The Lifestyle Chronicles - Run, Marcus, Run

You will not be hearing from me for a few days. Twenty-nine years ago I gathered together a small group of people in Charleston and we started a 10K run over the Cooper River Bridge. The purpose was to promote fitness and health in the local tri-county area. There were 700 participants that year.

Many talented and enthusiastic people have contributed their effort to the run over 29 years. This weekend we are expecting 50,000 people to participate.

I have such faith in the human spirit and I hope that faith never dims.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Human Spirit

Is each person only what they inherit from their parents? Is the future solely determined by the mixture of two sets of genes? Is that all there is to that?

Judith Harris in her book The Nuture Assumption advocates there is more potential to the future than what is inherited from parents. Certainly, genes set the stage and parents maintain, or not, the early conditions. Producing the play and attracting the audience is determined by the interaction of the child with the environment and their peers.

Unfortunately, some people inherit health problems and there are occasional mutations that convey poor health. These are not common. The future of health is determined by the interaction of a child, then an adult with the environment and their peers. Undoubtedly, the interactions of childhood influence conditions for the adult they become.

People are not victims and they are never restricted to being spectators in their own play. Nor, do they deserve poor health. Optimum health is the best health status a person can achieve. Although that may be more limited for some, there is a potential for each person. Achieving that potential depends upon personal effort and community commitment. Community commitment includes but is not limited to the healthcare system.

Nature is less forgiving than society. Each person is held responsible for their actions. The only appeal comes from within. I am reminded of Johnny Cash, his life and his song entitled "A Boy Named Sue". And, we want to avoid the fate of the kept rabbits that Richard Adams wrote about in Watership Down.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Never Surrender

One method of dealing with unhealthy lifestyle is to deny that it matters. The result is to remain at risk for a growing list of chronic diseases with increased morbidity and mortality. It is possible for unhealthy lifestyle not to be associated with the manifestations of chronic disease. But, the means to avoid or prevent chronic disease are limited and changing lifestyle is necessary to alter the etiology.

There is a story of Winston Churchill intoxicated at a dinner party. His dinner companion announced that Winston was drunk. He replied that she was ugly and tomorrow he would be sober.

It is not the health care industry that needs to adopt healthy lifestyle, it is the public. And, the public cannot rely upon the health care industry to provide healthy lifestyle. Organizing and developing a plan for optimum health is the responsibility of the individual and the community. Or, you could end up like Frankenstein, wired together piece by piece.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Frankenstein Defined

The Frankenstein Syndrome is the most common health care problem in the US. It is characterized by an excessive reliance upon high technology medicine to compensate for unhealthy lifestyle (smoking, excessive ingestion of alchohol, excessive use of medications, lack of physical activity, excessive stress, lack of sleep and obesity). The most severe cases are those people who suffer from chronic diseases and expect high technology medicine to provide significant relief with little or no changes in lifestyle by the patient. Interestingly, many of these people do not consistently comply with the therapies.

Long-term compliance with therapy for a chronic disease is much more difficult than people ever realize until they have to do it. Chronic disease management is an industry springing up to address this issue. Of course, the high cost of therapies and other logistical situations impact compliance.

The less severe cases of "Frankenstein" are those people who have not developed chronic disease but are at risk and have not made lifestyle changes. Also, included in this group are the "worried well" and those pursuing youth by means of untested supplements, inappropriate use of hormones and surgeries.

My apologies to any obstetricians who are upset about the use of increasing incidence of C-sections and inductions of labor as examples of the Frankenstein Syndrome. I believe that many obstetricians want to reduce the incidence of C-sections but the situation defeats them. To them I say that any effective health care reform must include education of the public and this is one of the focused campaigns to demonstrate change. Perhaps you should renew your effort now that reform is back on the national agenda.

Another example of the Frankenstein Syndrome is excessive use of medications. Advertisng of medications by pharmaceutical companies is a major influence. Part D of Medicare contributes to the problem. A useful national public health goal would be to link Healthy People 2010 to decreasing the utilization of medications by 15% (an arbitrary selection from the C-section playbook).

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Frankenstein's Day

Frankenstein has got to get out of the house more but he is so tired all of the time. He knows he should be more active but his knee is giving him fits. Maybe it is time to schedule that surgery.

He is thinking about trying some hormones; those herbal supplements don't seem to be working.

He had trouble sleeping last night. Maybe the doctor has something new for that pain in his back.

The garage is a mess. There is never enough time. He needs something to look forward to.

The Lifestyle Chronicles - Examination of Frankenstein

Frankenstein consists of many body parts. They don't function very well but each can be replaced with retrieved parts.

He appears frightening but in the right circumstances he can be gentle.

He doesn't get much love.

He is angry and depressed.

The Lifestyle Chronicles - The Frankenstein Syndrome

The evidence is mounting that something(s) happened in the American culture with consequences that began to manifest during the 1970s. Prior to the 1970s the incidence of overweight and obesity was generally stable and since then the incidence of both has doubled. Other consequences are the increasing incidence of chronic diseases such as type-2 diabetes and systemic hypertension.

American society needs to recognize there are long-term consequences of lifestyle decisions that may not be obvious. Even after the consequences become manifest the specific cause(s) and contributing factors may not be obvious.

Attitudes are a major contribution to lifestyle. It is entirely possible that health care became an unwitting co-conspirator with the American public to create an unhealthy environment. Since the 1970s there has been an explosion of capabilities and utilization of high technology health care. The American public has placed a high value upon the capability of medical technology to cure health problems regardless of how they live.

For example, what is going on with care during pregnancy and delivery? This is a biological process that in the absence of complications cannot be improved upon with technology. Pregnancy demands a healthy diet and a minimum of drugs. Until the natural time for delivery there is no better environment for the baby than the uterus. Yet, beginning in the 1970s the incidence of C-sections rapidly increased.

In 1970 the national rate for C-sections was 5%. It rose to more than 20% by the mid-1980s. According to the CDC's National Center for Health Statistics, nearly 1.2 million C-sections were performed in 2004 or 29.1% of all births. That was up from 27.5% in 2003 and 20.7% in 1996.

In 2000 a national public health goal was to reduce the C-section rate for healthy, first-time, full-term pregnancies to 15% by 2010. The rate of C-sections among women who have not previously had a C-section was 14.6% in 1996, 19.1% in 2003 and 20.6% in 2004.

One of every five births in America was induced in 2003. This was double the incidence in 1990. Tracking inductions at New York Presbyterian Hospital determined that they represented 34.4% of all births in 2005.

More than half-million infants were born preterm (less than 37 weeks gestation) in 2004 and the proportion of infants with low birth weight rose to 8.1% from 7.9% the year before.

According to a March of Dimes analysis, one-quarter of all singleton babies were born full-term at 39 weeks in 2002. Births at or near 40 weeks decreased by nearly 21% over the decade from 1992 to 2002 and there was a 12% increase in births occuring between 34 and 36 weeks (late preterm or near-term births).

Some babies born just a few weeks early need medical and nursing attention betond that given to full-term babies. Late preterm babies have increased risk of respiratory problems, feeding difficulties, hypothermia, jaundice and reduced brain development. The long-term consequences to health are undetermined.

Induction of labor has an increased risk for fetal distress, ruptured uterus and C-section.

Induced labor requires 24 to 36 hours of regular monitoring. Recovery from a C-section usually requires four days in the hospital.

American society requires that health decisions cause no harm. The requirement to demonstrate benefit is less clear but there is emphasis upon the relationship between benefit and cost. Assessing and managing health risk is a decision-making process of increasing importance to achieving and maintaining optimum health status. Risk based decision making begins a division of labor (no pun intended) between health care and medical care.

Thanks to Elisa at Healthy Concerns for bringing Frankenstein to my attention.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Losing The Fizz

A 20-ounce container of soda contains 250 calories and 67 grams of sugar, not to mention the sodium. The sugar is usually "high fructose" corn syrup. "Diet" soda contains the sodium and artificial sweetener. Sodas rank up there along side French fries and just below smoking as hazards to health.

The most likely source of large quantities of artificial sweetener is a beverage because the same beverage may be consumed throughout the day. The artificial sweeteners are chemicals that are very sweet. In addition to the potential for health problems, it is likely they stimulate appetite.

Teenagers given alternative beverages will drink them in place of sodas and they will lose weight.

Now, the good news. For the first time in 20 years, the number of cases of soda sold in the United States declined. Case volume in 2005 was down 0.7 percent, to 10.2 billion cases. Not much but it's a start.

All health professionals should warn every patient everytime they are seen to avoid sodas.

Water, tea and lemonade are good beverages that are good for you. And, don't be afraid of a little sugar. A cup of sugar in a gallon of tea is not excessive.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Health Assurance Is Insuring Health

In the not too distant past health insurance was a mundane topic. Now, it is a hot issue with special interest groups, politicians and the media fueling the fire. At the moment the health insurance chorus is singing with a multitude of discordant voices, but at least they have shown up for practice. This may turn into a rehersal and then a show.

To most patients health insurance is simply a payment mechanism. Patients expect bills for health care services to be submitted directly to the insurance company for payment. This procedure has the effect of discounting the value of service in the minds of patients. By the time the bill has made several prolonged round trips and partial payment has been rendered, any residual amount due to the provider is discounted to near zero in the minds of patients.

One straightforward change with the potential for profound impact would be for the patient to render full payment for professional service and submit the bill to the insurance company for reimbursement. It is a more responsible business transaction leading to a reorientation of values. For starters, the patients would be aware of prices. Health care providers and their patients, as well as insurance companies and their customers would be positioned in the proper relationship. Carrying cost and administrative overhead would be allocated to the appropriate parties. And, value for service rendered would be more apparant to the patient/customer.

The basic role of insurance is to share risk. Insurance compensates for predetermined risk by means of differential premiums or denial of coverage but the ultimate, lasting value is to reduce risk. All of us would be remiss if we did not insist that health insurance include mechanisms to manage risk with emphasis upon primary and secondary prevention. Otherwise, it is nothing more than a method to pay for sick care.

Why would someone with a healthy lifestyle want to share risk with those who have unhealthy lifestyles? The answer is they don't unless someone else pays the bill. If not the employers, then the government. In either case, health insurance without effective prevention is a formula for financial disaster.

The $64 (thousand, million, billion) question is how to implement effective primary and secondary prevention. I have always believed in hope and incentives but there appears to be some need for fear, enforcement and guilt. Traffic laws and police enforcement are effectively adjuncts for risk management to automobile insurance. Until we know better, the more effective route is to focus upon children and take a long-term view on salvation. In all likelihood the children will teach the adults. Focusing upon children includes young women before pregnancy and during pregnancy (a very special group in any civilization).

It would be highly productive to retool primary care as a specialty for preventive health care and a value added activity. Primary care "sick call" as it exists today has already been relegated to a low value activity. Redefining community health and creating a structure to manage community health is a component of this system.

If there is to be universal health insurance, let it start with prevention. The improvement of health status that results will change the health care system and the future of society as we know it.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - One Foot In Front of the Other

Thirty years ago, half of American children walked or rode bikes to school and today less than 15% will walk or ride bikes to school. Some of that decline is due to the conditions such as distance and lack of safe routes. One step to address this situation is the Safe Routes to School Program introduced by US Representative Jim Oberstar from Minnesota. The program calls for $100 million in 2006 to help states construct sidewalks, pedestrian crossings and bicycle parking, as well as slow down and reroute traffic near schools.

The State of Michigan and King County in (Seattle) Washington use land planning to promote healthy lifestyles and physical activity. Walkable communities provide suitable routes to walk and bike but they can go further and establish the necessity to walk or bike. Restricting vehicles with the exception of emergencies from the central city and in the vincinity of schools would be a good start. People need to walk in order to get from here to there. Otherwise, the excuses prevail.

Motion is lotion for the joints and the skin, and inactivity leads to rust. Physical activity is the Fountain of Youth that Ponce de Leon sought. He found it by treking around the countryside but did not recognize the discovery. American society has discarded walking in favor of creams, drugs and surgery. Nothing else exceeds physical activity for the broadest and most positive influence on metabolism and normal function of the body.

One foot in front of the other and soon you are there. It's called walking. Try it, you'll like it.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Everyday Health and Learning

Mayo Clinic and Dr. Levine again. This time they are testing a concept about classrooms. A chairless school with desks the children stand at and some learning technologies (iBook wireless notebook computers and iPods that play video) are the mechisms. The children, the teachers and the schools in Rochester have been eager to test the concept. They have had the assistance of business and organizations. Not only might this prevent or relieve the progress of obesity, it might improve the educational process.

The school districts of Greenville, Spartanburg and Pickens Counties in South Carolina have a project underway to promote healthy lifestyles and increase physical activity for kids. The project is called Zest Quest and it is conceived and directed by the Cliffs Communities with collaboration from the Cooper Clinic in Dallas.

These are innovative projects and we look forward to the results. Learning requires good health and good health is based upon learning.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Keep It Moving

Leave it to Mayo Clinic to take a common concept and elevate it to new status. My hat is off to
James Levine for advocating non-exercise activity thermogensis (NEAT). A very neat idea, indeed. He is correct that much, if not most, energy expenditure for individuals will be non-exercise activity.

Many people that I see have never taken a lick at a snake, or at least not for a long time. They need to start physical activity slowly and it is best if there is no indication of work or exertion. For kids and most people it helps if the activity is serves some purpose (get from here to there) or fun as in a game. Taking my hat off might qualify but gardening and dancing would be better. What is exercise but physical activity?

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - It Seemed Right At The Time

Only a fraction of our lifestyle decisions are concious thought. The unconcious mind is a powerful determinant of behavior. Habits, obsessions, addictions and social environments determine much of how people live. The greatest influence on health status is how people live. This is an important basis of primary prevention. Primary prevention and optimum health require placing the emphasis upon children. American society talks a good game about emphasizing the health of children but follow the money to determine what Americans are thinking. And, look at the incidence of obesity and type-2 diabetes for the results.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Hit List

Clear consensus and crisp decisions are difficult for many reasons. Insufficient data, differences in interpretation of data, emphasizing irrelevant data, differences of opinion, differences in experience and vested interests are some of these reasons. Yet, no decision is a decision and what you don't know can hurt you.

Based upon what you know and believe today, list the top five hazards to health. Here is my list:

1. Smoking
2. Inactivity
3. Reckless behavior (e.g., speeding, seat belts, alcohol, drugs, indiscriminate sexual activity)
   
4. Drinking sodas
5. Eating French fries
   

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Look Homeward Angel

Social environments influence behavior and behavior influences health status. Neighborhoods with high levels of social support have been found to play a role in crime and health problems relating to obesity among adults, including premature death and cardiovascular disease.

Deborah Cohen and her colleagues from the RAND Corporation identified neighborhoods in Los Angeles with the highest level of social support as those in which an above-average number of people surveyed said their neighborhood had the following characteristics: a close-knit community; adults who children look up to; people willing to help neighbors; neighbors who get along; adults who watch out to see that children are safe; neighbors who share the same values; adults who will take action if they see a child hanging out; adults who will do something if a youngster is defacing property with graffiti; and people who will scold a child showing disrespect.

Adolescents living in close-knit neighborhoods where adults provide social support are half as likely to be overweight or nearly overweight as other children. This was more important than the ethnic or racial make-up of the neighborhood, or the income of its residents. The RAND researchers suggested that new approaches to weight control might focus on fostering increased social interactions and more satisfying interpersonal relationships.

"Citing the potential for neighborhood groups to create a sports league or get a park for children to play in, Cohen said, together people can change their environment and make it healthy."

Amen, sister.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - Pogo Knows

The declining health status and escalating health care cost in America have stimulated many conclusions as to the cause of this situation. Analyzing these conclusions has become a national pastime. Solutions have been proposed but no solution has been found. Bernard Baruch is reported to have said that when shoe-shine boys begin giving stock tips, it is time to sell.

America's health care system gives new meaning to the law of diminishing returns. Perhaps some of the proposed solutions will relieve the situation. However, the greatest influence upon declining health status is lifestyle and that is a product of the culture. America has a culture that generates poor health and the health care system has no impact upon that situation, health insurance notwithstanding.

Of course, the relationship between culture and health has been recognized and dissected six ways to Sunday. Yet, one cannot help but feel the analyses and conclusions are superficial. The root causes of this complex issue are very basic and we may not want to know the answers.

What influence does the community have upon health status of the individual? How does the modern concept of privacy influence the sense of community and health status? What influence does subsidy, abundance and surplus have upon nutrition? How does political privledge contribute to subsidy, abundance and surplus? Is the quarter to quarter economic system the result of American psyche, an impact upon American psyche or both?

These are but a few of the thoughts that merit consideration. They can't be any more crazy than expanding the healthcare system as currently structured to cover everybody. Lifestyle is everything a person does all day, everyday and each bit of it influences health status. It was Pogo who said that he had met the enemy, and the enemy is us.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - NGA Wellness Where We Learn - State Initiatives

Previous posts have introduced and outlined the National Governors Association Healthy America initiative that was launched the weekend of February 25-26 at their winter meeting in Washington DC. Healthy America is supported by materials prepared by the Health Division of the National Governors Association Center for Best Practices.

Specific projects by states address each of the action items for governors. The list of projects is derived from materials supplied by the NGA Center for Best Practices. A project is listed only once even though it might apply to more than one action item. It is not a comprehensive list but it is representative. I hope you will be impressed with the momentum that is building at the state and local level to promote healthy lifestyles and prevent disease. The governors deserve our encouragement and support.

The reviews and analyses of twenty years of research were reported by Howard Taras in the Journal of School Health in 2005. This demonstrated substantial linkage between obesity, poor nutrition, physical inactivity and poor academic performance. Other studies have linked school performance with physical fitness and chronic health conditions.

The purpose here is not to further describe the problem but to list projects and efforts by states to find solutions and relieve the problem.

Wellness Where We Learn - Actions For Governors
Action 1: Encourage parental engagement in student health.

• Wisconsin Governor Jim Doyle released an educational guide for children and their parents designed to motivate parental commitment to nutrition and physical activity. It was mailed to parents in the state and distributed through schools and clinicians.
• Several of Iowa's schools allow children to use an electronic swipe card to purchase food from the cafeteria. Parents can monitor purchases via a website that also allows them to prohibit purchases of specific food items. This low cost tool has additional features, including the ability to track data for both individual students and entire schools, as well as eliminating some of the social stigma for low-income kids participating in free-linch programs.
• Coordinated Approach To Child Health (CATCH) in Texas is an alliance of parents, teachers, school staff, community partners and child nutrition personnel. Its objective is to teach children and their families how to be healthy throughout their lifetimes. The University of Texas Health Sciences Center at Houston developed the program, which incorporates a classroom curriculum, school nutrition guide and family activities to reinforce healthy behaviors.
  
• Texas requires school health advisory committees in elementary, middle and jubior high schools in each district and provides technical support for implementation through regional education service centers funded by the state. Parents must account for at least six of the 14 memberships seats of local councils.

Action 2: Conduct yearly assessments of individual student wellness.

• FitnessGram is a comprehensive health assessment tool that constitutes a child's age, height, weight and physical fitness by using measures such as sit-ups, push-ups and flexibility. Children can track their progress electronically and assess their fitness against national performance measures.
• Arkansas Governor Mike Huchabee signed a 2003 law that requires annual assessment of BMI for all school students. The BMI measure is reported to the students and parents, and a nongovernmental research group collects the data to assess the scores over time and by region.

Action 3: Promote regular physical activity during their school day.

• Michigan created a school-based program to help guide health policy changes, including strong recommendations of 150 minutes per week of physical education in elementary school and 225 minutes per week in middle and high school.
• In Minnesota's Red Lake District several schools serving Native American children have instituted regular physical activity, including a 20-minute walk every day. These efforts have been the most successful, when conducted during the school day.

Action 4: Support local school districts in efforts to develop healthy food policies.

• Pennsylvania contracted with Penn State University to survey the state's high schools about the presence of healthy foods and analyze the policy and financial impacts of their sales. The study results help Pennsylvania schools make informed decisions about their policies and schools can use examples from fellow schools statewide to find ways to improve student health.
• Orgeon public schools conducted a survey of soft drink contracts with schools. The analysis of the contracts found that incentives and revenues are more lucrative for vendors than they are for school districts, and result in less income per student than expected. The results pointed to some weaknesses in the contracting practices and opportunities for schools and districts to protect their funding streams while improving health options.
  See http://www.communityhealthpartnership.org.
• The Washington State Department of Health developed and disseminated a guidance document for assessing opportunities for wellness initiatives in schools and other settings. The guide provides program information from many public and private sector efforts and supplies tools for adopting wellness initiatives in schools.

Action 5: Use local chefs and farmers to offer attractive, healthier options for students.

• The New York City public school system hired a team of private sector professionals, including a professional chef to revitalize the menu offerings, the lunchroom environment and the business culture of the food service program. The new program relies upom a cadre of kitchen managers with local control using business model requirements for providing attractive, healthy menu options.
• The British Prime Minister recently announced a wholesale redesogn of the public school food system in the United Kingdom. Celebrity chef Jamie Oliver was a major friving force behind a nationwide initiative to completely revamp the food service program by making more healthy options available to every student each day.

This completes the series reporting on the National Governors Association meeting that presented their initiative for Healthy America. However, the work is just beginning and all of us will be needed to create Healthy America. Please let me hear from you with any ideas or additional local and state projects that should be added to the list. My email address is marcusnewberry@charter.com.

The Lifestyle Chronicles - NGA Wellness Where We Work - State Initiatives

Previous posts have introduced and outlined the National Governors Association Healthy America initiative that was launched the weekend of February 25-26 at their winter meeting in Washington DC. Healthy America is supported by materials prepared by the Health Division of the National Governors Association Center for Best Practices.

Specific projects by states address each of the action items for governors. The list of projects is derived from materials supplied by the NGA Center for Best Practices. A project is listed only once even though it might apply to more than one action item. It is not a comprehensive list but it is representative. I hope you will be impressed with the momentum that is building at the state and local level to promote healthy lifestyles and prevent disease. The governors deserve our encouragement and support.

Worksite wellness programs have demonstrated the potential to save millions of dollars in direct costs. Johnson Johnson's Healthy People Program estimates it saves $9 to 10 million annually from reduced medical untilization and lower administrative expenses. Citibank's comprehensive health management program saves $4.56 to $4.73 in reduced health care costs for every dollar invested in programming. Union Pacific Railroad's medical self-care program saves $2.78 for every dollar invested by reducing inappeopriate emergency room and outpatient visits.

Indirect costs of poor health can be two to three times the cost of direct medical expenditures. One review found indirect savings through reduced absenteeism and other health care costs resulting from worksite health promotion programs amounted to $3.50 for every dollar invested. Another review concluded that worksite health promotion programs, on average, realized a 28 percent reduction in absenteeism, a 26 percent reduction in health costs, a 30 percent reduction in workers' compensation and disability management claims costs, and a reported savings of $5.93 for every dollar invested.

Another concept of the total cost burden of poor health is "presenteeism", which refers to diminished on-the-job performance due to health-related problem(s). Unmanaged health issues such as allergies, depression, diabetes and asthma can significantly impair productivity when viewed cumulatively across an employee population.

A comprehensive wellness program consisting of health benefits, supportive workplace environment and personal accountability can improve employees' health management. Arkansas. North Carolina, Ohio and Virginia are examples of the few states offering more comprehensive models including data management, health risk assessment, risk reduction interventions, medical consumerism and disease management.

Wellness Where We Work - Actions For Governors
Action 1: Implement a yearly health risk assessment for all state employees.

• Arkansas Governor Mile Huckabee implemented a risk assessment program for employees and reduced insurance premiums $10 monthly for those who participated. Additional discounts are offered for adopting healthy lifestyles. Since beginning the program in 2004, 50% of the state's workforce have participated.
• Delaware Governor Ruth Ann Minner launched in 2003 the Health Rewards pilot study programs for state employees. Those enrolled in group health insurance programs were offered comprehensive health assessments, guidance and fitness prescriptions. Delaware realized more than $62,000 in immediate savings for the first 100 participants in the study.
• In Nevada, the Washoe County School District developed a wellness program with strong union support. Annually, each employee must submit a health assessment. Staff and retirees who do not submit their annual assessment contribute $40 per month to the wellness program. Employees must contribute an additional $10 monthly for each of their risk factors (e.g., smoking, obesity). Conversely, there are incentives for achieving health goals. Union leadership, employees and senior management have all been enthusiastic partners and participants in this effort. The program has been essentially self-funded by the incentive structure.
  

Action 2: Improve the "health" of state workplaces.

• Governor Mike Rounds initiated Healthy South Dakota that includes worksite-based policy changes such as smoke-free buildings and contributions to the health savings accounts of employees who enroll in the wellness program.
• The Centers for Disease Control and Prevention (CDC) piloted a worksite wellness initiative-called StairWELL to Better Health-that encourages employees to use the stairs rather than the elevators. The stairwells in the pilot building were carpeted and painted, and music was played during business hours. Small signs about the value of exercise were placed next to the elevators to encourage stair use. Most of these improvements were relatively low cost and the stair use greatly increased.
• Some states have instituted health and safety policies to encourage better health. For example, Arkansas and Wisconsin have banned smoking near or within srate office buildings.

Action 3: Provide access to health caoching and other preventive services for state employees and retirees.

• North Carolina Governor Mike Easley's HealthSmart program is built on the success of local pilot programs for disease management and wellness that identified employees with particular conditions and provide them with intensive health coaching on lifestyle changes and clinical disease management. From the local pilots state employees annually saved $22.5 million. Based upon those results, Governor Easley expanded the program to all employees in 2005.
• The City of Asheville, North Carolina initiated a diabetes management program that demonstrated improvement in controlling blood glucose levels; reduced direct medical costs and sick time; and showed $18,000 annual increase in productivity per employee with diabetes.
• Microsoft has conducted a number of programs to improve wellness among employees, including a coaching program for employees with a high BMI. The company also supports access to preventive services by charging no co-pays or deductibles for their use.

Action 4: Raise employee awareness and employee participation in worksite wellness programs.

• Under INShape Indiana, a comprehensive campaign to increase Hoosier wellness, Governor Mitch Damiels started an INnovators awards program to identify the "fittest" organization in the state. Governor Daniels will personally present awards to outstanding small, medium and large employers.
• Arizona Governor Janet Napolitano's Council on Health, Physical Fitness and Sports has raised the visibility of employee wellness throughout the state by awarding public, private and tribal organizations for successful contributions that improved health, fitness or recreation for all Arizona residents.
  
• Employees of the state of South Dakota receive $100 wellness incentive if they attain a personal health goal and $50 for participating in a health assessment.
  
• Some of the most popular state-sponsored programs encourages walking. Arkansas, Michigan, West Virginia and Virginia encourage physical activity through pedometer programs. Kentucky, New Mexico and Ohio encourage walking through statewide challenges and special events.
• The Work Well Program in Utah encourages state employees to exercise through a policy allowing workers 30 minutes of exercise, three days per week.
• South Carolina and Georgia have publically encouraged state health challenges.
• Michigan and Virginia provide walking trails for state employees around state campuses.

Action 5: Form coalitions and advisory groups across the public and private sectors.

• Oklahoma Governor Brad Henry uses an employee benefits council to guide benefit decisions for 36,000 active state employees. Representing the concerns and interests of state employees, the council has introduced incentive programs for employees to participate in physical activity and wellness check-ups.

The next posting will address state initiatives for Wellness Where We Learn.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - NGA Wellness Where We Live - State Initiatives

Previous posts have introduced and outlined the National Governors Association Healthy America initiative that was launched the weekend of February 25-26 at their winter meeting in Washington DC. Healthy America is supported by materials prepared by the Health Division of the National Governors Association Center for Best Practices.

Specific projects by states address each of the action items for governors. The list of projects is derived from materials supplied by the NGA Center for Best Practices plus a few of which I am aware. A project is listed only once even though it might apply to more than one action item. It is not a comprehensive list but it is representative. I hope you will be impressed with the momentum that is building at the state and local level to promote healthy lifestyles and prevent disease. The governors deserve our encouragement and support.

Wellness Where We Live - Actions For Governors
Action 1: Educate the public about existing community resources to raise awareness of services and opportunities.

• Arkansas-As part of the Healthy Arkansas initiative, Governor Mike Huckabee and several private sector organizations published the Better State of Health Guide Book to provide one comprehensive source of community resources for healthy eating, physical activity, physical education, smoking cessation and disease screening. The guide provides information on walking trails and various recreational activities throughout the state, organized by county. A Web site offers both English and Spanish versions of the guide in a format that is easily downloaded.
• Indiana-As part of INShape Indiana, Governor Mitch Daniels made information about community resources related to nutrition, physical activity and curbing tobacco use available on its website in a searchable database sorted by county. The state health commissioner hosted a series of regional summits throughout the state to identify innovative ways to address obesity and the lack of physical activity.
• North Carolina-Eating Smart and Moving More is a resource guide Governor Michael Easley funded to provide a curriculum on adopting healthier lifestyles for families in African American churches. Materials also include information on conducting training programs for local health promotion coordinators and their community partners. Color Me Healthy is a curriculum that integrates healthy eating and physical activity into child care. Head Start, WIC and elementary education funding used the Nutrition and Physical Activity Self-Assessment for Child Care (NAP-SACC) to assess and plan tailored programs for the curriculum, which reaches young children with consistent messaging across communities. The effort is complemented by 1-year grants awarded to 16 communities each year to improve nutrition and physical activity through policy and environmental changes.

Action 2: Partner with community organizations to communicate health information and encourage healthy lifestyles.

• South Carolina-To broaden health programs, Governor Mark Sanford entered into a partnership with the 7th Episcopal District of the AME Church, which reaches more than 275,000 South Carolinians through 600 churches in the state. Together with the State Department of Health and Environmental Control and the Medical University of South Carolina, Health-e-AME was created to host "praise aerobics", which combines gospel music with aerobic exercise; to promote healthier eating through an AME cookbook; to provide mobile prevention screenings for cancer, diabetes, hypertension, heart disease, sickle cell anemia and oral health; to provide information on local and state resources, such as hospitals, free clinics, dialysis clinics, hospice, home health agencies, county health departments and social services; and to offer healthcare and pharmaceutical assistance programs. Weekly health tips are given during worship services.
• California-To launch Get Healthy California: Governor's Summit on Health: Nutrition and Obesity, Governor Schwarzenegger partnered with the California Endowment, a foundation that seeks to increase healthy choices at the community level. The meeting convened business leaders, educators, public health experts and government officials to cultivate commitments for essential reforms to combat obesity in the state. During the meeting Governor Schwarzenegger received commitments from many private sector companies to pledge funds and resources for campaigns to increase healthy lifestyles.
• Massachusetts-Partnership for Healthy Weight focuses on policy and systemic approaches to increase healthy eating and physical activity. The partnership includes state departments of highways, parks and education; health advocacy organizations such as the American Cancer Society and the American Heart Association; health insurers; health care providers; public and private universities; the YMCA Alliance; and activity advocacy organizations-the Massachusetts Bike Coalition and the Massachusetts Rails to Trails. The partnership spurred efforts to provide healthier schools lunches; to promote after-school programs to combat obesity and physical inactivity; to incorporate nutrition and physical activities into programs for the elderly; and to increase awareness of the importance of physical activity and opportunities to be active.
• Arizona-The Obesity Prevention Program works with the Arizona Steps Along the Border Initiative (STEPS) to promote better health and prevent disease in border communities. STEPS cooperates with the state's Medicaid program to develop standards for providers to identify and manage childhood obesity. Arizona developed a program with WIC and the Arizona Nutrition Network to develop a portion size/healthy weight campaign that focuses upon parents and caregivers of children ages 5 years and younger.
• Michigan-Governor Jennifer Granholm's office worked with state leaders to plan land use patterns that use construction, revitalization, transportation and recreational spaces to encourage physical activity. The state also partnered with other organizations to develop a Safe Routes to School toolkit, which helps communities identify safe strategies to increase biking and walking to school. This innovative tool brings healthy land use planning to the neighborhood level, promoting community problem-solving and helping to change the cultural norm.
• West Virginia-The On the Move program collaborated with the West Virginia Main Street project to support "walkable communities", complementing several pilot projects that promote physical activity, including Physicians On the Move, Schools On the Move and Seniors On the Move.
• Rhode Island-The executive agencies developed recommendations in the state transportation plan to support safe pedestrian and bicycle transportation. The agencies partnered with the Rhode to Health Coalition to create a year-round walking program.

Action 3: Promote civic and personal responsibility for better health.

• South Carolina-Governor Mark Sanford and First Lady Jenny Sanford launched the Healthy South Carolina Challenge. The goal of the Healthy South Carolina Challenge is to increase South Carolinians' awareness of the association between physical activity, BMI statistics and smoking rates with rates of chronic diseases; to generate a competitive spirit among the counties in South Carolina for the creation of healthy changes and healthier lives; and to encourage collaboration and a sense of shared responsibility among different resources within the community. An award will go to the county that achieves the highest percentage improvement in its overall health and wellness as measured by percent change in BMI, smoking rates and physical activity. Fruit and vegetable consumption will be tracked for future years. Healthy Greenville is a county public health intervention project that is a challenge match with CardioVision 2020, which is a similar project in Olmsted County, Minnesota.
• Tennessee-Governor Phil Bredesen launched "Better Health: It's About Time," a public awareness program that supplies the guidance and tools for individuals to take charge of their health and track progress. Tennessee conducted a complementary multi-media effort called "Respect Your Health" that encourages behavioral change to reduce preventable chronic diseases.
• Washington-Governor Christine Gregoire encourages families and communities to adopt healthier lifestyles through the Governor's Community Health Bowl. In 2005, the Governor challenged residents to reach a statewide goal of walking one million miles over a five-week period. At the end of this successful challenge, the Governor joined school children walking up the capitol steps to reach the million mile goal.
• Arkansas-In 2005, Governor Mike Huckabee launched Changing the Culture of Health, challenging all citizens to shed pounds and be active while state agencies and counties devoted resources to changing the health culture toward wellness.
• Iowa-The Iowa Department of Health collaborated with Iowa State University Extension and Iowa Games to sponsor the third annual Lighten Up Iowa, a five-month weight-loss initiative based on improved nutrition and increased physical activity. Recognition and participation by Governor Tom Vilsack and other senior government leaders raised awareness of the program, which involved more than 19,000 Iowans in 2005.
• Missouri-Governor Matt Blunt's Council on Physical Fitness and Health collaborated with the statewide Council on the Prevention and Management of Overweight and Obesity to sponsor Shape Up Missouri, an eight-week fitness challenge among Missouri cities. The Governor has engaged over 22,000 participants and issues press releases to publically recognize winners of the competition.
• Indiana-As part of INShape Indiana, Governor Mitch Daniels launched the INnovators awards program to identify the "fittest" organization in the state. The INnovators program honors universities, counties, hospitals, religious congregations, large and small business, schools and state agencies that connect Hoosiers of all ages and incomes to state health and wellness resources.
• Arizona-Governor Janet Napolitano's Council on Health, Physical Fitness and Sports awards public, private and community organizations for successful contributions that improved health, fitness or recreation of Arizonians. Three categories are: Council Awards for corporations, government agencies, media professionals, schools and individuals who significantly improved the health and wellness of state residents; Mayors Awards for contributions by individuals or groups to physical activity among communities throughout Arizona; and Tribal Awards for individuals and groups that encouraged physical activities among tribes.
• Minnesota-Governor Tim Pawlenty's "Fit Schools" initiative recognizes schools that serve USDA-approved meals and provide numerous opportunities for students to be physically active. CardioVision 2020 is a project to prevent cardiovascular disease through personal commitment and community action for those who live and work in Olmsted County.
• Michigan-Governor Jennifer Granholm honors healthy communities that provide opportunities for residents to walk or bike.
• Vermont-Governor Jim Douglas annually honors large and small worksites that support access to physical activity and build a healthy workforce for Vermont. The awards have highlighted components such as pedometer-walking programs, fitness rooms and insurance benefits.
• Montana-The Montana Department of Health and Human Services works with child-care providers to reduce exposure to indoor air pollutants by children and staff. Child-care centers that voluntarily meet requirements receive a "Healthy Air Daycare" window display.
• Wisconsin-Governor Jim Doyle worked with Blue Cross Blue Shield Foundation of Wisconsin to distribute over 500,000 educational books on ways for parents to help their children lead healthier lives. The guide highlights the important role that family, realistic goals, nutrition and physical activity have in achieving good health. It includes a healthy-habit quiz to help families identify where to make changes in their lives, as well as nutritional guidance on creating healthier meals and recreational activities that parents and children can enjoy together.
• Colorado-Governor Bill Owens joined the Great Outdoors Colorado Board in announcing an unprecendented investment of $60 million in state lottery proceeds to preserve and create recreational areas for state residents. The state invested $48 million to preserve 80,000 acres of dramatic landscapes in the Laramie Foothills, Front Range Mountain Backdrop and San Juan Skyway. The remaining $12 million will develop two new state parks, trails and regional outdoor recreation areas.

Action 4: Improve access to healthy options in disadvantaged communities.

• Pennsylvania-Governor Ed Rendell increased healthy food options for thousands in low-income areas through the Fresh Food Financing Initiatives. The state leveraged grants and loans totaling $2.3 billion and entered public-private partnerships to build supermarkets, which have improved access to healthy foods and created 740 jobs.
• Hawaii-Health care providers, local produce farmers , chefs and Kaiser Permanente joined to provide fresh produce to a disadvantaged community. Each week a farmers 'market sells produce at little or no cost to the community. The health clinic holds weekly cooking demonstrations using food sold at the farmers' market and provides recipe cards for participants, as well as information on how nutritious diets and physical activity can improve health.
• Tennessee-Governor Phil Bredesen intitiated a program to enroll Medicaid beneficiaries with a BMI >30 in Weight Watchers. More than 700 Medicaid beneficiaries registered within 10 days at a discounted rate.

Action 5: Publicly share efforts by the governor's family to get and stay healthy.

• South Carolina-As part of the Healthy South Carolina Challenge, Governor Mark Sanford and First Lady Jenny Sanford promote physical activity with a yearly biking or kayaking tour. South Carolinians are invited to join the first family or engage in some other way as part of the Family Fitness Challenge.
• Georgia-Governor Sonny Perdue publically invited state residents to join him in his personal weight loss campaign. An estimated 2,500 residents participated in the six week effort, including workshops on selecting the best gear for sports, weight training, stress management and healthy grocery shopping techniques.
• Arkansas-Governor Mike Huckabee has lost 110 pounds and runs in marathons.
• Iowa-Governor Tom Vilsack runs marathons.
  

The next posting will address state initiatives for Wellness Where We Work.

Technorati Tags: lifestyle, health, prevention

The Lifestyle Chronicles - NGA Creating Healthy States

Creating Healthy States: Actions For Governors

Wellness Where We Live

1. Educate the public about existing community resources to raise awareness of services and opportunities.
2. Partner with community organizations to communicate health information and encourage healthy lifestyles.
3. Promote civic and personal responsibility for better health.
4. Improve access to healthy options in disadvantaged communities.
5. Publicly share efforts by the governor's family to get and stay healthy.

Wellness Where We Work

1. Implement a yearly health risk assessment for all state employees.
2. Improve the "health" of state workplaces.
3. Provide access to health coaching and other preventive services for state employees and retirees.
4. Raise employer awareness of and employee participation in worksite wellness programs.
5. Form coalitions and advisory groups across the public and priovate sectors.

Wellness Where We Learn

1. Encourage parental engagement in student health.
2. Conduct yearly assessments of individual student wellness.
3. Promote regular physical activity during the school day.
4. Support local school districts in efforts to develop healthy food policies.
5. Use local chefs and farmers to offer attractive, healthier options to students.
   

This action outline was developed by the the Health Division of the National Governors Association Center for Best Practices (NGA Center). The NGA Center helps governors and their key policy advisors develop and implement innovative solutions to challenges facing states.

The next postings will present specific actions of states that address each of these items.

Technorati Tags: lifestyle, health, prevention