|JOINING THE CONVERSATION > 2005
This discussion guide is intended to serve as a jumping-off point for our upcoming conversation. Please remember that the discussion is not a test of facts, but rather an informal dialogue about your perspectives on the issues.
NATIONAL HEALTHCARE ISSUES AND HOW THEY ARE RELATED TO LOCAL WELLNESS ISSUES
Nationally the healthcare system needs reform. The cost of healthcare is rising, people are uninsured or underinsured, and Medicare and Medicaid are in crisis. According to the healthcare providers, some of the catalysts behind rising healthcare costs are the following: an aging population which has benefited from medical technology that allows people to live longer; lifestyle choices in which most Americans live a sedentary life, leading to obesity, cardiovascular disease, and other related illnesses; the price of prescription drugs; and shifting the cost of healthcare from the employer to the employee.
Indiana is not immune to skyrocketing healthcare costs. In addition to its aging citizenry, the percentage of obese Hoosiers has risen 62 percent since 1991. Moreover, obesity in children has increased nearly 300 percent in the past 25 years and Indiana is now one of the leading states in childhood obesity with an astounding rate of 21.8 percent, 5 to 6 percent over the national average. This trend in lifestyle choices leads to chronic health problems for both adults and children.
More than 600,000 Hoosiers do not have health insurance. Uninsured patients often delay care, ultimately receiving costly emergency room treatment. Costs that are covered by Medicaid (and even typical health insurers) are primarily focused on treatment of illnesses rather than prevention.
In order to bring the issue from a national level to a local one, our dialogue will encourage discussion of individual wellness and building a healthy community as it relates to the larger healthcare issues.
THE ELEMENTS OF A HEALTHY COMMUNITY
Many say that a healthy community is one that embraces the belief that health is more than merely an absence of disease; it includes elements that enable people to maintain a high quality of life and productivity. A healthy community offers access to health care services that focus on both treatment and prevention for all members of the community.
The financial costs of an “unhealthy” community (or country) can be staggering. For example:
The fabric of a community and the community pool of human resources available to it is often called its “social capital.” This term refers to time and energy that is available for things like community improvement, social networking, civic engagement, personal recreation, and other activities that create social bonds between individuals and groups. A well-designed community with reasonable commuting times allow for social capital growth, including more time for families to spend together, more recreation/rejuvenation time for adults after work, and additional community involvement. Circumstances that prevent or limit the availability of social capital for a community and its members can have a negative effect on the health and well being of the members of that community. These negative effects on health and well-being can in turn have negative effects on the community as a whole.
Minorities and their knowledge/utilization of wellness and healthcare resources
The health disparities between African Americans and other racial groups are striking and are apparent in life expectancy, infant mortality, and other measures of health status. For example, in 1999 the average American could expect to live 76.9 years, the average African American could only expect to live 71.4 years. Factors contributing to poor health outcomes among African Americans include discrimination, cultural barriers, and lack of access to health care.
Many believe other minority groups experience poor health due to a similar lack of access to health insurance, as well as language and cultural barriers, lack of access to preventative care, and stigma associated with certain conditions. According to the Centers for Disease Control and Prevention, among Hispanics,Puerto Ricans suffer disproportionately from asthma, HIV/AIDS, and infant mortality, while Mexican Americans suffer disproportionately from diabetes. Asian Americans suffer disproportionately from certain types of cancer, tuberculosis, and Hepatitis B.
Studies have indicated poor doctor-patient communication may be partly to blame for health disparities, since more active participation of patients in conversations with their doctors has been linked to better treatment compliance and health outcomes. Overcoming cultural, social and economic barriers to equal healthcare access will take time and effort through education on both sides of the examination table.
Responsibility: What is the role of employers, schools and government in a improving the health of people in a community?
Role of Employers: Some say employers should take the lead in promoting a healthy community, noting that its in the employers’ best interest to do so. Adults with multiple risk factors for disease (e.g., high blood pressure, smoking, and sedentary habits) are more likely to be high-cost employees in terms of healthcare use, absenteeism, disability, and overall productivity. On the other hand, healthy employees are likely to incur lower medical costs and be more productive. But many businesses worry about the cost of promoting wellness. Many employers worry about the cost of sponsoring worksite health promotion activities or participating in community-wide health promotion campaigns. But others argue that these efforts benefit both their employees (past, present, and future) and their corporate image. They further note that savings from small decreases in absenteeism alone can more than offset the cost of a health promotion program. For example, a 1998 analysis of five absenteeism studies determined an average program savings of almost $5.00 for every dollar spent.
Role of Schools: In 2003, the National Association for Sport and Physical Education recommended the amount of time
devoted to physical activity during school hours be increased. The organization recommended at least 60 minutes, and up to several hours of physical activity per day. This is not surprising given the fact that inactivity has contributed to the recent obesity epidemic and sedentary living is a known threat to health.
In order for schools to play a key role in addressing childhood obesity, the Child Nutrition and WIC Reauthorization Act of 2004 requires districts with federally-funded school meals programs to develop and implement wellness policies addressing nutrition and physical activity by the fall of 2006. Model “wellness” policies include nutrition standards for foods and beverages sold individually; fruit and vegetable promotion; and nutrition education and promotion. Districts may find it more practical to phase in the adoption of wellness policies than to implement a comprehensive set of nutrition and physical activity policies all at once.
Some people argue that schools can't be expected to reshape children who are molded by parents and society before they even get there. The schools’ efforts are futile if not supported in practice by students’ families.
Confusion over authoritative boundaries has made it difficult for many states to mandate the regulating the amount of physical activity in schools. Mandating the increase in physical activity will require funding, so additional sources of funding must be identified – almost impossible for already cash-strapped states like Indiana.
But others point out that schools can set a better, more healthful, example. They point out the fact that school districts—many of them cash-starved-- have signed lucrative contracts with soda vending-machine companies. A 2002 study indicated that 76.3% of schools offered soft drinks in vending machines in 2000.
Some argue that the funds generated from vending machine sales help pay for sports programs, which do more to prevent obesity than banning soft drinks. And with education funding reductions, the monies gained from vending machine sales enable many schools to provide extracurricular activities, school improvements, and travel opportunities that they otherwise would not be able to offer.
Role of Government: Some say government should take the lead in building a healthy nation. They argue that in addition to specific healthcare legislation, government can regulate other factors that affect Americans’ health. Environmental regulations, including the air we breathe, the water we drink and use, the land and built structures that surround us, influence the quality of our lives.
Others argue that regulating environmental concerns in order to promote healthier communities comes at a cost – a cost either paid by taxpayers in increased taxes or by businesses through fines, taxes or renovations to meet new guidelines. Maintaining the balance of a healthy environment and a healthy economy is a major challenge for all levels of government today.
While the Federal Government wants to promote healthier living among Americans it continues to cut funding for programs aiming to reach that goal. Examples from the President’s fiscal year 2006 Budget include a $92.5 million cut in the nation's primary federal funding source for local parks, fields and trails development and a $12.5million cut to the Preventative Health and Human Services Block Grant. The block grants are theprimary source of funding to states to pay for anyof the 265 national health objectives in Healthy People 2010.
The Individual’s Responsibility: Many people note that the United States was founded on the basis of personal freedom, and that notion still stands today, as it is an individual’s choice regarding their lifestyle and their health. They say that while government can make recommendations regarding nutrition and exercise, and schools and businesses can provide healthy lifestyle opportunities, an individual must choose whether or not to follow those recommendations or take advantage of the opportunities available.
Conversely, they say, an individual must also accept the results of the lifestyle they have chosen. Someone who has maintained a healthy diet and exercise program can justly reap the health benefits that come from making those choices. Someone who chooses a poor diet and no exercise should accept that there are negative health consequences to those choices. While temptations abound in fast food, vending machines and large restaurant portions, only the individual can decide what health choices are right for him.
Critics of this line of thinking believe that society as a whole pays the price of individuals’ poor choices. People in poor health require more (and typical expensive) health resources, driving up the financial cost for everyone. These critics of leaving health choices up to the individual believe that it’s in our best interest financially, and maybe is even a moral obligation, to encourage wellness…for the benefit of all of society.
Approaches to Promoting Wellness
Some approaches to promoting wellness in our community include efforts by businesses, schools, government and individuals. Some ideas to consider are:
Business: Reduce work-related injuries resulting in medical treatment, lost time from work, or restricted work activity; Provide programs to prevent or reduce employee stress; Provide employer-sponsored physical activity and fitness programs; Offer incentives to employees to participate in health education/wellness programs
Schools: Increase amount of time dedicated to physical activity daily/weekly; Set and enforce nutrition standards for foods and beverages sold individually; Increase fruit and vegetable promotion; Increase nutrition education and promotion; Expose children to a wide variety of physical activities; Teach physical skills to help maintain lifetime health and fitness
Government: Set and enforce environmental regulations that benefit the health of Americans; Require schools to develop and implement wellness policies that address nutrition and physical activity; Change tax laws to enable low-income individuals and small businesses to purchase health insurance; Provide for the equitable tax treatment of employer-subsidized fitness programs (on- or off-site)
Individuals: Take advantage of wellness programs offered locally; Exercise on a regular basis; Set positive food-choice examples for children, both in and out of the home; Encourage family members and friends to eat well and exercise; Have an annual physical exam; Support legislators and educators who want to promote wellness within the community; Participate in community programs that emphasize wellness; Request an employer-based wellness program