From USAToday.com:
Kelle Shugrue’s 7-year-old son eats fresh fruit and vegetables at his public school, rides his bike along neighborhood paths and walked to school last week as part of a community effort to get kids moving.
The Shugrue family lives in Somerville, Mass., a Boston suburb hailed by health advocates for its seven-year investment in programs fighting childhood obesity and encouraging healthful living.
The model program is beginning to be replicated around the country, a small start on a huge task: preventing the onset of chronic diseases such as diabetes and heart disease that now account for 75% of the nation’s health care spending.
As the Obama administration and Congress tackle an overhaul of the health care system, chronic disease looms as a major impediment to controlling costs.
According to the Partnership to Fight Chronic Disease, 45% of Americans — 133 million people — suffer from at least one chronic disease such as asthma or hypertension. Because many of the conditions are brought on or exacerbated by obesity, which has doubled nationwide since 1987, experts say they can be prevented or at least better managed.
“Improving the management of chronic disease is a critical component of our plan to drive down the skyrocketing cost of health care,” says Nancy-Ann DeParle, director of the White House Office for Health Reform. “Two-thirds of Medicare spending is for beneficiaries with five or more chronic conditions.”
A down payment is coming.
In February, as part of the $800 billion economic stimulus package, Congress approved $1 billion for disease prevention and wellness programs. A third of that money is slated for immunizations; two-thirds for new programs to prevent chronic diseases.
The Department of Health and Human Services plans to announce early this summer how it will use that new money. “We want to help prevent disease and illness before Americans end up at the doctor’s office or the emergency room,” says Nick Papas, a department spokesman.
Experts at the disease partnership and in Congress say controlling chronic disease requires a two-pronged approach: preventing diseases before they begin and doing a better job helping patients manage their chronic conditions once they develop.
The issue will be up for discussion in the Senate on Tuesday when Finance Committee Chairman Max Baucus, D-Mont., holds the first of three roundtable discussions on health care reform. The subject of the session, which will include insurance company CEOs, doctors and nurses, and policy analysts, is how to make the health care delivery system more effective, including by better managing chronic care.
Building blocks of fitness
Somerville’s experiment began in 2002, when researchers from Tufts University decided to find out whether efforts to promote exercise and healthful eating could help prevent obesity among schoolchildren.
The program, Shape Up Somerville, was first aimed at elementary school kids, 44% of whom were either overweight or at risk of becoming overweight.
With grants from the federal Centers for Disease Control and Prevention and philanthropic groups, the researchers had schools replace French fries, candy, soda and other unhealthful foods with fresh fruit, skim milk and other nutritious choices. The city added bike lanes and pedestrian crosswalks to encourage people to exercise. Restaurants offered more healthful items on menus; residents planted community gardens.
After just one year, the schoolchildren first targeted showed results: They gained 15% less weight than other average kids their age. Twice as many people were riding bikes along the community’s bike paths.
“It’s powerful to see those numbers change like that,” says Nicole Rioles, who runs the ongoing Shape Up program.
Shugrue, 37, says she and her husband always have promoted healthful choices at home and she’s happy that the schools and the community reinforce that message for their second-grader, Henry, rather than undermine it.
Dozens more cities from Oakland to Louisville are following Somerville’s lead to develop similar programs. “We would love to give our two cents to the White House and anyone else planning for really healthy communities,” Rioles says.
Without such efforts, the Partnership to Fight Chronic Disease and other groups say, the government will never get a handle on health care costs.
According to the chronic disease partnership, the federal government spent $586 billion in 2008 on patients with at least one chronic condition, such as diabetes or heart disease.
Kenneth Thorpe, director of the Partnership, says those people who already have developed chronic conditions must be better managed so that their conditions don’t deteriorate and they don’t end up with costly hospital stays.
He favors community health teams made up of nurse practitioners and coordinators to monitor patients’ progress and make sure they take their medication.
Preventative steps
DeParle says the Obama administration is taking steps to improve care, even before the health care debate heats up.
“The administration has already begun reforming Medicare’s payment by rewarding doctors for better quality, efficiency and coordination of care,” she says.
Jeffrey Levi, director of the non-profit Trust for America’s Health, is more focused on solving the problem before it begins.
Levi says he’s sure changes to the health-care system will include funding and programs to prevent chronic disease. That wasn’t the case in 1993-94, during the last overhaul effort, when he said public health advocates were “banging at the door” to get heard.
“I am very confident (legislation) will include a serious commitment to public health and prevention,” Levi says.
