Transcript of the Healthy People 2010 Regional Meeting
Philadelphia, Pennsylvania
October 5-6, 1998

U.S. Department of Health and Human Services
Office of Disease Prevention and Health Promotion

Session I:
Promoting Healthy Behaviors and Safe Communities

MS. ROSENFELD: Good morning. We are going to try to get started. I invite the folks who are in the back who would like to move up to do so, although our microphone for public comment is taped down, so it has to remain where it is. It is not the most intimate gathering, but we will do our best.

My name is Betsy Rosenfeld. This is session one, promoting healthy behaviors and healthy and safe communities. We will be hearing comments on chapters 1 through 9 of the draft document for Healthy People 2010.

To help assure a fair opportunity for everyone to participate in today's hearings, I am going to lay out a couple of ground rules, which will be familiar, because they are similar to the ones we had in the morning session.

First, each oral statement is limited to three minutes so that we can hear from the greatest number of participants.

This light up here will turn yellow when one minute remains, and then red when your time is ended. So, you should try to sum up when you see the yellow light.

The second piece is that each individual or organization is limited to one oral statement for each of the focus areas.

Third, we will allow 20 minutes for each focus area which, if you do the math, is about six or seven commenters per focus area.

Then, if time permits, which it very well might, given the size of the crowd, we will have some time at the end for general comment.

If, for some reason, you are in a crowded focus area, don't worry; there is probably going to be time at the end for general comment.

We are pleased to have a variety of extraordinary experts to my right here. These are the folks who have been responsible for helping to think about and draft the indicators that you are here to comment on, the objectives.

I am going to introduce them with each focus area. If you would direct your comments to them, that would be very helpful.

They are essentially here to hear your comments and feedback, and to provide any clarification that might be necessary.

I also want to take this opportunity, before we begin queuing up, the folks who made this two-day session possible, from the Office of Disease Prevention and Health Promotion, particularly Linda Bailey, who has just been extraordinary, and Sheila Fleckenstein from her staff. I don't think they are here to hear me thank them, but hopefully other folks hear that.

They have been immensely patient and committed to this process. So, we should all thank them.

I invite those of you with comments on the first focus area, which is physical activity and fitness, to queue up at the microphone.

If anybody needs assistance and would prefer to have a hand-held microphone brought to them, we can arrange that as well. It is there in the back.

The federal representatives for the first focus area, focus area one, physical activity and fitness, are Christine Spain from OPHS, the Office of Public Health and Science, and Carol Nasarra from CDC.

Ms. Spain is a member of the Healthy People steering committee, and work group coordinator for this focus area. So, we will take public comment here, if there is any.

It doesn't look like there is at the moment. We will move to focus area two, which is nutrition. The federal experts on that are William Harlan from the NIH and Elisa Elliott from the FDA.

Dr. Harlan is a member of the Healthy People steering committee. We will take comment now on nutrition, if there is any.

MS. MOORE: I first want to congratulate the people who put together the physical activity and fitness one.

I thought it was really well done and I want to start off by saying that. My name is Barbara Moore. I am with Shape Up America.

On nutrition, there is a lot of discussion of overweight and obesity. For the most part, throughout that section, they are very meticulous about stating overweight and obesity.

Here and there -- and I don't have the exact pages with me, but I will provide them to you -- here and there you either leave out obesity or you leave out overweight.

I think that in view of all this discussion about defining overweight and defining obesity in terms of BMI, I think it is important to be consistent throughout the chapter.

I am more than happy to provide copies of where I have circled where either one or the other word was left out. In most instances, both words are there, but in some instances there are not. Thank you very much.

MS. ROSENFELD: Thank you very much. I should have said at the beginning, if you would state your name and what organization you represent, I would appreciate your doing that.

Your state of residence, that would be very helpful for the folks who are taking notes. Any more comments on focus area two, nutrition?

Okay, we will move to focus area three, which is tobacco use. The federal experts present are Sal Lucido and Sarah Knolls from the CDC. Any comments on the tobacco use objectives?

Okay, we are going to move to focus area four, which is educational and community-based programs. Our federal experts are David McQueen and Catherine Hutsell from the CDC.

Drs. McQueen and Hutsell are work group coordinators for this focus area of educational and community-based programs.

Okay, any comments on that focus area? We are going to move on to focus area five, which is environmental health.

Mark McClanahan from the CDC is our federal expert here. He is also work group coordinator for this focus area. Any comments on environmental health?

DR. LIM: My name is Suet Lim, and I work for a local health department here in Pennsylvania. Since the draft document came a little too late for me to discuss the objectives with my colleagues, my comments will be personal.

The main comment I have about the environmental health section is that the objectives, from a local health perspective, are difficult to measure because the focus seemed to be either at the national or the state level.

So, when we do assessments or when we do any reports, we try to measure where we are as a county, using the Healthy People 2000 objectives and for the coming decade the Healthy People 2010 objectives, we practically have very little to say about environmental health. That is it.

MS. ROSENFELD: Thank you.

MS. WILLIAMS: Hello. My name is Evelyn Williams. I am representing the American Speech, Language Hearing Association, ASHA. We have a comment on the environmental health section.

ASHA recommends that we add a new objective that is to increase to at least 50 percent the proportion of children and adults who recognize the hazard of intense noise to hearing, avoid unnecessary noise exposure, and use hearing protection devices.

Our rationale is, since the Office of Noise Abatement and Control at the Environmental Protection Agency was de-funded in 1983, determination of hazardous levels of environmental noise, regulation of community noise, and public information about noise risk to hearing related illnesses and injury have received limited federal and state attention.

Studies support that increased exposure to noise has affected the hearing of younger members of the population; that is, the hearing status of adolescents and young adults is becoming increasingly similar to that of older populations.

Some studies suggest that age-related hearing changes may not be solely related to structure deterioration, as much as they may reflect over-exposure in industrialized societies to environmental noise and other ototoxic agents.

For these reasons, hearing loss may be largely preventable if associated risks are known, identified and appropriate prevention strategies employed.

These prevention efforts should start with awareness programs in health and science curricula for elementary and secondary school prevention programs, in vocational education classes, and enforcement of the noise control act of 1972.

MS. ROSENFELD: Thank you for your comment.

We are going to move to focus area six, which is food safety. Elisa Elliott from the FDA is the work group coordinator for this area and our federal expert. Any comments on the food safety objectives?

MR. WILCKE: My name is Burton Wilcke. I am with the State of Vermont Department of Health. The food safety priority area addresses objectives on the responsibilities of consumers and retail establishments, but it doesn't appear to offer any objectives related to the responsibility of food producers and processors, despite the fact that there have been numerous outbreaks related to deficiencies in that arena.

There are a number of states in which there are small producers who seem to be exempt from any responsibilities and regulations, as well as food processors outside the United States who are not following appropriate food manufacturing procedures.

Perhaps an objective related to food processors and producers responsibilities would be in order.

MS. ROSENFELD: Thank you.

MS. BLOCK: Hi. My name is Molly Block. I am from the Maryland Department of Health. I would just like to ask if there is anything that is going to be done -- this is about environment, back tracking a minute.

Is there anything that we are going to do about the trucks and the buses and all those vehicles on the road, that shoot that black smoke into the air all the time? It is my own concern.

It has nothing to do with the Maryland Department of Health, but it is a concern of mine. Is there anything in there?

DR. MC CLANAHAN: Not really. We attempt to mirror EPA's air quality standards in various ways, but since we don't regulate and the EPA regulates, the control of diesel emissions is something that the EPA is in the process of establishing.

How that is going to work out, it is hard to say. They are putting controls on new diesel engines and retrofitting existing diesel engines.

MS. BLOCK: I have asked this question many times to a lot of government officials. Here I am getting the same answer from you, which is very difficult.

We take these brand-new cars and we have them go through emissions tests. It is absolutely ridiculous. Then these trucks are just throwing this terrible smoke into the air. I just don't understand why we can't do something with this, now that we are at the cutting edge here.

DR. MC CLANAHAN: One of the issues with all of these objectives is that they need to have some sort of measurable methods to follow in order to be able to document the progress or the lack thereof.

There isn't someone out there counting the number of diesel engines. There is no data base on which to deal with it. It is a nice idea, but tough to follow up.

MS. BLOCK: I don't even work with environmental health. It is just my concern.

MS. ROSENFELD: Thank you for your comment. Anyone else on focus area six, food safety?

We are going to move to focus area seven, which is injury and violence prevention. Laura Martin from the CDC is our federal expert and is the work group coordinator for this focus area for Healthy People.

MS. WILLIAMS: My name is Evelyn Williams. I represent the American Speech Language Hearing Association. We would like to comment on injuries and violence.

Communication disorders and hearing loss often result from unintentional injuries, especially those to the head.

Therefore, ASHA recommends the additional modification of the following objectives:

Objective 15, we would ask for a target population goal, or objective, that would increase the use of child restraint, booster seats, among children age five and above, or children weighing less than 80 pounds.

Then also, we would like to see an objective added to reduce concussions from sports injuries so that hospitalizations for this condition are no more than X per 100,000 people. Thank you.

MS. ROSENFELD: Thank you.

MS. BARTON: Good morning. My name is Eliza Barton. I am a registered nurse and a student nurse/midwife at the University of Pennsylvania. My comments are personal.

My comments are regarding objectives 36 and 38 in chapter seven, which is reducing the rate of forced sexual intercourse and the reducing sexual assault other than rape.

I would like to propose that these two objectives -- they are 36 and 38; they are separated by 37, which is regarding emergency housing for battered women and children.

I would like to propose that they be placed together to increase the strength of the two objectives.

I would also like to urge you to consider breaking objective 36 into specific target reductions, for forced intercourse in the context of incest, date and mate rape, and stranger rape. The target rates are very different and the plans of action are very different.

I would also ask for a separate objective for the target rate of women who have experienced forced sexual intercourse, who received no immediate post-trauma care by a specially trained sexual assault examiner, one who is proficient in the use of the forensic rape kit, and knowledgeable concerning community resources.

Finally, I propose a specific objective to reduce the number of women living with the ill effects of rape/trauma syndrome. Thank you.

MS. ROSENFELD: Thank you. Would anyone else like to comment on focus area seven, injury and violence prevention?

DR. BERNSTEIN: My name is Edward Bernstein. I am an emergency physician for 25 years and I represent the Society for Academic Emergency Medicine.

In Healthy People 2000, there was an objective that required protocols in place in the emergency department, and I don't see that in this new section.

I think it is critical that emergency departments are brought into this public health approach to domestic violence and violence against elders, child abuse.

I think that protocol should be re-instituted, a protocol for screening, detection, the safe discharge of patients and the access to shelters. Thank you.

MS. ROSENFELD: Thank you.

MS. REYNOLDS: My name is Arnetta Reynolds. I am the community liaison for the Women's Christian Alliance, a social service agency.

My main concern and personal concern is the dramatic bridge that we are facing in our communities concerning firearms.

I would just like to know if something is being done on the preventive measures, something that we can do to stop our youth from using guns in our community and amongst other communities.

It is such a hazard that people are afraid to come out of their homes or they are afraid to go pick up their Social Security checks.

We find that some of our youths get these guns, we don't know where they are coming from.

MS. ROSENFELD: Dr. Martin, do you have any clarification on that point? Are there objectives or indicators for handgun use?

DR. MARTIN: Yes, there are three objectives that address firearm injuries in the cross cutting section. They had to do with both violence and unintentional injuries.

Two of the three are aimed at safe storage practices. The other is just a general objective to reduce forearm injuries and death.

MS. ROSENFELD: Thank you for your comment. Does anyone else have a comment in focus area seven, injury and violence prevention?

Okay, we are going to move to focus area eight, which is occupational safety and health. Chuck Gollmar is our federal expert and he is also a member of the Healthy People steering committee. We will take comments now on occupational safety and health.

MS. MEYERS: Hi. I am Rosa Meyers. I am the regional women's health coordinator and a former occupational health nurse and nurse practitioners.

Two things that I would like to recommend are, I notice there was nothing on indoor air quality. That is something that, from my own experience in occupational settings, is very important.

I realize that there is a feeling of some people that what may be discomfort to others has been a lack of good indoor air quality. So, it has been a very subjective area.

There are standards that have been set forth on temperature, humidity and others that may not always be present in the work setting, as well as the air exchanges per hour, which contribute to the problem and the syndrome.

I think because that has been such a prevalent problem in the occupational setting, that is something that needs to be addressed.

The other piece I would like to address, I notice there is a lot of emphasis on hepatitis B and immunizations. We all know that one of the biggest rising area is hepatitis C in the work site.

In fact, many of your workers now, when they get tested as the result of a blood borne exposure, are also tested for hepatitis C.

While we still, of course, don't have any type of a vaccine or anything, I feel it is really important for workers to be given education and prevention.

It all goes along with blood borne pathogens in the OSHA standard training, but I think it is something that needs to be emphasized and people need to understand how that is transmitted. Thank you.

MS. ROSENFELD: Thank you for your comment. Any other comments on focus area eight, occupational safety and health?

Okay, we are going to move to our final focus area and then open it back up. That is focus area nine, oral health.

Our federal experts are Alice Horowitz from the NIH and Burton Edelstein from HRSA. Dr. Horowitz is a work group coordinator for this area.

DR. MORAZAN: Hello. My name is Christian Morazan. I am with the Hispanic Dental Association out of New York University College of Dentistry. I have a couple of issues.

My first issue is that one of the objectives of Healthy People 2000 was to increase the amount of oral screening for children at a kindergarten age level.

This was a particularly sharp need for the minority Hispanic and black children of the country.

This was one of the objectives of Healthy People 2000 where no progress was made. Not only was it not made, but also we are actually moving away from the target.

There is a very unique thing about dentistry. That is that many of the diseases that are treated by dentists are preventable.

One of the things that you can do to prevent these diseases is to get oral screening, certainly screenings when children are this young.

Caries can be prevented through oral hygiene instruction and fluorination, flossing; there are a number of ways of improving these things.

They are easy things to do. They really don't cost anything. The only thing you have to do is get the message out.

My basic question is, if the percentage of minority children, both black and Hispanic, that are being screened at an early stage in their life is dwindling, what is being done to improve this?

Why is there this lack of prevention at an early stage? A decadent dentition at an early age is a strong precursor for a decadent dentition in the latter stages of people's lives. Thank you.

MS. ROSENFELD: Thank you for your comments.

MS. WILLIAMS: Hello. My name is Evelyn Williams, representing the American Speech Language Hearing Association. I will comment on the oral health goal, as related to objective 13.

We are recommending that the goal be modified to include speech language components. The goal could read as follows:

Increase at least X percent the proportion of all children entering school programs for the first time who have received an oral health screening, including speech language components, referral and follow up for necessary diagnostic, preventive and treatment services.

Also, in the objective dealing with cleft lips and palettes, we recommend that a target population be added, to include Asian and American Indians, because of their high incidence of cleft palettes and lips.

MS. ROSENFELD: Okay, we are going to take any other comments on focus area nine and then open it up to a general comment, if you want to go ahead.

DR. MORAZAN: Once again, Christian Morazan from the Hispanic Dental Association from New York University College of Dentistry.

I have more like a general comment to make. It really isn't specific to any one objective.

I have reviewed the oral health objectives for the Healthy People 2010 draft document. I carefully considered what issues should be brought up, especially what should be brought up in a three-minute window of opportunity, which is the time allotted to present some critical issues.

I could speak about dental caries, periodontal disease, fluoridation, oral cancer screening, or any number of other oral health related factors.

Still, I believe that one single critical issue should be one of the primary goals of Healthy People 2010. It is not really a health issue, but it is more like a social issue.

That is the increase of minority, especially Hispanic and black, dentists, physicians and other health care providers.

You might say, what does this have anything to do with Healthy People 2010? It does.

Let me tell you right now, the class of 1999 at New York University College of Dentistry, that is the biggest college of dentistry in the country. There are 250 people in that class. There are two Hispanics, one black. That is it. The numbers are staggering.

Now, you could play with the figures any way you want, but the output of minority providers is going down. It is really, really bad.

This issue is of the utmost importance to every single aspect of Healthy People 2010, not only oral health, but also all the other objectives.

The elimination of disparities in health can only be done by providing care to the people. It is the providers of this care who must ultimately do it.

Now, if there are no minority providers, how is it reasonably going to be done? If there are minute numbers of Hispanic dentists and physicians, of black dentists and physicians, who is going to eliminate the disparities, like I said, not only in oral health, but also in all aspects.

Who is going to reach out to the population groups that are under-privileged and improve their health? When we talk about eliminating disparities, it is usually eliminating disparities from the more affluent people, the whiter sectors of our society, against the darker sectors of our society.

Minority enrollment in the dental and medical schools is plummeting. It is a fact. The time to do something about it is now.

It should be an over-riding priority to provide incentives to these schools -- all of these dental and medical schools -- in order to increase the number of minority enrollees.

MS. ROSENFELD: Please just sum up. Thank you.

DR. MORAZAN: Basically in a sum-up I would just say that we have to give some kind of federal prerogative to this problem.

There must be federal incentives to the schools to enroll more minority dentists and doctors. Thank you.

MS. ROSENFELD: Thank you for your thoughtful comments. Does anybody have any other comments on focus area nine, oral health?

Okay, we are going to open it to general comments on chapters one through 10. Please feel free to queue up at the microphone. The same rules will apply.

If you feel constrained by the three-minute limit, just remember, if you don't want to cycle back again and again for your three minutes, that we are taking comments via every mechanism possible -- fax, e mail, letters.

All that information is available in the various handouts and we can get it to you after the session as well. So, don't feel limited by the three minutes and don't feel like you have to go back for three-minute chunks. We are happy to take comments any other way.

MS. MOORE: Thank you. My name is Barbara Moore. I am with Shape Up America, and it is located in Bethesda, Maryland.

I have a concern and I don't have a solution. I just wanted to discuss this concern with you and propose a couple of ideas.

My concern is about the lack of prominence of obesity when you look at the overall structure of the document.

In other words, I think it is arguable that we should have a 10th chapter on obesity in this section.

I would propose that if we do have a chapter on obesity, that it should be nestled in there somewhere beside physical activity and fitness and nutrition.

I realize that another candidate might be in the disease section. Certainly when obesity gets severe enough, it qualifies as a disease. It has been identified as such by at least two NIH consensus conferences in the past 15 years.

The prevalence of obesity is at least 60 million people in America, adults, depending on which definition if you use.

If you use the more liberal definition, it goes up to 90 million adults are affected by obesity and overweight.

That doesn't include children. In children, depending upon which definition you use, somewhere between one out of four and one out of five are defined as overweight or obese.

I think we have to recognize that children are not just miniature adults. I think that the reasons why they are becoming overweight and obese might or might not be the same as accounting for obesity in the adult population.

I do think that obesity among children and obesity among adults deserves to be a chapter in and of itself. I think that I would urge you to consider this possibility, that there is such a need.

I am happy to submit my ideas in writing further, rather than take more of your time. I appreciate this opportunity to comment.

MS. ROSENFELD: Thank you.

MS. WILLIAMS: Hi. My name is Evelyn Williams, the American Speech Language Hearing Association. I just wanted to reference the cleft lips and palettes comment that I made in the last section, and that is related to objective 17.

I would like to reference the comments that I made in the environmental health section, related to increasing awareness of the hazards of noise exposure.

This particular comment should also be linked to the chapter four on educational and community-based programs. Thank you.

MS. ROSENFELD: Thank you.

DR. HUSSEIN: My name is Carleissa Hussein, from the Maryland State Department of Health and Mental Hygiene. My comments are personal.

I would first like to say that I commend the process for, again, having a focus on promoting healthy behaviors.

I consider this group of chapters probably the most important in the whole document because it relates to prevention and it relates to areas that the population can do something about.

Probably aside from the chapter on infrastructure, which I consider critical to all of public health, these are the most important.

For that reason, I wanted to share some of what I consider cross cutting issues, that should be addressed not only to this group but also to all the chapters, and I am glad that Debbie Maiese is here to take down some of my comments.

One of those cross cutting issues is health data. It came up earlier when persons made comments about problems in our society that we have no data for.

I think that we have to take responsibility as health professionals to then put down at early objectives the importance of collecting that data, the importance of identifying indicators.

Someone raised a question about the black smoke from trucks and buses. This is a real critical kind of issue. Because data is not available, we can't stop there, although we recognize it is not.

Somehow, in the promoting healthy behaviors, we must become more assertive and aggressive with our partners outside public health to do something about it.

Also, another cross cutting issue is health disparities. I know there has been a lot of talk about that throughout the two days.

I think that it is very important that, aside from having a chapter addressing that, each of the chapters needs to come up with specific ways and objectives or actions under the objectives to help guide us in how we address the issue of health disparities. It is a cross cutting issue that runs throughout.

Finally -- and I haven't heard anyone raise this issue, although I have not been everywhere. I couldn't quite get around to all the concurrent sessions. Somewhere -- and probably it is the infrastructure chapter, that I know is not here, we need to address the issue of leadership change.

We have an election coming. It may have some significant impact on what we do with Healthy People 2010, both at the national level and local levels.

Somehow, perhaps in infrastructure and other areas, we have to think of ways to foster continuity of our gains in public health, so that we are not trapped and caught every time there is a change of leadership and a change of emphasis in terms of how local and state funds are used.

I don't know exactly -- at this point I don't have a suggestion on the specific objective, but somewhere we need to address that and not quite behave as if we are on an island by ourselves working on public health while, in Washington and other places, some significant things are happening that will have a real interplay on how well we deal with this.

To plan ahead and be perhaps a little bit more business oriented and looking at the external environment may be very helpful. Thank you for your patience.

MS. ROSENFELD: Thank you.

MR. GARDESEY: My name is Mawuna Gardesey. I am with the State of Delaware Division of Public Health. My comments are personal.

Under the general heading of health promotion, it seems to me that when you look at the diseases that inordinately kill people across racial lines, you will find about these diseases that boil down to lifestyles, behavior patterns and what have you.

It seems to me that it would make our jobs a lot easier if we could inculcate these behaviors in children at a very early age.

In most states, though, that job falls to the department of education which, rightly or wrongly, doesn't particularly consider the idea of health education a top priority.

It is, of course, a top priority for the various departments of health. They do not have the control in that environment.

I noticed that under the section on injury prevention, for example, there are targets set for what schools could do.

I think it would be useful to look very carefully at setting up objectives as to what schools could teach by way of health education.

By that, I am not talking about just a set of facts, but actually developing some skills among the children that they hopefully will take with them for the rest of their lives.

We can seek to improve the prospects for life in children by insisting that they concentrate on their three Rs.

I very much doubt that anybody would think that they would have a very good quality of life if whatever life status they are able to achieve is embattled with poor health status. I think we need to look at that very carefully.

I am not particularly sure how we do that, but I think with the host of experts that we have sitting on the dais, that you will find some way to make that happen. Thank you.

MS. ROSENFELD: Thank you.

MS. HASKELL: Hello. I am Carolyn Haskell. I am an occupational health nurse practitioner and I manage an occupational health program for a manufacturing corporation.

I would like to just follow on the comments of the previous speaker. I think even more important than the development of these objectives is perhaps the strategy to implement them and assure that we meet our goals.

I would like to recommend that for each objective we try to identify both the non-profit groups and governmental agencies that can support that objective. Perhaps we can convince those agencies to take these objectives on as their organizational objectives, as well as the Healthy People 2010 objectives. I would like to give you an example of how that could be done.

I am also a member of the American Association of Occupational Health Nurses. That is a very pivotal group in implementing your occupational health and safety objectives.

I would like to recommend that you coordinate your strategic implementation plan with groups such as that group. Thank you.

MS. ROSENFELD: Thank you. Any other general comments?

MR. TOLA: Good morning. My name is Fred Tola. I come from Allegheny County Maryland and I represent the health department there in Allegheny County, Maryland.

Allegheny County, Maryland is a rural portion of the state of Maryland. It is considered part of the Appalachian region going across the United States.

I have two general comments in relation to ruralness. One of them is in respect to disparity and the gap and all.

We have heard about the different groups, racial groups, and their disparities. I think it is incumbent upon us to also consider the rural area, the Appalachian folks, and the disparity of health that goes there. I am sure you are probably going to be hearing that as you go forward in some of the other regions.

Second comment. One of the things of interest in our community is to develop, in a sense, a community effort to look at not only community health, but some of the other social and human welfare services.

I am thinking in relation to what Dr. Julius Richmond said yesterday about looking at other factors that have a very forceful impact on health.

I am wondering where, in the documents, are you all looking visionary in those aspects, so that we in public health can be moving forward to ameliorating some of those difficult areas of health that have obviously determinants in some other social areas like economics, like education and so forth. I am hoping that you might be able to address that. Thank you.

MS. ROSENFELD: Thank you. A number of commenters have raised that issue. We will be taking it back and strategizing about how to incorporate those kinds of issues into this document. Thanks. Other general comments?

I think what we are going to do at this point is go to plan B, which is that if we ran early, which we have, we are going to announce that we are going to leave the session open for a half hour. It is now five after 10:00.

I am going to stick with plan B until I hear otherwise from the folks who are running the show. Half an hour should give folks from other sessions, who are commenting in II or III, to get here. If it doesn't, then we may keep the session over past a half an hour.

At the moment, we will close at 10:35. If we are going to make a different plan, then we will announce that. Thanks.


MS. BINKO: I am JoAnn Binko from Philadelphia, Pennsylvania and the National Center of Excellence in Women's Health.

I just have a general question. I am not sure if I couldn't find it in the nutrition section or if it was under another title.

I find a lack of information on eating disorders. I see a lot of overweight and obesity, but not much on eating disorders, bulimia and anorexia. I was wondering if it was part of the document.

MS. ROSENFELD: Do we have someone here from nutrition?

DR. ELLIOTT: I am representing nutrition, but I have to apologize that I am really up from food safety. I am not familiar enough with the chapter to answer that question.

MS. ROSENFELD: We will try to get you some information.

DR. ELLIOTT: Bill Harlan is still here. He is in another session.

MS. ROSENFELD: Why don't you make sure that we have your information and we will try to get you an answer.

MS. MYERS: I am Rosa Myers, the women's health coordinator. I have a general comment on the physical activity section.

As a former -- I used to participate in school activities as a girl and developed very good physical activity habits as a result.

I realize you really, you know, in the strategic section, you are not really addressing this. One of the things that I came to realize rather early was that I was not a true athlete, but I was interested in maintaining myself in sports.

One of the things that I found out in school very early on is that if you were not really good, you would not be picked for the teams. Therefore, you have to then do your own physical activities program.

I see that that is a trend that you see more and more in the schools, where the emphasis really is on competitive sports.

If you look at the break down there between boys and girls and the decreasing amount of exercise percentages, even the smallest percentage of the boys -- I believe it is in the 67th percentile -- the girls, the most they are ever involved in the 9th grade is 62 percent and it goes down to 42 percent.

I think a lot of that really has to do with the emphasis placed on competitive sports. Competitive sports in our system means boys sports.

In the strategic section, it may assist some of the programs to emphasize that perhaps either the measuring tool may not be capturing, perhaps -- I am not really sure.

It is not so much, I notice, in basketball, swimming, jogging. They were talking about vigorous versus moderate, whatever.

It may not be capturing what the schools may be doing. Maybe the schools are not really doing anything for people other than competitive sports and teams.

Having a daughter myself, I remember when she started trying out. If she could not make it into a team, that was it; your options were closed.

MS. ROSENFELD: Thank you. Part of plan B is apparently to release, at this moment, our federal experts and thank them very much for being present and giving us the benefit of their knowledge and expertise, in drafting and thinking about these objectives.

If folks have other comments to make during the rest of this open session, we will be sure that those comments get back to these folks in Washington and to others. There is no danger that your comments won't be heard.

In the interests of using people's time efficiently, we are going to go ahead and thank them and release them. Thanks.

DR. ELLIOTT: I wanted to respond to the question about bulimia and anorexia. It is not mentioned in the chapter by that name.

There are objectives 15 and 16, which make reference to education and especially eating disorders at the middle school and high school levels. I will bring back your comments to the group.

MS. ROSENFELD: I want to thank you all very much. Just repeating the first part of plan B, which is that we will be open for general comment until 10:35, thanks.


MS. ROSENFELD: Session III is now open for general comment. That room is down one level. It is the Conference Center Room.

If you have general comments, we are going to take them in that room. We are consolidating all the sessions and closing this session.

So, plan B has been revised. Thanks.

[Whereupon, the session was adjourned.]

Philadelphia Transcripts and Summaries