July 29 to August 2, 2006.
TO: Members of the Executive Committee
FR: Representative George Flaggs, Jr., Chair, Human Services & Public Safety Committee
RE: Report of Activities of the Human Services & Public Safety Committee at the 60th Annual Meeting of the Southern Legislative Conference in Louisville, Kentucky, July 29 – August 2, 2006
The Human Services & Public Safety Committee convened on Sunday, July 30, for a program session and on Monday, July 31, for a business session during the 60th SLC Annual Meeting. The following is a summary of the speaker presentations and Committee activities during this event.
Sunday, July 30
Childhood Obesity: A National Epidemic
Dr. Christopher Bolling, Associate Professor, Cincinnati Children’s Hospital Medical Center
Victor Sutton,Director, Office of Preventive Health, Mississippi Department of Health
The Honorable Herschel Cleveland, Former Speaker of the House of Representatives, Arkansas General Assembly
With childhood obesity rates rising to astonishing levels throughout the United States, and particularly throughout the South, many believe obesity among children has exceeded what is considered to be mere, simple weight problems, yielding a formidable problem of epidemic proportions. Statistics show that if the swift increase of childhood obesity is left unbridled, children alive today may be the first generation in 200 years to have shorter life expectancies than their parents. The presenters offered prospective solutions and advice for states in combating this crisis.
Dr. Bolling’s Presentation
Dr. Bolling commenced the childhood obesity discussion by emphasizing the far-reaching threats obesity poses to society. Obesity in children creates lifelong health risks that both endanger the individual’s quality of life, as well as the individual’s life itself. While there is some skepticism in referring to childhood obesity as an “epidemic” or a “health crisis,” ignoring this problem may lead to dire repercussions. Likewise, there are financial concerns for states. Obesity “threatens to bankrupt our healthcare system if we are not careful,” Dr. Bolling warned.
Dr. Bolling defined obesity as “having a very high amount of body fat in relation to lean body mass.” Typically, adults with a body mass index (BMI – a calculation based on the height and weight of the individual) of over 30 are considered to be obese. Since a child’s BMI changes so rapidly, due to continued growth in height and often rapid fluctuation in weight, childhood obesity is more difficult to define and to gauge. Due to these almost daily developmental changes, children are measured based on percentile, and are categorized accordingly. Children who are “at risk for overweight” are those who fall within the 85th – 95th percentile of children their age. Children who are classified as “overweight” are those within the 95th – 99th percentile. And “obese” children are those who are above the 99th percentile for their age group.
Trends that can be identified as contributing factors to increased risk of childhood obesity can mirror trends in the general population that conduce obesity. For instance, minority populations have increased risk of obesity, which typically is associated with economic class. Particularly in the South, Latinos, African Americans and Appalachian populations are disproportionately affected by obesity. Inner city populations (which often largely consist of minorities) suffer increased obesity rates as well. With regard to children specifically, those who have at least one obese or overweight parent are at a greater risk of becoming obese or overweight themselves, and are at an even greater risk (seven to eight times) of remaining or becoming obese or overweight as adults. A study by David Whitaker of the University of Bradford School of Pharmacy shows that there are two major predictors for a child becoming overweight or obese as an adult: (1) being overweight by age three and (2) having an overweight parent.
Dr. Bolling spoke extensively about health risks stemming from being overweight or obese. These include increased risk of: sleep apnea; cardiovascular disease; colon cancer; liver disease (being overweight is one of the leading causes for liver transplants); osteoarthritis; stroke (there is a 13 times greater lifetime risk of stroke if a person is an overweight adolescent); adverse affects on quality of life indices; and type-2 diabetes. Dr. Bolling remarked that many of these diseases, which were once thought to affect only adults, are now becoming prevalent in children. The most noteworthy of these is type-2 diabetes. The Cincinnati Children’s Hospital, for instance, which is one of the busiest children’s hospitals in the world, once saw only one or two cases of childhood type-2 diabetes every year; now that number is in the hundreds. Sleep apnea is another example of an adult disease becoming prevalent in children. Once considered to affect only adults, it is now being diagnosed in children as young as two years of age. Orthopedic diseases are becoming more problematic in children as well. In addition, side affects of these conditions in children have exacerbated behavioral disorders, such as attention deficit disorder and other behavioral diseases.
In order to demonstrate the particular plight of Southern states, Dr. Bolling described the obesity trends that have developed in the United States since the mid-1980s. While the general population of the country as a whole has become increasingly larger, a clustering affect has been seen in the South and in the Midwest. In the early 1990s, many of these states reported 15 percent to 19 percent of their population as being obese. In 1998, some states began reporting 20 percent of the population as being obese and, in 2001, Mississippi became the first state with over a quarter of their population considered obese. Alabama and West Virginia joined Mississippi at this level in 2002, along with six other states by 2004. As of 2004, there were nine states with populations at or above 25 percent classified as obese; eight of them were Southern states (Michigan being the exception).
Dr. Bolling emphasized that while this is a problem that can be addressed, there is no “silver bullet” solution. Treatment must be multimodal, including behavioral, public health, private practice, and community aspects. Just as there are different levels of severity in children, treatments for obesity and being overweight should be considered on a corresponding spectrum—the treatment should mirror the condition of the child. States should promote environmental controls which encourage the use of parks. Communities should be aggressive in identifying, rather than ignoring, the problems in their schools associated with lunchroom menus, physical education programs, and recess time allotments. Parents should be involved in helping children develop healthy eating habits. Doctors and health professionals should be equipped with ways of identifying and instituting early practice intervention for at-risk adolescents. Everyone should make use of local programs that not only work toward prevention, but also help children who are considered “treatment failures.” The state, the community, the schools, the home, and the medical setting all should work collaboratively in order to develop programs to stifle the progression of this epidemic.
Mr. Sutton’s Presentation
Mr. Sutton’s presentation began with a video clip about the decreased general health of children in the United States and, consequently, the increased disease rates in these children. A study by the Centers for Disease Control and Prevention (CDC) indicates that sharp increases in obesity started approximately 25 years ago. Since the early 1980s, the number of overweight children in the United States has more than tripled. This rapid increase is the reason the term “epidemic” often has been applied to this problem. Unlike other epidemics that have “external” causes, such as a virus or other disease-causing agent, the problem of childhood obesity is one “caused by us, by the choices we make.” Echoing the sentiments of Dr. Bolling, Mr. Sutton emphasized that this is a very complex issue, one where many factors cause or intensify the problem and, likewise, one without a decisive deus ex machina.
Mr. Sutton stressed the financial strains obesity has brought on the Mississippi economy, pointing out that approximately $757 million a year is spent on treating obesity-related problems in Mississippians. In an effort to suppress this growing cost, Mr. Sutton’s division of the Mississippi Department of Health, the Office of Preventive Health, works on the prevention side of the problem. Mr. Sutton acknowledged the importance of treatment of obese children, but emphasized the importance of prevention, pointing out that the greatest potential for combating obesity is preventing bad behavior in the beginning of people’s lives, as opposed to trying to change bad habits.
While acknowledging the importance of curtailing the potential for obese children to become obese adults, Mr. Sutton noted the immediate benefits of encouraging healthy lifestyles in children. For instance, several studies have shown that healthier children perform better academically. Additionally, children who exercise throughout the day can focus better in the classroom. The Mississippi Alliance for School Health (MASH) is an organization, established in 1993, whose mission is to collaborate with the Mississippi Department of Education in providing coordinated school health programs for state schools. Coordinated school health programs are plans, analogous to many school health programs designed by the CDC, that attempt to involve students, parents, and faculty in efforts to create healthy environments for children. Many of these are funded through mini-grants (usually $1,500 to $3,000) and oblige schools to create their own programs for health promotion.
Mr. Sutton briefly addressed the issue of vending machines in schools, which has come to the forefront in childhood obesity and school health conversations. Mr. Sutton began by criticizing school districts for their hesitancy to address problems associated with vending machines in schools, due largely to contracts with food and beverage companies that guarantee plentiful revenue for the schools. Mr. Sutton spoke on Mississippi’s research efforts in this area, which largely have dealt with providing generic choices, rather than name brands, in vending machines; requiring that 50 percent of choices in vending machines be water or 100 percent fruit juices; and varying the prices of different products in vending machines in order to encourage consumption of healthier products. The goal, Mr. Sutton argued, is to help schools maintain revenue while helping children become healthier. Mr. Sutton maintained that it is possible to make these necessary changes, if there is a collaborative effort with the private sector to do so.
Mr. Sutton closed his presentation by reiterating the ubiquitous benefits of helping children lead healthier lives. Health benefits for the children themselves are obviously the most pressing nuance of the obesity struggle, and the consequences of failure are likewise the most disastrous. Mr. Sutton emphasized the rippling affect that change can have, such as the economic benefits for states, many of which currently spend millions of dollars every year on treatment for obesity-related ailments. Mr. Sutton closed by adding that healthy kids make better students. Better students make healthy communities. And healthy communities make healthy states.
Speaker Cleveland’s Presentation
Speaker Cleveland began his presentation by quoting an uncanny statistic regarding the affects obesity has had on things like air travel: In the year 2000, major airlines spent an extra $275 million in transporting obese people. Speaker Cleveland’s remark was intended to emphasize what a serious matter obesity had become in this country, as well as how obesity in general, and childhood obesity in particular, has come to affect everyone in society.
Speaker Cleveland’s first point of discussion involved questions states may have regarding how to capture and hold people’s attention regarding the issue of obesity. His answer was a restatement of the theses of Dr. Bolling’s and Mr. Sutton’s presentations: emphasizing wholeness. It is important for societies to recognize that the problem of obesity affects more than those who are obese. The most obvious example of this is escalating healthcare costs. States spend millions of dollars every year treating obesity-related ailments. Another way to keep this conversation motivating is to stress the fact that without some type of change, generations of children will endure severe health problems and many will suffer diminished quality of life and premature death.
Speaker Cleveland then moved into a discussion of the 2003 legislation passed in Arkansas, Act 1220, which established the Child Health Advisory Committee. This Committee comprises 16 members who are appointed jointly by the Department of Health and the Department of Education. These departments both have the responsibility of writing regulations for schools and then presenting these regulations to the Education Commission for approval. Typically, the regulations deal with various aspects of health in schools, such as vending machine policies, school lunch programs, and physical education requirements. The Child Health Advisory Committee works to devise health policy for Arkansas schools, creating various programs and initiatives that are implemented by the Education Commission.
According to Mr. Cleveland, in 2003, Arkansas received tobacco settlement money, all of which was allocated to health initiatives, including Act 1220. Deciding where the money was to be used was a long, arduous process. The first action in this development involved deciphering: (a) what obligations state legislators have to their citizens and (b) what rights legislators have to “interfere” in the lives of their citizens. As those involved in the issue began looking at children in the state, they recognized that about half of the Arkansas annual budget went to funding education, and that almost every child in Arkansas had some form of health coverage. Through this evaluation it was discerned that although Arkansas dedicated a substantial portion of state funds to the education and medical coverage of its children, the obesity crisis remained unaddressed. Therefore, the proponents of Act 1220 felt that they had both an obligation to the obese children of their state, as well as the right to do something about it.
Act 1220 mandates that parents shall be provided with an annual Body Mass Index (BMI) by age of their child, as well as an explanation of what BMI means and health effects associated with obesity. The Arkansas Child Health Advisory Committee is charged with making recommendations on the implementation of Act 1220 and decided that parents will receive information regarding their child's BMI on a confidential health report. Reports such as these are recommended by the American Academy of Pediatrics for all children every year. The BMI of each child in Arkansas public schools has been measured and reported.
In closing, Speaker Cleveland addressed controversial aspects of the legislation, such confidentiality issues raised about the BMI initiative. Whether it is being lauded or criticized, the legislation had attracted a great deal of attention in Arkansas. During the year after which the legislation was enacted into law, there were approximately 750 newspaper and magazine articles, written in 72 out of 75 Arkansas counties, about it. The overall result of programs created by Act 1220 has been the stabilization of the escalating obesity crisis in Arkansas. The next step, according to Speaker Cleveland, is to make the weight go down.
Monday, July 31
Pandemic Influenza: Awareness, Preparedness and Response
Christopher Downing, Director, Region IV, United States Department of Health and
The threat of a pandemic exists when there is an imminent danger of a new influenza virus for which people have little or no immunity. Recently, health officials have become concerned that the highly pathogenic avian H5N1 virus, which currently exists in eastern Asia and several other countries, may pose a significant threat to human health. In December, 2005, the U. S. Congress apportioned $350 million for state and local pandemic influenza preparedness endeavors.
Mr. Downing’s Presentation
Mr. Downing, who oversees activities in Region IV, which includes Alabama, Florida, Georgia, Kentucky, Mississippi, North Carolina, South Carolina, and Tennessee, began by thanking the chair, vice chair, and the members of the Committee on behalf of U.S. Health and Human Services Secretary Mike Leavitt, and stated that the secretary considers pandemic threat to be a top priority for HHS.
Citing the HHS’s national pandemic influenza plan, which was released last fall, Mr. Downing gave a brief history of the escalating concerns in the United States regarding the threat of anthrax, SARS, and West Nile Virus. The threat of avian H5N1 influenza has prompted even more concern. The U.S. Centers for Disease Control and Prevention (CDC) began four years ago working with states on preparedness plans, and the federal government’s plan includes $350 million for state and local governments to use for general preparedness measures. An additional $160 million has been allotted to expanding the strategic national stockpile at the CDC, which provides ventilators and other public health emergency equipment. Also, $1.4 billion has been allotted for antiviral medications.
Currently, research is underway to produce vaccines, but there are some obstacles. First of all, the most effective vaccines are produced directly from the strain of influenza that they are intended to combat. Therefore, the best vaccine essentially cannot be created until the influenza manifests itself in the human population. This phenomenon results in a several-month interval between the time when the influenza begins and when a functional vaccine is available. The second major obstacle in creating vaccines is that, in the case of avian H5N1 influenza, for instance, egg-based production, which uses chicken eggs to cultivate vaccines, is the most effective vaccine manufacturing method. However, eggs are difficult to stockpile and may not be readily available during the time of an outbreak. In light of the impediments for preparation, the federal government is investigating the prospect of producing a vaccine from a cellular strand, which could be produced more quickly in the event of a pandemic. Also, HHS is working on “universal” vaccines that would protect against almost any outbreak.
Mr. Downing also discussed the use of anti-viral treatments, which are important, but do not completely protect against any pandemic. Anti-viral treatments also could lead to human immunity to the virus. Therefore, Mr. Downing emphasized that readiness should not be measured on availability of anti-viral treatments (currently, the United States is prepared to vaccinate 25 percent of the population). Anti-viral doses are divided into three categories of availability: (1) 40 million doses will be available to state and local governments for distribution under state and local prioritization plans (based on those who are most susceptible to infection and adverse affects of infection); (2) Six million doses will be used for containment purposes. Where there are major outbreaks, vaccines will be moved quickly to these areas in order to prevent the spread of the virus; and (3) 31 million additional doses, which will be available to states, can be purchased with a 25 percent federal subsidy.
International efforts by the federal government to contain viral outbreaks, such as the one being experienced with the avian H5N1 influenza, are underway. More than $30 million is being spent on developing vaccines in countries like Thailand and Vietnam, where the virus is most prevalent. Awareness and intergovernmental coordination both are very important in this regard, particularly since new cases of the influenza have been identified in Indonesia, Turkey, Iraq and Eastern Europe. The CDC and the World Health Organization are working to identify the origin and the implications of these outbreaks. Human-to-human cases are few, but they do exist.
Mr. Downing closed by emphasizing the importance of coordination. There are responsibilities at every level of government and, in the event of an outbreak, it should be the local officials who make major decisions for their communities. It should be local officials, for instance, who decide whether or not schools stay open, how people are treated, to whom vaccines and anti-virals are administered, and how those vaccines are distributed. Throughout the country’s history, public health has been, and must remain, a local function. According to Mr. Downing, local officials know what their capacities are, what unique local conditions exist, and how to best involve the people in the planning process. While the federal government plays a significant role in preparedness, such as in international coordination and planning, state and local officials are best situated to efficiently prepare communities for disaster. These efforts, however, must be coordinated with the federal government, as well as with the HHS and the CDC, in order to achieve the most promising results. The goal, Mr. Downing emphasized, is not to stop a pandemic from happening, but to lessen the impact.
Together Rx Access Presentation
Roba Whitely, Executive Director of Together Rx Access
Ms. Whitely gave a presentation on her organization’s program that helps people who do not have prescription drug coverage but are not eligible for Medicare. Currently in the United States, there are more than 46 million people who lack health insurance, including over 9 million children. With this program, over 37 million of these individuals can immediately gain access to prescription drugs. The prescription drug program is free to the user and is available in all 50 states and Puerto Rico. To qualify, an individual must be at or below 300 percent of the federal poverty level and not be eligible for Medicare. Currently, there are over 600,000 people who actively participate in this program.
Election of Officers
At the recommendation of the Nominating Committee, chaired by Senator Yvonne Miller
of Virginia, the Committee elected Representative George Flaggs, Jr. of Mississippi and Representative John Arnold of Kentucky to their second terms as chair and vice chair, respectively.
SLC Fall Meeting
Savannah, Georgia, November 10-13, 2006
All committees of the Southern Legislative Conference will meet during the SLC Fall Meeting in Savannah, Georgia, November 10-13, 2006. Committee sessions will take the form of open roundtable discussions, with conference wide plenary sessions for all members. In keeping with the wishes of the SLC appointing authorities, please note that meeting notification does not authorize travel.
Staff Liaison: Jeremy Williams, firstname.lastname@example.org, (404) 633-1866
Southern Legislative Conference 60th Annual Meeting
Human Services & Public Safety Committee
July 28 – August 2, 2006
Representative Pam Adcock
Representative Marilyn Edwards
Senator Randy Laverty
Senator Jim Luker
Senator Percy Malone
Herschel Cleveland, Former Speaker of the House of Representatives
June Dewetering, Canada-U.S. Interparliamentary Group
Representative Clay Cox
Representative Burke Day
Representative Billy Horne
Representative Gene Maddox
Representative Vance Smith, Jr.
Representative John A. Arnold
Representative Tom Burch
Representative Jimmie Lee
Representative Ruth Ann Palumbo
Senate President Pro Tempore Katie Stine
Representative Addia Wachner
David Guy, E-ON U.S.
Barbara Hawkins, E-ON U.S.
Nancy Hublar, Beverly Enterprises, Inc.
Speaker Billy McCoy
Senator Kelvin E. Butler
Representative George Flaggs, Jr.
Representative Pat Montgomery
Senator Joseph C. Thomas
Victor Sutton, Mississippi Department of Health
Christopher Bolling, Cincinnati Children’s Hospital Medical Center
Representative Joe Brown
Senator Emmett Hanger
Senator Yvonne B. Miller
Senator Roman W. Prezioso, Jr.