|Implemented in this survey?|
In 2005, National Governors' Association Chairman Mike Huckabee created a yearlong 'Healthy America' initiative to address worsening health problems in the US. The first of its kind initiative assembled a bipartisan task force and worked with public and private sectors to promote behavioral and lifestyle changes that would contribute to sustainable, long-term health across the nation. The initiative led to a spur in development and implementation of wellness programs across the country.
The Center for Diseases Control and Prevention estimates that roughly 65 percent, or 129 million, of adults in the United States are overweight, with more than 60 million who are obese and 9 million severely obese.
In reponse to the growing burden of chronic diseases on health care systems and economy across the United States, Arkansas Governor Mike Huckabee, and 2005-2006 Chair of the National Governors Association (NGA), created a yearlong initiative called "Healthy America: Wellness Where We Live, Work and Learn". According to Governor Huckabee, his initiative is about "building a culture of physical activity, disease prevention and wellness in the United States". The initiative aimed to encourage and assist state governors in developing and implementing wellness initiatives. It also intended to bring together public and private sectors to promote behavioral and lifestyle changes that contribute to sustainable, long-term health.
Under the Healthy America initiative, the NGA was set out to
The initiative was meant to put more focus on prevention instead of treatment in public policies regarding health care. Diseases caused by lack of physical activity, poor diets and unhealthy lifestyles have been a major factor in rapid health care costs increases. The initiative believed that governors and states need to fight the epidemic by instituting programs that would improve the health and wellness of their residents and thereby reducing the share of health care costs in their state budgets.
Governors, state policymakers, civil society
|Degree of Innovation||traditional||innovative|
|Degree of Controversy||consensual||highly controversial|
|Structural or Systemic Impact||marginal||fundamental|
|Public Visibility||very low||very high|
Obesity and chronic diseases are increasingly being recognized as major epidemics in the United States, and is getting more attention both on the local and national levels. This initiative is an addition to the ongoing efforts to fight the epidemic in response to worsening health outcomes and escalating health care costs around the country.
|Implemented in this survey?|
Arkansas Governor Mike Huckabee's determination to improve the health of his state and country started with a personal experience. Weighing 300 pounds, he was diagnosed with Type II Diabetes in 2003. Realizing that his life was at risk, he promptly went on a strict diet and began an exercise routine. His ambition and shedding 100 pounds led him to national fame. He started the Healthy Arkansas initiative to fight obesity by promoting exercise breaks for office workers, expanded insurance coverage for obesity treatment, established strict nutritional guidelines for school lunches and introduced body mass index report cards that are sent home to parents.
As Chair of the NGA, he used the opportunity to promote health and wellness through the Healthy America initiative, modeled after his Healthy Arkansas program. He also assembled a task force of 6 other governors who are also very committed to improving health and wellness in their states. He believes that a 'lifestyle revolution' can happen, citing successes from concerted government efforts on littering, seatbelt use, smoking and drunk driving.
The approach of the idea is described as:
Local level - Healthy Arkansas Initiative
The Healthy America initiative received wide support from governors around the country. As the yearlong initiative came to an end (August 2006), the NGA Center for Best Practices launched a Healthy States Grant Program with financial support from a number of large pharmaceutical and food and beverage companies: Altria/Kraft, General Mills, PepsoCo, Wal-Mart, Anheuser-Busch, AstraZeneca, Novo Nordisk, Aetna, Johnson & Johnson, GlaxoSmithKline, and Pfizer. 13 states were awarded grants up to $100,000 for the development and implementation of state-based efforts and policy changes to encourage healthy behaviors. Despite support from these corporations, there is great general concern in the food industry regarding the direction of the anti-obesity fight, namely potential lawsuits like those filed against tobacco companies in the 1990s.
There was no strong opposition against the initiative, but some criticisms had been heard from parents on the Healthy Arkansas Initiative. These parents voiced concerns over 'government intrusion and fragile young egos' with the body mass index report card that was sent home to parents. Residents of the southern state feel that there is too much 'policing' and cautioned that Governor Huckabee may be raising a culture war in the southern state reknowned for their soul food and all-you-can-eat-buffets.
|Governor Mike Huckabee||very supportive||strongly opposed|
|National Governors Association||very supportive||strongly opposed|
|Private Sector or Industry|
|Pharmaceutical/ Food Industry||very supportive||strongly opposed|
A new NGA chair is elected every year, and each year, the chair will choose an issue and form an initiative. Like other NGA chair initiatives, The Healthy America Intitiative is a yearlong campaign promoted by Governor Huckabee during his tenure from 2005-2006. It is not intended to become a policy, but rather, it was aimed at encouraging and supporting state policymakers in developing and implementing programs and policies to promote wellness and healthy living for adults and children. The initiative falls within the context of many state-led efforts and initiated others such as a soda-ban in Californian schools, tightening of tobacco-free school regulations in Maine, increasing hours of physical education in schools in Michigan, etc.
|Governor Mike Huckabee||very strong||none|
|National Governors Association||very strong||none|
|Private Sector or Industry|
|Pharmaceutical/ Food Industry||very strong||none|
Although the NGA did not present data or statistics that showed improved health in states involved with the initiative, it is apparent that a large number of states have taken on the development and implementation of health and wellness programs. At the last NGA annual meeting in August, at the end of the yearlong initiative, Vice Chair Arizona Governor Janet Napolitano said that the initiative has spurred governors, policymakers, private industry and the medical community to 'enact real, tangible solutions to help our nation become healthier and more active'.
The NGA places great focus on health as evidenced by the programs reported and tools available on their website. At the very least, the Healthy America initiative brought to national and state level policymakers more attention on the unhealthy behaviors and lifestyles that are attributing to a worsening obesity and chronic diseases epidemic in the United States. The effort to encourage governors and state policymakers to make positive changes in their states can be considered a helpful addition to other local efforts in promoting health and wellness in the United States. Nonetheless, there is continuing debates on what the appropriate levels of policy interventions are regarding personal choice and behaviors, and how much regulation should be imposed on the food and beverage industry.
|Quality of Health Care Services||marginal||fundamental|
|Level of Equity||system less equitable||system more equitable|
|Cost Efficiency||very low||very high|
National Governors Association Chairman, Mike Huckabee's Healthy America Initiative 2005-2006. At www.nga.org/portal/site/nga/menuitem.751b186f65e10b568a278110501010a0/?vgnextoid=cd86f8dbc1ff6010VgnVCM1000001a01010aRCRD&vgnextchannel=92ebc7df618a2010VgnVCM1000001a01010aRCRD
Healthy America Taskforce, Creating Healthy States: Actions for Governors, ed. K. Nolan and J. Mulheron, February 2005, www.nga.org/Files/pdf/0602CREATINGHEALTHYSTATESACTIONS.pdf> (accessed 28 April 2006).
National Governors Association Center for Best Practices: Health. At www.nga.org/portal/site/nga/menuitem.8274ad9c70a7bd616adcbeeb501010a0/?vgnextoid=c0294bf37ebdff00VgnVCM1000001a01010aRCRD
New York Times: "The Slenderized Governor, With Advice to Share." September 10, 2006. At www.nytimes.com/2006/09/10/us/10weight.html?ex=1161403200&en=237527a1056a3d9d&ei=5070
PR Newswire: "AstraZeneca Pledges Support for Arkansas Governor's Healthy American Initiative." February 28, 2006. At www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/02-28-2006/0004308504&EDATE
Mello, M.M., Studdart, D.M., Brennan, T.A. Obesity (2006). The New Frontier of Public Health Law. NEJM 354: 2601-2610. http://content.nejm.org/cgi/content/full/354/24/2601 (accessed 16 October, 2006)
Karen Pak Oppenheimer, Carol Medlin