Wednesday, July 14, 2010

Is Spending Stimulus funds on Fitness Initiatives Irresponsible?

Mayor Julian Castro recently announced that the San Antonio Metropolitan Health District had just received
$15.6 million in stimulus funds to improve fitness and reduce obesity in SA.  The funds are part of the Health and Wellness initiative backed by First Lady Michelle Obama and Health and Human Services Secretary Kathleen Sebelius.  There were 44 grants in all.  San Antonio's proposal is

To improve opportunities for physical activity, nutrition, and active living, the San Antonio Metropolitan Health District will work with community partners to expand the number of public facilities, including schools that are available for after-hours use for physical activity. San Antonio also will encourage city development projects to improve protection for vulnerable users, in accordance with Complete Streets recommendations. The project also will implement voluntary healthy food and beverage guidelines for local restaurants and will conduct trainings for education leaders to improve physical activity and the availability of healthy foods in schools.
This sounds good, but as my fellow blogger Albatross at Strange in San Antonio points out you can bring a horse to water but you can't make him drink.  As far as he is concerned this is a waste of taxpayer money.  If people really want to lose weight they can go outside and exercise and eat healthy food.  Everyone knows this, but many people don't chose to follow the recommendations.  His other complaint is how are these funds going to stimulate the economy.

So first, let's look at the facts.

On average the poorer the city the higher the obesity rate.  Slightly more than 18% of the population and 26.7% of children live in poverty in San Antonio, which means the poverty rate in SA is 1% higher than the state of Texas as a whole and 5% higher than the US poverty rate of 13%.  Poverty is associated with obesity because poor people usually live in areas where fast food is abundant but grocery stores are scarce (otherwise known as food deserts), fatty foods are less expensive and more energy dense (and tasty) than fresh produce and lean meats, school playgrounds either have no playground equipment or the playgrounds are surrounded by chain link fences, and playing or walking outdoors is discouraged because of safety issues, poor or no sidewalks and few if any nearby parks.  San Antonio has the added bonus of hot weather for about 5 months out of the year.   And a personal observation of my own, lots of people across all socioeconomic levels don't cook, either because they don't know how, they don't like doing it or they don't have time.

Here is a local example.  I was on Fresno at Blanco yesterday. The census tract for this area has an urban residential population of 7,619 and has lots of impervious ground cover that contributes to higher temperatures in cities. Today's temperature, (as of 1:19 pm taken at Thunderbird Hills about 5 miles away) is 97.5 degrees, the highest temperature listed on Weather Underground for SA. The persons living below the poverty level in this area is estimated to be about 24.2 % and the median household income for the area is just above $30,000.  (the US poverty threshold for a family of 4 is just over $22,000)

There are several fast food chains represented on the corner of Blanco and Fresno (MacDonald's, Tink-a-Tako, Burger King, Las Palapas) and a Culebra Meat Market that sells fresh meat, a little bit of produce and lots of packaged food.  Down the street about 1/2 mile is a La Fiesta grocery store.  In this week's ad, chicken drum sticks cost the same per pound as fresh peaches, and plums cost 20 cents more per pound.  Tomatoes and jalepeno peppers are 10 cents more per pound than the drum sticks.  There is also an HEB about 1/2 mile away in the opposite direction.  It's ad has similar pricing for produce and lots of processed food on special.

The nearest park is Kenwood Park, about 1/2 mile away, it has a pool, 2 playgrounds, athletic fields, basketball court, and a hard-surface trail.  The nearest elementary school, Rogers in SAISD, has no visible playground.  All of it's open space seems to be taken up by parking lots and portable buildings.  The nearest indoor recreation facility, Indoor Soccer Club, is about 3 miles away and costs $600 for men, and $450 for women and children to join a team, plus referee fees and the cost of an ISC approved team uniform.  So it appears that access healthy food and recreational activities is somewhat limited in this area.

The national Food Stamp program does make special provisions to use WIC funds to buy fresh produce, but this is only for pregnant women and children under 5.  The free lunch program also makes sure to include fresh produce, but as most moms will tell you, most kids would rather eat cereal (a daily item on the breakfast menu at South Side ISD) than an apple or an orange.

But wait, the HEALTHY study, sponsored by the National Institute of Diabetes and Digestive and Kidney Diseases, found that
a school-based program can help lower obesity and certain risk factors for type 2 diabetes in youth at high risk for the disease,” said Griffin P. Rodgers, M.D., director of the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK).
The intervention significantly lowered the obesity rate among children whose body mass index, or BMI, was initially at the 85th percentile or more. 

Researchers were surprised to find that the number of overweight and obese students had declined in comparison schools as well as program schools. “The decline in the number of overweight and obese children in comparison schools was a welcome but unexpected finding,” said study chair and lead author Gary D. Foster, Ph.D., of Temple University, Philadelphia.  “Future analyses will try to clarify the reasons for the improvement in these schools.  For example, we’ll look at the comparison schools to see if they made healthy changes to the school environment because of increased awareness about the problem of childhood obesity.”
So interventions in schools do work (six middle schools in SAISD participated in the study) , but families have to be involved as well. Right now San Antonio Sports is sponsoring the Fit Family Challenge.  They are trying to get 10,000 people involved in the free program and are offering prizes such as family vacations, $1000 in cash, free gym memberships, and free athletic shoes as incentives.  They also have free fitness events occuring throughtout the city.  The challenge started at the beginning of May and they are still accepting applications, but there's no data on how many people are actually participating.
But what about economic stimulus?

According to the Texas Comptroller's office, obesity cost Texas employers about $3.3 billion in 2005, and obesity levels have risen since then.  Health care, absenteeism, decreased productivity and disability all contributed to these expenses.  So, first off, if you save employers money, then they will have more money to hire workers.  Also healthier workers lead to higher production which also contributes to the bottom line.  So it appears that making people healthier will be good for the economy.

Many companies have started programs to increase fitness levels among their employees, switching their health benefits to encourage fitness programs.  This is great for people who work for these companies and have health insurance, but wait a minute, obesity rates are highest in low income areas where people are less likely to have health insurance.

But obesity doesn't just effect employer pocket books, it effects all tax payers.   According to the Texas Comptroller's office
an analysis of data from the 1998-2000 BRFSS found that, while 20 percent of the total U.S. adult population was obese, the adult Medicare and Medicaid populations were 20.7 percent and 29.6 percent obese, respectively. During the same period, 22 percent of all Texas adults were obese, while 20.7 percent of the state’s Medicare population and 35.8 percent of its Medicaid population were.
Medicaid, then, has a more obese population, and Medicaid costs for obesity, as a percentage of all Medicaid costs, are greater than for Medicare recipients or the total population. The percentage of Texas’ 2003 health care expenditures attributable to adult obesity in Medicaid (11.8 percent) was 73.5 percent higher than for Medicare (6.8 percent) and 93.4 percent greater than for the total population (6.1 percent).
In all, about half of the health care costs attributable to obesity fell under Medicare and Medicaid in 2003. Medicare and Medicaid recipients in the U.S. accounted for 52.0 percent of all obesity health care costs; in Texas, they accounted for 44.7 percent of all obesity health care costs.

So, is spending stimulus funds on obesity a irresponsible?

Reducing obesity rates would definitely improve our economy. Better access to healthy food, recreational activities, sports activities parks, bike routes and sidewalks could encourage physical activity and lower obesity rates, but here again motivation is key.

Remember back in the 1960's when it seemed like just about every adult smoked?  The government enlisted us kids to stop the smoking.  I remember being very anti-smoking in elementary school, to the point of throwing away cigarettes (and getting into trouble for it.)  And now the smoking rate among men is 30% lower.  (of course there was some legislation thrown in too.)  So what's the key to motivation:  youth indoctrination, better access to a healthy life style, and yes, probably some legislation (like the NYC transfat law) will probably all have to be used to get the obesity epidemic under control.

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