolved to actively support the obesity prevention initiative. Other supporters will emerge as the initiative moves forward through the hearing process. Because it is not a bill, but rather, part of the budget, there are not official co-sponsors and supporters as there would be for other types of legislation, making it harder to identify key supporters.

The California Department of Health Services in April released a well publicized report documenting the high cost (21.7 billion dollars) of obesity, overweight, and inactivity in the state.  The report, entitled "The Economic Costs of Physical Inactivity, Obesity, and Overweight in California Adults: Health Care, Workers Compensation, and Lost Productivity." has garnered a great deal of attention in the press, and may help to convince skeptics of the importance of state-led obesity prevention. 

Influences in policy making and legislation

The governor's anti-obesity initiative is part of the 2005-2006 budget proposal that is currently being debated in the legislature. The Senate heard the portion of the budget containing the obesity initiative for the first time in April. Despite the presence of a number of supporters of the plan, legislators expressed concern that 6 million dollars in the midst of a budget crisis was too much - especially considering that many voluntary efforts financed with non-state funds have increasingly been active in the state. The senate in April decided to take no action until they could discuss the matter further with the Governor's administration.

Adoption and implementation

Because details are still emerging about this plan, it is hard to predict who will be involved in the adoption and implementation. The Department of Health Services will be the coordinator (and in some cases the funder) for various state agencies, departments, and community groups as they work on collaborative obesity prevention projects. 

Monitoring and evaluation

The department of Health Services envisions allocating $500,000 of the $6 million in proposed obesity prevention funding for evaluation of the causes of obesity and the impact of anti-obesity interventions and policy decisions. It would contract out these studies.

Expected outcome

Because details of the obesity prevention initiative are still emerging, it is difficult to provide an analysis of the likelihood of success. What is clear, however, is that the obesity epidemic in California is one of the most serious public health problems facing the state, and mirrors the problem faced by the nation as a whole. If the state does not step forward soon to address the problem, the already staggering costs of obesity will continue to rise.

The state's successful fight against tobacco over the past 18 years indicates that a state-organized, community-based multi-faceted approach to an overwhelming public health problem can have a significant and positive impact. However, deep political and financial commitments from the state are necessary.  

The Governor's anti-obesity initiative, if passed, would represent a positive first step towards state leadership on a seemingly overwhelming problem.  It is clear, however, that this initiative is just that: a first step. Considerably more resources will need to be devoted to prevention and treatment in coming years if the state is to succeed in reducing the state obesity burden.

References

Sources of Information

Centers for Disease Control and prevention, Nutrition and Physical Activity division http://www.cdc.gov/nccdphp/dnpa/obesity/

California HealthLine www.californiahealthline.org

Governor's Budget Homepage - The California Obesity Initiative http://govbud.dof.ca.gov/BudgetSummary/MAJORPROGRAMAREAS/HealthandHumanServices/section2_4.html

California Obesity Prevention Initiative http://www.dhs.ca.gov/ps/cdic/copi/default.htm

"The Economic Costs of Physical Inactivity, Obesity, and Overweight in California Adults: Health Care, Workers Compensation, and Lost Productivity." Study conducted by Dr. David Chenoweth for the California Department of Health Services. April 2005.  Available online at http://www.dhs.ca.gov/ps/cdic/cpns/press/downloads/CostofObesityToplineReport.pdf

Author/s and/or contributors to this survey

Sarah Weston, Institute for Global Health; Carol Medlin, PhD, Institute for Global Health

Suggested citation for this online article

Sarah Weston, Institute for Global Health; Carol Medlin, PhD, Institute for Global Health. "Obesity Prevention Initiative". Health Policy Monitor, April 2005. Available at http://www.hpm.org/survey/us/d5/1