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Governors' Healthy America Initiative

Country: 
USA
Partner Institute: 
Institute for Global Health (IGH), University of California Berkeley/San Francisco
Survey no: 
(8)2006
Author(s): 
Karen Pak Oppenheimer, Carol Medlin
Health Policy Issues: 
Public Health, Prevention, Responsiveness
Current Process Stages
Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no yes no no no no no

Abstract

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.

Purpose of health policy or idea

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.

Main points

Main objectives

Under the Healthy America initiative, the NGA was set out to

  • raise awareness of the need for healthier and more active lifestyles;
  • bring together experts to discuss solutions for obesity prevention and wellness promotion for children and adults;
  • seek out best practices and innovative state and local programs;
  • hold workshops and provide tools for state officials to implement effective programs in their states;
  • explore opportunities in public-private partnerships and improving relevant state programs such as Medicaid, food stamps, etc.; and
  • urge every governor to develop and implement state employee health initiatives.

Type of incentives

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.

Groups affected

Governors, state policymakers, civil society

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Characteristics of this policy

Degree of Innovation traditional neutral innovative
Degree of Controversy consensual rather consensual highly controversial
Structural or Systemic Impact marginal marginal fundamental
Public Visibility very low low very high
Transferability strongly system-dependent system-neutral system-neutral

Political and economic background

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.

Purpose and process analysis

Current Process Stages

Idea Pilot Policy Paper Legislation Implementation Evaluation Change
Implemented in this survey? no yes no no no no no

Origins of health policy idea

Arkansas Governor Mike Huckabee's determination to improve the health of his state and country started with a personal experienceWeighing 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.

Initiators of idea/main actors

  • Government
  • Private Sector or Industry: Although some pharmaceutical and food corporations provided financial support for state grants program, their support does not necessarily reflect unified views from their respective industries.

Approach of idea

The approach of the idea is described as:
new:

Innovation or pilot project

Local level - Healthy Arkansas Initiative

Stakeholder positions

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.

Actors and positions

Description of actors and their positions
Government
Governor Mike Huckabeevery supportivevery supportive strongly opposed
National Governors Associationvery supportivevery supportive strongly opposed
Private Sector or Industry
Pharmaceutical/ Food Industryvery supportivesupportive strongly opposed

Influences in policy making and legislation

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.   

Legislative outcome

n/a

Actors and influence

Description of actors and their influence

Government
Governor Mike Huckabeevery strongvery strong none
National Governors Associationvery strongvery strong none
Private Sector or Industry
Pharmaceutical/ Food Industryvery strongstrong none
Governor Mike Huckabee, National Governors AssociationPharmaceutical/ Food Industry

Positions and Influences at a glance

Graphical actors vs. influence map representing the above actors vs. influences table.

Expected outcome

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.

Impact of this policy

Quality of Health Care Services marginal neutral fundamental
Level of Equity system less equitable neutral system more equitable
Cost Efficiency very low neutral very high

References

Sources of Information

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)

Author/s and/or contributors to this survey

Karen Pak Oppenheimer, Carol Medlin

Suggested citation for this online article

Karen Pak Oppenheimer, Carol Medlin. "Governors' Healthy America Initiative". Health Policy Monitor, October 2006. Available at http://www.hpm.org/survey/us/d8/1