Funding - Let's Get Moving

Data from a 1993 study reported on in the Journal of the American Medical Association showed that 14% of all deaths in the United States were due to sedentary lifestyles and poor dietary habits. High blood pressure, coronary heart disease, Type 2 diabetes, and colon cancer are just some diseases attributed to inactivity, obesity, and an unhealthy diet. In 2002, 50 million people in the U.S. had high blood pressure, 12.6 million had coronary artery disease, 17 million had diabetes (90-95% of which were Type 2), and each year 107,000 people are diagnosed with colon cancer. With inactivity comes obesity. The percentage of obese people nearly doubled in the decade from 1990-2000. It is no wonder then that Healthy People 2010 lists physical activity and obesity (and overweight) as the top two public health concerns.

What is being done to get us moving and losing weight? A few programs funded by the federal government are presented here.

ACEs: Active Community Environments. This is a Centers for Disease Control and Prevention (CDC) initiative to promote active lifestyles within communities. The goals: "encourage development of pedestrian and bicycle friendly environments [and] promote active forms of transportation like walking and bicycling." The Task Force on Community Preventive Services recommends creating or increasing access to trails and promoting their use. Trails "represent a diversity of opportunity from the gifted athlete interested in a convenient place to train to the individuals who are looking for an aesthetically pleasing place to take an after dinner walk to a family walking to spend time together."¹

Increased aerobic activity, like walking and bicycling, helps in weight loss. It significantly reduces blood pressure and can protect against non-insulin dependent diabetes. According to the results of some studies, this type of regular exercise can also improve the symptoms of mild-to-moderate depression and anxiety "of a magnitude comparable to that obtained with some pharmacological agents."¹⁰

In 2002, the U.S. Department of Health and Human Services teamed up with the National Recreation and Park Association¹¹ to promote the idea that parks are places where "community members can come to … exercise … and participate in other ways to make a difference in their success and well-being."¹²

Kids Walk-to-School Program. Physical fitness is not just for adults. This community-based program encourages children to walk to and from school, in groups, accompanied by adults. The program also encourages community partnerships with schools, PTA, local police departments, departments of public works, civic associations, local politicians, and businesses to create safe routes to walk or bicycle. Besides physical fitness for adults and children, additional benefits include safer, friendlier neighborhoods and less traffic congestion, according to the CDC.

This Alabama mother's quote from International Walk-to-School Day 2001 just may sum up the CDC's goals: "We walk every day regardless of the weather. It makes the day brighter to have the quality time going to and from school with [my son] Eric. He loves the sights and sounds and he is one of only 4 walkers at his school. So sad when we are so dependent on cars for our transportation and what we miss out on in nature. We do not have sidewalks but have a petition in progress to get them. We would love to get a grant to put them on our street to the school to get more kids out."¹³

The federal government also funds obesity prevention programs through individual state health departments.¹⁴ The funding targets physical activity as well as nutrition programs. California's Obesity Prevention Initiative is a partnership of state agencies. Their programs target those under 18 years old in an attempt to get the youth to start leading a healthy lifestyle that will (hopefully) carry over into adulthood. The Michigan Department of Community Health is using its funding for obesity prevention programs targeting the African American community.

Sources: Centers for Disease Control and Prevention. "Youth Risk Behavior Surveillance — United States 1993, 1995, 1997, 1999, and 2001." MMWR, various dates. Centers for Disease Control and Prevention. National Center for Health Statistics. "Data table for figure 7.1 Percent of adults aged 18 years and over who engaged in regular leisure-time physical activity: United States 1997-2001." Retrieved August 27, 2002 from http://www.cdc.gov/nchs/major/nhis/released200207/figures07_1-7_3.htm. Centers for Disease Control and Prevention. Nationwide Trend Data. Behavioral Risk Factor Surveillance System. Retrieved August 27, 2002 from http://apps.nccd.cdc.gov/brfss/Trends/trendchart.asp. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health, 2nd. ed., November 2000. Retrieved August 27, 2002 from http://www.health.gov/healthypeople. Centers for Disease Control and Prevention. National Center for Chronic Disease Prevention and Health Promotion. Department of Nutrition and Physical Activity. Data retrieved August 12-27, 2002 from http://www.cdc.gov/nccdphp/dnpa/. U.S. Department of Health and Human Services. "National Recreation and Park Association and U.S. Department of Health and Human Services Working for the Nation's Wellness," February 26, 2002. Retrieved August 12, 2002 from http://web.health.gov/healthypeople/Implementation/nrpa/. "2001 iwalk photos and quotes." Retrieved August 27, 2002 from http://www.iwalktoschool.org/quotes/quotes4.html. Office of the Assistant Secretary for Planning and Evaluation. U.S. Department of Health and Human Services. Physical Activity Fundamental to Preventing Disease, June 20, 2002. Retrieved August 27, 2002 from http://aspe.hhs.gov/health/reports/physicalactivity/.

Quitting the Habit: Smoking

"Cigarette smoking is the single most preventable cause of disease and death in the United States. Smoking results in more deaths each year in the United States than AIDS, alcohol, cocaine, heroin, homicide, suicide, motor vehicle crashes, and fires — combined."¹⁵ The medical costs of smoking are estimated at $50 billion a year. Tobacco use is the third major public health concern cited in Healthy People 2010.

The Centers for Disease Control and Prevention's (CDC) report Best Practices for Comprehensive Tobacco Control Programs outlines nine components for a comprehensive tobacco control program. These include: community programs, chronic disease programs, school programs, enforcement of existing policies, statewide programs, counter-marketing, cessation programs, surveillance and evaluation, and administration and management. This report also contains funding formulas for each of the programs. These formulas are used by the CDC in order to estimate total program costs. The estimates vary with state population size. The CDC makes two estimates, a low estimate and a high estimate. The chart above shows the percentage of the CDC's low estimate that is actually spent in each state on these programs. For example, the CDC's low estimate for total program costs in California (if they would implement all of the CDC's recommended programs) was $165.1 million in fiscal year 2002, but the state actually spent $137.8 million, or 83%.¹⁶ "na" means data were not available for that state.

State spending varies widely (from 6% in Tennessee to 217% in Hawaii). Does this variance correspond to the prevalence of smoking in each state? Not necessarily. The table below shows the states with the highest cigarette smoking prevalence and their ranking in terms of percentage spent relative to CDC recommendations.¹⁷ Only Ohio's funding rank was higher than its adult smoking prevalence ranking. The Healthy People 2010 goals for smoking prevalence are 12% for adults and 16% for 9-12 graders.

Top 5 States with the Highest Cigarette Smoking Prevalence, 2000 and Rankings of Percentage Spent Relative to CDC Recommendations, 2002

State	Cigarette smoking prevalence, adults 18 years old and over (%)	Tobacco control funding rank	State	Cigarette smoking prevalence, 9-12 graders (%)	Tobacco control funding rank
Kentucky	30.5	35	North Dakota	40.6	28
Nevada	29.1	31	West Virginia	38.5	22
Missouri	27.2	12	Kentucky	37.4	35
Indiana	27.0	37	Alaska	36.5	18
Ohio	26.3	2	Louisiana	36.4	45
National	23.3		National	28.0

Why isn't funding proportionate? Is it a lack of money?¹⁸ No. From 1999-2004, most states will receive a combined average of $41 billion from settlements with the tobacco companies. The median CDC funding estimate for all the recommended programs is $14.5 billion, or 35.4%. For small states (less than 3 million people), $7-20 per person would cover the costs of implementing all of the CDC recommended programs. In large states (more than 7 million people), this cost would be lower: $5-16 per person. Perhaps funding for these programs is simply a matter of legislative priorities.

Are these programs effective? Yes. California's per capita consumption of tobacco declined by 16% from 1992 to 1996. Massachusetts's per capita consumption declined by 20% during the same time period. What worked? Raising tobacco taxes and mass-media antismoking campaigns. Tobacco use among Florida middle-schoolers and high-schoolers declined 2.5% and 2.2%, respectively. What worked with these teenagers (and pre-teens)? Mass-media antismoking campaigns, community-based activities, education and training, and enforcement of existing laws.

The next panel discusses the prevalence of substance abuse and government funding priorities for substance abuse programs.

Sources: Tobacco Information and Prevention Source (TIPS). National Center for Chronic Disease Prevention and Health Promotion. Centers for Disease Control and Prevention. U.S. Department of Health and Human Services. "Tobacco Control Funding Summary, Fiscal Year 2002," "Current Cigarette Smoking Among Adults Aged 18 and Older, 2000," "Current Cigarette Smoking and Tobacco Use Among Youth, Grades 9-12," "Best Practices for Comprehensive Tobacco Control Programs, August 1999 Fact Sheet," and Tobacco Control State Highlights 2002. Retrieved August 28-29, 2002 from http://www.cdc.gov/tobacco/. U.S. Department of Health and Human Services. Healthy People 2010: Understanding and Improving Health, 2nd ed., November 2000.