CCHPA Part 1

Harold Goldstein, DrPH
Executive Director
California Center for Public Health Advocacy
The Critical Role of Public Policy
in Keeping People Healthy
Lessons from Obesity Prevention

Promote the establishment of
public health policy at both the
State and local levels

OVERVIEW
1. Public Health Perspective
2. Key Role of Public Policy
3. Lessons from Obesity Prevention
4. Soda as Examplary

Medicine
historically
focuses on
individuals

PUBLIC HEALTH:
Healthy people
in healthy communities

Obesity Trends* Among U.S. Adults
BRFSS, 1985
No Data <10% 10%–14%
(*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person)

BRFSS, 1990
No Data <10% 10%–14%

BRFSS, 1995
No Data <10% 10%–14% 15%–19%

BRFSS, 2000
No Data <10% 10%–14% 15%–19% ≥20%

BRFSS, 2005
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

BRFSS, 2008
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Rates in California
1985 - 2009
ObesityPrevalence
8.9%
CDC, 2010

Obesity Rates in California
1985 - 2009
ObesityPrevalence
8.9%
24.8%
CDC, 2010

Childhood Obesity
Overweight among children
aged 6-19 increased nearly
4-fold from 1963 – 2000.

So What’s Happening?
Genetic change?
Less will power?
Less informed?
or
Have we built a toxic environment?

Junk Food is EVERYWHEREJunk Food is EVERYWHERE

Fast Food Restaurants
+ Convenience Stores

Grocery Stores

Grocery Stores + Produce Vendors

Grocery Stores + Produce Vendors
California: 4.18
Retail Food Environment Index

$10 BILLION IS SPENT ANNUALLY ADVERTISING
FOOD AND BEVERAGES TO CHILDREN IOM, 2005

Human beings are biologically hard-
wired to crave fat, sugar and salt

Cities are Designed for Cars,
Not People
Cities are Designed for Cars,
Not People

9.4
20.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
0 to 4 5 to 9 10 to 14 15 or more All U.S.
AdultsYears of U.S. Residence
%Obese(BMIof30ormore)
Kaplan et al. AJPM. 2004:27(4):323-6.
Adult Obesity Among Latino Immigrants,
1998

1998
9.4
14.5
20.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Kaplan et al. AJPM. 2004:27(4):323-6.

1998
9.4
14.5
21.0
20.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Kaplan et al. AJPM. 2004:27(4):323-6.

1998
9.4
14.5
21.0
24.2
20.0
0.0
5.0
10.0
15.0
20.0
25.0
30.0
Kaplan et al. AJPM. 2004:27(4):323-6.

“It is unreasonable to expect that people
will change their behavior easily when
so many forces in the social, cultural,
and physical environment conspire
against such change.”

Personal
Responsibility
OR
Collective
Responsibility

Personal
Responsibility
AND
Collective
Responsibility

Individual Behavior
or
The Environment

Individual Behavior
WITHIN
Public Policy
The Environment
The social, economic, and political
context in which we make our food
and activity choices
Public Policy

Major Public Health Movements
 Sanitation
 Worker Safety
 Clear Air / Clean Water
 Auto Safety
 Drunk Driving
 Lead Poisoning
 Violence Prevention
 Tobacco Control
 Obesity / Chronic Disease

Universal Lessons
 NOT only a matter of personal responsibility
and “more education”
 Social, cultural, and economic norms must
be changed so personal responsibility
can be more easily exercised
 Federal, state, and local policies play crucial
role

Major Public Health Movements
 Worker Safety: OSHA laws
 Clear Air / Clean Water: pollution stds
 Auto Safety: seat belts, airbags
 Drunk Driving: blood alcohol limits
 Lead Poisoning: lead out of gas/paint
 Violence Prevention: gun safety
 Tobacco Control: age limits, taxes, etc
 Obesity / Chronic Disease

CA School Food Reforms
(1999–2005)

SB 12
(K-12 Food Standards)
SB 965
(High School Beverages)
SB 19 (Nutrition Standards, 2001)
LAUSD (Soda, Junk Food, 2002-3)
SB 677 (Soda Ban, 2003)
All schools K-12
K-8
Pilot Test Standards
CA School Food Reforms
(1999–2005)

2007 - 2008
Give consumers the information
they need so they CAN make
healthy choices
MENU
LABELING

FOOD AWAY FROM HOME AS SHARE
OF TOTAL FOOD EXPENDITURES
United States (1929 - 2006)
1929 1956 1961 1966 1971 1976 1981 1986 1991 1996 2001 2006
20%
30%
40%
50%

Which Denny’s option has the least
calories?
Ham & Cheddar Omelet 595 cal 36%
Country Fried Steak & Eggs 464 cal 11%
French Toast w/ Syrup & Marg 1,003 cal 15%
Pancakes w/ Syrup & Marg 650 cal 29%
Field Poll, 523 registered voters, April 2007

 Research to support the policy
 Extensive media coverage
 Powerful coalition of supporters
 Extraordinary legislative champion
 Tipping point of local efforts
Classic Public Health Advocacy
Campaign

Surgeon General on Smoking: 1964
“…cigarette smoking contributes substantially
to mortality from certain specific diseases
and to the overall death rate.”

Per Capita Cigarette Consumption
1955-2002
Numberofcigarettes
1964
5,000
4,000
3,000
2,000
1,000
1955 1970 1980 1990
2002
US adults (18+ years)

Tobacco Policies
 Smoke-free schools, workplaces
 Extensive K-12 education
 Health care sector participation
 Advertising restrictions
 Warning labels
 Tobacco taxes (CA Prop 99)
- funding state/local programs
- anti-tobacco ads

Surgeon General on Diet: 1988
“…over consumption of
certain dietary compo-
nents is now a major
concern for Americans.”

“Overweight and
obesity have reached
epidemic proportions
nationwide.”
Surgeon General on Obesity: 2001

Overweight Prevalence*
1980-2000
* US adults (18+ years)
1980 1990 2000
PercentOverweight
20%
40%
60%
80%
1988

If these problems go unchecked:
The long term consequences
will be staggering

“ We need very big
PUBLIC POLICY CHANGES
to stop diabetes and obesity from
ruining our young people.”
Newt Gingrich
Tavis Smiley Program, NPR
June 11, 2004

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