Barriers to provision of healthcare in rural areas include "provider shortages and infrastructure issues." (Hearne, et al. 2004)
Obesity related costs are inclusive of both direct and indirect costs which include 'medical costs and lost productivity' in excess of $117 billion each year. (estimates of U.S. Department of Health and Human Services; as cited in Hearne, 2004) in fact, obesity is accounted for approximately $75 billion in medical expenses in 2003 alone with one-half of these costs being financed by Medicaid and Medicare constituting 6% of the HHS 2003 budget. Obesity-related expenditures for all fifty states and the District of Columbia were estimated at $21.3 billion for Medicaid in 2003. Obesity related costs for employers and businesses are inclusive of: (1) lost productivity; (2) paid sick leave; and () the increased costs of health, life and disability insurance. (Hearne et al. 2004 p.6) With the present rate of obesity-related disease growth among schoolchildren in the state of Texas the future is one that is characterized as "bleak" as the number of overweight Texans is predicted to triple from today's 3.5 million to 9.6 million by year 2040. If recent trends continue the costs in health care for treating obesity related illnesses is expected to increase from today's $10 billion to in excess of $40 billion in only one generation. It is reported that in the year 2002 the "Texas acute care hospitals lost approximately $6.5 billion in uncompensated care." (Ibid) the work entitled: "Active Hours Afterschool: Childhood Obesity & the Role of Afterschool Programs as a Solution" states: "There are not yet any long-term data on the costs of afterschool, but in the short-term, obesity prevention programs are clearly far less costly than treating the disease itself." (nd)
Reported in the "Joint Interim Committee on Nutrition and Health in Public Schools: Interim Report to the 79th Legislature" is that HMOs in Texas, when asked to provide the number and dollar value of claims paid in cases of morbid obesity diagnosis or where it was a comorbidity factor responded as shown in the following table labeled Figure 1.
Response of HMOs to the Number and Dollar Value of Claims Paid in Cases of Primary Morbid Obesity Diagnosis & Obesity as a Comorbidity Factor in Diagnosis
Diagnosis Type Number of HMOs
Total Number of Total Value of That Reported Data
VII. Policy Focus and Requirements
The state of Texas enacted a law in 1999 that states essential public health services focus to be inclusive of the following:
1) Monitor health status of individuals in the community to identify community health problems and hazards;
2) Diagnose and investigate community health problems and hazards;
3) Inform, educate and empower the community in regards to health issues;
4) Mobilize community partnerships in identifying and solving community health problems;
5) Develop policies and plans that support individual and community efforts to improve health;
6) Enforce laws and rules that protect the public health and ensure safety in accordance with those laws and rules;
7) Link individuals who have a need for community and personal health services;
8) Research new insights and innovative solutions to community health problems; and 9) Evaluate the effectiveness, accessibility and quality of personal and population-based health services in a community. (the State of Health Care Policy Brief, 2005)
The Texas Department of Health or the Department of State Health Services (DSHS) in 2002 is stated to have "convened more than 800 public and private organizations involved in the state's public health system to "identify shared priorities and actions for improving the health of Texans." (Hearne, et al., 2004) Goals identified by the Texas Strategic Health Partnership are inclusive of the following goals:
1) Promote healthy nutrition and physical activity;
2) Promote health choices regarding risky behavior;
3) Recognize mental health as a public health issue and promote prevention, early detection and treatment;
4) Increase high school graduation rates, adult literacy, college attendance, and other advanced education and training;
5) Reduce environmental health threats and consumer hazards. F. Reduce infectious disease with a focus on immunization;
6) Ensure by 2010 that essential public health services are available for all Texas communities;
7) Ensure by 2010 that a diverse set of governmental and non-governmental partners will meet Texas' public health needs;
8) by 2010, Texas communities will be aware of the structure, function and availability of the public health system;
9) by 2010, the public health system workforce will be educated to meet evolving needs. K. By 2010, the public health system will operate with a flexible funding system that meets community public health needs;
10) by 2010, Texas public health system partners will be informed by, and make decisions based on, a statewide, real-time, standardized, integrated data collection and reporting system(s) for demographic, morbidity, mortality and behavioral health indicators. (Hearne, et al., 2004)
Summary and Conclusions
From all appearances, the wellness nutritional program implementation in the state of Texas will serve the state well in the treatment and prevention of childhood obesity. The components that are in place throughout the schools, community and businesses and which include the involvement of teachers, parents and other key community and school individuals, agencies and groups which are all essential in the creation of a strategic alliance toward reduction and prevention of childhood obesity in the state.
The State of Health Care: A Few Indicators and Current Issues - Policy Brief (2005) Health Policy Forum. 18 Mar. 2005. Online available at http://220.127.116.11/search?q=cache:AnztNPi0UboJ:www.texashealthinstitute.org/pdf_files/SOHC.pdf+Texas+Bill+73+Obesity+and+Overweight+Council+Wellness&hl=en&ct=clnk&cd=14&gl=us.
SB 73 Legislative Session 80(R) 1766 MSE-D. Texas Legislature History
Active Hours Afterschool: Childhood Obesity & the Role of Afterschool Programs as a Solution (nd) Online available at http:www.afterschoolallieance.org/active_hours/Obesity-Afterschool_Solution.pdf.
The State of Health Care: A Few Indicators and Current Issues Policy Brief (2005) Health Policy Forum. 18 Mar 2005. online available at http://www.texashealthinstitute.org/pdf_files/SOHC.pdf.
The Healthy States Initiative: A Partnership to Promote Public Health. State Official's Guide to Wellness. (2006) Online available at http://www.healthystates.csg.org/NR/rdonlyres/D48FC4CD-1F7A-4CB6-A5B5-8DBF4ED500CC/0/WellnessSOG2006.pdf..
Joints Interim Committee on Nutrition and Health in Public Schools - Interim Report to the 79th Legislature. (nd) Online available at http://www.tea.state.tx.us/comm/sb474rpt.pdf.
Proven Texas Program Helps Prevent Childhood Obesity (nd) C & C. Associates.