<DOC>
[108 Senate Hearings]
[From the U.S. Government Printing Office via GPO Access]
[DOCID: f:96660.wais]
S. Hrg. 108-747
PREVENTING CHRONIC DISEASE THROUGH HEALTHY LIFESTYLES
=======================================================================
HEARING
before a
SUBCOMMITTEE OF THE
COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE
ONE HUNDRED EIGHTH CONGRESS
SECOND SESSION
__________
SPECIAL HEARING
JULY 15, 2004--WASHINGTON, DC
__________
Printed for the use of the Committee on Appropriations
Available via the World Wide Web: http://www.access.gpo.gov/congress/
senate
__________
U.S. GOVERNMENT PRINTING OFFICE
96-660 WASHINGTON : 2004
____________________________________________________________________________
For Sale by the Superintendent of Documents, U.S. Government Printing Office
Internet: bookstore.gpo.gov Phone: toll free (866) 512-1800; (202) 512ÿ091800
Fax: (202) 512ÿ092250 Mail: Stop SSOP, Washington, DC 20402ÿ090001
COMMITTEE ON APPROPRIATIONS
TED STEVENS, Alaska, Chairman
THAD COCHRAN, Mississippi ROBERT C. BYRD, West Virginia
ARLEN SPECTER, Pennsylvania DANIEL K. INOUYE, Hawaii
PETE V. DOMENICI, New Mexico ERNEST F. HOLLINGS, South Carolina
CHRISTOPHER S. BOND, Missouri PATRICK J. LEAHY, Vermont
MITCH McCONNELL, Kentucky TOM HARKIN, Iowa
CONRAD BURNS, Montana BARBARA A. MIKULSKI, Maryland
RICHARD C. SHELBY, Alabama HARRY REID, Nevada
JUDD GREGG, New Hampshire HERB KOHL, Wisconsin
ROBERT F. BENNETT, Utah PATTY MURRAY, Washington
BEN NIGHTHORSE CAMPBELL, Colorado BYRON L. DORGAN, North Dakota
LARRY CRAIG, Idaho DIANNE FEINSTEIN, California
KAY BAILEY HUTCHISON, Texas RICHARD J. DURBIN, Illinois
MIKE DeWINE, Ohio TIM JOHNSON, South Dakota
SAM BROWNBACK, Kansas MARY L. LANDRIEU, Louisiana
James W. Morhard, Staff Director
Lisa Sutherland, Deputy Staff Director
Terrence E. Sauvain, Minority Staff Director
------
Subcommittee on Departments of Labor, Health and Human Services, and
Education, and Related Agencies
ARLEN SPECTER, Pennsylvania, Chairman
THAD COCHRAN, Mississippi TOM HARKIN, Iowa
JUDD GREGG, New Hampshire ERNEST F. HOLLINGS, South Carolina
LARRY CRAIG, Idaho DANIEL K. INOUYE, Hawaii
KAY BAILEY HUTCHISON, Texas HARRY REID, Nevada
TED STEVENS, Alaska HERB KOHL, Wisconsin
MIKE DeWINE, Ohio PATTY MURRAY, Washington
RICHARD C. SHELBY, Alabama MARY L. LANDRIEU, Louisiana
ROBERT C. BYRD, West Virginia (Ex
officio)
Professional Staff
Bettilou Taylor
Jim Sourwine
Mark Laisch
Sudip Shrikant Parikh
Candice Rogers
Ellen Murray (Minority)
Erik Fatemi (Minority)
Adrienne Hallett (Minority)
Administrative Support
Carole Geagley
C O N T E N T S
----------
Page
Opening statement of Senator Arlen Specter....................... 1
Opening statement of Senator Tom Harkin.......................... 2
Opening statement of Senator Patty Murray........................ 4
Prepared Statement........................................... 4
Statement of Hon. Tommy G. Thompson, Secretary, Department of
Health and Human Services...................................... 4
Prepared statement........................................... 8
Statement of Kenneth L. Gladish, Ph.D., national executive
director, YMCA of the USA...................................... 20
Prepared statement........................................... 22
Statement of Vernon E. Delpesce, chief executive officer, YMCA of
Greater Des Moines............................................. 25
Prepared statement........................................... 27
Statement of Eric K. Mann, president and CEO, Pittsburgh
Metropolitan YMCA.............................................. 30
Prepared statement........................................... 32
Statement of Dean Ornish, founder, president and director,
Preventative Medicine Research Institute....................... 37
Prepared statement........................................... 39
Statement of Jack Rule, CEO, incentaHEALTH....................... 42
Prepared statement........................................... 43
Statement of Karen Silberman, executive director, National
Coalition for Promoting Physical Activity...................... 45
Prepared statement........................................... 48
Prepared statement of Senator Thad Cochran....................... 54
Prepared statement of Cheryl G. Healton, Dr. P.H., president and
CEO, American Legacy Foundation................................ 54
PREVENTING CHRONIC DISEASE THROUGH HEALTHY LIFESTYLES
----------
THURSDAY, JULY 15, 2004
U.S. Senate,
Subcommittee on Labor, Health and Human
Services, and Education, and Related Agencies,
Committee on Appropriations,
Washington, DC.
The subcommittee met at 9:30 a.m., in room SD-192, Dirksen
Senate Office Building, Hon. Arlen Specter (chairman)
presiding.
Present: Senators Specter, Harkin, and Murray.
opening statement of senator arlen specter
Senator Specter. Good morning, ladies and gentlemen. The
Appropriations Subcommittee on Labor, Health and Human
Services, and Education will now proceed.
Today's hearing is going to be on the subject of preventing
chronic diseases through healthy lifestyles, a wellness
hearing, focusing very substantially on the issue of obesity.
And, at the outset, I thank my distinguished colleague, Ranking
Member Senator Harkin, for having suggested a special hearing
on this subject. We will be examining the issues as to chronic
illnesses which affect some 75 percent of the $1.8 trillion
annually which is spent on healthcare. Obesity is now the
second leading cause of death in the United States,
contributing to at least some 400,000 deaths annually,
according to statistics from the Centers for Disease Control.
This subject has special prominence at the moment because
Secretary Thompson has just announced a program which will open
Medicare for the issue of obesity, with some additional studies
being required to see how the treatments would affect obesity
and how this categorization would fit into the overall Medicare
program. But there is no doubt that the issues of lifestyle,
exercise, diet are major factors with some real prospects for
cutting very deeply into the cost of medical care in the United
States if we would adopt alternative approaches to lifestyles.
This is a subject of special interest to me, because my son
Steve, younger son, is a Ph.D. in nutrition and has done
extensive research in obesity, and most recently decided that
he wanted to be in a clinical practice, and is now a medical
student at the University of Vermont. So the subject of
nutrition and obesity has been on the Specter agenda for a long
time.
It was introduced--with just another personal note--by my
wife, who is a nutrition expert, ran a cooking school, made
frozen pies which were prohibited from the Specter dining
table, and has raised a slender, non-obese group, with a focus
on this issue, and I'm glad to see that it is coming into
national prominence, because I think a great deal could be done
if more Americans would adopt this lifestyle of Senator Harkin
and myself, which is squash every morning at 6:30 and non-
fattening foods, and a regimen of diet and lots of meditation.
We would cut the medical costs of America very substantially.
Secretary Thompson has just said he waived his right to
testify.
Now I call on my distinguished colleague, ranking member/
partner, Senator Harkin.
opening statement of senator tom harkin
Senator Harkin. Well, thank you very much, Mr. Chairman. I
hope you don't mind if I don't join you for the squash game. I
have other ways of exercising. I don't know about that squash,
but I know you do it every morning, and that's really
commendable.
I just want to thank my chairman and my friend, Senator
Specter, for calling this important hearing today. For those of
you that know this subcommittee, you know that Senator Specter
and I have worked as a team for many, many years. We agree on
so many issues that cut across party lines, when it comes to
medical research, when it comes to Center for Disease Control
and Prevention, and this issue, also, wellness and prevention.
And this is an issue that is important to both of us, and it is
something we're going to pursue diligently.
I am pleased to see that we have such a distinguished group
of witnesses, beginning with our distinguished Secretary
Thompson.
I want to publicly commend you, Mr. Secretary, for your
commitment to promoting wellness, for the generous time and
energy you have devoted to initiatives such as the Healthy
Lifestyles and Disease Prevention Campaign. Not to disparage
any former Secretaries--we've had a lot of good Secretaries of
Health and Human Services in the past--but I can publicly say
that this is, I believe, the first Secretary that has really
focused on changing this paradigm, getting us more into
wellness and prevention, than anyone before you, and I really,
really appreciate that and commend you for it, Mr. Secretary.
I would like to recognize an Iowan who will be testifying
this morning, Mr. Vernon Delpesce, who's representing the Des
Moines YMCA; also a former Iowan, Mr. Jack Rule, who's Chief
Executive Officer of incentaHEALTH. I also want to state that
the Y is doing an outstanding job--not only in Iowa, but
nationwide--in promoting health and fitness. I understand that
Mr. Delpesce will use this hearing to unveil YMCA's major new
project to promote community wellness--nationwide, by the way.
Hopefully, Senator Specter and I can work together to help
include some funding, hopefully, in a bill to help promote the
Y in this excellent effort. We need to mobilize the public and
private sectors--everything from schools to businesses to
communities, everybody--in the cause of wellness and disease
prevention. We know that healthcare costs are out of control in
this country. Insurance premiums are going up at an alarming
rate. More and more people are losing health insurance
coverage. Everyone talks about the runaway cost of healthcare,
and all we talk about--it seems like we're talking about access
and coverage--access to the healthcare, and coverage--but
that's just for if you get sick. We ought to be talking about
how we provide access to healthcare. I've often said we don't
have a healthcare system in our country, we have a sick-care
system. If you get sick, you get care. But what if you want to
stay healthy in the first place? What incentives are there?
What's built into the system to keep you healthy in the first
place?
So when we talk about access, let's talk about access to
``health-care''--access to a whole set of incentives, programs,
from school on up--through the private sector, the public
sector--that would encourage you to be healthy in the first
place. And so we need to kind of shift that.
I've often said, in the United States we get an A. If you
look at the world, and health around the world, we get an A in
treatment and fixing people up. We're the best. But we get an F
when it comes to prevention and keeping people healthy in the
first place. And that's just not sustainable, given that 75
percent of the money we now spend on healthcare is accounted
for by chronic diseases--heart disease, diabetes, cancer--many
of these, in large part, preventable. Risk factors, such as
physical inactivity, poor nutrition, smoking, untreated mental
illness, lead to these expensive chronic conditions--yet only 2
percent of healthcare spending in the United States goes
towards the prevention of chronic disease--obesity, costing our
nation $117 billion a year in lost productivity, absenteeism,
and leading to other chronic illnesses.
Some experts are saying that the generation growing up
today could be the first to have a shorter life span than their
parents. So we need to make a new approach, a comprehensive
approach towards wellness.
I have introduced a bill called Healthier Lifestyles and
Prevention bill to provide incentives to schools, employers,
communities, to focus on health promotion and wellness, to
create better nutrition, physical activity, mental health
opportunities for kids in schools, to give the FTC, Federal
Trade Commission, authority to regulate unfair marketing to
kids, nutrition labeling on menus in chain restaurants.
I guess what I'm saying is, this has got to be a
comprehensive approach. A sliver here and a sliver there won't
work. This has got to be multifaceted.; it's got to be
comprehensive. It can't be just the government; it's got to be
the private sector. It can't just be adults; it's got to be
kids. And it's got to be communities.
I was visiting a new housing development recently, and it
is being built with no sidewalks. So how do kids ride their
bikes? How do they walk to school when you don't even have
sidewalks any longer? So bike paths, sidewalks, things like
this, we have to start thinking about all of this when we pass
all of this legislation here in the Congress.
Well, I've taken too long, and you've been very kind to
give me this time, Mr. Chairman. I just want to thank you for
your example of fitness. And, yeah, you're in good shape.
You're in good shape. So I appreciate your example, and our
partnership in working together, and your stewardship of this
committee. It's an honor to work with you.
Senator Specter. Thank you very much, Senator Harkin. Thank
you for those kind comments.
Senator Murray, would you care to make an opening
statement?
OPENING STATEMENT OF SENATOR PATTY MURRAY
Senator Murray. Mr. Chairman, I will submit my opening
statement for the record.
But just let me take this opportunity to thank you for, I
think, this very important hearing to talk about health in our
communities and the fact that physical activity has and does
make a difference in that. I think we know that chronic disease
that is caused by obesity and unhealthy lifestyles is costing
us billions of dollars in this country, and I think it is an
effort, as Senator Harkin said, that we need to take on from
every single level.
PREPARED STATEMENT
I don't think it's any surprise to any of us who have
watched what's happened over the past several decades as a lot
of our schools have eliminated physical education programs and
after-school activities, where a lot of our kids really learned
the importance of these and really learned to enjoy it, which
is a lifetime learning for them that they need to have. I think
we know they can't do it alone. They need to have support. We
need to find ways to make it happen and to fund these solutions
at all levels.
I look forward to this hearing and the outcomes of it.
Thanks very much, Mr. Chairman.
[The statement follows:]
Prepared Statement of Senator Patty Murray
Mr. Chairman; I want to thank you for scheduling this important
hearing. I also want to thank all of the witnesses today for their
testimony and their recommendations.
We are all in agreement that we face a serious public health threat
that could cripple our health care system.
Chronic disease--caused by obesity and unhealthy lifestyles--could
cost our health care system billions of dollars annually in addition to
the human toll it takes.
Unfortunately, many of the problems we face with respect to obesity
and inactivity are of our own making.
--Overcrowded schools have been forced to sacrifice playgrounds and
gyms for classroom space.
--Limited education dollars have forced many schools to eliminate
physical activity or after-school programs that help children
learn healthy lifestyles.
Our schools can play a role in teaching children about the
importance of physical activity and nutrition.
--But they cannot do it alone.
We must provide them with the support they need to help parents and
families instill good habits in our kids.
While the challenge can appear overwhelming at times, I think we
can work together to reverse these disturbing trends toward obesity.
--But it will require a change in our mindset,
--and a willingness to give our wholehearted support to finding--and
funding--solutions.
I'm glad we've called this hearing today, and I look forward to
continuing to work with my colleagues and committed advocates for
better health for our children.
STATEMENT OF HON. TOMMY G. THOMPSON, SECRETARY,
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Senator Specter. Thank you very much, Senator Murray.
Mr. Secretary, we welcome you, again, to this hearing. You
have come to this distinguished position at the start of the
Administration with President Bush; career started in 1966, in
the Wisconsin General Assembly; Governor since--between 1987 to
the year 2000, when he became Secretary of Health and Human
Services; the longest-serving governor in Wisconsin's history;
Chairman of the National Governors Association; a long list of
accolades which we'll put in the record, and we'll save most of
the time to hear your important testimony.
The floor is yours.
Secretary Thompson. Thank you very much, Senator Specter.
Let me, at the front end, thank you for your leadership. Thank
you for being an example of physical fitness, of an individual
that speaks out on what I consider the most important issue
facing the healthcare industry, the health and welfare of all
Americans. And I thank you for this hearing. I think it is
probably the most important hearing that I've ever been at, and
I want to thank you for having it. And I appreciate it very
much.
I also want to express my deepest sympathy to you and to
your staff on the passing of Carey Lackman from breast cancer
yesterday. It's time, Senator, that we solve this problem once
and for all. My family, my mother-in-law died from it, my wife
is recovering from breast cancer, my young daughter just came
down with it. So I know full well the terrible seriousness of
this disease, and I wish nothing but the best for you and her
family. And thank you very much----
Senator Specter. Well, thank you for those expressions of
sympathy. For those who may not know, Carey Lackman Slease
passed yesterday morning at 5:30, after a long bout of illness
with breast cancer. So thank you, Mr. Secretary.
Secretary Thompson. Senator Harkin, I could have--when I
saw you this morning on television, on FOX, I was--it made my
whole day. Thank you so very much for speaking out and leading
in this effort, asking for this hearing. To me, it is so
important. And thank you for being here, Senator Murray. I wish
everybody in the Senate could be here to hear the testimony
this morning on trying to transform healthcare.
When you look at it, America is not very healthy. Some 125
million Americans have one or more chronic illnesses. We spent
$1.5 trillion, 15 percent of our gross national product--75
percent of it goes for chronic illness. Seven out of ten
Americans that died last year from chronic illnesses. A good
share of them could have been prevented by a change in
lifestyles. Lifestyles need to be changed.
Medicare--we spend 95 percent of our Medicare dollars
waiting for people to get sick. It's a curative healthcare
system, not a preventive healthcare system. Less than 5 percent
of Medicare money is spent on prevention. Now, none of us in
this room would ever set up a system like that. It is
absolutely wrongheaded.
In the Medicare Modernization Act for the first time,
because of the leadership of Representative Nancy Johnson and
my Department, we were able to get, I believe, the most
important part of the Medicare Modernization Act--that is, the
induction physical. Next year, on January 1, 2005, everybody
that's 65 that's going to go into Medicare is going to get a
preliminary physical, and then we're going to start monitoring
diseases. We're going to start monitoring diseases and helping
people to change their lifestyles.
We also are changing our coverage decision today, which is
a sea-change in Medicare. Until now, Medicare has never allowed
for obesity to be considered an illness. For the first time,
starting with the Medicare coverage changes next year, we're
now going to be able to use scientific evidence to treat people
with obesity, a tremendous change.
Tobacco--and I know, Senator Harkin, you've led on this,
and I thank you so very much--$155 billion we spent last year
on tobacco-related illnesses; 442,000 Americans died. If we're
really going to be concerned about public health, if we want to
reduce healthcare costs, let's start getting people weaned from
tobacco uses in America once and for all. We should regulate
it, and we should really get out the information necessary in
order to start controlling disease resulting from tobacco use.
I go around and, people at the Humphrey Building that I see
smoking, I take cigarettes out of their mouth and tell them I
love them and I tell them they shouldn't do it.
We also, from the Department, want to thank each of you for
allowing us to reprogram the dollars so that we can use our own
money to instill a National Quit Line at the Department. We're
now going to be up--as of November of this year, we're going to
have a National Quit Line, so anybody in America can call in,
get information, including information on medicines to help
them quit. Seventy percent of Americans that smoke want to
quit. Let's help them quit. We will reduce deaths, reduce
healthcare costs, and improve the quality of health of America.
We also are doing something that I think is very neat. We
are the first Department that is going to try and be campus-
free, not only in the buildings, Senators; we're going to ask
our employees not to smoke on the campus. We've already started
that at the CMS; we're going to do it, on November 15, on the
National Quit Line and also in our Smoke Out effort. We're
going to have that at CDC. I'm going to try to do it in the
whole Department. And this, to me, is important.
We spend $135 billion a year on diabetes; 200,000 Americans
die each year from diabetes--and a good share of them don't
know they have it. One quarter of the Americans that have
diabetes don't know that they are diabetic. Eighteen million
Americans, right now, have Type 2 diabetes, and 41 million more
Americans are prediabetic. And unless we change it--can you
imagine? Just look at the figures. Extrapolate, from $135
billion from 18 million Americans to 41 million Americans that
are prediabetic, what it's going to cost in the future unless
we do something about it.
We are holding public hearings throughout America. We've
had three of them. We're going to have a national program for
the Department in order to try and get people to come in and be
tested.
Also, in Medicare, for the first time next year, people on
Medicare are going to be able to come in and get diabetes
screening. And we're hoping, then, to be able to start
monitoring them. One quarter of the people on Medicare that
have diabetes don't know they are diabetic, and it is time we
find out who they are, and start assisting them right now.
Obesity, Senator Specter mentioned it cost $118 billion
last year, and that it's the second leading killer. Well, those
were 2000-year figures. We think this year it exceeded tobacco.
We think the 400,000 people that died from tobacco--rather from
obesity-related illnesses in 2000 now will exceed, this year,
tobacco-related illnesses.
What we're trying to do in the Department--when I came
here, I put the whole Department on a diet. I've lost 15
pounds. People in my Department--you know, we come from
Wisconsin, and there isn't anything that cannot be improved
without adding butter and cheese and beer.
But I'm trying to get people to start looking at their
diet. I'm not saying, ``Stop eating,'' but exercise, use
moderation. My whole Department is on a diet, and we're trying
to make this a way to really show an example to the Nation.
We also are putting in our stairwells--we're painting
pictures in our stairwells, hanging pictures in the stairwells.
We're going to put music in the stairwells. And we're putting
signs on the elevator, ``If you don't need to use the elevator,
walk up the stairs,'' and be able to start getting some
exercise while you're doing it. I walk up seven flights of
stairs every single day in the Department. It's an example that
I try and set for the Department. We also have a program that
we think is very good, and that one is called ``Steps to a
HealthierUS.''
This committee has been very good to the Department. It's
given us $13 million the first year; it gave us $45 million
last year; and we're asking for $125 million next year for
cities to compete to set up programs--walking lanes, bicycle
paths--and be able to get people out in the communities. We
want the paths well-lit and safe so families do the necessary
walking with their families and are able to take the small
steps to a healthier lifestyle.
I'm also meeting with the health insurance companies. I
said, if automobile insurance companies can give a tax break or
an insurance break for people that have good driving records,
why can't we set up health insurance for individuals that do
the right thing, and be able to give them a break on their
health insurance? And they said that they had never thought of
it, or they don't want to do it, or there's some legal
problems. I think if we pushed them, we could accomplish that.
If the automobile insurance companies can do it, why can't
health insurance companies do it?
I've asked many of the restaurant associations,
restaurants, to come in and talk to me. We have monthly
meetings with those, and fast-food industries, ask them to come
in and be able to see if we can voluntarily get more
information on the menus. A lot of them are doing so, and I
would like to thank those that are doing it. We have to push
more of them to do more in the future.
FDA is going to be changing food labels. We're going to be
adding--increasing the font size for calories information.
We're also going to put the number of calories, not only for
the total package, but also for each meal, so that individual
consumers have better information as to what they are eating,
how much they should be eating, and so on.
We're also putting a tremendous emphasis on, with the
Department of Agriculture, increasing the consumption of fruits
and vegetables, especially with minorities. We want to make
sure that they're able to understand the importance of good
diet and good exercise, because diabetes and obesity is really
disproportionately impacting minorities. And we need to attract
individual leadership in the minority communities to make sure
we start transforming that.
What I'm saying, ladies and gentlemen, is that if we want
to really get at healthcare, if we want to improve the quality
of health, we've got to go from a curative system to a
prevention system.
My Department has also teamed with the Ad Council on
several ads promoting healthy lifestyles. I'm wondering if I
could quickly show them. There's just three of them. I think
they're funny. They give an effective message. I don't know if
you can see it. If you can show them--we've already had--we've
had $25 million of free coverage in the first 3 months, and I
think that's a pretty good indication that they're effective
yet funny. But--I don't know if you can play them--they're very
quick. Can you show them to the Senators?
[Video presentation of examples of the Department of Health
and Human Services ad campaign.]
Secretary Thompson. They have been well received. And what
we're trying to do is, we're trying to use humor. We're trying
to use humor to get people to recognize the importance of
healthy lifestyles.
I would just like to conclude by thanking you for
introducing the legislation, Senator Harkin, for asking Senator
Specter, and Senator Specter for holding this hearing, and for
both of your examples on public health. We also are putting on,
through the President's Council on Physical Fitness, a program
in which you can log onto the internet, set up a program of
exercise, record how well you're doing and get credits from the
President's Council on Physical Fitness, but also be able to
compare yourself to other people to see how well you're doing.
And this is something that we've got on our Web page, and is
just one of the things we're doing in the Department to really
try and transform it.
PREPARED STATEMENT
But the truth of the matter is, if we really want to change
healthcare and improve healthcare in America, we've got to look
at--stop smoking, watch what we eat, and eat moderately, and do
exercise. It's common sense. It will take a transformation of
the current healthcare system, but it's the right thing to do.
It's the right issue. And thank you so very much for having
this hearing.
[The statement follows:]
Prepared Statement of Hon. Tommy G. Thompson
INTRODUCTION
Mr. Chairman, Members of the Committee, thank you for the
opportunity to participate in today's hearing and this important
discussion on healthy lifestyles, health promotion, and disease
prevention.
The United States faces a grave and significant health challenge.
Seven of 10 deaths each year are caused by chronic diseases. The
underlying causes of these diseases are often risk factors that can be
successfully modified years before they ultimately contribute to
illness and death. Three such factors-tobacco use, poor nutrition, and
lack of physical activity-are major contributors to the nation's
leading killers. America's poor eating habits and lack of physical
activity are literally killing us. Even worse, America's children are
more sedentary and overweight than ever before. The prevalence of
overweight has more than doubled in children and tripled in
adolescents, and there are indicators that suggest that diabetes rates
among children are also increasing,
Chronic diseases account for more than 60 percent of medical care
expenditures. The total cost of obesity is up to $117 billion per year.
We estimate the number of Americans dying from obesity will surpass the
number of deaths due to tobacco this year. Tobacco use causes 440,000
deaths annually and costs $75 billion just in direct medical costs. In
2002, the estimated cost of diabetes in the United States was $132
billion and the work disability rate is 26 percent for those with the
disease and 8 percent for those without diabetes.
That is a lot of bad news. The good news is that while the problem
is vast, the solution is achievable, and I want to talk today about my
vision for making that happen.
It is one of my primary goals as secretary to make certain that all
Americans understand what they can do to protect their health.
Prevention is the power to protect your health. I intend to continue to
promote a national dialogue about the state of America's health--with
prevention as the primary focus. We need to strike a better balance
between preventive care and treatment. Our mission at the Department of
Health and Human Services is to do just that. There is no better time
to put the health of America front and center than now. We need to get
off the couch, have fun and live healthy. By practicing even a little
prevention, we will have a nation that is as strong in heart and body
as it is in spirit.
DEPARTMENT OF HEALTH AND HUMAN SERVICES STEPS TO A HEALTHIERUS
INITIATIVE
The President recognizes that a healthy America is a strong
America. In June 2002, President Bush launched the HealthierUS
initiative designed to help Americans, especially children, live
longer, better, and healthier lives. The President's HealthierUS
initiative helps Americans take steps to improve personal health and
fitness and encourages all Americans to: (1) be physically active every
day; (2) eat a nutritious diet; (3) get preventive screenings; and (4)
make healthy choices concerning alcohol, tobacco, drugs and safety.
Two years ago, I launched Steps to a HealthierUS to help Americans
lead healthier lifestyles. At the heart of this program lies both
personal responsibility for the choices Americans make and social
responsibility to ensure that policy makers support programs that
foster healthy behaviors and prevent disease. The Steps initiative
envisions a healthy, strong, U.S. population supported by a health care
system in which diseases are prevented when possible, controlled when
necessary, and treated when appropriate.
The central message of the Steps to a HealthierUS initiative is
that small steps can make a big difference. We want people to
understand that they do not need to make drastic changes to their
lifestyles to be healthier. We are not asking every American to run a
marathon, join a gym, or give up eating their favorite foods. Small
steps, such as playing outside with your children, going for a walk,
snacking on fruits and vegetables, or taking the stairs instead of the
elevator, can make a big difference in our health.
The cornerstone of the Steps initiative is the community grant
program. Last year, the first year of the grant program, 23 communities
were funded. This year $44 million is set aside to help additional
communities develop action plans to implement programs that promote
disease prevention and health. The interest in this program has been
overwhelming and we are receiving far more applications than we can
fund each year. For next year, we have requested $125 million to
support this grant program. These funds are used to help implement
community action plans for activities ranging from establishing
community walking programs to helping schools, worksites, shopping
malls, senior centers and other community locations establish exercise,
nutrition, and smoking cessation programs. We are targeting diabetes,
asthma and obesity because of their rapidly increasing prevalence in
the United States and the ability for individuals to control and even
prevent these diseases through exercise, diet and other strategies that
will be implemented with these grant funds.
In addition to the community grants, the Steps initiative has
several other components. In December of 2003, HHS awarded eight Steps
Innovation in Prevention Awards in seven categories to groups and
organizations recognizing their accomplishments and highlighting the
concrete health improvements that each has achieved. For the past two
years in the spring, the Department has sponsored the Steps to a
HealthierUS: Prevention Summit in Baltimore, Maryland. The summit
brought together more than 1,000 providers and practitioners,
educators, and policymakers, community and industry leaders to discuss
promising approaches for tackling key challenges. Both of these
components of the Steps initiative have fostered the exchange of
information about what works to put prevention into practice.
Another aspect of the Steps initiative is the partnership program
where other public and private sector organizations work with HHS to
support and promote healthier living. These partnerships are designed
to encourage other organizations to follow the lead of the Innovation
Award recipients.
In the past year, I have met with many individuals and hosted a
series of roundtable sessions with business leaders, researchers,
providers, insurers, and other interested parties to discuss health
promotion and disease prevention issues and strategies. I also convened
several departmental workgroups on obesity, diabetes, tobacco use,
health literacy and health messaging to review current programs and
progress. In April 2004, I released my ``Blueprint for Action'' which
represents the product of these various efforts and outlines simple
action steps to guide individuals in their quest for healthier
lifestyles. It also encourages other interested parties and
organizations, such as health care providers, employers, communities,
insurers, media, schools, and government to collaborate and cooperate
to overcome obstacles, to promote healthy lifestyles and reduce the
burden of chronic diseases.
In addition, last fall I launched my ``Secretary's Challenge--Steps
to a HealthierHHS'' for employees in the Hubert Humphrey Building. This
work site health promotion program encouraged my employees to become
more physically active by exercising at least 30 minutes a day, five
days a week for six weeks. I plan to take this challenge to all HHS
employees and other federal departments soon.
ADVERTISING CAMPAIGN
We also are conducting a creative public education and advertising
campaign. Our ads run on T.V., radio, and the Internet, in English and
Spanish. They are humorous ads that show people finding body parts--
love handles, double chins, and big bellies--that have been ``lost'' by
people who are practicing healthier habits. They send the message that
small steps can make a big difference in leading healthier lifestyles,
and they do so without making people feel guilty or discouraged. This
Healthy Lifestyles campaign includes a web site, www.smallsteps.gov
that offers consumers ongoing ideas, 100 small steps, and support to
pave the road to a healthier lifestyle.
Our public service campaign will continue, and we are expanding it
with the Ad Council. We will build upon the Small Steps campaign in the
coming year, but we also will be adding a new advertising campaign
targeting children. We want to educate children early about the
importance of being active and eating healthy. We want to help
reinforce the messages that parents teach their children: eat your
vegetables; go outside and play; put down the video games and play a
game of tag. Then later next year, we plan to freshen the adult
campaign with new ads.
When you combine these two Ad Council campaigns with our VERB
campaign demonstraton, which focused on increasing physical activity
among 9-13 year olds, we are getting our targeted messages to much of
our population. First year data from a VERB evaluation suggests that
the campaign reached its target audience and contributed to improved
levels of physical activity.
We are providing motivation for our children, their parents, and
adults to take the right steps to lead a healthy life. We also can
certainly use the media's continued help in getting out these important
messages to adults, children, and entire families.
MEDICARE MODERNIZATION ACT
If you talk to senior management of corporations in almost any
industry about their biggest concerns, you hear over and over about
rising health care costs. Much of these costs are linked to preventable
chronic diseases. That is why employer spending on prevention is a wise
investment. When I talk with employers or insurers or food producers, I
tell them, if you have not made an effort to make your policies
consistent with healthy habits, you are missing an opportunity to lower
health care expenses and absenteeism, and increase productivity.
We at HHS are leading by example. Medicare is the Nation's largest
provider of health insurance, affecting more than 40 million seniors
and people with disabilities. With this past year's Medicare
Modernization Act, I pushed to include more preventive benefits in
Medicare. Now, starting in January 2005, seniors entering Medicare will
be offered a complete, ``Welcome to Medicare'' physical. In addition,
all people on Medicare will be covered for blood tests that can
diagnose heart diseases. Additionally, those high at risk for diabetes
will be covered for blood sugar screening tests.
It makes sense to spend money on preventive medicine. Preventive
care enables doctors and patients to diagnose and treat health problems
earlier, changing our health care system from a focus on treating
disease to a focus on preventing disease. This shift in thinking will
pay off not only in lower health care expenses, but also in a better
quality of life for all Americans.
OVERVIEW OF OBESITY AND DIABETES EPIDEMIC IN UNITED STATES
Today we face an epidemic of obesity--a major risk factor for heart
disease and stroke, diabetes, and certain forms of cancer. Right now,
our country is just too fat, and we have a crisis on our hands. By way
of comparison, obesity has roughly the same association with chronic
health conditions as does 20 years of aging. Few of our citizens have
healthy nutrition and physical activity levels. The impact of this
physical inactivity on medical costs is substantial and is likely to
grow unless trends in physical activity change among older adults.
In the United States, obesity has risen at an alarming rate during
the past 20 years. In fact, two out of every three of Americans now are
overweight or obese. Even worse, the prevalence of overweight children
has risen drastically. More than half of children who are overweight
have at least one additional cardiovascular disease risk factor, such
as elevated cholesterol or high blood pressure.
In 2000, the cost of diseases associated with obesity was estimated
to be $117 billion for direct and indirect costs. Of the approximately
$1.6 trillion [$1.3 in 2000 but $1.6 in 2002 according to CMS] spent on
health care each year, about 75 percent of these dollars are spent
treating chronic diseases such as heart disease, cancer, and diabetes,
and $75 billion of that treats obesity alone.
In fact, there is a corresponding overwhelming rise in diabetes
that we cannot afford to ignore. Today, at least 18.2 million Americans
have diabetes, of which 5.2 million have the disease but have not yet
been diagnosed. At least 41 million more have the condition known as
``pre-diabetes.'' These people have higher than normal blood glucose
levels and are at increased risk of developing diabetes. These facts
are too troubling to disregard and too grim to just accept. Type 2
Diabetes was once considered a disease of the middle-aged and elderly,
but now we are seeing it in our children.
My Department and this Administration absolutely refuses to accept
the increase in the prevalence of diabetes, currently the sixth leading
cause of death in America. We must act against this long-term public
health crisis of obesity. If we do not improve, the gains in life
expectancy and quality of life resulting from modern medicine's
advances on disease will erode, and more health-related costs will
burden the nation. We must educate Americans about how to take
responsibility for their own health and the health of their family
members, how to build healthy nutrition and physical activity into
their daily lives, and how to make wise choices.
Therefore, we are acting for change, acting boldly and with energy
and focus. The agencies of my Department are performing leading-edge
research, and looking for ways to use those research findings to lead
us to action.
Although the increasing burden of diabetes and its complications is
alarming, much of this burden could be prevented with early detection,
improved delivery of care, and better education on diabetes self-
management. A modest and attainable improvement in our level of
activity and the food we eat will work wonders. It is scientifically
proven that moderate physical activity can substantially reduce the
risk of developing type 2 diabetes--not to mention heart disease, colon
cancer, high blood pressure and obesity. We are doing everything we can
to make diabetes a bad memory, and we will not accept such a thing as a
``tolerable'' incidence of diabetes, while we can still research more,
educate more, and treat more Americans.
We are taking a number of other important steps to address obesity,
diabetes and improve the overall wellness of Americans:
In November of 2003, HHS launched the Diabetes Detection
Initiative: Finding the Undiagnosed. This community-based effort seeks
to identify persons with undiagnosed type 2 diabetes and refer them to
follow up blood testing and treatment if necessary.
We also are in the process of consulting with the public and
relevant stakeholders on diabetes issues. As part of the process to
create this action plan, three half-day town hall ``listening
sessions'' are scheduled in different parts of the United States, to
highlight the important steps that individuals, health care
practitioners and providers, businesses, and communities are taking to
detect diabetes and educate patients, their families, and other
Americans. The first town hall meeting focused on prevention of
diabetes and was held in Cincinnati, Ohio on March 29, 2004 with over
350 attendees. The second town hall was held in Little Rock, Arkansas
on June 18 and discussed diabetes detection and education. The third
town hall meeting is scheduled for Seattle, Washington on July 26, and
will focus on treatment of diabetes.
Other departmental activities include:
FDA
In August 2003, FDA established an Obesity Working Group (OWG) to
advise the Agency on innovative ways to deal with the increase in
obesity and to identify ways to help consumers lead healthier lives
through better nutrition.
In March 2004, the FDA released its comprehensive report to combat
obesity with a focus on the message, ``Calories Count.'' The report
focuses on providing consumers with better information to help them
lead healthier lives through better nutrition.
The FDA is presently working to:
1. Improve Food Labels
Consumers need more information to make sound food choices in the
areas of calories and serving sizes. FDA has received petitions from
manufacturers to provide for nutrient content claims for the
carbohydrate content of foods. FDA is in the process of evaluating the
petitions and plans to define terms such as ``net,'' ``low,'' and
``impact'' so that consumers are armed with better and more accurate
information when making food choices.
FDA is also encouraging the use of comparative labeling statements
to make it easier for consumers to compare different types of foods and
make healthier substitutions. For example, ``One medium apple (80
calories) contains 47 percent fewer calories than a one ounce serving
of potato chips (150 calories).''
2. Restaurant Nutrition Information
FDA is urging the restaurant industry to launch a nation-wide,
voluntary, and point-of-sale nutrition information campaign for
customers. FDA also encourages consumers routinely to request nutrition
information when eating out. In addition, the final report calls for
the development of options for providing voluntary, standardized,
simple, and understandable nutrition information, including calorie
information, at the point-of-sale in a restaurant setting.
3. Increased Enforcement Activity
FDA plans various enforcement activities to ensure the accuracy of
the information in the Nutritional Facts panel and to ensure that
consumers can monitor their intake of calories and nutrients. This
includes stricter enforcement activities against those manufacturers
that declare inaccurate serving sizes.
This past year also witnessed a major change in the nutrition label
on foods to include a separate listing of trans fatty acids. This was
the first significant change on the Nutrition Facts panel since it was
established in 1993.
The FDA has also undertaken a broad effort to crack down on
misleading information and/or unsafe dietary supplements, and proposed
new regulations to establish good manufacturing practice requirements
for dietary supplements. The FDA took steps to remove dietary
supplements containing ephedrine alkaloids from the market. These
products were extensively promoted for aiding weight control and
boosting sports performance and energy. One of the key messages of this
effort is that there are no safe quick fixes when it comes to losing
weight and improving athletic performance, and it is only through
proper diet, nutrition and exercise that we can improve our physical
performance and, more importantly, maintain and improve our health.
And, the FDA is partnering with other federal agencies to combat
obesity among kids. The Power of Choice is an after-school program
developed jointly by HHS's FDA and USDA's Food and Nutrition Service.
The materials guide pre-teens toward a healthier lifestyle by
motivating and empowering them to make smarter food and physical
activity choices in real-life settings. A Leader's Guide, containing
ten sequenced interactive sessions engage adolescents in fun activities
that develop skills and encourage personal development related to
choosing foods wisely, preparing foods safely, and reducing sedentary
behaviors. Most activities require little or no pre-planning and are
simple to do. The Leader's Guide also includes easy snack recipes, 170
Nutrition Facts cards, and posters on four key topics, and a computer
disk provides supplemental activities to each of the 10 sessions, a
self-training video for the leader, community support suggestions, and
much more.
NIH
Through its research mission, the NIH is seeking to capitalize on
recent scientific discoveries to further understand the forces
contributing to obesity and develop strategies for prevention and
treatment. NIH expects to spend roughly $400 million this year on
obesity-related research, and the Administration has requested more
than $440 million for fiscal year 2005.
As the problems of overweight and obesity have grown, the need for
new action and research has become more evident. In response, NIH
assembled a Task Force to identify areas for new research across its
many institutes. In March 2004, NIH released the draft of its Strategic
Plan for NIH Obesity Research (www.obesityresearch.nih.gov). This
report identifies key areas of research needed, priorities among those
areas, a road map and strategies for advancing these research
priorities, and the establishment of a committee for monitoring
progress in addressing the issues and problems relating to overweight
and obesity. The NIH expects to make the final, published Strategic
Plan for NIH Obesity Research available shortly.
5 A DAY FOR BETTER HEALTH
One of the most recognizable efforts to promote good nutrition and
healthy eating habits has been the National Cancer Institute's 5 A Day
for Better Health Program. This national nutrition program seeks to
increase to 5 or more the number of daily servings Americans eat of
fruits and vegetables. In addition to its widely known slogan, the 5 A
Day program reaches many individuals through health care provider
networks, the internet, and print media to provide information about
the health benefits of eating more fruits and vegetables, as well as
easy steps for adding more of them into daily eating patterns.
CDC
The National Nutrition and Physical Activity Program to Prevent Obesity
With 2004 funding, the CDC will support obesity prevention programs
in a total of 28 states. Of these, 23 states will be funded at the
capacity-building level to hire staff with expertise in public health
nutrition and physical activity, build broad based coalitions, develop
state plans, identify community resources and gaps, implement small-
scale interventions, and work to raise public health awareness of
changes needed to help state residents achieve and maintain a healthy
weight. The other five states are funded at the basic-implementation
level to put their state plans into action, conduct and evaluate
nutrition and physical activity interventions, train health care and
public health professionals, provide grants to communities, make
environmental changes, and strengthen obesity prevention programs in
community settings.
In addition, CDC provides funding to 23 states for the
implementation of school-based policies and programs to help young
people avoid behaviors that increase their risk for obesity
specifically unhealthy eating and inadequate physical activity.
Making it Happen--School Nutrition Success Stories (MIH)
This material features the stories of 32 schools and school
districts that have implemented innovative strategies to improve the
nutritional quality of foods and beverages offered and sold on school
campuses. MIH is a joint project of the Food and Nutrition Service of
USDA and the Division of Adolescent and School Health of CDC.
OTHER KEY HHS ACTIVITIES
Administration on Aging Action
The Administration on Aging's (AoA) National Policy and Resource
Center on Nutrition, Physical Activity and Aging was created for the
purpose of increasing and improving food and nutrition services to
older Americans through their caregivers at home, with community-based
service providers, and in long-term care systems. The Center focuses on
linking proper nutrition and physical activity as key themes in the
healthy aging process. One strategy for making this link has been the
development and publication of a community guide entitled, ``You Can!
Steps to Healthier Aging'', that details a 12-week program to help
older Americans ``eat better'' and ``move more.'' The Center is
awarding 10 mini-grants to local communities to implement the You Can!
Program in 2004.
AoA provides funding to states to implement health promotion and
disease prevention activities. Educational information is disseminated
through Senior Centers, congregate meal sites, and home-delivered meal
programs. Health screening and risk assessment activities including
hypertension, glaucoma, hearing, nutrition screening, cholesterol,
vision, diabetes, bone density, and others are also provided. Physical
activity and fitness programs are provided along with education about
the prevention and reduction of alcohol, substance abuse, and smoking.
CONCLUSION
We must continue to work hard to spread the gospel of personal
responsibility. Each of us has to take responsibility for making the
right choices when it comes to diet and exercise. My Department has
taken steps to promote this attitude--and most importantly, we are
trying to do it in creative ways without inflicting the guilt that
turns so many people off.
From the day I arrived at the Department, I made healthy living and
disease prevention our cornerstone priority. I put our whole Department
on a diet, and I lost fifteen pounds myself. I began handing out
pedometers, to help people walk 10,000 steps a day. Now they are a
fashion statement.
My challenge to Americans is to find a way, not just one way, but
several ways to spread the message of healthy living. Through
employers, neighbors, churches, community groups, and even your own
family, there are countless opportunities for each of us to encourage
disease prevention and healthy living in our own lives.
I thank you for your interest and the opportunity to share with you
some of HHS's many activities related to promoting healthy lifestyles
and reducing the burden of obesity and chronic diseases in America.
Let's keep the dialogue going so this issue stays on our radar screen
until it is not a problem anymore. We can work together to make this
happen.
Senator Specter. Thank you very much, Mr. Secretary.
You have indicated the policy change to expand coverage of
obesity treatments such as gastric bypass surgery, with the
proviso that before such procedures will be covered by
Medicare, they must first be shown to improve health. There
have been very extensive procedures, such as gastric bypass,
for many years, and studies have shown it to be effective. Why
not start now, Mr. Secretary--at least with gastric bypass,
where there is a good bit of evidence that they are
successful--to put Medicare to work on the issue?
Secretary Thompson. I'm willing to do that, Senator
Specter. The truth of the matter is, this has been a tremendous
sea-change from what the former coverage was at CMS. It didn't
allow for anything dealing with strictly obesity. The coverage
would allow for diabetes, if it was for treatment. But I think
this is a giant step forward, and we're looking at exactly what
you're talking about, to go the next step. This is, sort of,
the middle step, but I think the next step is what you're
asking for, Senator Specter, and we're looking at that, and
we're compiling the scientific evidence in order to make that
change. And I thank you for the question.
Senator Specter. Well, I would encourage you to do that,
because I believe it will prove out that it'll be a savings by
preventing further ailments.
Mr. Secretary, I want to cover one other subject--our time
is limited, and we have a long list of witnesses--and that is
the stem cell issue where you wrote, yesterday, to the Speaker
of the House of Representatives, with an idea for a registry.
And I think it is a good idea. And as I have heard about it, it
will make available, through the registry, stem cell lines
where--there are now lines which have been permitted by the
President's declaration back in August 2001 for Federal
funding--so that companies which own these lines and are
currently making it difficult for other researchers to use
them, there can be some pressure from the funding, which they
now get from NIH or Health and Human Services, to facilitate
the availability of those stem cell lines to other researchers.
The question that I have for you relates to the total
number of lines. When the President made his announcement--
dramatic speech, at 9 o'clock on August 9, 2001--he said that
there would be some 63 stem cell lines made available. That
number then went into the 70s, and has come back to about 19,
and maybe now about 20 or 21--in the low 20s. Would it be
possible--and some of those lines have problems on
contamination with mouse feeder--would you be willing to
explore, on behalf of the administration--and I understand the
sensitivity of the issue when your letter to the Speaker was
very diplomatically and delicately phrased--but would you be
willing to consider a program which would determine the current
number of lines which are available, and seek to raise the
number of available lines to, say, 63, which was the original
number that President Bush made available back in that famous
August 2001 speech?
Secretary Thompson. I would, Senator, but I want you to
know the President is very committed to his policy. But I
certainly will explore the possibility of seeing if there are
other lines available that would meet the requirements of the
President so that we could increase it. I think that is a very
good suggestion, and I will follow through on that.
Senator Specter. Well, I think that it could fit within the
contour as to what the President has said when he has his own
reasons and his own conclusions as to making the stem cells
available. But having taken a stand on 63 lines, it seems to me
that that would be accommodate-able on both policy and
political reasons, and I would very much appreciate it if you
would explore that.
Secretary Thompson. Thank you very much.
I would also like to point out that we're going to be
funding, Senator--and I know that you appreciate this--three
centers of excellence to try and encourage more scientists and
more knowledge-based----
Senator Specter. At least two in Pennsylvania, Mr.
Secretary?
Secretary Thompson. Pardon?
Senator Specter. At least two in Pennsylvania?
Secretary Thompson. Well, we certainly----
Senator Harkin. And one in Iowa?
Secretary Thompson. Well, certainly one in your favorite
city, Senator, but I'm trying to get one into Wisconsin, too.
One into Iowa, but I really think--what we've found is that
a lot of scientists don't know how to replicate--once they get
the stem cell line, they make mistakes, as far as growing them
and then differentiating the cells. And what we're trying to do
is set up courses first in order to teach them how to do that.
Second, then, to bring together scientists of like-minded
persuasion with regard to stem cell development and research
and be able to see whether or not we can develop a more
scientific knowledge, more scientists to go into the field, and
that's what we're trying to do with these Centers of
Excellence. I think it's a good idea and we're trying to do
that. But the President and I both feel very strongly about the
importance of investing in stem cell research.
Senator Specter. The red light went on in the middle of
your answer, and I'm going to stick to the time because we have
so many witnesses, so I'll turn now to Senator Harkin.
Secretary Thompson. Thank you, Senator Specter.
Senator Specter. Thank you.
Senator Harkin. Thank you again, Mr. Chairman.
Mr. Secretary, thank you for your great leadership. I think
you have set a new high standard for your position as Secretary
of Health and Human Services, for you and for whoever may come
after you, whenever that may be, in the distant future. But I
just hope you will continue to use your bully pulpit, as you
have been, and continue to push this, and not only just under
your own jurisdiction, but for things outside.
Now, kind of, what I'm leading to is that--for a little
history here, in 1978 the Federal Trade Commission came out
with proposed regulations to regulate advertising to kids. As
I've researched this--and I was here at the time, but I was in
the House, and I--kind of, a new Member, I probably didn't know
that much about it at the time--but what happened is that the
Soft Drink Association, certain food industries and stuff, got
together--advertisers, advertising associations--and really
bore down on Congress. Congress then passed a law basically
prohibiting the FTC from regulating advertising to kids. I
think it is factual to say that, today, the FTC has more
authority to regulate advertising to us, adults, than it does
to kids.
Since that time, we have seen this plethora of ads now, and
things directed at kids, everything from counting books, at the
earliest ages, to all the things they see on television, and on
and on.
So as, sort of, our ombudsman, which you are, on
healthcare, child health, and child obesity, give us your
thoughts--or if the administration has any position on this--to
ensure that the FTC has the same authority to regulate
advertising to children as it does to adults. And considering
any other regulatory steps that might be taken to address the
improper targeting of junk-food advertising aimed at kids. I
just wonder if you--any thoughts you have on that.
Secretary Thompson. Senator, since I am not an expert in
that subject, FTC, I don't know if I'm the right person to give
any administrative opinion on that. But let me tell you my
personal opinion. I think the more that we can really get the
information out there to children, that's the future. And,
Senator Murray said it best, there's very few schools that
provide for physical education anymore. We've got to get more
physical education back into schools. We've got to get proper
advertising to our children wherever possible. That's a
personal opinion of mine. And I think that you're going in the
right direction, Senator Harkin, and I thank you for it, but I
am not in any position to talk about that area, other than my
own personal opinion.
Senator Harkin. I understand. I just--you know, again, the
idea being that--and I hope you will take a look at that and
think about it, and perhaps think about talking about, at
least, having some regulations on how we advertise junk food to
kids.
I had a poster here. Where is it? Give me that. I'll just
show you some of the things happening now to kids, at the
earliest age. This is some of the things that are happening
now. Here is a counting book, ``Learn to Count From 1 to 10,''
the Oreo Cookie counting book. Here is a Goldfish counting
board book, the M&Ms counting board book. Out of all that,
there's one that is healthy; that's Cheerios. At least, I think
it's fairly--and maybe I could be corrected on that, I don't
know, but at least that's not real sugared up and everything.
But is this kind of thing. You know, it's----
Secretary Thompson. We're trying to do a better job on
labeling through FDA, Senator Harkin, and----
Senator Harkin. Say what?
Secretary Thompson. We're trying to do a much better job
through labeling at FDA. We just put out a rule, a final rule,
on trans-fatty acids. And, for the first time, companies are
going to have to put on the food label, as of January 1, 2006,
the calories and the amounts of the trans-fatty acids.
Senator Harkin. Our friends to the north, Canada, Great
Britain, many European countries, I don't know who all,
definitely do regulate advertising to kids when it comes to
junk food and stuff like that. We just don't. And this goes
back, again, to a law passed by Congress in 1980. We did, we
passed a law.
Secretary Thompson. I'm for you.
Senator Harkin. I know. I just want to get this out there.
You know? And----
Secretary Thompson. I'm glad you do.
Senator Harkin [continuing]. We need to move in that
direction.
Now, my red light is on, darn it. But preventative
service--thank you for what you're doing in Medicare. We've got
to continue to move in that direction. You've taken the first
big steps in doing that. I've had a lot of medical people
complain to me that--you know, that in Medicare, they just
can't get the preventative kind of reimbursement for good
preventative services for the elderly that they need. And,
yeah, but if they get sick, they can get the curative, as you
say. So the more you can push Medicare and help us to think
about how we might change some--if we need to change the law,
or if you can do it administratively--to get Medicare more into
providing the up-front preventative services, especially
smoking for the elderly, weight reduction, exercise, nutrition.
Man, the elderly can prevent a lot of illnesses and stuff, and
the impact on Medicare, if we just have those four things.
Secretary Thompson. One fourth of the seniors that have
diabetes don't know it, and they're in Medicare. So what we're
going to do, if we don't start screening--we're going to wait
until they get some kind of eye failure or renal failure or
whatever. Then we're going to spend hundreds of thousands of
dollars trying to get them back to health. It just doesn't make
any sense at all. Thank you.
Senator Harkin. Well, again, my highest accolades to you,
Mr. Secretary. You've been a great leader.
Senator Specter. Thank you, Senator Harkin.
Senator Murray.
Senator Murray. Well, Mr. Secretary, thank you very much
for both your personal and professional modeling of appropriate
behavior and what we need to do to focus on this, and I truly
appreciate it.
One of the things you talked about extensively in your
remarks was moving to prevention, which I think is absolutely
critical. And one of the best programs I have seen out in the
communities that works on prevention and screening and early
detection goes right to those 44 million uninsured people in
this country, and that's the Health Community Access Program,
the HCAP program, that has been so successful that we've worked
on in a bipartisan way for a number of years, to fund, here in
Congress, and I think it goes right to making sure that pre-
screening for diabetes, those kinds of things, happen at a
community-based level for the uninsured.
I noted that you recently took $20 million from that
program to put into the AIDS Drug Assistance Program, another
program I think we all support and care about, we've worked on
in a bipartisan way. But I am deeply troubled that that funding
came from a program that does precisely what you are working to
do today, to do prevention, to do it in a community-based
level, particularly for uninsured, who have the least access.
And I'm--want to know, you know, what your intention is with
that. I know we're going to work again very hard this session
to fund that program, but raiding that $20 million is robbing
Peter to pay Paul.
Secretary Thompson. Well, let me respond to that. You know
that only 15 percent of the money in that program can go to
services, and that money had already been allocated to the
services, and all the programs that were going to be funded
under that particular program this year had been funded. So the
extra money is what we----
Senator Murray. But what it does is, it doesn't allow that
program to expand. At a time when we know that prevention, that
community-based models work the best, that the uninsured
numbers are growing, it seems to me that we should be making
sure that that program expands, not contracts.
Secretary Thompson. Senator Murray, I--all I can tell you
is that I'm not as favorably disposed to that program. I do not
believe it has been as effective as other programs we have in
the Department. You and I differ on that. But I want you to
know that all of the things that were going to be funded under
that program in this fiscal year were funded. Now, granted,
there could have been new applications for new programs, but,
at that particular time, when we redirected the money to the
AIDS program, the money for this particular fiscal year had
been used, and only 15--under the congressional law and under
the law of the land, only 15 percent of the money in that
program can be used for services, and that money had already
been used.
Senator Murray. Well, I do disagree with you on the
effectiveness of that. And I've been out in my State, and
visited a number of the CAP grantees who are doing tremendous
things with uninsured people, young kids in particular, getting
them in for early screening, early screening for diabetes,
early screening for a number of things that--these kids don't
have access to healthcare, and we know prevention is the way we
need to go. And I would invite you out to my State to see
specifically what some of these programs are doing.
But I do want you to know that I plan to fight for this
funding again. We've been doing it for 5 or more years, we've
done it in a bipartisan way. We're going to fund this program,
and I think we've got enough support in Congress to do that. I
think it's what we do need to do.
Secretary Thompson. I just think there are other programs
that we have in the Department that are much more effective and
do a better job, Senator Murray. And you and I won't ever agree
with that, but I just----
Senator Murray. Well, I'd love to have----
Secretary Thompson [continuing]. I think your State is
doing some wonderful things----
Senator Murray [continuing]. I'd love to have you come out
and see some of the----
Secretary Thompson. I will----
Senator Murray [continuing]. Programs in my State----
Secretary Thompson [continuing]. Be more than happy to come
out there.
Senator Murray [continuing]. That really are----
Secretary Thompson. I'd be more than happy to come out and
spend the day with you----
Senator Murray [continuing]. Fabulous.
Secretary Thompson [continuing]. Senator Murray, and watch
your programs.
Senator Murray. We'll be----
Secretary Thompson. I'd love that.
Senator Murray. All right.
Secretary Thompson. I do it----
Senator Murray. Let me----
Secretary Thompson [continuing]. All over the country, so
I'd be more than happy to do it.
Senator Murray. Well, know we're going to be fighting for
the funding here, and----
Secretary Thompson. Thank you.
Senator Murray [continuing]. I'd take you up on that.
But let me ask you, really quickly, on another issue, and
that's the 5 A Day Program that--I've been working with our
apple and vegetable growers to do the 5 A Day Program that CDC
has been promoting.
Secretary Thompson. And agriculture.
Senator Murray. And agriculture. I think it's great. I'm a
huge supporter.
Secretary Thompson. Good for you.
Senator Murray. I'm concerned that the only way people can
get information is on the CDC Web site, which, you know, I've
got to tell you, as a parent, you just don't go cruising
through the CDC Web site to get information about that. How can
we do a better job of getting that actually into the hands of
parents who need that kind of information? Is there a lead
agency? Do you have a way of making sure that all of the
different agencies that work with this can get the information
out to people?
Secretary Thompson. Sure, absolutely. It's a good point,
and I'm always looking for good suggestions and ideas on how to
improve the operation of the Department. I'll take that back
and see if we can't get it on our master Web page. And I also
will ask Ann Veneman to put it on her Web page in Department of
Agriculture.
Senator Murray. Okay, appreciate it. Thank you very much.
Secretary Thompson. Thank you for your idea.
Senator Specter. Secretary Thompson, Senator Harkin has a
30-second Q&A.
Secretary Thompson. Yes.
Senator Harkin. Very short. I see we have Dr. Dean Ornish
going to be testifying later. This has to do with----
Senator Specter. Half the time's gone, Tom.
Senator Harkin [continuing]. With the food pyramid. Are you
working in collaboration with the Department of Agriculture to
redefine and redesign the food pyramid?
Secretary Thompson. Department of Agriculture has complete
jurisdiction of the food pyramid, but we are--we're the lead
agency this year with regard to nutrition, and we're holding
our hearings right now. The last hearing's going to be in
August, and we're going to have a report, in collaboration with
the Department of Agriculture, in December of this year, with
regard to fruits and vegetables, and also to nutrition.
Senator Harkin. Well, I'm--Agriculture may have
jurisdiction over that. They may. But you're the experts in
this, and your Department is, and I hope there is a close
collaboration between Agriculture and you on the food pyramid.
Secretary Thompson. There is, Senator. Very much so.
Senator Harkin. Okay. I'm----
Secretary Thompson. And the food pyramid, I think, is going
to be based upon the hearings and meetings we're having right
now, in which the Department of Health and Human Services is
the lead agency.
Senator Harkin. Because it is my opinion, having been, you
know, in Agriculture--I've been chairman and ranking member of
that committee--and also here, that your Department needs to
have the majority of input into designing that food pyramid.
But you are collaborating with them.
Secretary Thompson. Yes, we are. We're having joint
meetings right now. And the last joint meeting's going to be in
August. Then we're going to have a report this year. But before
I issue the report--I'm going to get the scientific results in
August--I'd like to come up and sit down and go over those with
you in September/October, Senator Harkin.
Senator Harkin. I feel better about it now. Thank you.
Senator Specter. Thank you very much, Senator Harkin.
Thank you, Mr. Secretary. We very much appreciate your
coming in. We like your new ideas, and we urge you to implement
them as fast as possible.
Thank you.
Secretary Thompson. Thank you. And let me say, in
conclusion, you people have been great. This, to me, like I
said at the beginning, is probably the most important hearing
that could be held on the most important subject facing
America, so thank you. On my behalf, thank you.
STATEMENT OF KENNETH L. GLADISH, Ph.D., NATIONAL
EXECUTIVE DIRECTOR, YMCA OF THE USA
Senator Specter. Thank you, Mr. Secretary.
We turn now to Panel Two, Dr. Ken Gladish, Mr. Vernon
Delpesce, Mr. Eric Mann.
Dr. Gladish is the national executive director of the YMCA
for the United States. Prior to his current position, he was
executive director of the Indianapolis Foundation for the
William E. English Foundation; bachelors degree from Hanover
College in Indiana, and a masters and doctorate degrees in
foreign affairs from the University of Virginia.
Thank you for joining us, Dr. Gladish, and we look forward
to your testimony.
Dr. Gladish. Mr. Chairman, Mr. Harkin, thank you so very
much for the invitation. I'm pleased to be here representing
the more than 2,500 YMCAs in American communities.
You know, for 150 years the YMCA has been engaged alongside
American kids and their families and communities on seeking to
support and encourage the development of healthy, balanced
lifestyles. The broad challenge of finding a healthier, more
life-enhancing way to live demands a renewed and aggressive
social response. As the Secretary said--incidentally, the
Secretary is a great friend of the YMCA, both in his
governorship of Wisconsin and in his current role--we agree
with the Senators that the emphasis on prevention is a key to
the future of a healthier United States.
The YMCA serves more than 18 million American citizens, 9
million under the age of 18, 9 million over the age of 18. We
work largely with men and women who are motivated to seek the
improvement of their own health. But given our capacity and
spread throughout America in 10,000 delivery sites, very deeply
engaged in the State of Pennsylvania and the State of Iowa,
we've come to the same conclusion that the Senators have, the
subcommittee has, the HHS has, and other leaders in American
health life, we need a renewed attention to prevention. And so
the YMCA, in response to the rising attention and concern
around the rise of chronic disease--most especially obesity,
diabetes, and asthma--is announcing today a new project called
Activate America, which will provide opportunity in 14 States
and cities around the country to have the YMCA help convene
groups of community leaders to focus on how we might, together,
in a collaborative way, in a comprehensive way, in a community
way, address the issue of the prevention of chronic disease.
We realize that the Federal Government cannot solve this
problem for American communities and American citizens, that,
really, self-reliance and individual responsibility at the
family level is important. But the Federal Government can play
an important role in at least three distinct fashions. First,
by rising attention to the issue, which the subcommittee and
the Senators are doing today. Second, providing a rhetorical
context in which the real facts about the challenges to
American citizens in these arenas are recognized. Third, by
providing incentives for communities and charitable
organizations like ours and other private-sector enterprises to
focus on this activity and to make certain that there are means
and methods by which American communities and families can lead
their children and themselves to a healthier circumstance.
Our Activate America Project does engage support from a
broad range of the sectors in American life. Public officials
in each of the 14 communities, including Pittsburgh,
Pennsylvania, and Des Moines, Iowa--I'm accompanied by the
chief executives of the YMCAs of those two communities--will be
actively engaged in this work. Local mayors and city councils
and county and public-health officials will be engaged. And we
have the extraordinary and strong support of two major American
companies--JCPenney Corporation, through its after-school fund,
and the Kimberly-Clark Corporation, who are great friends of
the YMCA, of their own employees in the communities that they
serve.
Our effort is also focused on transforming our own work and
outreach. We recognized, as we crossed the divide of the 20th
into the 21st century, that the YMCA, as one of America's
leading charitable and not-for-profit entities, is probably
more qualified than perhaps any other community-based
organization to convene groups around this question. But we
also need to change our own behavior inside our own 2,500-some
physical facilities. We've been at this work since 1851. You
know that we invented, in the YMCA, basketball and volleyball
and racquetball, along with a good bit of the advances in
physical education. We are, likewise, concerned, along with the
rest of the community and parents of America, about the decline
of physical education in American schools. And we know that we
reach millions of young people through our own education and
recreation programs, but we are not, as a community-based
organization, doing enough yet. So our associations are
committed to a decade-long effort to transform our own work in
this regard, to focus more effectively and efficiently on
prevention, to establish a baseline for active engagement of
those that are not, on their own will and witness, seeking out
the opportunity to improve their own health. And, like the
Secretary and the Senators have said, that a lot of this is
about common sense, but, sadly, we don't provide enough
encouragement for American kids and families to follow the
commonsense evidence of both research and practice and common
experience of our grandmothers and grandfathers.
PREPARED STATEMENT
The YMCA is pleased to be here today to testify on behalf
of the importance of prevention, to commit our best efforts to
our Activate America enterprise, to pledge our collaboration
with the public and private sectors and our cooperation with
key civic leaders, like yourselves. Senators, we're pleased to
be here. We appreciate the attention to the effort. And I'm
also especially honored to be present with my colleagues from
Des Moines, Iowa and Pittsburgh, Pennsylvania.
[The statement follows:]
Prepared Statement of Kenneth L. Gladish
Mr. Chairman and Members of the Subcommittee: I am Ken Gladish and
I serve as the National Executive Director of the YMCA of the USA.
Secretary Thompson, thank you for being so outspoken in your support of
programs that prevent chronic diseases. Your leadership by example has
been extraordinary. Senator Specter, Senator Harkin, and members of
this subcommittee, thank you for your genuine commitment to ensuring
that disease prevention programs remain funded and a priority for this
Congress. We know there are many programs vying for your support and
everyone in this room thanks you for keeping health promotion at the
top of your list.
The broad challenge of finding a healthier, more life-enhancing way
to live demands a fundamentally new and aggressive social response. No
longer can we afford to think of America's health and wellness as the
sole responsibility of the medical and public health profession.
Collectively, all sectors of our communities and nation must come
together to advance a common strategy and sincere commitment to chronic
disease prevention in order to remove the barriers and increase the
supports for healthy living for all of the kids and families of our
great country.
As America's oldest and largest community-based, charitable
organization with a core mission focus on healthy living, the YMCA is
committed to organizing a broad based movement to help Americans find
healthier ways to live. Indeed, as a leading American charity, it is
our civic and community responsibility that calls us to act and demand
the best efforts of our fellow nonprofits and the entire philanthropic
sector. Our tax-exemption provided by the government and the trust
afforded us by the American public, manifested through volunteer hours
and donated dollars, demands our response to this public crisis. I have
attached a chart to my written testimony that is submitted for the
record which shows the depth and breadth of the YMCA movement and our
unique qualifications for tackling this issue.
Let me be clear: the nation's 2,575 local YMCAs see the obesity and
chronic disease crisis in this country as the issue that will define
our organization's role in society for years to come. Just as YMCAs'
responded to the shortage of childcare in the 1970's--quickly becoming
the nation's largest provider of childcare--we are now galvanized
around the need to collectively respond to society's great struggle to
live healthier and happier.
Recognizing our public and moral responsibility to fully engage
ourselves in the battle against obesity and related chronic diseases,
the YMCA has launched a long-term initiative, called YMCA Activate
America<SUP>TM</SUP>. This effort has three core principles:
--One--we will take a more holistic approach to health. YMCAs will
strengthen their long-standing commitment to health through
spirit, mind and body.
--Two--we will develop parallel program and public policy strategies.
YMCAs will help their communities, states, and the nation,
develop and implement policies to encourage healthy living.
--Three--we will embrace collaboration as a core methodology. YMCAs
will reach out to, and work more effectively with, government,
business, health, foundations, and academic and research
sectors, among others.
The first plank of this effort is an internally-focused, three-year
research and development effort aimed at developing new YMCA
operational and program strategies to support healthy living by all
Americans--especially youth and racial, ethnic and low-income groups at
greatest risk. In addition to receiving expert advice from the CDC and
the Robert Wood Johnson Foundation, we are investing millions of our
own dollars and are partnering with scientists at Harvard and Stanford
University to better understand and respond to the central question:
``What does a person need to sustain positive lifestyle health
changes?'' This effort is no less than a complete re-tooling of how
YMCAs serve our 19 million members.
The second plank of this effort is an external effort aimed at
broad community mobilization and is why I am before you today. The
centerpiece of this external effort will be a national conference this
September in Washington, DC. Through the support of our committed and
engaged corporate partners--JC Penney Afterschool and the Kimberly-
Clark Corporation--14 projects are being kicked-off today in 14 states
involving diverse communities from throughout the country. Each
community will be represented by a team of civic, business and public
leaders that include YMCAs and other sectors of the community, such as
public health, schools, businesses, park and recreation departments,
faith-communities, and philanthropic and academic institutions. The
community leadership teams will participate in the September conference
to learn best practices and create action plans aimed at promoting
healthier living. Two of the cities that will participate in the
conference are with me this morning: Des Moines, Iowa, and Pittsburgh,
Pennsylvania. In a moment you will hear from leaders from each of these
cities who will explain why they are involved in the YMCA Activate
America<SUP>TM</SUP> conference and what they hope to accomplish in
their community.
At our conference, we will not be reinventing the wheel by creating
a new model for community mobilization. There are plenty of successful
models already available that the YMCA Activate AmericaTM communities
will be able to learn from and adopt. For example, the federal REACH
program--funded through CDC--has been in existence for several years
and supports local programs aimed at eliminating racial and ethnic
health disparities. We know this program is successful and CDC
officials will attend our conference and help our communities
understand why REACH works and what they need to do to achieve similar
success in their community. The same is true for Secretary Thompson's
Steps to a HealthierUS program and Active Living By Design, a program
funded by the Robert Wood Johnson Foundation. Each of these three
programs will serve as templates for our communities to follow and
replicate.
Let me be clear that this effort is not about getting more people
into YMCAs. In fact, a true measure of success will be helping people
understand that physical activity is not something that must be done
only in a Y facility, but something that must be incorporated into
everyday living. This effort is about each community leveraging
available resources through existing fine organizations like the Y's,
the Parks and Recreation Departments, along with programs offered by
disease prevention organizations such as the American Cancer Society,
the American Heart Association, AARP, the Public Health Departments and
others. YMCAs along with like-minded organizations will work with
government and community leaders to design a community approach to
improving the health and wellness of our citizens, lowering health care
cost in our country and creating strong kids, strong families and
strong communities.
Fortunately, at the federal level we have leaders like you who
understand that community-based and community-led programs provide the
only chance of creating lasting behavior change. Senator Specter--who
has long-championed community health promotion programs--and Senator
Harkin--who recently introduced YMCA-endorsed legislation that contains
many excellent provisions aimed at strengthening community-based health
programs--are both to be commended for your leadership and vision. I
thank you for holding this hearing and I look forward to our continued
work together.
YMCA's Unique Qualifications to Build Healthy Communities:
--YMCAs are located in all 50 states, with 2575 YMCAs serving over
10,000 diverse communities across the country--no other
community-based organizations have the same reach.
--Collectively, YMCAs have more than 624,000 committed volunteers
that can further promote the goals of healthy communities.
Currently, YMCAs involve 18.9 million people each year,
including 9 million youth under age 18 in a wide variety of
programs.
--The YMCAs have a distinguished track record of community-level
leadership and collaboration and they have a long history of
raising funds to assist public health efforts and to ensuring
that no one is denied access to programs for a lack of ability
to pay. YMCAs raise millions of dollars that benefit local
communities. YMCAs collectively were ranked No.1 in The Non-
Profit Times Top 100 (November 2003) after raising $714 million
in pubic support to be used for scholarships, subsidies and
other community services.
--Health and fitness have been part of YMCA's charitable mission for
more than 100 years. YMCAs have a track record and ability to
reach individuals of all ages through their programs and can
support communities in delivering programs that promote healthy
behaviors and prevent diseases and complications, such as
diabetes and obesity.
--The nation's 2,575 YMCAs are collectively one of the largest
providers of health and wellness programs and activities in
the country. YMCAs have infrastructure, commitment and
flexibility to meet the needs of communities across the
country.
--YMCAs are also the nation's largest provider of child care and
afterschool programs, collectively serving 7.5 million
school-age kids in afterschool programs and 500,000
preschoolers at more than 9,000 child care sites
nationwide.
--YMCAs operate 2,000 resident camps serving youth, teens and
families--most offer age-appropriate physical activity.
--YMCAs are the largest providers of youth sports programming year
round, serving over 4.5 million youth in programs such as
basketball, swimming, soccer, t-ball, volleyball and flag
football, which get youth moving while developing a sense
of teamwork, good sportsmanship, and self-confidence.
--Recognizing the need for baby boomers to get and stay healthy, 62
percent of YMCAs offer older adult fitness programs; 38
percent older adult aquatic classes; 21 percent offer
walking classes/clubs; and 36 percent offer strength
training for older adults.
--Hundreds of YMCAs across the country already offer a wide array of
fitness and wellness programs that are delivered to
communities. Annual surveys of YMCAs enable the compiling of
the following statistics which show the number of YMCAs that
offer programs and services in 2003 related to youth and adult
activity (note: YMCAs offer far more health and wellness
programs than listed below, but due to space limits, only a
representative sample can be provided):
------------------------------------------------------------------------
Number of
Program YMCAs
offering
------------------------------------------------------------------------
YMCA Healthy Kids DayTM.................................... 1,294
Programs in aquatics for people with physical disabilities. 564
Preschool movement......................................... 718
Programs specific for people with diabetes................. 135
Physical education for homeschoolers....................... 598
Programs for people with chronic disease................... 109
Parent-child exercise classes.............................. 424
Adult obesity programs (for obese adults).................. 224
Teen fitness/exercise...................................... 887
Child obesity programs (for obese children)................ 351
Youth fitness/exercise..................................... 952
Weight management/nutrition programs....................... 655
Older adult fitness/exercise programs...................... 1,281
Health risk/lifestyle appraisals........................... 524
Strength training classes for older adults................. 828
Corporate health and fitness programs...................... 417
Strength training programs for youth....................... 851
Walking classes/clubs...................................... 483
Youth sports............................................... 1,661
Water fitness classes...................................... 1,357
Day camps for youth........................................ 1,678
Tobacco programs (2002 statistic, question not asked in 112
2003).....................................................
Arthritis Aquatics classes................................. 1,013
------------------------------------------------------------------------
--YMCAs offer the physical facilities for community activities and
meetings, and YMCAs can provide programs out in the communities
for further participation by target populations.
--YMCAs collaborations with government agencies, schools, churches
and others make YMCAs a stronger community partner. Sample
collaborations included in 2003:
------------------------------------------------------------------------
Number of
Collaboration YMCAs
------------------------------------------------------------------------
Federal Government agency.................................. 412
Local government agency.................................... 1,408
State government agency.................................... 827
Elementary school.......................................... 1,531
Middle school.............................................. 1,193
High school................................................ 1,118
Churches................................................... 1,138
Parks and Recreation....................................... 1,004
Hospitals.................................................. 898
Corporations............................................... 668
Community Coalitions....................................... 508
------------------------------------------------------------------------
STATEMENT OF VERNON E. DELPESCE, CHIEF EXECUTIVE
OFFICER, YMCA OF GREATER DES MOINES
Senator Specter. Thank you very much, Dr. Gladish.
We turn now to Mr. Vernon Delpesce, president and CEO of
the YMCA of Greater Des Moines. Prior to this assignment, he
held YMCA positions in Houston and Columbus, Ohio.
Thank you for joining us, Mr. Delpesce, and we look forward
to your testimony.
Mr. Delpesce. Thank you.
Good morning. My name is Vernon Delpesce, as stated, and
I'm the president and CEO of the YMCA of Greater Des Moines.
I want to begin by thanking both Senator Specter and my
Senator, Tom Harkin, for their interest and commitment in the
prevention field. I especially applaud your efforts as they
relate to children and families, which are of great interest to
the YMCA. And I'd just thank you for the opportunity to come
here and visit with you today.
As Senator Harkin knows, as Secretary Thompson talked about
Wisconsin and some of the great foods they have there that may
hinder their ability to stay fit, in Iowa we have a
longstanding tradition at our State fair, which comes up in a
couple of weeks, that any particular food--any type of food
there is that you can put on a stick and deep-fry, is sold at
our State fair.
It is one of the highlights of the fair, but it certainly
does not contribute to our effort here today. So we have a ways
to go in terms of the culture of our State.
But Iowa is certainly an example of what is occurring
across the country related to chronic disease. In the last
decade, the number of people who are obese in Iowa has almost
doubled--almost doubled--in the last 10 years. The prevalence
of diabetes has also grown at an alarming rate, especially in
children and minorities in the State.
According to the Prevention Research Center at the
University of Iowa, 62 percent of Iowans today--62 percent--are
either overweight or obese. I did include an attachment with my
testimony that has some further information regarding that.
Preventable chronic disease is costly today, but, if the
trend continues, it will be very devastating to our future. And
the only way to turn it around is going to be through
prevention.
In Des Moines, various community leaders have stepped up to
the plate and recognized these trends, and have begun to take
action. A couple of examples, Principal Financial Group and
Meredith Corporation, two of our largest employers, have taken
on very extensive wellness programs. The State of Iowa has
sponsored the Iowa Games, as well as Lighten Up Iowa, that will
focus on helping people be more active and lose weight.
YMCA in Des Moines, we impact about 56,000 people per year,
about half of them being youth. And we're excited to be a part
of this. We, of course, are doing what we can--our part, too.
We've just entered into a collaborative effort with the
American Heart Association, the American Diabetes Association,
and the American Cancer Society to be able to get their health-
related materials in the hands of the people who need it the
most. We recognize them as the real experts when it comes to
providing education, as we're the experts in providing the
activity. Also, reaching teens is important to us, and, Senator
Harkin, you've helped us with that in the past, and greatly
expanded our teen programming at 21 cities across the State.
One other thing that's very important to us in Des Moines,
as it is, I know, to all YMCAs, and that is what we do in
disadvantaged communities. Last year, in Des Moines, we gave
about $1.1 million worth of scholarships and financial aid away
to disadvantaged people in our community. But we are committed
that people in low-income communities deserve, and we will
provide them with, the same level of programs and activities
and services as any other community in town. And so we're very
proud of that.
As we begin to work on this, it's been very exciting to
recruit the folks that will help us with Activate America, and
I just would like to share with you some of our community team
leaders who are going to help us with this effort. Former
Governor Terry Branstad, who is now the president of Des Moines
University, which is an osteopathic medical school, will help
us. Mary Mintzer Hansen, who is the director of the Iowa
Department of Public Health--as a matter of fact, Mary shared
with me that they are working on a strategic plan for their
health department throughout the State, and Activate America
actually fit--she said, ``We could not have written it better
to fit into the strategic plan.'' So we're glad to be working
with her. Dr. John Lowe, who is with the University of Iowa,
Prevention Research Center; Dr. Ed Hertko, a retired physician
and board member for American Diabetes Association; Kay
Halvorson, who's the Wellness Director at Principal Financial
Group; and a couple of others. As a matter of fact, I will
share with you, the Mayor--who is not listed on here--the Mayor
of Des Moines has actually, at his request, wants to serve on
this committee because he sees the great impact that it can
have on the city of Des Moines. And so, again, I'm confident
that, with the folks we have at the table, we're going to make
a big difference. But the--I also have to share with you--the
numbers and the percentages and all don't mean as much as just
the people that we have with us. And I have Ellie Westercamp, a
9-year-old who will be with us later today sharing her story.
And it's the real people that it's really about, and the people
we can help.
PREPARED STATEMENT
Again, I thank you for the opportunity to be here today,
and I applaud what you're doing for this prevention effort.
[The statement follows:]
Prepared Statement of Vernon E. Delpesce
Good morning, my name is Vernon Delpesce and I am the President of
the Des Moines YMCA. I want to begin by thanking Senator Specter and my
Senator, Tom Harkin, for their interest in preventing chronic disease
in this country through programs that promote healthy lifestyles.
The state of Iowa is an example of what is occurring across the
country related to chronic disease. In the last decade the number of
people who are obese has almost doubled. The prevalence of diabetes has
also grown at an alarming rate, especially in children and minorities.
According to the Prevention Research Center at the University of Iowa,
62 percent of Iowans are overweight or obese (See Attachment A).
Preventable chronic disease is costly today, but if this trend
continues it could be devastating to our future. I believe the only way
to turn things around is through prevention.
In Des Moines, various community leaders have recognized these
trends and are starting to take action. Local corporations like
Principal Financial Group and Meredith Corporation are providing
extensive wellness programs for their employees. And our state health
department sponsors the Iowa Games and Lighten Up Iowa which involve
thousands of people who are becoming more active and losing weight.
The Des Moines YMCA has also responded. We currently serve 56,000
people annually--one half of these are under the age of 18. Through a
collaborative effort with the American Heart Association, the American
Diabetes Association, and the American Cancer Society, we are putting
health related educational materials in the hands of the people who
need it the most. Thanks to the support of Senator Harkin, we are
reaching more teens than ever before by expanding teen programs in 21
cities across Iowa. In addition, we have a commitment and
responsibility to serve low income individuals and families. Like all
YMCAs throughout the country, we do not turn people away due to an
inability to pay. Last year alone we provided over $1.1 million in
scholarships and subsidies to ensure that our programs are open and
accessible to all so disadvantaged people have the same access to our
health and fitness programs as everyone else.
The dramatic increase in obesity and chronic disease in Iowa has
caused us to provide a renewed emphasis on our programs that focus on
physical activity and healthy eating. As a matter of fact last Saturday
we completed two one-week camps for children with diabetes. Three
hundred and fifty youth with diabetes and sixty five medical personnel
attended YMCA Camp Hertko Hollow to learn good nutrition habits. They
also learned how to monitor their blood sugar and give themselves
insulin injections. They had a lot of fun; and yes Senator Harkin, they
learned the importance of eating fresh fruits and vegetables.
Despite all of our efforts--and the efforts of the public health
community in the city--we are losing ground. This is why Des Moines has
decided to participate in the YMCA's Activate America project. In Des
Moines, our team consists of 8 community leaders including: Former
Governor Terry Branstad, the President of Des Moines University; Mary
Hansen, the Director of Iowa Department of Public Health; Dr. John
Lowe, the Director of the Prevention Research Center at the University
of Iowa; Dr. Ed Hertko, retired physician and board member of the
American Diabetes Association; Kaye Halvorson, the Wellness Director
for the Principal Financial Group; Sam Carroll, Executive Director of
Is It Good For The Kids?; Doug Reichardt, the Chairman and CEO of
Holmes Murphy a large insurance brokerage firm and chairman of the Iowa
Games; and myself.
I am confident that the results of our effort will begin to reverse
the trend; however it is more important for me to remember that behind
the numbers and percentages are people. People like 9-year-old Ellie
Westercamp who is with me today. Ellie overcame severe asthma by
increasing her activity through a swimming program. It is about the
real people who live healthier and more fulfilling lives as a result of
our programs that keep me motivated to work on projects like Activate
America.
Again, I thank you for your commitment to prevention and I look
forward to our work together in the months and years ahead.
Attachment A.--Obesity in Iowa
[Provided by Prevention Research Center, University of Iowa]
Since 1990, the prevalence of adult obesity in Iowa has increased
from 12.8 percent to almost 23 percent. The following chart shows the
obesity rates in Iowa compared to those in the United States.\1\
---------------------------------------------------------------------------
\1\ CDC. (2004). Behavioral Risk Factors Surveillance System:
Trends Data--Nationwide vs. Iowa. Retrieved July 9, 2004, from http://
apps.nccd.cdc.gov/brfss/Trends/
trendchart_c.asp?state_c=IA&state=US&qkey=10010&SUBMIT1=Go
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Since 1990, the prevalence of overweight adults in Iowa has
increased from 35.7 percent to over 38 percent. The following chart
shows the overweight rates in Iowa compared to those in the United
States.\2\
---------------------------------------------------------------------------
\2\ CDC. (2004). Diabetes Surveillance System. Retrieved July 9,
2004, from www.cdc.gov/diabetes/statistics/prev/national/tprevage.htm
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
In 2002, 62.2 percent of Iowans were either overweight or obese.
According to the CDC, Iowa has the 18th highest rate of obesity in
the United States. The following table shows the obesity rates for the
20 states that have the highest obesity rates in the country.\3\
---------------------------------------------------------------------------
\3\ CDC. (2004). Obesity Trends. Retrieved July 9, 2004, from
www.cdc.gov/nccdphp/dnpa/obesity/trend/prev_reg.htm
STATES WITH THE HIGHEST OBESITY PREVALENCE IN THE UNITED STATES, 2001
------------------------------------------------------------------------
Obesity
State rate
------------------------------------------------------------------------
West Virginia 27.5
Mississippi 26.8
South Carolina 25.8
Alabama 25.7
Louisiana 25.5
Texas 25.5
Michigan 25.4
Tennessee 24.6
Kentucky 24.5
Indiana 24.1
Pennsylvania 24.0
Arkansas 23.7
North Carolina 23.5
Georgia 23.5
Missouri 23.2
Ohio 23.0
Oklahoma 22.9
IOWA 22.9
Kansas 22.8
Wisconsin 21.6
------------------------------------------------------------------------
In Iowa, the prevalence of diabetes has increased from 4.4 percent
to 5.7 percent since 1994. The chart below shows the rates of diabetes
in Iowa compared to the rates of diabetes in the United States.\2\
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
STATEMENT OF ERIC K. MANN, PRESIDENT AND CEO,
PITTSBURGH METROPOLITAN YMCA
Senator Specter. Thank you, Mr. Delpesce.
We turn now to Mr. Eric Mann, president and chief executive
officer of the YMCA of Pittsburgh; bachelor of science from
Mars Hill College in Mars Hill, North Carolina, and did
graduate work at Loyola Marymount in Los Angeles.
Thank you for being with us, Mr. Mann, and the floor is
yours.
Mr. Mann. Thank you, Mr. Chairman and Senator Harkin and
members of the subcommittee.
I do thank you for giving us the opportunity. Senator
Specter you are a friend of ours, and have helped us in a lot
of ways in some programs in our community that work in
underprivileged communities, so I thank you for that.
The city of Pittsburgh and the YMCA, we are embarked upon
this health and wellness and this lifestyle program. You were
talking about the--what happens about recently attributed
expenditures. Pennsylvania, alone, has $4.1 million that's
attributed, that goes out because of obesity-related issues.
We are very fortunate to be in a community that has very
strong partners that we're going to be working with our
Activate America Program. We are working with Highmark Blue
Cross Blue Shield, which is the largest healthcare insurer in
Pennsylvania. We have, also, UPMC, which is the largest
healthcare provider, that's going to be one of our partners. We
have the Catholic church, the Pittsburgh diocese, that will be
part of our team. We've recruited the Center for Minority
Health at the University of Pittsburgh that will be part of our
team that will help the YMCA start to address the critical
needs for our community.
The beauty about Activate America is that it is providing
the vehicle for like-minded organizations to address this issue
as one group, versus five or six different groups, at the local
level. And so as you speak about, ``How can you make a real
change in this particular industry,'' I think this is the kind
of process that puts public and private partners together to
make a real impact.
In Pittsburgh, we serve about 164,000 participants, of
which half are youth. We are the largest provider of after-
school childcare, where we serve 2,000 children a day. And the
YMCA, as part of its mission, we provide health and fitness
programs to those 2,000 children per day at our sites. Along
with partnering with the Catholic church in a program called
Fit For Life, we provide the instructors and go in and teach
the physical education that they're not able to do.
We are committed to this. Our partners in this is really
looking forward to how we can make a real impact and get the
services to the people that need it. We, like the YMCAs across
the country, we do not turn anyone away because of their
ability to pay. And so we believe, because of our position in
the community, because of our significant partners, and because
this is something that's going to have focus, this will make a
tremendous impact at reversing some of the issues and some of
the trends that we see. It's going to take this kind of
gargantuan effort in order for us to do that.
PREPARED STATEMENT
So I appreciate the time, and I understand that this is a
very, very important issue, and we're excited about the
opportunity. And, again, I thank you, Senator Specter, as my
home Senator, for what you're doing in this particular effort.
[The statement follows:]
Prepared Statement of Eric K. Mann
Mr. Chairman, Senator Harkin and Members of the Subcommittee, my
name is Eric Mann, and I am the President and CEO of the Pittsburgh
Metropolitan YMCA. I want to begin by thanking my Senator, Arlen
Specter, and Senator Tom Harkin, for their commitment to preventing
chronic disease in this country through programs that promote healthy
lifestyles and help people to eat better and get active. I specifically
applaud this subcommittee's commitment to encourage healthy lifestyles
among our nation's kids, families and communities. This is important
work and I thank you for your commitment and for inviting me to speak
here today.
The city of Pittsburgh provides a good example to showcase trends
in chronic disease. Over 75 percent of adults in Pittsburgh report an
average consumption of less than 5 servings of fruit and vegetables per
day. In Pennsylvania, obesity-attributable expenditures for direct
medical expenses are estimated to be $4.138 billion.
Various community leaders in Pittsburgh have recognized these
trends and are starting to take action. Highmark Blue Cross/Blue Shield
is working with the public school system on a health and fitness
curriculum for all elementary children. The Centre for Minority Health
at the University of Pittsburgh sponsored a month long community
awareness program highlighting health issues in the Black community.
As the leading charitable community-service organization in the
city, the Pittsburgh Metropolitan YMCA has also responded. We currently
serve 164,377 individuals--one half of these are under the age of 18.
We have a specific commitment to the overall health and wellness of our
youth and seniors who live in our under-resourced and minority
communities and would like to thank Senator Specter for the support he
has given us for our work in these communities. Like all YMCAs
throughout the country, we do not turn people away due to an inability
to pay and last year provided $395,133 in scholarships and subsidies to
ensure that our programs are open and accessible to all.
The dramatic increase in obesity and chronic disease in Pittsburgh
has caused us to provide a renewed emphasis on our programs that focus
on physical activity and healthy eating. We offer Fit for Life, which
is a collaborative effort between the Pittsburgh YMCA and the Catholic
diocese to provide physical education for elementary school children.
Our Spark (Sports, Play & Recreation for Kids) program is a
collaboration with Highmark, designed to develop health and fitness
curriculum for the 2,000 children who are served through our 50
different after-school sites. Through food banks and other food
programs, we are serving 3,708 families.
What is becoming very clear in Pittsburgh is that all sectors of
the community must come together and collectively develop a unified
strategy for preventing chronic diseases. This is why Pittsburgh has
decided to participate in the YMCA's Activate America Pioneering
Healthier Communities project. In Pittsburgh, our team consists of 8
community leaders, including the key leaders from Highmark Blue Cross/
Blue Shield, Pennsylvania's largest health insurer, UPMC, the region's
largest health care organization, along with the Center for Minority
Health and the Pittsburgh Catholic diocese. Our purpose is to become
dramatically more effective in partnering to improve the spirit, mind
and body of our kids, families and communities.
I am confident that the results of our effort will be dramatic. As
an example of exactly what dramatic' means, I have Marty Balawejder
with me here today. Marty has literally turned his life around--taking
on depression, underemployment and his own poor physical health to
become a Pittsburgh success story. He will speak at a press conference
later this morning about his personal achievements. Just as Marty
continues to challenge himself to lead a healthier lifestyle, we as a
community are prepared to do the same thing.
Again, I thank you for your commitment to this issue and for the
opportunity to speak here this morning.
Risk Factor Trends in Pennsylvania 1990-2002 \1\
Since 1990, the prevalence of adult obesity (adults with a Body
Mass Index of 30 or greater) in Pennsylvania has nearly doubled from
12.5 percent to 24 percent.
---------------------------------------------------------------------------
\1\ National Center for Chronic Disease Prevention & Health
Promotion, Behavioral Risk Factor Surveillance System, 2002.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Since 1990, the prevalence of overweight adults in Pennsylvania has
increased from 33.8 percent to 35.6 percent.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Since 1990, the percentage of adults who report an average
consumption of less than 5 servings of fruit and vegetables per day has
steadily remained around 75 percent.
<GRAPHIC(S) NOT AVAILABLE IN TIFF FORMAT>
Pennsylvania has the 11th highest rate of obesity in the United
States. The following table shows the obesity rates for the 20 states
that have the highest obesity rates in the country.
STATES WITH THE HIGHEST OBESITY PREVALENCE IN THE UNITED STATES, 2001
------------------------------------------------------------------------
State Obesity rate
------------------------------------------------------------------------
West Virginia 27.5
Mississippi 26.8
South Carolina 25.8
Alabama 25.7
Louisiana 25.5
Texas 25.5
Michigan 25.4
Tennessee 24.6
Kentucky 24.5
Indiana 24.1
PENNSYLVANIA 24.0
Arkansas 23.7
North Carolina 23.5
Georgia 23.5
Missouri 23.2
Ohio 23.0
Oklahoma 22.9
Iowa 22.9
Kansas 22.8
Wisconsin 21.6
------------------------------------------------------------------------
Senator Specter. Well, thank you, Mr. Mann.
You have a very good partnership lineup with the University
of Pittsburgh Medical Center, UPMC, and also the Blue Cross
Highmark. Can you give the subcommittee an idea, specifically,
of what kind of programs you will carry out? Give me an example
as to what you will do?
Mr. Mann. One of the programs that we are currently
running, I spoke out, our after-school program, we, in
collaboration with Highmark Blue Cross Blue Shield, we run a
program called SPRK, and it's Sports Play Recreation for Kids.
This curriculum is designed to get children active again. And
so Highmark----
Senator Specter. Get the children active on sports.
Mr. Mann. Any activity. Sports is just one of them. A lot
of them have nothing to do with----
Senator Specter. Exercise.
Mr. Mann. Exercise.
Senator Specter. How about information on diet and----
Mr. Mann. Diet and nutrition is a very large part of it.
The Center for Minority Health is a very prominent research arm
at University of Pittsburgh. They are providing the stats and
the research, and will be doing an evaluation on what we do, in
terms of our programming.
Senator Specter. Mr. Delpesce, what are you going to do to
counteract the culture of deep-fried food?
Mr. Delpesce. I may have to call on Senator Harkin on that
one to help me. I'm not sure. But some of the things that we're
going to work on are community design efforts. And, as was
stated, we're--with the people we have the table, we do think
we can impact some, in terms of the sidewalks--Principal
Financial Group actually has committed $10 million to a
riverwalk in downtown Des Moines that isn't going to focus on
retail along the river----
Senator Specter. How about the deep-fried food?
Mr. Delpesce. What's that?
Senator Specter. What are you going to do about that? Are
you going to tell people not to eat it?
Mr. Delpesce. Absolutely.
Senator Specter. Good.
Mr. Delpesce. We are going to put a lot of effort forth in
teaching better nutrition, absolutely. And we're going to work
with the Department of Education to work on the physical
education issue in the schools. And then we're also--one of the
areas that we're very interested in is in the low-income and
minority communities there, where the prevalence of this is
just unbelievable. And so we're going to do what we can to----
Senator Specter. Dr. Gladish, could you devise a program
which would be directed to Philadelphia cheesesteaks?
Governor Rendell spoke at the NAACP meeting on Sunday night
and touted the Philadelphia cheesesteaks, which he said are
unique because they use bad meat and no cheese; they use Cheese
Whiz, which melts better, and they are used so that--
customarily, where you drain off the fat; for a Philadelphia
cheesesteak, you drain in the fat--and there is a calculation
on the stringiest meat that can be found.
All of which adds to an extraordinary good taste. Now, as
the head of a national program, what is your answer to combat
the Philadelphia----
Dr. Gladish. Senator, if the----
Senator Specter [continuing]. Cheesesteak?
Dr. Gladish [continuing]. The Philadelphia cheesesteak will
help grow hair, I'll eat as many as you'd like me to.
I'll tell you what, this is a really key concern, because
nutrition and activity have to go together, and they really
have to operate at the individual level. What we've discovered
in our YMCA work is that there are apparently significant
social, psychological and personal barriers to a very
substantial percentage of our population--kids and adults, and
adults as models for kids--around these fundamental issues. So
our Activate America Project is also engaged with Stanford
University, Harvard University, with the CDC, with HHS help,
and others, I'm trying to examine a different kind of an
approach, a model that will encourage and provide incentive and
reward for persons to change their personal lifestyle. Because
at the policy level, we can adopt a whole wide range of
important, significant, and affirmative policies, incentives,
and the rest, but unless we can find means at the community-
based level--in schools, in homes, in YMCAs, in Boys and Girls
Clubs, and other settings--to encourage folk to change their
behaviors and to provide a reasonable image of what that
means----
Senator Specter. Dr. Gladish, that's a fine----
Dr. Gladish [continuing]. We're not going to succeed.
Senator Specter [continuing]. That's a fine theoretical
answer. Now, time is almost up, so I'm going to yield to
Senator Harkin, but I'd like you to supply the subcommittee
with a written answer to how you deal with the Philadelphia
cheesesteak. There, you have a delicacy which people love to
eat, and it's deleterious to their health. So give that some
thought.
Senator Harkin.
Senator Harkin. My thought is to eat maybe one a year, or
something like that, just cutting down on how much you eat of
that stuff. And the Iowa State Fair is another example. I mean,
I go every year, gonna go again this year, and it's just booth
after booth of everything you shouldn't eat. And it sends the
wrong signal to our kids, who go to the Iowa State Fair. We
need to provide more fruits--fresh fruits, fruit drinks,
healthy kinds of foods at places like that to send the proper
example to our kids, as well as what we should be doing in our
schools.
Since Senator Specter got off on the Philadelphia
cheesesteak, I mean, look, we know a lot of these foods are bad
for us, but, again, sometimes in moderation, as long as you
don't eat too much of it, and you don't eat it all the time--I
mean, look, I like a Big Mac as much as anyone else, but I
don't eat five of them a week. I mean, to me, this is a treat.
A couple, three, or four times a year, I'll have a Big Mac, and
it's a nice treat. You know, I'm not opposed to that. It's just
the constant barrage that you get that this is good to eat all
the time, and it's not. So we have to have better information
on moderation in eating those kinds of foods, and make sure
that these are not the kind of things that you consume all the
time.
I don't have any other questions. I just want to say, Dr.
Gladish, thank you for your announcement today of the Activate
America Program. The cities, the States--couple of States
you're going to be doing in this. To me, the Y is providing the
kind of dynamic, energetic, forward-looking leadership that we
need to get to a broad community out there. And I don't know of
any entity in the country that can do a better job of reaching
that broad spectrum of people, everywhere from kids to adults,
from all walks of life, than the YMCA. So, again, I thank you
for that. I look forward to the press conference we're going to
be having with you shortly. That's why I don't want to ask any
questions, because we've got a couple of more witnesses we've
got to get through. But thank you very much for what the Y is
doing.
Senator Specter. Thank you very much, gentlemen.
We turn now to our third panel, Dr. Dean Ornish, Mr. Jack
Rule, and Ms. Karen Silberman. Our first witness is Dr. Dean
Ornish, founder, president, and director of the Preventative
Medicine Research Institute in Sausalito, California, Clinical
Professor of Medicine at the University of California in San
Francisco, and founder of UCSF's Osher Center for Integrative
Medicine; written extensively about how comprehensive lifestyle
changes can reverse coronary heart disease; medical degree from
Baylor; a master's degree from the University of Texas at
Austin.
STATEMENT OF DEAN ORNISH, FOUNDER, PRESIDENT AND
DIRECTOR, PREVENTATIVE MEDICINE RESEARCH
INSTITUTE
Senator Specter. Thank you very much for joining us, Dr.
Ornish. And, at the outset, I will say for the record that I
have participated in your CADRE program, which you have at
Walter Reed, and the results which you have had on reversing
coronary problems and now prostate cancer. They're milestone
research achievements, so we thank you for what you have done,
and we look forward to your testimony on the obesity issue. The
floor is yours.
Dr. Ornish. Thank you.
Well, thank you, Senator Specter. I want to just publicly
acknowledge your support, Bettilou Taylor and others in your
office for your support, and Senator Harkin for your
leadership, as well--this new legislation, I think, is among
the most important that I've ever seen in my lifetime--and also
for appointing me to the White House Commission on
Complementary Alternative Medicine Policy.
You know, we tend to think of advances in medicine as a new
drug, a new laser, a new surgical technique, something really
high-tech and expensive. And in our studies, my colleagues and
I at the nonprofit Preventive Medicine Research Institute and
the University of California-San Francisco, have been able to
use very high-tech, state-of-the-art measures to prove how
powerful these very low-tech and low-cost interventions can be.
You know, chronic diseases, like heart disease, cancer,
obesity, are, by far, the leading cause of death and disability
in this country. And $1.8 trillion were spent on treating these
diseases last year. As you mentioned earlier, as Secretary
Thompson mentioned earlier, most of that is going for treatment
rather than prevention.
We've focused, for the last 27 years, on heart disease,
because it's, by far, the leading cause of death and
disability, and more money is spent on that than any other
chronic disease. We were able to show that--at the time, it was
thought that once you had heart disease, it could only get
worse, but what we were able to show is that, rather than
getting worse and worse, most people could actually get better
and better, and much more quickly than people had once thought
possible. And I think these findings are giving many people new
hope and new choices that they didn't have before. We've found
that--and I think bypass surgery is a good model, as well as a
good metaphor, because more money is spent on that--$30 billion
last year on bypass surgery, another $30 billion on
angioplasty--and yet it's not been proven to prolong life,
except in a very small segment of patients, and angioplasty has
yet to be proven to prolong life or prevent heart attacks, and
yet we spend large amounts of money. It's a great metaphor
for--it's like mopping up the floor around a sink that's
overflowing without also turning off the faucet. We're
literally bypassing the problem without treating the cause. And
I think what we've been able to show is that when you treat the
cause, the need for drugs and surgery is greatly reduced, and
the cost savings are corresponding to that.
We were able to show, in randomized controlled trials, that
heart disease is reversible. Ninety-nine percent of men and
women who had heart disease were able to stop or reverse the
progression of the disease, and we published that in the
Journal of the American Medical Association and other major
medical journals.
Having seen what a powerful difference these changes in
diet and lifestyle can make, I'm interested in finding ways to
make them more available to the American public. We were able
to show that these programs are not only medically effective;
they're also cost effective. We worked with Highmark Blue Cross
Blue Shield, with Mutual of Omaha, with other major insurance
companies, and we have found that almost 80 percent of people
who were told they needed a bypass or angioplasty were able to
safely avoid it by changing diet and lifestyle. Mutual of Omaha
calculated saving almost $30,000 a patient within a year. Other
studies with Highmark Blue Cross Blue Shield have found that
they were able to reduce their healthcare costs by 50 percent
within 1 year in a matched control-group study.
We've collected data now on more than 2,000 patients who
have gone through our programs in various hospitals throughout
the country. We've trained them through our nonprofit
institute, and we have data now on more than 2,000 patients who
have gone through them.
We have been working with Medicare to do a demonstration
project, and we've been able to show, across the country,
across the board, the same kinds of changes in diet and
lifestyle, the same medical benefits, and the same kind of cost
benefits that we were able to show on our earlier studies.
You know, I used to think that the primary determinative
medical practice was science, which is why I'm a scientist and
a professor of medicine at University of California, but I'm
really becoming more aware that the primary determinant of
medical practice is reimbursement. We doctors do what we get
paid to do. We get trained to do what we get paid to do. If we
change reimbursement, we change medical practice and medical
education.
We were working with different insurance companies--over 40
who are covering our program in the sites that we've trained--
but the real Rosetta Stone, the tipping point, in all of this
is Medicare. If Medicare covers programs like these on a
generic, nonproprietary basis, then other insurance companies
will follow their lead, and then they will be available. In
contrast, in hospitals that we trained, even though they showed
better clinical outcomes than have ever before been reported,
many of those programs had to close down for a lack of
reimbursement.
PREPARED STATEMENT
So my plea to you today is to first thank you for your
visionary leadership, Senator Specter and Senator Harkin, and
also to say, I think the time is right to make programs like
what we're doing--not limited to what we're doing, but any
program that has the science to back up that diet and lifestyle
can make a difference--available to people who most need them--
and the best way to do that is to have Medicare make this a
covered benefit, because otherwise it will--always remains on
the fringes of Medicare. But if Medicare covers this, it'll
become part of the mainstream. And there's enough evidence
now--from randomized trials, from demonstration projects--to
show that this program is medically effective and cost
effective. It's time to make a decision.
Thank you.
[The statement follows:]
Prepared Statement of Dr. Dean Ornish
Mr. Chairman, distinguished colleagues, thank you very much for the
privilege of being here today. My name is Dr. Dean Ornish, founder and
president of the non-profit Preventive Medicine Research Institute and
Clinical Professor of Medicine at the School of Medicine, University of
California, San Francisco (UCSF). I appreciate the opportunity to
appear before this Committee.
Chronic diseases such as coronary heart disease, diabetes, cancer,
and obesity are the leading causes of death and disability in the
United States. Approximately $1.8 trillion were spent last year on
health care in this country, and 75 percent of this amount was spent on
treating Americans with chronic illnesses, including heart disease,
cancer, obesity, and diabetes. However, less than 2 percent of this was
spent on preventing these diseases. Clearly, more can be done.
According to Secretary Tommy Thompson, who has been a visionary leader
in promoting prevention and healthy lifestyles, ``If current policies
and conditions hold true, by the year 2011 our nation will spend over
$2.8 trillion annually on healthcare.''
There is an epidemic of obesity facing America as well as in much
of the industrialized world. Over 300,000 Americans each year die from
illnesses caused or worsened by obesity, a toll that may soon overtake
tobacco as the chief cause of preventable deaths. Approximately 65
percent of adults and 15 percent of children are overweight or obese,
and that number is increasing. The costs of obesity may exceed $100
billion per year.
Obesity is a major cause of the epidemic of diabetes. In 2000,
approximately 17 million Americans had diabetes, costing approximately
$132 billion. Complications of diabetes include heart disease and
damage to the eyes, nerves, and kidneys. When people lose weight, they
are often able to reverse the progression of diabetes and reduce or
discontinue insulin and other medications.
While there is a genetic component to chronic diseases, increasing
scientific evidence documents that the primary determinants of these
illnesses are the lifestyle choices that we make each day. Many people
tend to think of breakthroughs in medicine as a new drug, laser, or
high-tech surgical procedure. They often have a hard time believing
that the simple choices that we make in our lifestyle--what we eat, how
we respond to stress, whether or not we smoke cigarettes, how much
exercise we get, and the quality of our relationships and social
support--can be as powerful as drugs and surgery, but they often are.
During the past 27 years, my colleagues and I at the non-profit
Preventive Medicine Research Institute and the University of
California, San Francisco School of Medicine have conducted a series of
randomized controlled trials and demonstration projects showing that
these changes in diet and lifestyle are both medically effective and
cost effective. We used the latest in high-tech, state-of-the-art
diagnostic technology to prove the power of these low-cost and low-tech
interventions.
We initially focused on coronary heart disease as an example of the
power of diet and lifestyle changes because cardiovascular disease is
the leading cause of premature death in men and women in this country.
Since 1900, it has been the number-one killer in the United States
every year but 1918. Heart disease claims more lives each year than the
next five leading causes of death combined, including cancer. Coronary
heart disease is the single largest killer of American males and
females. Every 26 seconds an American will suffer a coronary event such
as a heart attack, and every minute someone will die from one.
In addition to its prevalence, heart disease is a model for
understanding the benefits of preventing and addressing the underlying
causes of a chronic disease rather than only literally and figuratively
bypassing it. We don't have to wait for a new breakthrough in
technology to prevent it. Knowing what we now understand, coronary
heart disease could be prevented in the vast majority of Americans if
they were willing to make sufficient changes in diet and lifestyle. For
example, one study of 84,129 women in the Harvard Nurse's Health Study
found that women who did not smoke, were not overweight, exercised
moderately, and ate a healthful diet had 82 percent fewer coronary
events than other women. Additional changes in diet and lifestyle could
reduce this number even further.
In 2001, more than one million coronary angioplasty procedures were
performed at a cost of more than $30 billion, and more than 500,000
coronary bypass operations were performed at a cost of another $30
billion. 1,314,000 diagnostic cardiac catheterizations were performed
in the United States at a cost of more than $23 billion.
Despite these costs, bypass surgery prolongs life in less than 3
percent of patients who receive it, and no randomized controlled trial
has ever proven that angioplasty prolongs life or prevents heart
attacks. Also, approximately one-third of angioplastied arteries
restenose (clog up) again after only six months, and one-half of bypass
grafts reocclude (clog up) within only a few years.
This is somewhat akin to changing the oil filter in your car
without also changing the oil, or mopping up the floor around an
overflowing sink without also turning off the faucet. Dr. Denis Burkitt
used to show a slide of people raising money to pay for ambulances and
a hospital at the base of a cliff rather than for a fence at the top to
keep cars from falling off.
In addition to these costs, more than $20 billion were spent last
year in the United States on cholesterol-lowering drugs, including
statins. This number is likely to increase substantially given a report
this week that encouraged more aggressive treatment of elevated
cholesterol levels using these drugs. While cholesterol-lowering drugs
have clear therapeutic benefits, patients should also be offered more
intensive diet and lifestyle interventions that have been proven to
lower LDL-cholesterol by approximately the same amount at a fraction of
the costs and with similar therapeutic benefits.
The major clinical benefit of bypass surgery and angioplasty is to
reduce angina (chest pain), and this can be accomplished in most
patients by changing diet and lifestyle. Instead of a ``quick fix''
that often recurs, diet and lifestyle may cause continued improvement
in coronary heart disease.
Your body often has a remarkable capacity to begin healing itself
if you give it a chance to do so by addressing the underlying causes of
chronic diseases. In our research, we documented, for the first time,
that the progression of coronary heart disease can be reversed in most
patients simply by making comprehensive lifestyle changes. These
include a low-fat, whole foods diet, moderate exercise, stress
management techniques, and support groups.
In our randomized controlled trials, published in the Journal of
the American Medical Association and other major journals, we found
that 99 percent of people with severe coronary heart disease were able
to stop or reverse it by making comprehensive lifestyle changes,
without drugs or surgery. There was some reversal of coronary
atherosclerosis after one year and even more improvement after five
years, and there were 2.5 times fewer cardiac events.
Most of the patients with severe angina (chest pain) because pain-
free within only a few weeks, and quality of life improved
dramatically. Also, we found a 40 percent reduction in LDL-cholesterol
after one year without cholesterol-lowering drugs, comparable to what
can be achieved with drugs but without the costs or side-effects. They
lost an average of 25 pounds in the first year and kept off half that
weight for at least five years. In contrast, the diet recommended by
the National Cholesterol Education Program and American Heart
Association lowers cholesterol by only 3-5 percent and is not
sufficient to stop the progression of coronary heart disease in most
patients.
Other studies of our comprehensive lifestyle program have
replicated these findings, including demonstration projects in
hospitals throughout the country. In a demonstration project involving
eight hospitals, Mutual of Omaha found that almost 80 percent of people
who were eligible for bypass surgery or angioplasty were able to safely
avoid it for at least three years by making comprehensive lifestyle
changes instead. Extrapolating these findings nationwide would have
saved approximately $50 billion.
At Highmark Blue Cross Blue Shield of Pennsylvania, Dr. Don
Fetterolf (Vice President and Senior Medical Officer) and his
colleagues found that medical claims utilization was reduced by 50
percent in only one year in patients who went through our program of
comprehensive lifestyle changes when compared to a matched control
group of patients who did not.
We now have collected data on more than 2,000 patients who have
gone through our program in hospitals throughout the United States who
have shown similar improvements. 389 of these patients are at least 65
years of age. The Centers for Medicare and Medicaid Services is now in
the process of conducting a demonstration project of this lifestyle
program in the Medicare population.
Increasing evidence links diet and lifestyle changes with reducing
the risk of the most common cancers, including breast cancer, prostate
cancer, colon cancer, and lymphoma. We recently completed the first
randomized controlled trial demonstrating that the progression of early
prostate cancer may be modified by making similar changes in diet and
lifestyle. What is true for prostate cancer is likely to be true for
breast cancer as well.
In addition to preventing and reversing disease and lowering health
care costs, comprehensive lifestyle changes often cause significant
improvements in quality of life. We have found joy of living to be a
much more powerful motivator for people to make and maintain changes in
diet and lifestyle than fear of dying.
In general, my colleagues and I have found two basic approaches are
effective. The first is to make small, incremental changes such as
walking 2,000 steps more per day and to consume 100 calories less per
day. Over time, these small changes add up and make a meaningful
difference. This is the approach popularized by Dr. James Hill in his
program, ``America on the Move.''
A second approach is to motivate people to make more intensive
changes in diet and lifestyle. Paradoxically, some people find it
easier to make big changes than small ones because when they make
comprehensive changes in diet and lifestyle, they often feel so much
better, so quickly, that it reframes the reason for making these
changes from fear of dying to joy of living.
Alterations in diet, for example, may affect blood flow within
hours, for better and for worse. After a whole foods, low-fat meal,
blood flow to the brain may improve, so people often describe feeling
more alert and aware. Blood flow to the heart often improves; in our
studies, most patients reported dramatic reductions in the frequency of
angina within a few weeks. Erectile dysfunction may improve as blood
flow increases to sexual organs. Most patients are able to lose weight
and keep it off.
One of the most effective anti-smoking campaigns was organized by
the California Department of Health Services. Billboards featured a
``Marlboro Man'' character with a limp cigarette hanging out of his
mouth with the headline, ``Smoking causes impotence.'' For many men,
this is more motivating than ``smoking causes heart attacks and
emphysema,'' which are too frightening to contemplate.
Many patients say that there is no point in giving up something
that they enjoy unless they get something back that's even better--not
years later, but weeks later. Then, the choices become clearer and, for
many patients, worth making. They often experience that something
beneficial and meaningful is quickly happening.
The benefit of feeling better quickly is a powerful motivator and
reframes therapeutic goals from prevention or risk factor modification
to improvement in the quality of life. Concepts such as ``risk factor
modification'' and ``prevention'' are often considered boring and they
may not initiate or sustain the levels of motivation needed to make and
main comprehensive lifestyle changes.
In our experience, it is not enough to focus only on patient
behaviors such as diet and exercise; we often need to work at a deeper
level. Depression, loneliness, and lack of social support are also
epidemic in our culture. These affect not only quality of life but also
survival. Several studies has shown that people who are lonely,
depressed, and isolated are many times more likely to get sick and die
prematurely than those who are not. In part, this is mediated by the
fact that they are more likely to engage in self-destructive behaviors
when they feel this way, but also via mechanisms that are not well-
understood. For example, many people smoke or overeat when they are
stressed, lonely, or depressed.
I have been consulting with some of the large food companies such
as PepsiCo, ConAgra, and McDonald's during the past few years, and I
have been encouraged by what they are doing. Their concerns about
litigation and legislation combined with the awareness of a growing
market for healthier foods have created new opportunities. When
companies like these use their considerable advertising and marketing
resources to educate people about the benefits of healthy lifestyles
and to provide more healthful products that are fun, convenient and
tasty, then the health of our country is likely to improve. Also,
worksite health promotion programs have shown considerable cost savings
and improvements in productivity.
Given the enormous cost savings, dramatic improvements in quality
of life, and objective medical outcomes that result from changes in
diet and lifestyle, why is there so much more emphasis on treatment
than on prevention?
The primary determinant of medical practice and medical education
is reimbursement. The primary determinant of reimbursement is Medicare,
since almost all insurance companies follow Medicare's lead in deciding
what to cover. We doctors do what we get paid to do and we get trained
to do what we get paid to do.
Therefore, if Medicare would begin to reimburse diet and lifestyle
programs on a certified but non-proprietary basis, this would put much
more emphasis on prevention of chronic diseases and would motivate
physicians and other health professionals to use diet and lifestyle
interventions as treatments for coronary heart disease, obesity,
diabetes, hypertension, hypercholesterolemia, and other chronic
diseases. Of all legislation that Congress could enact, this would have
the most impact in changing the emphasis of medical practice from
treatment to prevention. Reimbursement for preventive services is an
important part of Senator Harkin's HeLP America Act. An ounce of
prevention really is worth a pound of cure.
STATEMENT OF JACK RULE, CEO, INCENTAHEALTH
Senator Specter. Thank you very much, Dr. Ornish.
We now turn to Mr. Jack Rule, the CEO of incentaHEALTH, an
employer-based weight-loss company in Denver, Colorado; a
native of Iowa. Mr. Rule played professional golf and received
his bachelor's degree in business administration from the
University of Iowa.
Thank you for joining us, Mr. Rule, and we look forward to
your testimony.
Mr. Rule. Thank you, Mr. Chairman and Senator Harkin. I
want to thank you for allowing me to testify in front of your
distinguished subcommittee. I appreciate the chance to address
the obesity crisis and its related health issues.
As this subcommittee well knows, our country is facing a
largely preventable health crisis. Studies indicate that, in
2002 alone, obesity was directly responsible for $117 billion
in healthcare costs. The obesity epidemic is associated with 39
million lost work days and 63 million additional medical visits
each year. Simply stated, Americans are eating too much, and
exercising too little. Clearly, any system that has a realistic
chance of positively influencing these startling statistics
warrants consideration by our government and the private
sector.
In our view, to reach the largest number of people in the
shortest period of time, the most logical place to attack the
obesity crisis is in the workplace. Sixty-five percent of
America is overweight or obese. As a result, a typical employer
is paying inflated healthcare costs for almost two-thirds of
its workforce. Employers obviously have a significant economic
incentive to help their employees lose weight, but they need a
weight-loss system that is realistic and cost-efficient.
We believe such a system should do several things. First,
it should be scalable. The program needs to address large
numbers of employees at the same time. Next, it must be cost-
effective for both the employer and the employees. Ideally, it
should provide financial incentives to both. Third, it should
be practical and safe. There are no silver bullets in the
weight-loss war. The effective program must be based on
nutritional and exercise facts, not fads. Fourth, it must be
easy to use, require minimum effort for the employer to
administer, and, most importantly, be effective. Finally, it
should be measurable for the individual and the sponsoring
organization. The individual participant must be able to see
personal progress while maintaining personal privacy. The
employer must be able to gauge overall program performance and
measure their return on investment.
At incentaHEALTH, we have developed a system that meets all
of these criteria. Our program is designed to lower a person's
weight while reducing the organization's healthcare costs. The
incentaHEALTH solution uses proprietary automated technology,
realistic and tailored exercise and nutritional advice, and a
unique incentive program to help participants modify their
lifestyle and lose weight.
The program rewards participants with cash incentives if
body weight is lowered, and then maintained at the reduced
levels. The funds for the incentive are made available from a
portion of the employer's healthcare cost-savings generated
from reduced absenteeism, fewer medical visits, and lower
pharmacy costs.
The mechanics of the program are simple, but effective.
Participants use an exclusive and private automated weigh
station to track weight-loss progress. Todd Maguire, the chief
technical officer of incentaHEALTH, and designer of our
technology, is standing by our HEALTHspot weight station. Todd
will be available after the hearing, should anybody be
interested in a demonstration.
The HEALTHspot station identifies, weighs, and takes the
picture of the participant. The encrypted data is then
transmitted to our secure server. The process is HIPAA
compliant, takes less than a minute, and requires no monitoring
or assistance from the sponsoring employer. The incentaHEALTH
system provides daily e-mail coaching tailored to each
participant. As each person enrolls, they select a unique
exercise program based on their personal fitness condition and
their desired workout location. The chosen exercise program is
outlined via daily e-mails, which include information on
nutrition, meal ideas, exercise techniques, and motivational
success stories. IncentaHEALTH offers e-mail and telephone
support throughout the entire process. The individual, in
addition to losing weight and improving their health, receives
a small cash payment.
For the sponsoring organization, the financial incentive is
reduced overall healthcare costs, less absenteeism, increased
productivity, and healthier employees. The incentaHEALTH
program is designed to pay for itself. Our business model
indicates that for every $1 of program cost, the employer will
receive approximately $2 in first-year healthcare cost savings.
PREPARED STATEMENT
We believe this is a commonsense way to address the serious
healthcare issues. Mr. Chairman and Senator Harkin, we
appreciate your giving us the time to show you one approach
designed to address the critical obesity problem.
[The statement follows:]
Prepared Statement of Jack Rule
Mr. Chairman, I am Jack Rule, Chief Executive Officer of
incentaHEALTH, a high technology, employer-based, weight loss company.
Thank you for allowing me to testify in front of your distinguished
Subcommittee. I appreciate the chance to address the obesity crisis and
its related health issues.
As this Subcommittee well knows, our country is facing a largely
preventable health crisis. Studies indicate that in 2002 alone, obesity
directly contributed to $117 billion in health care costs. Obese and
overweight employees claim up to $1,500 more in health care costs each
year and incur 77 percent higher prescription drug costs than those
with a healthy body weight. The obesity epidemic is associated with 39
million lost workdays and 63 million additional medical visits each
year.
Clearly, any system that has a realistic chance of positively
influencing these startling statistics warrants consideration by our
government and the commercial sector. In our view, both the health and
human costs associated with the obesity epidemic demand it.
At incentaHEALTH, we believe the most logical place to attack the
obesity crisis is in the workplace. Sixty-five percent of America is
overweight or obese. As a result, a typical employer is paying inflated
health care costs for almost two-thirds of their workforce--employers
have a significant economic incentive to help their employees lose
weight but they need a weight loss system that is realistic and cost
efficient.
We believe such a system should do several things:
First, it should be scalable. The program needs to address large
numbers of employees at the same time.
Next, it must be cost effective for both employers and employees.
It should be a winning proposition for the individual and the employer.
Ideally, it should provide financial incentives for both.
Third, it should be practical, safe, and, most importantly,
effective. There are no ``silver bullets'' in the weight loss war. An
effective program must be based on nutritional and exercise facts--not
fads.
Fourth, it must be easy to use and follow. That suggests that it be
workplace based, offer both exercise and nutritional alternatives, and
require minimum effort to administer.
Finally, it should be measurable--for the individual and the
sponsoring organization. The individual participant must be able to see
personal progress while maintaining personal privacy. The sponsor must
be able to gauge overall program results and measure a return on their
investment.
At incentaHEALTH we believe we have developed a system that meets
all of these criteria. An innovative health care technology company,
incentaHEALTH's weight loss program is designed to lower a person's
weight while reducing an organization's health care costs. The
incentaHEALTH solution uses proprietary automated technology, realistic
and tailored exercise and nutritional advice, and a unique incentive
program to help participants modify their lifestyle and lose weight.
The program rewards participants with cash incentives if body weight is
lowered and then maintained at the reduced levels. The funds for the
incentive are made available from a portion of the employer's health
care cost savings generated from reduced lost time, medical visits, and
pharmacy costs.
The mechanics of the program are simple but effective.
First, participants use an exclusive, and private, automated weigh
station to track weight loss progress. Our automated station, called
HEALTHspot, is linked to an advanced reporting system that provides
measurable, but individually private, results of overall participant
progress. To ensure integrity and privacy in the system, an enrolled
participant simply enters his or her telephone number or individual pin
into the keyboard, scans his or her fingerprint into the system, and
when prompted, stands on the digital medical quality scale. The
participant's photograph is digitally taken as the scale records the
weight and the data is encrypted and transmitted to the secure
incentaHEALTH server. The system prohibits unauthorized access and the
information handling practices meet the HIPAA requirements for
treatment of personal health information. By the time the participant
returns to his or her personal computer, the information weight,
picture, and progress is available for individual review on-line
through our website. Additionally, the technology can also calculate an
individual's body fat percentage. The whole process takes, on average,
less than a minute and requires no monitoring or assistance by the
sponsoring agency.
Next, in addition to individual and composite group weight
measurements, the system provides daily email ``coaching'' tailored to
each participant. The emailed material offers nutritional education,
detailed instruction on exercise techniques, and meal ideas as well as
motivational success stories of successful participants. As each person
enrolls, they select a unique exercise program based on their personal
fitness condition--Foundation, Intermediate, or Advanced. They also
select whether they will workout in a fitness center or at home. Our
workout advice offers an assortment of suggested exercises. Strength
training suggestions target each muscle group and offers detailed video
alternatives for both typical gym strength training machines and
readily available resistance bands for use at home or on the road.
Aerobic advice includes options for both interval and endurance
training.
Based on the selections made, a specific exercise program is
outlined via the daily emails for each twelve-week period. The program
is one year in duration. Additionally, the emails offer nutrition
education, detailed instruction on exercise techniques, and meal ideas
as well as motivational success stories. If a participant has questions
or is having difficulty reaching targeted weight goals they may contact
incentaHEALTH by email or telephone for assistance or guidance.
Human nature being what it is, we believe an effective incentive
program is a vital component to our program--for both the individual
and the corporation or agency.
For the individual, the incentive, in addition to reduced weight
and improved health, is a cash payment. While participants may weigh in
as often as they like, ``official'' weigh-ins are conducted on a
quarterly basis. Based on the results of the quarterly weigh-in the
employee may qualify for a small incentive check as a reward for their
progress. If the weight loss is maintained for the next quarter the
participant receives a second check. If weight loss continues, the
participant receives a larger check. If weight is gained, the checks
stop. While relatively small, the checks provide a positive
reinforcement; they are ``attention getters.'' IncentaHEALTH monitors
the progress, processes the payments, and distributes the incentives to
the participants; the sponsoring organization in turn reimburses
incentaHEALTH.
For the sponsoring organization, the incentive is reduced overall
health care costs, less absenteeism, increased productivity, and
healthier employees. Put simply, employers are paying a high premium
for the health care costs associated with overweight and obese
employees. For example, in one study, overweight employees cost
employers an additional $1,500 in yearly health care costs. In another
study, obese employees were found to be twice as likely as lean
employees to take seven or more illness related absences in a six-month
period. Another study indicates that a positive weight reduction can
reduce prescription drug costs by 77 percent.
Our program is designed to pay for itself. The typical
incentaHEALTH program has three cost elements: a fixed $3,000 fee for
the annual lease of equipment, a $9 fee per month per participant, and,
on average, a $3 fee per month per participant for the incentive
payments. In return for this relatively modest investment, the
employers can achieve significant savings. In a population of 1,000
persons, on average 65 percent are overweight or obese. Of those 650,
we assume that at least 50 percent or 325 will voluntarily sign up for
the program and of those who participate, 50 percent or 160
participants, will lose and keep off at least 10 percent of their
weight. We project that anyone who loses 10 percent of their body
weight will save $500 a year in medical costs. Therefore, 160
successful participants would equal $80,000 in annual savings for a
program cost of $45,000.
In fact, in our initial pilot effort with Kaiser Permanente our
assumptions have proven to be quite conservative. We exceeded our
enrollment expectations by 60 percent and our weigh-ins by 52 percent.
In our first quarter alone, of two hundred and twenty-six individuals
who weighed in, one hundred and seventy four individuals lost weight--
77 percent of participants. In total, 1,164 pounds have already been
lost and body mass indexes have shown significant improvement. Fifteen
participants are now classified in the healthy weight category rather
than overweight and another ten individuals are no longer clinically
obese.
In summary, the program is designed to produce measured, healthy,
and steady weight loss over a prolonged period. It is not another ``yo-
yo'' weight loss gimmick. A yearlong process, the goal is the
establishment of a healthy and maintainable life style that improves
the health and overall fitness of the participant and saves the
employer crucial health care dollars. I believe that the unique system
developed by incentaHEALTH provides both employers and employees a
common sense way of addressing serious health care issues in a cost
effective and realistic way.
Mr. Chairman, thank you for providing me an opportunity to share my
views and show you one approach designed to address the critical
obesity issue. I am happy to answer any questions the Subcommittee may
have.
STATEMENT OF KAREN SILBERMAN, EXECUTIVE DIRECTOR,
NATIONAL COALITION FOR PROMOTING PHYSICAL
ACTIVITY
Senator Specter. Thank you very much, Mr. Rule.
We turn now to Ms. Karen Silberman, Executive Director of
the Coalition to Promote Physical Activity. Prior to her
current position, she was conference director in the Points of
Light Foundation; bachelor's degree from Oberlin, and MBA in
nonprofit management from Indiana University.
Thank you for joining us, Ms. Silberman, and we look
forward to your testimony.
Ms. Silberman. Thank you.
The National Coalition for Promoting Physical Activity
(NCPPA) is a coalition of major health, fitness, and recreation
associations working to advance policies and programs that
encourage physical activity. NCPPA was created in response to
the 1996 Surgeon General Report on Physical Activity and
Health. The American College of Sports Medicine, the American
Heart Association, and the American Alliance for Health,
Physical Education, Recreation, and Dance convened the
coalition as a way to advocate and educate Americans on the
importance of regular physical activity.
NCPPA has since grown to include a broad cross-section of
national and local organizations, including Federal agencies,
corporate partners, trade and professional associations, and
national charitable organizations. Our members are as diverse
as the American Cancer Society, the National Recreation and
Park Association, AARP, the YMCA, Nike, and the NCAA.
NCPPA's members independently address a host of issues
pertaining to physical activity, including health science,
education, environment, population-specific outreach and
activity behavior. By working together and building on existing
relationships in the public/private industry sectors, NCPPA is
developing new alliances and partnerships to coordinate and
focus public education campaigns, policy development, and media
education.
Our work is motivated, in part, by the alarming rates of
obesity, chronic disease, and inactivity in our country.
America faces a national health crisis of epidemic proportions.
Physical inactivity combined with overweight has, in less than
30 years, made the United States a Nation of overweight and
out-of-shape individuals. According to the CDC, the incidence
of overweight or obesity among adults increased steadily from
47 percent, in 1976, to 61 percent, in 1999. And despite proven
benefits of regular physical activity, more than 60 percent of
Americans do not get enough physical activity to provide health
benefits.
Every year, four major killers strike 1.5 million
Americans--heart disease, stroke, diabetes, and cancer--
diseases that could be prevented, in part, by regular physical
activity. Researchers estimate that 34 percent of heart-disease
deaths are attributable to physical inactivity. The estimated
direct and indirect costs of these four diseases in 2002
amounted to $465 billion. Physical inactivity and obesity now
rank second, after tobacco use, as the leading cause of death
in the United States, and the newest figures estimate that
400,000 deaths annually are attributable to poor diet and
inactivity.
The epidemic of obesity spares no population, including
children. A report by the National Center for Health Statistics
stated that, in 2002, approximately 15 percent of all children
and adolescents were overweight, three times as many overweight
children and adolescents as reported in 1980, which translates
into over 9 million children. And nearly three out of every
four overweight teenagers will become overweight adults. And
overweight children are more prone to both kinds of diabetes,
cardiovascular disease, and asthma.
Moderately intense daily physical activity has long been
recognized as an essential ingredient to a healthy life, but,
increasingly, physical activity has been engineered out of
Americans' daily lives. An anecdote to rising rates of disease
and medical costs clearly necessitates increasing rates of
physical activity. Regular physical activity is associated with
numerous health benefits, including reduced risk of developing
heart disease, stroke, diabetes, certain types of cancer, and
obesity, a reduced risk of osteoporosis in women, improved
psychological well-being, especially for persons suffering from
anxiety and depression, and reduced risks of unhealthy
behaviors--for instance, substance abuse and violence--among
children and adolescents. And a study in California echos what
we already know, anecdotally, that children who increase their
daily physical activity from 3 to 5 days a week have a 20
percent increase in overall fitness, a 20 percent improvement
in school attendance, and a 20 percent improvement in school
grades. Physical activity is simply the most effective and
inexpensive form of prevention we have available. It is the
closest thing to a magic bullet that we have.
NCPPA does not believe that we can legislate individual
behavior change, but we do believe that we can make our
physical environment more conducive to being physically active.
We need legislation that encourages physical activity as part
of a healthy life, that incentivizes it when necessary, and
makes it an attractive option for all Americans.
The challenge in America, a country in which 25 percent of
the population reports no leisure-time physical activity, is to
develop effective physical-activity policies. NCPPA believes
that we need daily physical education in schools, and suitable
equipment and facilities to carry out these activities.
Physical education helps students develop the knowledge,
skills, behavior, attitudes, and confidence needed to be active
for life, while providing an opportunity for students to be
active during the school day. We need policies that ensure that
walking, bicycling, and other forms of physical activity are
safe and accessible, especially for children to and from
school. We need non-motorized forms of transportation included
in transportation policy. We need workplace and labor policies
that encourage physical activity. We need policies that help
change social norms to facilitate the understanding that
physical activity is an important part of daily life. And,
finally, we need policies that encourage development and access
to physical-activity facilities.
PREPARED STATEMENT
NCPPA is glad to be taking a lead on the way we address
physical inactivity and related chronic diseases, and we
believe there is broad public support for measures that promote
prevention activities, legislation that increases physical-
activity opportunities, and policies that support and encourage
physical activity among children.
We will continue to advocate and educate on these issues,
and we look forward to working with this Subcommittee.
Thank you.
[The statement follows:]
Prepared Statement of Karen Silberman
Karen Silberman joined the National Coalition for Promoting
Physical Activity (NCPPA) in January 2002. NCPPA is a coalition of
major health, fitness and recreation associations working to advance
policies and programs that promote physical activity. NCPPA's mission
is to unite the strengths of public, private, and industry efforts into
collaborative partnerships that inspire and empower all Americans to
lead more physically active lifestyles.
NCPPA's goal is to increase the adoption of physically active
lifestyles by educating policymakers and interested individuals about
the benefits of physical activity and influencing policy to build
sustainable, physically active environments. In addition, NCPPA works
to foster the efforts of individuals and organizations dedicated to
creating healthier communities through physical activity participation
in the schools, at the worksite and in communities
Prior to her position at NCPPA, Karen worked for Association
Management Group (AMG), an association management company that manages
trade and professional organizations. During her four-year tenure at
AMG Karen served several clients included, Consulting Engineers
Council, Smart Card Forum, Association of Legal Administrators and the
American Association of Naturopathic Physicians.
Prior to AMG, Karen was the Conference Director at the Points of
Light Foundation, an organization that promotes and encourages
volunteer service. Additionally, Karen spent two years at the American
Heart Association managing fundraising events in the state of Maryland.
Karen received her BA in Sociology from Oberlin College and her MPA
in Nonprofit Management from Indiana University.
Senator Specter. Thank you, Ms. Silverman.
Dr. Ornish, when you talk about reducing medical costs
through the kinds of programs that you have, on reversal of
plaque in the arteries, on the prostate cancer, you strike a
real chord with--a major problem facing America today, as you
know, is the increasing cost of healthcare.
Dr. Ornish. Yes.
Senator Specter. To what extent can you document your own
programs to be cost effective or actually save Medicare
dollars?
Dr. Ornish. Well, we've already documented that over the
last 27 years. First, we demonstrated that these lifestyle
changes are medically effective. We used angiograms, PET scans,
radionuclide ventriculograms, cardiac events, a 91-percent
reduction in the amount of chest pain, and two-and-a-half times
fewer cardiac events, including heart attacks and bypasses and
angioplasties, simply by changing diet and lifestyle. The
evidence is really overwhelming.
But we then showed that this is not--and, by the way, just
parenthetically, it's--to me, the whole metaphor is, Are we
going to bypass blocked arteries, are we going to have gastric
bypass? I mean, these are all really not addressing the cause.
But when you treat the cause, it's both more medically
effective and more cost effective.
We've been able to show that. First, Mutual of Omaha did a
demonstration project in eight hospitals around the country--
that included Harvard and Beth-Israel in New York, and UCSF,
and Scripps, but also in Omaha, Des Moines, South Carolina, and
in Broward General Hospital in Fort Lauderdale--and we found
that we could motivate people to make bigger changes in diet
and lifestyle than have ever before been reported, and to get
better outcomes than have ever before been reported, not only
medical outcomes, but also cost outcomes. Mutual of Omaha found
they saved almost $30,000 immediately because most of those
patients who were told they needed a bypass or angioplasty were
able to safely avoid it for at least 3 years.
In addition, Highmark Blue Cross Blue Shield of
Pennsylvania, in your home State, found that they could reduce
their healthcare costs by 50 percent in both heart patients and
in non-heart-patients.
I want to emphasize again, we focused on heart disease
because it's the most common cause of death in men and women,
and the most expensive use of healthcare dollars. But diabetes,
hypertension--people lost weight, and they kept it off, they
felt better, their depression improved--in every way we can
measure, when you change diet and lifestyle, it affects chronic
diseases across the board. And we're about to publish the first
study showing that the progression of prostate cancer may be
influenced for the better by changing diet and lifestyle. If
it's true for prostrate cancer, it'll almost certainly be true
for breast cancer. And I also want to add my sympathy to Ms.
Lackman.
So what's frustrating to me is that we have so much
evidence showing that this is both medically effective and cost
effective, and yet it's so hard to get agencies like Medicare
to say, ``You know, this is exactly the kind of program that we
need--this one and ones like it--to save money and to make the
American people healthier in a way that's not going to involve
cutting services, but, rather, empowering people with
information.''
Senator Specter. Would you provide the subcommittee with
the written materials which show the cost savings?
Dr. Ornish. They're in my----
Senator Specter. Ms. Silberman, if you had your choice
between golf and squash, what would your recommendation be?
Ms. Silberman. It depends if you're going to drive the golf
cart or if you're going to walk the 18 holes.
Senator Specter. Well, Mr. Rule, I know you're a
professional--were a professional golfer. How do you rate golf?
My wife has become an addict at golf. But if you were making a
recommendation to somebody starting out on an exercise program,
how would you rate golf contrasted to tennis or squash or
basketball or some of the aerobics which build up the pulse
rate a little faster?
Mr. Rule. Well, if you--Mr. Chairman, if you had a
tolerance for frustration, I'd recommend golf. But if you're
just looking for exercise, I think you can get a lot more
exercise playing basketball or any of the sports that raise
your heart rate.
Senator Specter. Mr. Rule, we'd be interested if you would
provide, in a written response, the amplification of the
comment you made that your program is cost effective--saves
money, doesn't cost money.
Senator Harkin.
Senator Harkin. Thank you very much, Mr. Chairman.
I really appreciate this entire panel being here, and
especially Mr. Rule for being here. Now, you went to Waterloo
High School.
Mr. Rule. Yes.
Senator Harkin. You must have graduated in 1957?
Mr. Rule. Yes.
Senator Harkin. Is that the year that Dowling beat Waterloo
for----
Mr. Rule. I knew you were going to bring that up. Yes, it
is. We lost, in the finals of the State basketball tournament,
to Dowling.
Senator Harkin. Well, Jack Rule, at that time, was the big
threat about our winning--my high school winning the State
championship that year, and we did prevail that year. We did
win that year. But, gosh, I remember your--people have been
talking about you being a golfer, but I always think of you as
being a basketball player for Waterloo.
Well, listen, I'm really delighted to see you again and to
hear what you're doing, especially with this program. And I
understand you're marketing this to businesses all over, right?
Mr. Rule. Yes.
Senator Harkin. How about a small business. Tell me, Jack,
about someone that just employs 20 or 30 or 40 people. Could
they afford to do this?
Mr. Rule. Senator, I think that the breakpoint's probably
at about 100 employees. Our model shows that if you have 100
employees, you're going to have about 65 of those people that
would be eligible, meaning they have a BMI of over 25, be
eligible to earn a check.
Senator Harkin. Yeah.
Mr. Rule. And we figure that half of those people will
actually participate. And so, the 12-month period. So when you
get--when you have to pay for the technology which allows this
to be HIPAA compliant and--it becomes uneconomic at the lower
levels, breaking down the participants on that basis.
Senator Harkin. Are there any Federal tax incentives for a
business to do this kind of activity?
Mr. Rule. Not to my knowledge, there are not. And, in fact,
Senator, I'm glad you asked that question, because we could use
some help.
The tax law, basically, says that if a corporation pays for
their employee to participate, not only does the employee have
to pay taxes on what this benefit, is whatever is paid on their
behalf----
Senator Harkin. Yeah.
Mr. Rule [continuing]. But also, the small incentive
checks, they have to pay tax on that, as well----
Senator Harkin. Yeah.
Mr. Rule [continuing]. Which, in that case, I think there's
less of an argument. But I think when you look at the--an
employee having to pick up, as taxable income, the cost of the
employer's efforts to have them lose weight, I think that's
wrong.
Senator Harkin. An employer does not get to deduct that it,
either.
Mr. Rule. That's correct.
Senator Harkin. I have a bill in to do this. I don't know
the number of it, but I'll get it to you to take a look at.
It's just to provide--that if a company provides this type of
health prevention and wellness programs, that it would be a
deductible expense for the business, and not a taxable benefit
to the employee.
Mr. Rule. That's a tremendous----
Senator Harkin. Well----
Mr. Rule [continuing]. Effort.
Senator Harkin. Yeah. And that would cut across all these
businesses. Also, I'm just very concerned about how we help a
lot of small businesses do this. They really can't afford to
build a fitness center, for example. They could afford--and
some could--to perhaps provide a benefit to join a health club,
or something like that, that might be around. And in that
regard, they need some tax benefits and some up-front
incentives to do this in the workplace.
So any other thoughts, Jack, you have on that, and how we
get--provide, again, incentives--we provide tens of billions of
dollars a year in tax incentives for this and that, and this
and that. But we don't provide it for businesses to provide
wellness programs for the workers.
Mr. Rule. Senator, there is one idea I'd like to pass along
in that regard. One of the problems--one of the appeals of our
program is obviously that the employee gets paid to lose
weight. But the HIPAA rules are too prohibitive as far as
somebody taking their weight at a small company's location,
where somebody is standing with a clipboard and taking their
weight in order to have measurable----
Senator Harkin. Yeah.
Mr. Rule [continuing]. Performance. If there was a way to
have the employer take the weight and provide it to us, then
our program would work for the smaller companies, as well as
the large company.
Senator Harkin. Have you ever looked at Townsend
Engineering, in Des Moines, Iowa, what they did?
Mr. Rule. No.
Senator Harkin. If you ever get back there, take a look at
what they did with their wellness programs, and the incentives
that they have provided to their workers--vacations, this and
that, time off. It's been--and for families, for the whole
family--it's been great. And both Ray and Ted Townsend will
tell you that their productivity has just gone through the
roof, and no one take sick time, no one ever leaves work. I
mean, they--that's just been a great incentive program.
Dr. Ornish, I know our time's running out again, I just
want to thank you for all that you've done to make Americans
aware of diet and eating right, nutrition. I've visited a
couple of your sites that Mutual of Omaha did, one in New York,
and----
Dr. Ornish. The one in Des Moines?
Senator Harkin [continuing]. And talked to people who had
been involved in your program. And it is amazing how much
better the feel, and that fact that they didn't have recurrence
of any chest pain and angina and things like that. And that's
been several years ago when I visited that.
Dr. Ornish. Yes.
Senator Harkin. So it's clear that this--that your approach
works. But, again, it's the idea of how you get the incentives
in there.
Dr. Ornish. Exactly.
Senator Harkin. Medicare pays for all this patching,
fixing, and mending, but we don't get to this step, of
preventative healthcare, and that we need to incentivize this
somehow.
Dr. Ornish. I completely agree with you, Senator. You know,
I mentioned that heart disease kills more Americans each year
than virtually everything else combined. But what I failed to
say was that, knowing what we now know, 95 percent of that
could be prevented.
Senator Harkin. Yeah.
Dr. Ornish. So it's a staggering contradiction. And yet, as
you indicated, Medicare and insurance companies will pay for
the bypass, they'll pay for the angioplasty. Most insurance
companies will pay for cholesterol-lowering drugs, which cost
$20 billion last year, and that number is only going to go up,
especially this week, with the report saying that they're going
to prescribe even more. And most of those expenses could also
be avoided by simply changing diet and lifestyle.
But, even more importantly, the reason I feel so
passionately about this is, I've seen, over and over again,
people who didn't have hope, who were told--who literally
couldn't walk across the street without getting severe chest
pain, and, within weeks, most of those people become pain free,
as you have seen. It transforms their lives. And that's why
people are able to make and maintain these changes.
So I remain deeply grateful to you and Senator Specter and
Ms. Taylor and others for making it possible for us to get to
this point. And I think our work can really be a model for
showing people that if you can reverse disease, clearly you can
help prevent it.
Senator Harkin. But, Dean, we've got to start with kids
early on.
Dr. Ornish. Couldn't agree with you more.
Senator Harkin. The junk food they're eating--look what
they're eating in schools, look at the--and not only just what
they're eating, how much people are eating now.
Dr. Ornish. Yes.
Senator Harkin. I mean, the portions of food are getting
immense. It's just staggering how much they put on a plate now
for you to eat, as if that's desirable.
Dr. Ornish. Well, I've been consulting also with some of
the major food companies--with PepsiCo, with ConAgra, with
McDonald's--to say, you know, there is an opportunity here for
you to do well and do good by changing what you make. They're
in the behavioral-modification business, too. And if they can
use all those advertising and celebrities and resources to make
it convenient and fun and hip and interesting and sexy to eat
healthfully and exercise, to develop programs with kids, then I
think we might be able to make a difference there, as well.
Senator Harkin. Thank you.
Ms. Silberman, exercise again. We talk about nutrition and
diet, but exercise--80 percent of elementary-school kids today
get less than an hour of P.E. a week. I was just in Iowa last
weekend, Sioux City, elementary-school kids receive two 25-
minute periods a week. That's it. Elementary schools are being
built without a playground, without any exercise areas, around
the country today.
When I was a kid--probably Jack, too, in Waterloo; maybe
many of us, at least our age--we had recess in the morning,
recess in the afternoon, and a half-hour after lunch. And it
had to be 40 below zero before we could stay indoors.
You had to get out and exercise--run around, do things. And
kids today aren't--there are problems like the PEP Program in
schools. And I think, with all due respect to my friend, Mr.
Rule, who was a star athlete in high school, and beyond, we
focus too much on sports. I mean, I visited schools where they
have exercise programs for every child, even kids with
disabilities, every day of the week. They track them, they map
their body mass index, their cholesterol; they give them
charts, and they show them how to progress--every child getting
physical activity every day during the week. Now, somehow we've
got to incentivize that, too.
I leave you with this. When I was a kid in grade school in
rural Iowa, we got our report cards for all the courses and
stuff, but we also had another section of the report card that
things on it like deportment--which I never did well in, but I
won't get to that--but it also had health, it had to do with
what you did in health. You know, if it's important for kids to
graduate from school today with good grades and to exercise
their brains, it's also, I think, important for kids to
graduate from school today with good health. Why is that not a
part of our report-card system? Why is that not part of the
incentive system? As you go through school, you are graded on
how well you eat, what nutritious foods you take in, how much
you exercise, what your health condition is as you progress
through school. Why isn't that part of our whole school system
in America?
Ms. Silberman. I think that we need to have a cultural
shift. I mean, I think you're absolutely right, we've got to
get kids more active regularly, we have to have them learn
early the love of movement and fitness and being active, so
that it's part of their everyday life as they become adults.
And I think you're right, the school is the perfect delivery
system for that, and we're doing children a disservice by
pushing P.E. off, and recess off, of the daily activities that
should be included.
Senator Harkin. In Sioux City--last weekend I was there--
they've laid off five P.E. teachers because of cut on school
funding. And they're the first to go, P.E. teachers. They get
rid of them. And what a terrible signal to send to kids.
So I encourage you, through your organization, to do what
you can on--and we don't control local schools. That's local.
But we've got to somehow provide the leadership and the bully
pulpit and the incentives--whatever we can provide, incentive-
wise, to local school districts--to provide that kind of
physical activity for kids.
Ms. Silberman. I agree.
Senator Specter. Thank you very----
Senator Harkin. So we need your help.
Thank you, Mr. Chairman.
Senator Specter. Thank you very much, Senator Harkin.
Thank you, Ms. Silberman, Dr. Ornish, and Mr. Rule. I want
to compliment the YMCA on what they're undertaking to do here.
I very much regret I will not be able to join you at the press
conference, but I think it's a great, great program, and I'm
delighted to see Pittsburgh is 1 of the 14 cities.
ADDITIONAL SUBMITTED STATEMENTS
We have received the prepared statements of Senator Thad
Cochran and Cheryl G. Healton, president and CEO, American
Legacy Foundation that will be placed in the record.
[The statements follow:]
Prepared Statement of Senator Thad Cochran
Mr. Secretary, we appreciate your exemplary service as Secretary of
Health and Human Services and your good efforts to prevent disease by
encouraging Americans to adopt healthy lifestyles and practice good
health habits. We have heard you say on several occasions that ``we
need to stop making healthy living a fad in America, and start making
it a way of life.''
Prevention strategies, as well as lifestyle and dietary changes,
are the best tools to combat diabetes, heart diseases, and many other
chronic conditions that afflict our population. The economics of
prevention strategies are dramatic and data show that preventing
instead of treating disease is very cost effective. For every $1 spent
on diabetes education, $3 are saved on hospitalization costs, and
estimates are that if 10 percent of adults began a regular walking
program, $5.6 billion in heart disease costs could be saved. Because of
this tremendous return on investment, such strategies present the
greatest hope for areas of our country that suffer disproportionately
from disease.
One of the agencies with primary responsibility for preventing
disease is the Centers for Disease Control and Prevention--we often
forget to mention the prevention component of the CDC's mission. It is
my hope that we can continue to increase funding for the public health
research being conducted by the CDC. This research will help us to
better understand which interventions and programs are the most
effective at changing lifestyles, improving exercise and dietary
habits, and affecting behavioral decision making. I hope we can
continue to focus resources on this important area.
I believe Secretary Thompson and federal agencies such as the CDC
recognize the value in health promotion. I also believe prevention and
healthy lifestyle changes hold the greatest promise for overcoming the
tremendous health challenges facing my state of Mississippi and our
nation. It is my hope that the Congress will encourage and strengthen
these efforts.
______
Prepared Statement of Cheryl G. Healton, Dr. P.H., President and CEO,
American Legacy Foundation
I would like to take this opportunity to commend Senator Arlen
Specter and Senator Tom Harkin for holding this hearing to examine the
important issues of healthy lifestyle and disease prevention and to
thank them for allowing me to submit this testimony for the record on
behalf of the American Legacy Foundation. Although we may not lobby or
take positions on specific legislation, we invite you to look to us as
a substantive resource on questions regarding tobacco related health
issues.
Tobacco-related disease continues to be leading cause of
preventable cause of death in the United States. Since 1964, more than
12 million people in the U.S. have died from smoking. While trends show
a decline in cigarette use, we must remain vigilant to ensure that all
of the gains made in the battle against tobacco related disease are not
lost.
Tobacco kills 440,000 Americans each year and afflicts thousands
more with heart disease, cancer, emphysema, stroke and other tobacco-
related diseases. It is responsible for more deaths than alcohol, AIDS,
car accidents, illegal drugs, murder and suicides combined and tobacco-
related illness costs our society billions of dollars in public and
private health care costs and in lost productivity.
My esteemed colleagues addressed many of the issues linking healthy
lifestyle and disease prevention and brought to light a number of
promising initiatives that will serve as models for a healthier
America. I would like to bring one of the American Legacy Foundation's
most successful programs to your attention as well: the truth
campaign.
80 percent of adult smokers begin their deadly habit before turning
18. The best way to reduce adult smoking is to prevent smoking
initiation during youth. Every day in the United States, more than
4,000 young people between the ages of 12 and 17 try a cigarette for
the first time, and about 2,000 will become daily smokers. About 23
percent of U.S. high school students and 10 percent of U.S. middle
school students smoke cigarettes. Of youth who are smokers, about one-
third will eventually die from a tobacco-related disease. These figures
are frightening. Knowing what we know today, this and future
generations of young people need to be spared a lifetime of addiction,
illness and death.
The American Legacy Foundation has been exploring the tobacco
habits of teens for more than five years and recently released the
First Look Report 13 in order to disseminate the findings of the 2002
National Youth Tobacco Survey. This report presents very positive
trends in the reduction of youth smoking, but it also brings to light
areas that still require our attention. The good news is that current
smoking has declined among high school students from 28 percent in 2000
to 23 percent in 2002, but the rate of 10 percent of middle school
students who smoke regularly remains almost unchanged.
With its blunt messaging and frank approach, the award winning
truth campaign is routinely cited as one of the reasons behind record
declines in youth smoking rates. The data supporting the effectiveness
of the truth campaign serves as a powerful reminder to policy makers
that tobacco awareness campaigns produce positive results.
Unfortunately, truth is at risk. This year the American Legacy
Foundation received its last payment from the Master Settlement
Agreement (MSA). This is because the MSA included a sunset provision
which only guaranteed funding for the first five years and then only in
subsequent years if 99.05 percent of the tobacco market-share was held
by participating companies, including all of the major U.S. tobacco
companies as well as many smaller companies. That market-share is no
longer being met and thus, tobacco companies are no longer required
under the MSA to continue making payments to support public education
programs at the American Legacy Foundation.
The sunset in funding for the American Legacy Foundation's truth
campaign comes at a time when tobacco companies continue to spend
billions each year to advertise their deadly products. In 2001 alone,
the tobacco industry spent a record $11.2 billion marketing their
products--up by $5 billion since the MSA was signed. Although the
American Legacy Foundation is aggressive in our counter-marketing
efforts, the industry routinely outspends us by 200 to 1. Without
continued funding, the truth campaign could be effectively silenced by
2008, if not sooner. Without truth, a new generation will be
vulnerable to the advertising messages of the tobacco companies. As it
stands, the American Legacy Foundation finds itself in the position
where it is the last national safety net for youth tobacco prevention
programs. States are using tobacco education funds provided through the
MSA to make up for fiscal deficits. Other major foundations have been
forced to reassess their priorities. And, despite substantial national
focus on FDA regulation of tobacco products and other important tobacco
related policy issues, there has been virtually no discussion of the
importance of youth tobacco counter marketing campaigns. Even the White
House Office of National Drug Control Policy has steadfastly refused to
include youth tobacco control messages in its National Youth Anti-Drug
Media Campaign--despite that fact that such inclusion would be within
its mandate and despite the fact that it appropriately decided this
year to include youth alcohol use.
The link between underage tobacco use and other illicit drugs can
no longer be overlooked. According to a study conducted jointly by the
American Legacy Foundation and the National Center on Addiction and
Substance Abuse (CASA), 60 percent of repeat marijuana users smoked
cigarettes first, and teens who smoke cigarettes are 14 times likelier
than their non-smoking counterparts to try marijuana, six times
likelier to buy marijuana in an hour or less, and 18 times likelier to
say most of their friends smoke marijuana. Marijuana is widely regarded
as the ``gateway'' drug, opening the door for young people to try
illegal drugs like cocaine, heroine, and ecstasy. I believe that this
report supports the view that cigarettes can also be a ``gateway''
drug.
The findings of the study are staggering given the large number of
teens who try smoking or regularly smoke. Smoking cigarettes introduces
teens to the sensation of inhaling a drug and desensitizes them to the
feeling of smoke entering their lungs. Even among their peers, 77
percent of teens say cigarette smokers are more likely to smoke
marijuana and teens who are current cigarette smokers are more likely
to be repeat marijuana users than one-time marijuana users. This
destructive behavior can permeate groups of friends making the peer
pressure to smoke cigarettes, drink alcohol and smoke marijuana
extremely high.
The study also revealed that 55 percent of teens who are current
cigarette smokers report that more than half of their friends use
marijuana, compared with only three percent of those who have never
smoked cigarettes. This underscores for parents, teachers, policymakers
and anyone else concerned with the welfare of American children, the
importance of intervening to end tobacco use and prevent other drug
abuse.
If we truly seek a healthy America, we must reinforce and renew our
commitment as a nation to youth tobacco prevention. The truth campaign
is a proven, life-saving tool in this effort. I would like to thank the
committee members, particularly Senators Specter and Harkin, for the
opportunity to present the views of the American Legacy Foundation on
this important issue. Thank you.
CONCLUSION OF HEARING
Senator Specter. Thank you all very much for being here.
That concludes our hearing.
[Whereupon, at 11:15 a.m., Thursday, July 15, the hearing
was concluded, and the subcommittee was recessed, to reconvene
subject to the call of the Chair.]