Workplace Wellness, Part II

By Greg Cook, HCP Associate

Most employers realize healthy employees are better for the bottom line. The question then becomes how to achieve a healthy workforce without bankrupting the company. Another question is how to make the effort attractive to workers. And a third question is what laws exist—or might exist—to help companies implement these changes to complement other areas of public health policy.

One preliminary task is settling on definitions. At least four different terms are used for this area of wellness: workplace, worksite, workforce, and employee. The first two emphasize the place where people work, while the second two terms refer to the people at the place. The two different emphases should be seen as complementary, not opposed. Workplace and worksite mean that many of these services are delivered on-site (and can be associated with occupational safety considerations in some cases); workforce and employee refer to the human component of a business instead of the infrastructure. But what does a wellness plan entail? The American Heart Association has a succinct sketch of basic components: “a comprehensive program should encompass tobacco cessation and prevention, physical activity, stress management/reduction, early detection/screening, nutrition education, weight management, and cardiovascular disease prevention.” Other aspects that might be included are “back pain prevention and management, adult vaccination, alcohol and substance abuse assessment, maternal and infant health education and guidance regarding effective use of the health care system.” The ongoing sluggishness in the private sector and budget shortfalls in the public sector mean funds for workplace wellness can be hard to come by. The federal health care law includes provisions such as tax incentives to help businesses implement wellness programs. Here in Washington, some further policy options might include: providing state B & O tax credits for smaller employers offering workplace wellness activities; developing a workplace wellness materials (language) translation center; and, urging WA’s congressional delegation to push for faster implementation of federal health reform provisions that support workplace wellness programs.

Some beneficial changes could happen at the internal level. One simple change involves re-considering food and beverages served at meetings. The CDC has these suggestions for offering healthier foods. Another element to consider is shifting how food is presented in cafeterias. The New York Times recently had an interesting interactive graphic of how this could work. (The example is for a school lunch line but could be adapted.) Grocers and other retailers have long known that shelf location is an important element in marketing and consumer choice. Advocates of this approach call for a level playing field for healthy foods.

The Healthiest Communities Partnership (HCP) is a state-wide private-public effort to identify and promote public policies in workplace wellness and other areas. HCP hopes to make healthy choices the easy choices. For more information on HCP, click here.

Workplace Wellness 101

By Greg Cook, HCP Associate

Do workplace wellness programs work? Are they worth the investment by employers? Do employees make full use of them? And what are the goals of workplace wellness? These are the questions U.S. employers, unions, policy makers and public health researchers are asking. Thankfully, there are answers based on solid evidence and rigorous study.

A benchmark for this field is the Health Affairs study published in January of this year. (For a link to an abstract of that article click here.) The authors surveyed published studies in the field and came to this conclusion: “medical costs fall by about $3.27 for every dollar spent on wellness programs and that absenteeism costs fall by about $2.73 for every dollar spent.” They do caution that “[a]lthough further exploration of the mechanisms at work and broader applicability of the findings is needed, this return on investment suggests that the wider adoption of such programs could prove beneficial for budgets and productivity as well as health outcomes.” This is the kind of bottom-line proof hard-pressed employers need in order to make decisions that will not hurt their finances and benefit their greatest resource—their employees. Workplace wellness programs are also good news for the field of public health. Researchers in Washington state have laid out the case for such programs as beneficial to both employer and employee and an important part of overall public health strategy.

However, evidence also provides another truth about workplace wellness programs: They need to be targeted and they need to be implemented with thought and attention to the needs of the employer, workplace, and workforce. A study sponsored by the non-profit National Institute for Health Care Reform (NIHCR) shows that there are better and worse examples of implementing these programs. (NIHCR is a joint effort of auto-makers and unions; to see the study click here.)

The broader business community has already done work in this area. For instance, the U.S. Workplace Wellness Alliance—co-chaired by the U.S. Chamber of Commerce and the Partnership for Prevention—has formulated proposed policies based on scientific research and the needs of businesses. (For a link to USWWA’s website click here.) The Healthiest Community Partnership (HCP) is beginning this work in Washington. HCP is a public-private partnership committed to policies to roll back chronic disease often connected to smoking, nutrition, and lack of healthy physical activity. For more information on HCP, its members, and its goals, click here.

References:

Baicker, Katherine, Cutler, David, & Song, Zirui. (2010, Jan. 14). Workplace wellness programs can generate savings. Health Affairs. Accessed on 11/15/2010 at http://content.healthaffairs.org/cgi/content/abstract/hlthaff.2009.0626v1.

Harris JR, Lichiello PA, Hannon PA. Workplace health promotion in Washington State. Prev Chronic Dis2009;6(1). http://www.cdc.gov/pcd/issues/2009/jan/07_0276.htm. Accessed 11/15/2010.

Tu, Ha T., & Mayrell, Ralph C. (2010). Employer wellness initiatives grow, but effectivenessvaries widely. Accessed at http://www.nihcr.org/Employer-Wellness-Initiatives.html on 11/15/2010.

U.S. Workplace Wellness Alliance. The business case for investing in worksite health promotion. Accessed at http://www.uswwa.org/portal/uswwa/case/default on 11/15/2010.

Private, Public Agree on Benefits of More Fresh, Local Food

By Greg Cook, WHF Associate

This October grocery giant Wal-Mart Stores announced a comprehensive plan to bring more locally-produced foods into is supply chain and on its shelves. Wal-Mart’s position is that this move will help food producers around the world and offer fresh foods to more people. As part of the move, Wal-Mart will provide a “sustainability index” for consumers to use to help make choices between similar products. This plan is one more endorsement of thinking about health, nutrition, and local food producers, with the added feature of “scaleability,” meaning that, due to Wal-mart’s ability to manage its procurement and supply on a vast scale, locally-gown foods may become available to a wider population. Critics of the growing local food movement have pointed to distribution and marketing difficulties, but Wal-Mart’s new emphasis in this area could be a game-changer. As “the world’s largest grocer” (according to The New York Times), Wal-Mart’s commitment to buying and selling locally-grown food and investing in growers sends an unmistakable signal to others in the grocery sector.

Wal-Mart’s new focus could bolster efforts in Washington to promote agriculture across the state and offer healthier choices to our state’s residents. This state is fortunate to have The Access to Healthy Food Coalition, a group of private and public partners looking at how food gets to people and how that process can be improved, as well as improving the quality of food while also supporting Washington farmers. Earlier this year, the coalition issued a report on the subject: Opportunities for Increasing Access to Healthy Foods in Washington (click here for a link to that report). This report attempts to show many of the ways healthy food makes its way onto the plates of Washingtonians.

When private and public forces connect to overcome barriers and increase the supply of healthy local foods, families, businesses, and institutions can then work on ways to make healthy choices (such as selecting nutritious foods) the easy choices. That is a cornerstone of the Healthiest Communities Partnership’s (HCP) approach. HCP is a private-public partnership bringing together businesses, philanthropies, non-profits, community groups, and government to craft policies fighting back against chronic diseases and making Washington a healthier state. For more information on HCP, click here.

Community Members Volunteer to Get Kids Excited About Fitness

By Greg Cook, WHF Associate

For children, the journey to fitness begins at home but continues at school. And for some Seattle kids, that means walking to and from school. Kids in the Phinney Ridge area have been joining together since 2005 to make the trip to school as part of a “walking school bus.” This effort relies on parent volunteers to ensure everything runs smoothly. Participants say they enjoy the exercise and interacting with others as well as getting exercise. The lack of exercise and corresponding decline in the health of many school-age children has worried observers in the health care sector, business, and even the military. According to The New York Times, a panel of retired military officers reports that an alarmingly high number of armed forces recruits fail basic physical fitness tests.

Thankfully, the message that our children need better exercise and nutrition habits is being heard across Washington state. In Pierce County’s Edgewood, for instance, students at one school participate in a voluntary fitness program with lessons about good nutrition. Program founder Ladd Wolfe says that he sees many of the participating children go on to keep up their healthy habits. The U.S. Department of Health and Human Services (HHS) has published a guide entitled “Promoting Physical Activity and Healthy Nutrition in Afterschool Settings” with strategies and suggestions “to reverse childhood obesity trends by promoting healthy lifestyles for children and youth.”

The Washington Health Foundation’s Healthiest Communities Partnership (HCP) applauds these efforts as a solid first step to roll back the spread of chronic diseases in our state’s communities. HCP is a public-private partnership seeking to promote policies that will contribute to making our state the healthiest state in the nation. Policy advocates from business, health care, philanthropies, and non-profits, together with the Washington State Department of Health, will be convening to shape an action agenda to help our children, our workforce, and our families and communities in the fight against chronic diseases. For more information on HCP and this effort, click here.

Public Procurement of Food and Healthy Communities

By Greg Cook

Public purchasing by institutions such as schools and hospitals is big business. It is also a crucial part of strategies to roll back increasing levels of chronic diseases.

Leaders from both the public and private sectors have begun to consider the role public procurement of food plays in nutritional health among populations of students and others fed through publicly-funded means. The Kaiser Permanente Institute for Health Policy (IHP) puts it this way: “The food system is a key pathway to individual, public and global health—above and beyond basic nutrition.” Re-assessing the procurement process can have many benefits, including improved nutrition for consumers, reduction of public health scares involving pathogens such as salmonella, decreased pollution, and a decrease in health inequalities for at-risk populations and minorities.

Companies in the private sector are showing some ways in which procurement can be re-thought. Walmart has been making efforts to purchase more locally-sourced and organic foods. Chipotle Mexican Grill is guided by its corporate philosophy of “food with integrity” in reaching outside the existing supply chain to buy humanely-raised and drug-free meats.

There is also movement in the public sector. Washington State has instituted a farm-to-school food program that encourages schools to purchase food from nearby producers. Another aspect of this program is a set of pilot projects at state prisons to serve food grown by inmates.

Current issues of procurement arise, ironically, from past success in standardizing and efficiency. The massive scale of much procurement has led to small and/or local suppliers being shut out of the process. The growth of huge supply chains has also interacted with fluctuating transportation costs.

The Healthiest State Campaign and the Washington State Department of Health are working to bring together concerned private and public advocates from business, philanthropies, non-profits, and government to talk about ways to improve the public procurement process and work on other issues. This Healthiest Communities Partnership seeks to enlist interested partners from throughout the state to make our state a healthier state and our communities healthier places to live, raise families, and do business.

For more information on the Healthiest Communities Partnership click here.

After the School Day

By Greg Cook, WHF Associate

For far too many students across our state, the end of the school day means the start of problems such as overeating, lack of exercise, excessive media exposure, and use of tobacco products. All these negative behaviors can lead to health problems among our young people—tomorrow’s leaders, work force and defenders. But there are efforts underway in both the private and public sectors to push back against unhealthy trends and ensure Washington communities are places fro healthy kids.

Last month in Tacoma, the Boys and Girls Clubs opened the Donald G. Topping Regional HOPE Center, a place for children to learn and play outside the school day. The HOPE Center, along with a new East Side satellite branch and existing facilities, offer opportunities for youth to get after-school tutoring and enrichment, participate in healthy physical activity, and take advantage of the presence of trained listeners. HOPE was funded in large part by private philanthropies and businesses: “the Ben B. Cheney Foundation, the Gary E. Milgard Family Foundation, and. . .Tacoma businessman Henry T. Schatz (and his General Plastics Manufacturing Co.) and the late Donald G. Topping,” according to The News Tribune.

In the public sphere, the Department of Health and Human Services (HHS) offers its afterschool.gov site to bring together resources for after school programs. It offers guidance on setting up and running after school programs, activity ideas, resources, and links to related topics and non-governmental organizations. The HHS site includes state by state information as well as reports; the WA page can be found here.

The Healthiest State Campaign together with the state Department of Health is working to promote a statewide private-public partnership that may identify positive after school trends as part of the Healthiest Communities Partnership. The partnership aims to make healthy choices the easy choices across Washington.

For more information on the Healthiest Communities Partnership, click here.

Community Gardens as Antidotes to Isolation

By Greg Cook, WHF Associate

Across the nation, more and more people are re-discovering gardening. Some do it to become self-sufficient, while others are concerned about food coming from far-away places. Neophyte gardeners are learning about planting, maintenance, harvesting, nutrition, and preservation. A related trend is the rise in community gardening. Networks of neighbors are pitching in to make vacant spaces in the urban landscape sources of bounty for families and individuals. Sometimes these community gardeners get assistance in the form of small grants, in-kind services or technical advice/expertise from municipalities and/or non-profits.

An example of that in our state is Tacoma’s 2010 initiative to help community gardens throughout the city. Tacoma partnered with The Tacoma-Pierce County Health Department, Pierce Conservation District, and Cascade Land Conservancy to hire a full-time community garden coordinator. A column from The News Tribune tells some of the story behind that position what it entails. Coordinator Kristen McIvor reports that there is widespread enthusiasm for the gardens, but not just for the obvious reasons. While growing nutritious local food would be an obvious result of the gardens, for many community gardeners “getting to know their neighbors” was important, McIvor said. That anecdotal evidence reinforces research that isolation has an impact on individuals in our society. Community gardens are a way for people to voluntarily get together to accomplish a common task and build local bonds of trust and cooperation while engaging in healthy activity.

An example of the possible links between isolation and chronic diseases comes in the field of immigrant health. Public health workers have found that many immigrants are in good health when they arrive in the U.S., but that their health can often decline as they live here and become acculturated in their communities if residence. Researchers believe one reason for health declines is the stress on family life and social networks. Immigrants typically come from vibrant families, but long hours of work fray those connections. In the film “Unnatural Causes,” one girl tells that when her family lived in Mexico, her mother was at home when the children returned from their school day. But in the U.S., her parents work long hours to support the family and arrive home hours after their children. Fortunately for that family, their community offers a welcoming place for children to come for recreation and tutoring after school. Many school-age children do not have healthy alternatives.

The Washington Health Foundation and the state Department of Health are reaching out to the private and public sectors to look at these issues and join together to fight chronic disease across Washington. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

Good News for Employee Wellness Programs

By Robin Brown and Greg Cook, WHF Associates

Cost-conscious employers looking to help their employees and be more productive may find that investing in workplace wellness is one piece of the puzzle. Earlier this year Bloomberg Businessweek reported on a new study unveiled at a meeting of the American Heart Association's Nutrition, Physical Activity and Metabolism Conference. That study showed promising results for “a voluntary 12-week, team-based wellness program that focused on diet and exercise.” A growing number of studies show that workplace wellness—when correctly targeted, planned, and managed—can help employees attain better health and employers see lower rates of absenteeism.

Another piece of good news on this front is the inclusion of workplace wellness funding and incentives in the federal Patient Protection and Affordable Care Act. The largest benefits for small businesses in terms of wellness programs come from the authorization of grants to be issued for up to five years for small businesses (defined as businesses employing under 100 workers that are working over 25 hours each week) to create new, comprehensive workplace programs. Eligible businesses are those that, as of March 23, 2010, did not already have workplace wellness programs in place. Such programs must include health awareness initiatives, efforts to expand employee participation to the highest degree possible, programs such as counseling and self help programs that promote healthy lifestyle choices and discourage unhealthy choices. Programs must also take place in a work environment that is considered supportive due to policies that promote healthy choices.

An additional change that comes under this bill requires the CDC to provide businesses of all sizes with resources in the form of technical help, tools, and consultations that will help the employers assess their wellness programs. A nationwide assessment of wellness programs will also be undertaken by the CDC and will result in recommendations to congress for guidelines for the most effective means of implementing employee wellness programs. Finally, the bill allows for an increase in incentives employers can offer for participating in wellness programs and for meeting health goals. It increases the amount from twenty to thirty percent of the cost of coverage and provides that these incentives can be offered as rebates or discounts. This amount may eventually be raised to fifty percent after a study is conducted by the Secretaries of Labor, Health and Human Service, and the Treasury. In the case that employees are at a particular disadvantage for meeting the health goals an alternative standard must be offered.

Encouraging workplace wellness is one more way that healthy choices can be the easy choices. The Healthiest State Campaign in collaboration with the Washington State Department of Health is bringing together a public-private partnership to promote ways to fight chronic diseases across the state. For more information on the Healthiest Communities Partnership, click here.

Chronic Diseases and Minority and Low-Income Communities

By Greg Cook, WHF Associate

Chronic diseases are found in all groups of people of all different races and income levels. However, minority and low-income groups represent a disproportionate number of those suffering from chronic diseases linked to poor nutrition, lack of physical activity, and tobacco use. The federal Centers for Disease Control (CDC) and Washington State are both addressing the health disparities found in minority communities.

Now local efforts to improve health within minority communities seem to be bearing fruit. The REACH coalition of Public Health—Seattle and King County has been working to reduce levels of diabetes in high-risk communities. The Seattle Times reports on one Mexican restaurant owner who—concerned for both his personal and community health—worked with REACH to provide a healthier menu for his patrons. Growing awareness of the costs of chronic disease among minority communities and business owners coupled with technical assistance from local public health experts is proving to be a winning combination in reducing health disparities and improving health for all of our state’s residents. Restaurant owner Ramiro Rubio recognized the possible took advantage of public health’s nutritional expertise to use more healthful ingredients to replace some of the less-healthy starches and fats. He and a nutritionist worked together to balance concerns about elements like flavor, amounts of carbohydrates, and traditions such as chips and salsa on every table. Rubio is trying to make a small contribution to the health of his community while acknowledging the deep rootedness of food habits within a culture.

Foods once considered “ethnic” are moving into the mainstream. One example of this trend is the fast-growing national chain Chipotle Mexican Grill, which operates on a “food with integrity” philosophy to serve its customers locally-sourced and nutritionally sound products. Chipotle has gone outside the standard mass-procurement model to locate and work with producers of meat, poultry, and other foods who eschew the industrial style models that prevailed for decades. Leaders in the effort to get a broader range of healthy nutritious foods to the public and especially populations in public institutions are considering alternative methods of food procurement.

Minority and low-income communities may be especially prone to chronic disease due to lack of access to a full range of nutritional food and healthy activities. The CDC’s approach to pushing down chronic disease takes into consideration those factors and uses a range of “MAPPS” strategies: Media, Access, Point of decision information, Price, and Social support/services. The Washington Health Foundation (in collaboration with the Washington State Department of Health) is guided by MAPPS in its Healthiest Communities Partnership, a public/private partnership to reduce chronic disease across Washington state and throughout all its communities.

To find out more about the Healthiest Communities Partnership click here.

Smoking Cessation Efforts for American Indians in Washington

By Coral Sisk, WHF Associate

More than 160,000 people in Washington State identify themselves as American Indian or Alaska Native. While some are members of the 29 federally-recognized tribes and live on reservations across Washington, approximately two-thirds live in or near cities such as Seattle, Tacoma, and Spokane. In Washington roughly one third of American Indians smoke commercial tobacco [1]. They also suffer from chronic diseases, such as cancer, diabetes and heart disease, at a much higher rate than the general population [2].

Tobacco cessation and prevention programs are effective and important ways to reduce the rates of chronic disease. Currently, American Indian communities across Washington are receiving funds from various sources to help them develop effective and sustainable tobacco prevention programs. These include:

• The Washington State Tobacco Prevention and Control Program, administered by the Department of Health, is currently providing $635,000 to 19 tribes, the Seattle Indian Health Board, and the American Indian Health Commission to reduce commercial tobacco in American Indian communities.
• Tribes operating gaming casinos in Washington State are required by gaming compacts to provide a percentage of their revenues on smoking cessation and prevention. For 2009 and 2010 combined, tribal casinos used over $3 million to groups around the state to discourage tobacco use. Approximately 70 percent of these funds were distributed to support Tribal smoking cessation and prevention efforts [5].
• The state Department of Health received federal stimulus funds to help addictions and mental health treatment centers to integrate tobacco cessation into their treatment plans and create tobacco free facilities. Many of the treatment centers receiving this training and technical assistance serve tribal and urban Indians [4].

The Healthiest State Campaign with help from the Washington State Department of Health is reaching out to American Indian and other communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

Sources:

1. Washington State Department of Health Tobacco Use Statistics: http://www.doh.wa.gov/tobacco

2. Northwest Area Indian Health Board Statistics: http://www.npaihb.org/programs/project/nttpn_data_statistics/

3. Indian Country Today News: http://www.indiancountrytoday.com/living/health/80266097.html

4. U.S. Dept. of Health & Human Services: http://www.hhs.gov/news/press/2010pres/02/20100205a.html

5. Washington State Gambling Commission: http://www.wsgc.wa.gov/agendas/archives/2010/jul_tribal_contributions_presentation.pdf

Quality School Physical Education Leads to More Active Kids

By Adam Nelson, WHF Associate

According to Washington State standards, students in grades 1-8 must participate in 100 minutes per week of Physical Education (PE). But a 2009 study by the University ofWashington Center for Public Health Nutrition says that the average 7^th grader takes part in 50 minutes per week of PE, and only 7 minutes of aerobic activity per PE class. Improving the quality of physical education by maximizing the quantity, enjoyment, knowledge and physical abilities for youth, is an important step toward increasing the overall physical activity children level of children in Washington.

There has been innovation in PE coming from the private sector. One company, HOPSports, developed a system to improve the quality of physical education that is now used at three sites in Washington including Camas High School. To improve traditional PE, HOPSports system is a pre-package set of video PE lessons, tailored to meeting national physical education standards. The PE teacher can choose videos based on their goals for specific lesson plans. In addition to lessons which lead students through a 10-30 minute exercise routine, the warm-up videos provide health education on topics of anti-smoking, nutrition, and the environment.

A 2008 case study of 16 North Carolina schools that implemented the program found that compared to traditional PE courses, physical activity class time increased by 45 percent, student enjoyment of PE increased significantly, and students' intent to be physically active outside of class also increased. By implementing fun innovative ways to engage a broader base of students, it makes sense that children will be more physically active.

Programs like HOPSports and SPARK are just one way to increase the quality of physical education in Washington. Moving forward on PE is only one reason the Healthiest State Campaign is teaming up with the state Department of Health to promote a new public/private Healthiest Communities Partnership. We want to make healthy choices, like regular physical activity, the easy choices in our state.

To learn more about the Healthiest Communities Partnership, click here.

Second-hand Smoke

By Coral Sisk, WHF Associate

Research on secondhand smoke exposure shows that carcinogenic compounds enter the bodies of non-smokers and can increase their risk for chronic disease [1]. Washington State has adopted tobacco bans in public spaces such as restaurants, bars, and workplaces in order to limit second-hand smoke exposure. Now an increasing number of people are demanding that they have the same protection from secondhand smoke in their homes. Many people living in apartments have chronic health conditions like asthma and suffer serious problems when even small amounts of smoke drift into their units. Apartment and condominium owners around the state are creating no-smoking policies for their multi-unit housing complexes. These policies protect people from smoke drifting into their homes while they reduce cleaning costs and risks from fire damage.

In addition to protecting non-smokers, restrictions on where people can smoke is an evidence based, public health strategy for reducing tobacco use. By limiting smoking in public spaces, tobacco use becomes more inconvenient. In 2010, smoking has become less socially desirable and less acceptable than in the past. There is strong public support for keeping secondhand smoke away from vulnerable populations such as children. By cutting down on the amount of smoking and limiting exposure to secondhand smoke we are helping Washington move up the healthiest state index.

The Healthiest State Campaign with help from the Washington State Department of Health is reaching out to communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

Reference:

1. Second Hand Smoke: Questions & Answers:

http://www.cancer.gov/cancertopics/factsheet/Tobacco/ETS

Can We Transform WA Into a Blue Zone?

By Greg Cook, WHF Associate

Can you imagine a community where hardly anyone suffers from chronic diseases such as diabetes? A place where heart disease is a thing of the past and the smell of tobacco smoke is unknown? A location where you and your neighbors expect to live well past the average life expectancy? Such places exist in the real world, and scientists studying health and longevity have a name for them: “Blue Zones.”

Blue Zones (the title of a book) have been identified in several locations around the world. Life in a Blue Zone includes healthy eating, plenty of daily movement, and a positive outlook on life. Now there are efforts underway to replicate Blue Zones in other places. One such pilot project is underway in Minnesota, as reported on in an August, 2010 edition of U.S. News & World Report. So far, the results are promising, with increased rates of walking, a shift to better eating habits, and numerous stories of weight loss.

Could communities across Washington state become Blue Zones? There are some encouraging developments. Recent data show that our state has one of the lowest smoking rates in the nation. There is a growing consensus that school children require more exercise (including to and from schools as a part of that exercise) and better nutrition. This awareness has been bolstered by legislation on farm-to-school food purchasing and safe routes to schools infrastructure projects.

Blue Zone promoters are looking at the workplace as another front on the campaign to invest in good health and erode levels of chronic disease. Provisions in the new federal health care legislation will assist small business owners set up employee wellness programs. Such programs, when properly implemented, prove to be a win-win for employers and workers: absenteeism rates decline and employees enjoy a healthier life both at work and at home in the community.

The non-profit Washington Health Foundation through its Healthiest State Campaign in collaboration with the Washington State Department of Health is laying the groundwork for a state-wide public/private partnership to put some of these ideas into practice. The Healthiest Communities Partnership is assembling members from the business, non-profit, medical, and government sectors to begin strategizing about how to make our state a healthier state, and to make good everyday decisions about smoking, nutrition, and physical activity the easy choices.

To find out more about the Healthiest Communities Partnership click here.

Tobacco Taxes

By Coral Sisk, WHF Associate

With all the talk in recent years about obesity, it is easy to lose sight of the fact that tobacco use still “noses out” obesity as the leading cause of preventable death.

Taxing tobacco is one of the most effective ways to reduce smoking [1]. Studies show that a 10% real price increase on tobacco products results in a reduction of 6-7% in smoking among youth [2]. Voters are favorably inclined towards raising tobacco taxes [3] to address state deficits rather than increasing income or sales tax. At the same time, non-profit social organizations lack funding for programs that assist and engage the mentally ill, addicts, the poor, homeless, and minority populations in smoking cessation. Studies show that as tobacco use abates, these groups contain an increasingly disproportionate share of remaining smokers. This year in Olympia, Legislators tacked on an extra buck in tax on every pack of smokes, but the lion’s share of those funds will go into the state’s general fund. Taxing tobacco is among the most effective means for promoting cessation, so the tax is a tobacco reduction strategy in itself. But as remaining smokers become fewer and more difficult to reach, more intensive prevention programs as well as clinically provided cessation interventions require continued public funding. The Healthiest State Campaign is pleased for the legislature’s continued support, albeit at a reduced level now, for a public health approach to tax fund use to support tobacco cessation efforts as part of healthy communities and opportunities for everyone. But more still needs to be done for the sake of health and equity.

The Healthiest State Campaign with help from the Washington State Department of Health is reaching out to communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

References:

1. U.S. Department of Health and Human Services (HHS), Reducing Tobacco Use: A Report of the Surgeon General, Atlanta, Georgia: HHS, CDC, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health, 2000, http://www.cdc.gov/tobacco/data_statistics/sgr/sgr_2000/index.htm.

2. http://www.tobaccofreekids.org/research/factsheets/pdf/0021.pdf.

3. http://www.tobaccofreekids.org/reports/state_tax_report/downloads/state_tax_polling_2010.pdf.

http://www.tobaccofreekids.org/reports/state_tax_report/.

Safe Routes to School Encourage Kids to Be Active

By Adam Nelson and Greg Cook, WHF Associates

As children in Washington age they engage less and less in healthy physical activities. Sixty-two percent of 6^th graders, forty-six percent of 8^th graders, forty-four percent of 10^th graders and forty percent of 12^th graders met physical activity recommendations according to a report from the Washington State Department of Health (WSDOH) released in January 2010. What can be done and, just as important, what is being done to reverse the downward slide into inactivity? One part of the puzzle is the federally-funded Safe Routes to School program. In our state the program is administered by the Washington State Department of Transportation (WSDOT). There is also a national alliance devoted to promoting this approach to improving health and safety.

Safe Routes to School programs are foundational for promoting life-long physical activities among our state’s children. Programs like Safe Routes to School, and organizations like the Washington Bicycle Alliance and Feet First, are working to make walking or bicycling in the community safe and sustainable activities. Evidence-based research published in 2010 demonstrates that by engaging families, schools, urban planners, and public safety professionals, these programs, and programs like them, help increase the rates of physical activity by creating safe environments for youth.

In previous years WSDOT has awarded $10 million to 39 projects under Safe Routes, and another $15 million toward general pedestrian and bicycle safety. Larrabee Elementary School in the Bellingham School District is one of the first projects to be completed by the WSDOT. The project includes bicycle and pedestrian safety education, increased enforcement, a neighborhood awareness campaign and promotional events at school. The school community at Larrabee now has increased access to physical activity opportunities by engaging parents, teachers, students and school staff to turn an infrastructure improvement into a health improvement.

WSDOT is currently reviewing grant applications for Safe Routes to School projects. At the federal level, Safe Routes to School funding has been under assault but for the time being remains in place. At a time when there is growing recognition of epidemic levels of childhood obesity, cutting a program to promote childhood activity seems short-sighted. This 2008 report from WSDOH lays out the public health policy choices necessary to get us on track in the race to become the healthiest state in the nation. Safe Routes to Schools for our children can play an important role in that race and can help make walking or biking to school the easy choice.

The Healthiest Communities Partnership with help from WSDOH is reaching out to communities across the state to build a broad-based public/private partnership for preventing chronic diseases, making healthy choices about diet, exercise and tobacco the easy choices. To learn more about the Healthiest Communities Partnership, click here.

Loans Help Farmers Market Food

By Coral Sisk, WHF Associate

Farms equal food. When local farmers provide food for their communities they help make fresh nutritious foods an easier choice for people wanting to lead healthier lives. The Humanlinks Foundation, in conjunction with Banner Bank, recently began an innovative micro-finance program that encourages aspiring Washington farmers to strengthen their local farming communities. This program does the remarkable—it empowers small farmers or local farmer want-to-bes with a small, but critical amount of capital in the form of a micro-loan at a favorable interest rate. These loans can be used to start a farm or expand an already existing agriculture enterprise. Studies show that micro-financing has one of the lowest default rates as a loan program and creates an equal playing field for entrepreneurship throughout most social-economic levels.

More local farmers equal more fresh produce. This effort by Humanlinks and Banner Bank provides one model for encouraging a sustainable and healthy Washington State by granting small farmers the financial ability to produce more fresh food for our communities. The consumption of such foods decreases the risk of chronic disease. Rapidly increasing amounts of farmland across the nation are disappearing due to rising costs in agriculture. Small farmers without access to favorable credit have had a tough timekeeping up with production needs. But now Washington State has an opportunity to preserve precious farmland that will be utilized by hardworking farmers to produce food. Visit www.humanlinksfoundation.org for more details on how to take advantage of this loan program and help spread the word to aspiring agriculture entrepreneurs or farming communities in Washington State.

Want to get involved? The Healthiest Communities Partnership with help from the Washington State Department of Health is reaching out to communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices. To learn more about the Healthiest Communities Partnership, click here.

More data can be found on the DOH website:

http://www.doh.wa.gov/cfh/NutritionPA/facts_and_figures/worksite_data/default.htm.

(Note: Data are from 2005 and 2006 and cover access to healthy foods as well as access to places to be physically active in Washington.)

Screen Time

By Adam Nelson, WHF Associate

Up to $10 billion dollars per year are spent by food marketers, targeted at children as young as two years old. Food advertising does affect children’s food preferences, and has been linked to childhood obesity. The CDC recommends no more of 2 hours per day of screen time per day for children, one reason being the exposure to food related advertising. Screen time is defined as time spent watching television, playing video games, and using the computer.

Food advertising is thought to be one specific reason for screen time’s link to obesity, in addition to reduced time for physical activity. A study published in Feb. 2010 suggests that media advertising is a link to obesity in children. The study separated media into 5 different categories divided by educational content, exposure to advertising, and media i.e. DVD, cable, or broadcast TV. Media that contained food advertising was linked to obesity, but children who spent more time in front of the screen were not found to be less physically active.

Several actions can help reduce the negative effects of advertising on children’s food preferences. Counter-advertising for nutritious foods and implementing policies limiting food advertising to children are some community level actions which can be taken. Parents may also take an active role in reducing exposure to advertising by limiting screen time by restricting commercial based programming, choosing educational based programs such as those found on PBS, and discussing food choices with children. The Washington Active Body Active Minds website is a resource for parents who what to learn more about the effects of screen time.

Media based advertising is just one contributor to the obesity epidemic in Washington State. The Healthiest State Campaign is teaming up with the state’s Department of Health to develop a new public/private Healthiest Communities Partnership. We want to make healthy choices, like regular physical activity, the easy choices in our state.

To learn more about the Healthiest Communities Partnership, click here.

Employee Wellness Programs and Tobacco Cessation

By Coral Sisk, WHF Associate

Employee wellness programs offered through employers can be a crucial component for people trying to manage their chronic conditions and make informed decisions about their healthcare. A growing number of employers are recognizing that providing opportunities for their employees to attain higher levels of health contributes to greater productivity—everyone ends up a winner.

Here in Washington, The Sound Health and Wellness Trust provides wellness support for chronic disease prevention as well as tobacco cessation resources through their LiveWell health benefits program available at no additional cost with employer-provided medical coverage plans. Livwell launched its Quit for Life program [1] in 2008 and has experienced a satisfaction rate of 94.8% among its thousands of participants. In addition to access to resources like Quitline, professional coaches, and medications, the Trust offers incentives to quit such as $100 rewards for five completed phone counseling sessions with a certified Quit Coach. The Trust estimates that out of the 28,000 eligible members, 4,200 are tobacco users. The average annual goal for the Quit for Life participation is 6.0% and in 2009 the trust assisted 9.8% of this population with their smoking cessation goals. Employee supported wellness programs are just one of the several evidence based strategies for aiding tobacco cessation. This is one choice that some employers have made to encourage access to healthy behavioral change outreach.

The Healthiest Communities Partnership is a public/private collaboration between the Washington Health Foundation’s Healthiest State Campaign and the Washington State Department of Health. The essence of this effort is about finding the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.

References:

1.) http://www.soundhealthwellness.com/ppo/aboutQuitForLife.php

Too Much Salt in Our Diets?

By Robin Brown, WHF Associate

Recently, talk of government intervention in the issue of American salt intake has been drawing attention from both ends of the political spectrum. The federal government is under pressure from the Institute of Medicine to place limitations on the amount of salt consumed by Americans as we observe a dramatic rise in cardiovascular disease and hypertension within the general population [1]. However, many feel that such regulations would allow unacceptable levels of governmental control over individual choices. On the other side of the argument stand those who maintain that the government is a more appropriate entity to control salt intake than the industries profiting from the sale of salty foods.

It is estimated that only eleven percent of the salt that we consume on a day-to-day basis actually comes from our own saltshakers [2] and that up to seventy-five percent comes from prepared food we buy [3]. The unhealthy effects of high levels of salt intake are undeniable. A recent study of the relationship between habitual salt intake and cardiovascular disease and stroke demonstrates a strong association between high salt intake and increased risk for those diseases [4]. Salt intake is the most important factor in differences of blood pressure both within as well as between populations. A diet high in salt can worsen renal disease and asthma, and there is some evidence that it is linked to osteoporosis [5]. Yet, we as Americans consume almost twice the recommended amount of salt per day, costing the country between ten and twenty-four billion dollars yearly for the cost of related health care problems [6].

The salt reduction policies in other nations have proven successful. For example, in 2003 England’s Department of Health and food manufacturers came together to help reduce individual salt consumption to below 2,400 milligrams daily. Since these efforts began, salt consumption in England has dropped ten percent, saving an estimated 6,000 lives. Finland has taken even more dramatic action and the results are promising. Starting in the 1970’s, the government has required “high salt” labels on any foods with salt content above a certain level, and salt consumption has fallen thirty percent [7]. In the U.S., while there has been no official policy limiting the amount of salt in foods sold, a total of sixteen large food companies have pledged to limit salt in their products. These manufacturers include Kraft Foods, Subway, Starbucks, and Heinz, and they have made this promise thanks o the National Salt Reduction Initiative [8]. The National Salt Reduction Initiative is a coalition of health organizations and local governments that aims to reduce salt intake from packaged and restaurants foods by 25 percent over the next five years [9].

Whether you believe that the government should restrict our salt intake through policy change, or believe in individual choices through increased awareness, this is a problem that is costing all of us in terms of general health as well as in terms of money. It is, however, a problem that can be solved through collective effort.

The Healthiest Communities Partnership with help from the Washington State Department of Health is reaching out to communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices. To learn more about the Healthiest Communities Partnership, click here.

References

[1] Badger Emily. “Uncle Sam's Hand on Your Salt Shaker,” Miller-McCune Online.

[2] Ibid.

[3] O'Callaghan, Tiffany. “U.S. Food and Drug Administration plans to set limits on sodium content in processed foods.” Time Online.

[4] Ibid.

[5] MacGregor, Graham A. "More Adverse Effects.” American Journal of Hypertension.

[6] Ibid.

[7] Ness, Roberta B. “Controversies in Epidemiology and Policy: Salt Reduction and Prevention of Heart Disease.” National Association of County and City Health Officials.

[8] Rogers, David, “Dietitians Support National Salt Reduction Initiative to pinch sodium intake,” Palm Beach Daily News.

[9] “Health Department Announces Proposed Targets for Voluntary Salt Reduction in Packaged and Restaurant Foods.” New York City Department of Health and Hygiene.

Walmart leading effort to offer fresh and local food and produce

By Corinne McCuskey, WHF Associate

In the March 2010 edition of the The Atlantic Monthly, Corby Kummer offers a new perspective on what Wal-Mart is offering its customers. (“The Great Grocery Smackdown: Will Walmart, not Whole Foods, save the small farm and make America healthy?” http://www.theatlantic.com/magazine/archive/2010/03/the-great-grocery-smackdown/7904/ )

Many people do not associate Walmart with access to healthy and affordable food. Walmart has risen to the heights of commercial success by being known as a great place to find value and savings and not necessarily where most folks go to find fresh fruits and vegetables. Kummer explores this new side of Walmart. The corporation has had its share of high-profile legal disputes; however, these new images in the magazine article and hearing first-hand comments here in Washington is burnishing the superstore’s image.

Kummer explains that the Walmart stores he has visited offered local organic produce at reasonable prices. The products were seasonal and comparable to those offered at a local farmers market or at Whole Foods. Most of all, in the short video attached to the article, Kummer states that Walmart will offer fresh produce to a lot of consumers that would not normally have access to such products. He says that he has not looked into the much discussed ethics or employment issues surrounding Walmart, and that is research you can do on your own. What he does outline is how an American institution not known for promoting healthy eating is offering an opportunity for the majority and minority to access healthy and affordable produce, something much needed in a country that is searching for a solution to trim waistlines and offer healthful alternatives to high-fructose snacks.

“Eat better” is often touted as the mantra for how to fix obesity; however, moving toward better eating is not so easy, especially in a community without a Whole Foods or farmers market and the lack of funds to afford such markets even if they existed in the community. Walmart has the ability to serve most populations, regardless of income and geographic dispersion and enormous power to change what we buy as a society. (Kummer refers to a whole book written about that power: The Walmart Effect.) Walmart is encouraging “eating better” in communities that normally would not be able to access or afford healthy, fresh food. Whatever your personal thoughts about the store, I have to applaud their efforts--whether self-serving or going along with the times, it’s a good move.

Could Walmart be one of the forces that drives down prices for locally grown healthy foods and makes it accessible to the masses? Could it be a major contributor to decreasing the obesity epidemic? That is still up for debate, but it appears that Walmart is trying some new strategies that I will be watching and possibly even buying into.

For more information about what the Healthiest Communities Partnership is doing collectively to encourage healthier lifestyles, click here.

Fighting Obesity

By Meghan Lyle, WHF Associate

Most of us are familiar with the headlines about the US obesity epidemic. In Washington State about 1 in every 4 adults is obese, and even more are overweight. The national spotlight is now on the issue with Michelle Obama promoting her Let’s Move initiative to combat childhood obesity. “One in three kids are overweight or obese,” says the First Lady, “and we’re spending $150 billion a year treating obesity-related illnesses.”

Everyone knows the problem--the question is, what’s the solution? In all likelihood, there isn’t just one solution. Obesity is a many-fold problem, with researchers pointing to factors like an environment filled with advertising and easy access to unhealthy foods, limited time for exercise and poorly designed neighborhood infrastructure, as well as diminishing cooking skills of the average American. A multi-dimensional problem requires a multi-dimensional answer. That’s why the Centers for Disease Control and Prevention (CDC) awarded funds earlier this year to all of the states to start working on the issue. They are calling this work “Communities Putting Prevention to Work.” The CDC wants the states to use evidence-based MAPPS strategies (which stands for Media, Access, Point of Purchase, Price and Social Services) to make change happen across the country.

One of the hot topics of nutrition research is healthy food access. We know that not everyone lives near a large grocery store with lots of healthy food options. In fact, one of the problems seems to be that disadvantaged groups seem to have more limited access to big grocery stores, while convenience stores seem to cluster in these neighborhoods. The Let’s Move campaign refers to these areas as “food deserts.” Some neighborhoods are getting behind the issue by trying to transform existing convenience stores into places with healthier options. A West Seattle store owner in Delridge got headlines for doing this in December 2009, with help from the Delridge Neighborhood Development Association. Projects like this are needed to increase access to healthy food around the state.

Want to get involved? The Healthiest Communities Partnership with help from the Washington State Department of Health is reaching out to communities across the state to build a broad-based public/private partnership to prevent chronic diseases. It is all about exploring together the best ways to make healthy choices about diet, exercise and tobacco the easy choices.

To learn more about the Healthiest Communities Partnership, click here.