Healthy Future US Blog

There were a number of good insights and promising strategies described in the Healthy Eating, Active Living special supplement of SSIR Summer 2019.    Yet the authors also admitted that child obesity and adult chronic diseases continue to grow. One key weakness of the social determinants of health (SDOH) framework is that there are so many challenging “determinants,” that scarce resources for change can get spread and diluted.   So we end up with good SDOH change anecdotes—while actual state & national health statistics worsen. To maximize impact, especially to reach the tipping point of actually reversing 40+ years of worsening health habits, we need to prioritize.   One highly promising “80/20” (and, yes, SDOH) strategy is through K-12 schools—literally with 20% of the US population, for 13 years, at just the right developmental stage to learn and change.   There are scalable, low cost, school-based strategies that dramatically increase fitne...

We meet them all the time:  people trapped in their job, in order to keep their health benefits.   We need a study on the negative impact on entrepreneurship and the economy from people health-handcuffed to their current jobs.  From my limited anecdoctal evidence, the costs are astronomical.   Two-income families have made the labor market much more geographically immobile, and now health insurance is exacerbating the job-jail. Modern Healthcare just summarized results of a new Peterson-Kaiser study  on employer health insurance and the actual cost to employee families, of the combination of employee share of premiums plus employee out-of-pocket health costs. Employers keep shifting more and more health costs to employees. The only good news is that employers are still paying a (fast-shrinking) % of premiums--so health costs are still cheaper than being self-employed.  [Also, if we end up back in the uncovered pre-existing conditions bad-...

The headline reads: Cancer Deaths Decline 27% Over 25 Years But the subheadline reads, rather ominously:  Improvement reflects reduced smoking but obesity could influence future projections Yes, indeed:  the American Cancer Society declares that obesity has ALREADY become the second biggest preventable cause of cancer, after smoking.  And the Mayo Clinic reinforces that with the slogan:  "Sitting is the New Smoking." We reached our highest cancer mortality rate in the early 1990s, following inevitably after our highest cigarette smoking rate in the early 1960s...        ...Yet we haven't even reached our highest child and adult obesity rates yet. So look for a big uptick in obesity-related cancer in the coming decades, as we continue to neglect to address the main obesity root causes: inactivity & unhealthy nutrition. We can pray for a miracle cancer cure to emerge in the meantime.  But we can also do something much more conc...

Sorry for another Downer but... The 3rd biannual Physical Activity for Children and Youth, 2018 US Report Card was published recently.  No surprise: the USA received a D- grade for overall child physical activity. One thing I like about these report cards, even though the data are imperfect and the bad news is daunting:  they get media attention.  Both Cronkite News and the local CBS and independent TV affiliate have contacted us about this so far. One of their initial takes: well, at least Arizona is more fit than most other states.  Boy, that is looking hard for a silver-lining in a very dark cloud. This Report Card measures fitness by % of children who are overweight or obese--using BMI: Body Mass Index.  This is not a great approach for measuring fitness. (We all know that kids--and adults--can be fit yet overweight, or unfit though normal weight.)  But BMI is a readily available proxy statistic that is roughly comparable across all states. ...

The New York Times  recently noted that popular economic statistics such as GDP and average wage growth are not capturing what is happening with many families.    In my view, we also need to regularly report net disposable income by class and quintile.  Net disposable income shows an even more accurate picture of why many working- and middle-class people are not “feeling the GDP growth love” personally.   The government (BLS) assembles the household wage & spending data needed to do this, but is not pulling it together and presenting it. Combining these shows long-term wage stagnation worsened considerably by higher health costs.  Not only are health costs hampering wage growth, as employees accept lower wage increases, in order to preserve their health benefits;  households are also using up those limited new wages in the form of higher deductibles & premiums.   ( See slides. )

Only 14% of US adults smoke now --compared to 42% just over 50 years ago. That's a 2/3 decline. Yet many of us think that we can't change Americans' unhealthy activity & nutrition habits. Why has smoking gone down so dramatically, while obesity & diabetes keep going up?  Well, we actually seriously tried, as a society & a political system, to reduce smoking.  We have not seriously tried to reverse obesity & diabetes. How did we reduce smoking so much?  Here is my grading of how poorly we are doing, at using strategies that worked against smoking--to fight inactivity & unhealthy nutrition: - Broad & profound awareness of seriousness of problem  (D) - Strong physical & health education programs in schools  (D) - Hard-hitting, pervasive public information campaigns  (F) - Very strong government health warnings  (D) - Large insurance premium discounts for healthy behavior  (D) - Cost-effective behavior cessati...

I get so tired of hearing this: "It costs less to buy a burger from McDonald's that to eat healthy food from the supermarket." "Low-income families just buy processed food, they don't cook their own food anymore." That always sounded questionable.  Here is a study showing in great detail that fast food is much more expensive than healthy food bought at the supermarket . Also, it turns out that the vast majority of meals eaten by low-income families are prepared at home: Blisard N, Stewart H. How low-income households allocate their food budget relative to the cost of the Thrifty Food Plan. Economic research report, United States. Washington, DC: Department of Agriculture, Economic Research Service, 2006;20. What is true is that buying healthy vs. unhealthy foods can cost $1.50/person/day more, at retail prices.  However, when health cost consequences are factored in, unhealthy foods cost twice as much .