Thompson

Opportunities and Challenges: Mapping the Future : 

Opportunities and Challenges: Mapping the Future Joseph W. Thompson, MD, MPH Surgeon General State of Arkansas Associate Professor UAMS Colleges of Medicine and Public Health National Association of State Boards of Education July, 2007

Who is one of the largest employers offering health insurance in your state? : 

Who is one of the largest employers offering health insurance in your state?

Arkansas Public School Employees / State Employees Health Insurance Plan : 

Arkansas Public School Employees / State Employees Health Insurance Plan Largest state-based insurance plan (~ 120,000 employees) Major state influence in plan design / payment structure / network development Self-insured plan with traditional benefit structure / Aging work force with chronic illnesses Three phased strategy undertaken: 1) Awareness – Health Risk Appraisal (2004) 2) Support – New benefit incorporation (2005) 3) Engagement – Healthy discounts (2006)

Self-Reported Risks : 

Obese 32% Daily Cigarette Users12% Physically Inactive 21% No Risks 11% O+P9% C+P1.5% C+O2% C+O+P1% HRA Respondents Eligible to Incur Claims (N=43,461) O = Obese P = Physically Inactive C = Daily Cigarette Use C7% O20% P 10% Self-Reported Risks Other Risks 39%

Average Annual Total Costs (Med + Rx) : 

Average Annual Total Costs (Med + Rx) Average cost for all HRA respondents eligible to incur claims $3,097 Average cost for those with no risks $2,382 Average cost for those with any of the three risk factors $3,427 Obese Daily Cigarette Users Physically Inactive

Annual Average Total* Costs Linked to Obesity : 

Annual Average Total* Costs Linked to Obesity *Includes medical (inpatient and outpatient) and pharmacy costs for 18-84 year old state employees. Total difference $1,297 (54%)

Average Annual Total* Costs Linked to Obesity compared with No Risk by Age Group : 

Average Annual Total* Costs Linked to Obesity compared with No Risk by Age Group $0 $1,000 $2,000 $3,000 $4,000 $5,000 $6,000 $7,000 $8,000 $9,000 $10,000 18-24 25-34 35-44 45-54 55-64 65-74 $1,382 $1,857 $1,991 $2,409 $3,266 $4,338 $4,522 (104%) *Includes medical (inpatient and outpatient) and pharmacy costs for state employees.

Slide 8: 

1998 Obesity Trends* Among U.S. AdultsBRFSS, 1990, 1998, 2006 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2006 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Act 1220: Arkansas Child and Adolescent Obesity Initiative : 

Act 1220: Arkansas Child and Adolescent Obesity Initiative

National Childhood Obesity Trends : 

NHANES data sources: Ogden et al. Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000. JAMA 2002;288(14):1728-1732. Ogden et al. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555. Percent Overweight US 6-11 yr US 12-19 yr 1963-65 1966-70 1971-74 1976-80 1988-94 99-00 01-02 03-04 National Childhood Obesity Trends

84th General Assembly Act 1220 of 2003 : 

84th General Assembly Act 1220 of 2003 Goals: Change the environment within which children go to school and learn health habits every day Engage the community to support parents and build a system that encourages health Enhance awareness of child and adolescent obesity to mobilize resources and establish support structures An act to create a Child Health Advisory Committee; to coordinate statewide efforts to combat childhood obesity and related illnesses; to improve the health of the next generation of Arkansans; and for other purposes.

Act 1220 Requirements : 

Act 1220 Requirements Establishment of an Arkansas Child Health Advisory Committee Vending machine content and access changes Physical activity / education requirements Requirement of professional education for all cafeteria workers Public disclosure of “pouring contracts” Establishment of local parent advisory committees for all schools Confidential child health report delivered annually to parents with body mass index (BMI) assessment

Arkansas Board of Education actions : 

Arkansas Board of Education actions Vending machines restricted until 30 minutes after lunch in all schools 12-ounce maximum beverage size 50% healthy options required No competitive foods in cafeterias Cafeteria food service education Nutrition and health curriculum changes 30 minutes per day physical activity (K-12) 2007 change to accept activities (9-12 grades)

AR Health Care Environmental Response : 

AR Health Care Environmental Response Local school, community and faith-based initiatives Development of first continuing medical education program for clinicians Regionalization of secondary and tertiary care (e.g., Fitness Clinic at AR Children’s Hospital) Elimination of fiscal barriers to reimbursement (Medicaid / SCHIP) Increased awareness of physical activity needs (Mini-marathon) Changes to built environment – world’s longest pedestrian bridge

Act 1220 Requirements : 

Act 1220 Requirements Establishment of an Arkansas Child Health Advisory Committee Vending machine content and access changes Physical activity / education requirements Requirement of professional education for all cafeteria workers Public disclosure of “pouring contracts” Establishment of local parent advisory committees for all schools Confidential child health report delivered annually to parents with body mass index (BMI) assessment

Child Health Report (2004) : 

Child Health Report (2004) Source: Arkansas Center for Health Improvement, Little Rock, AR, 2004.

Participation in Arkansas BMI Assessments (Grades K–12) : 

Participation in Arkansas BMI Assessments (Grades K–12) *Results include all data available for years 1, 2 and 3 for grades K–12 and data received by June 6, 2007 for year 4. Some public schools and districts merged after year 2. The most common reason students were not assessed for BMI was absence from school (of total reporting 6.3 percent in year 1, 7.6 percent in year 2, 6.7 percent in year 3 and 8.1 percent in year 4). Annually up to 6 percent of students or their parents refuse to participate. Data source: Arkansas Center for Health Improvement. Year Four Assessment of Childhood and Adolescent Obesity in Arkansas (Fall 2006–Spring 2007), Little Rock, AR: ACHI, September 2007.

Percentage of students classified as overweight or at risk for overweight by Arkansas public school district (’05–’06) : 

Percentage of students classified as overweight or at risk for overweight by Arkansas public school district (’05–’06) Source: ACHI. The Arkansas Assessment of Childhood and Adolescent Obesity—Tracking Progress (Year 3 Fall 2005–Spring 2006). Little Rock, AR: ACHI; September 2006.

Percent by Gender and Ethnic Group (2005–2006) : 

Percent by Gender and Ethnic Group (2005–2006) Data source: ACHI. The Arkansas Assessment of Childhood and Adolescent Obesity—Tracking Progress (Year 3 Fall 2005–Spring 2006). Little Rock, AR: ACHI; September 2006.

UAMS College of Public Health Evaluation of Act 1220 (2006) : 

UAMS College of Public Health Evaluation of Act 1220 (2006) Parents’ awareness of obesity-related health problems increased (1/3 recognized problem > 2/3) 95% of parents read some or all of the Child Health Report and 67% found the report helpful No feared consequences of BMI measurements Measureable change occurring: Families reducing consumption of chips, soda, sweets Younger children reducing soda consumption Teens reducing vending purchases at school Teens increased amount of physical activity No increase in physical education time Innovations in schools and communities across the state – taste tests in cafeterias, curriculum changes Parental support of improved cafeteria options Fay W. Boozman College of Public Health. Year Two Evaluation Arkansas Act 1220 of 2003 to Combat Childhood Obesity. http://www.uams.edu/coph/reports/Act1220Eval.pdf. Accessed 27 March, 2006.

National and Arkansas Childhood Obesity Trends : 

National and Arkansas Childhood Obesity Trends NHANES data sources: Ogden et al. Prevalence and Trends in Overweight Among US Children and Adolescents, 1999-2000. JAMA 2002;288(14):1728-1732. Ogden et al. Prevalence of Overweight and Obesity in the United States, 1999-2004. JAMA 2006;295(13):1549-1555.

2007 Legislative Actions on Obesity : 

2007 Legislative Actions on Obesity Enacted HB 1713: An Act to permit schools to count relevant school activities toward physical activity requirements. Act 201: Modification of periodicity for BMI assessment (every 2 years—K, 2nd, 4th, 6th, 8th, 10th grades) with standardized protocol and written op-out procedures adopted statewide Proposed but not enacted HB 1173: An Act to repeal the requirements that school districts must provide to parents an annual body mass index report on each student. SB 227: An Act to permit schools to sell vended products during academic school periods HB 1522: An Act to permit public schools to develop a policy allowing the use of candy and gum in the classroom.

What Next? : 

What Next?

Immediate Opportunities : 

Immediate Opportunities Align education, health, and financing options to support parents and communities in making change Update and expand school nutritional guidelines in accordance with IOM recommendations Incorporate financial coverage for childhood obesity SCHIP (reauthorization 2008)/Medicaid Rules & Regs “No Child Left Behind” education reauthorization Consider personal physical performance goals Local and state investments in food access, built environment, and multi-facet strategies for impact Consider Medicare’s future financial risk to support current prevention programs