Childhood Obesity: Texas Senate Bill

Childhood Obesity: Texas Senate Bill

The state of Texas has passed a Bill to be enacted into Law, specifically Texas Senate Bill 73 that has as its' focus the reduction and prevention of childhood obesity in the state. Childhood obesity in the state of Texas is higher than the national average and the state has responded with the introduction of an initiative that is inclusive of schools, communities, parents, businesses, and insurance coverage providers. The program has been named CATCH or a "Coordinated Approach to Child Health" headed by the Texas Department of Health, the American Heart Association's Texas Chapter and the Center of Health Promotion and Prevention Research at the University Texas Health Science Center at Houston. The Department of State Health Services has been appointed to "analyze and evaluate whether a statewide wellness council would assist the department in promoting consumer health and educating Texans on the importance of proper nutrition and physical activity in preventing obesity-related health concerns. Costs associated with childhood obesity include both direct and indirect costs illustrated in high personal costs, direct national costs and rising disability claims. It is clearly demonstrated in the cost analysis within the attached work that it is clearly more expensive to ignore this problem than to enact and implement the proposed wellness and nutrition program in the state of Texas. Strategic alignment of all stakeholders is shown to be 'key' to successful implementation of this program in the state of Texas.

CHILDHOOD OBESITY: TEXAS SENATE BILL 73

Objective

The objective of this work is to research and review childhood obesity relating to Texas Senate Bill 73.

Introduction

The state of Texas states that the overweight and obesity rates for Texas fourth-graders are approximately double the national average for that age group and furthermore than childhood obesity has more than doubled in the past 20 years. The obesity rates for Latino/Hispanic and African-American children in Texas are among the highest in the nation. Being overweight not only increases the risk of developing high blood pressure but also increases the chance of developing type 2 diabetes, kidney problems and certain types of cancer. In answer to the problem of childhood obesity in the state of Texas, the Texas Department of Health, the American Heart Association's Texas Chapter and the Center of Health Promotion and Prevention Research at the University Texas Health Science Center at Houston implemented CATCH - or 'A Coordinated Approach to Child Health'. The CATCH program is inclusive of the following components: (1) a curriculum, physical education and healthy eating components and parent involvement; (2) Physical education classes with a design that promotes physical activity throughout the life of the individual through a blend of fun and fitness; (3) School cafeterias preparation of foods that are lower in sodium and fat; (4) Teachers utilize a curriculum that supports and promotes healthy habits that have been proven to prevent disease of a chronic nature; and (5) Parents provide reinforcement with health messages at home by using interactive assignments that are fun as well. Family fun nights are hosted by the schools and include the entire family in the development of healthy lifestyles. The impact of the CATCH Program has been phenomenal affecting in excess of 900,000 students with interventions that "have been demonstrated to significantly improve students' eating and physical activity behaviors and decrease the fat content of school lunches. CATCH received its' certification through the Texas Education Agency.

I. Policy Issue and Description

In Section 7 of the Texas Senate Bill 80(R) SB 73 it is stated that the Department of State Health Services "shall analyze and evaluate whether a statewide wellness council would assist the department in promoting consumer health and educating Texans on the importance of proper nutrition and physical activity in preventing obesity-related health concerns. The wellness council is appointed in the promotion and advancement of health in the workplace, schools and communities in both private and public sectors. It will be up to the statewide wellness council to make a determination of whether the objectives could be achieved which are "related to health care cost containment, reduced absenteeism, improved employee health status and improved morale." (Texas Senate Bill 80(R) SB 73) the date set for submission of the determination is September 1, 2008. At this time, the Department of State Health Services will submit a report to the governor and his staff.

II. Statement of the Problem

The costs of obesity related healthcare are soaring according to the report published by the Alliance for a Healthier Generation (nd) the costs are expressed as those characteristics of (1) High Personal costs; (2) Direct National Cost; and (3) Rising Disability Claims. Furthermore, the children who are overweight and obese are at an increased risk for developing serious health-related problems. The council has a limited amount of time in which to make the assessment and submit a recommendation to the Governor of Texas and his staff as to the necessity and feasibility of the wellness council implementation in the state of Texas.

III. Precedent/History of the Policy/Issue

Listed as "A Bill to Be Entitled an Act regarding the prevention and treatment of obesity-related health concerns" Chapter 161, Health and Safety Code is amended in [Section 161.901] entitled "Obesity-Related Treatment and Prevention Initiatives." This council is composed of the commissioner of agriculture, the commissioner of state health services and the commissioner of education in cooperative initiative focused on the promotion of better health and nutrition in the prevention of obesity among children and adults in the state of Texas. This agency is required to submit a report to the speaker of the House of Representatives each odd-numbered year prior to January 15. Public Awareness Campaigns have been outlined in the Bill for the improvement of awareness relating to consumer health as well as publication of obesity and overweight consequences in health care and prevention."[Section 161.902] in regards to Research [Section 161.902] the Department of State Health Services along with the Texas Department of Insurance will be responsible for identifying and encouraging evidence-based clinical interventions for prevention and treatment. Guidelines for the medical community will be promoted by the Department of State Health Services as well as for the insurers and health benefit plan insurers in the development and implementation of treatment plans.

IV. Background (Social, Economic, Ethical, Political, Legal)

Obesity policies are failing in America and according to Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC) (2004) "If you looked at any epidemic --whether it's influenza or plague from the middle ages -- they are not as serious as the epidemic of obesity in terms of the health impact on our country and our society." (2004) According to the work entitled: "F as in Fat: How Obesity Policies are Failing in America" Hearne et al. (2004) states: "Every segment of society has a role to play in fighting the epidemic, especially such stakeholders as the food industry, consumer groups, the medical community and the government." In fact, it is stated that: "From school lunches to sidewalks, government involvement is crucially important in combating obesity. The federal government, through its position of national leadership, can put obesity at the top of the country's public health agenda, and each state, through its health department, can identify goals and strategies to improve the health of its citizens." (Hearne, et al., 2004)

V. Stakeholders

Stakeholders in this initiative include the citizens of Texas, the schools, communities, health care facilities, Medicaid, Medicare, Insurance providers, physicians, medical facilities, and in fact, are inclusive of every individual, business organization and institution throughout the state of Texas. This initiative is of the nature that makes it q requirement that all these individuals and entities strategically align if this is to be a successful initiative in the prevention and reduction of childhood obesity in the state of Texas.

VI. Cost Benefit Issues

The work of Hearne et al. (2004) states that "From a policy standpoint, chronic health problems lead to chronic budgetary problems for state leaders. In Texas, health and human services needs account for about a third of the total state budget despite extensive efforts to curb spending.. Faced with a projected budgetary shortfall of almost 10 billion for the 2004-2005 biennium and unwilling to increase taxes, the 78 Medicaid and the Children's Health Insurance Program (CHIP), effective September 2003." (Hearne, et al., 2004) Factors that are "closely related to health status" are two factors of (1) poverty and (2) level of education. In fact, Hearne et al. (2004) relates that 39.5% of Texans were found to have incomes that were 200% of the Federal Poverty Level in 2004 in comparison to the national average of 31%. Poverty factors affect the likelihood of access to health care services and nutritional and self-care maintenance. Furthermore, there are a stated 25% of Texans who are uninsured compared to the national average of 16%. Stated to be a barrier to the provision of quality health care is the fact that the "medically Underserved Area" is stated at 69% compared to a national average of 62%. 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

Claims Paid

Primary Diagnosis

Comorbidity Factor