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Institute of Medicine (Meeting 6)September 30, 2010

Dr. Harold GoldsteinExecutive Director

California Center for Public Health Advocacy

Public Health Strategies to Improve Health

Lessons for Obesity Prevention in California

Promote the establishment of public health policy at both

the state and local levels

Childhood Obesity School Nutrition Standards (1999-2005) Physical Education Funding (2006) Food Access (2007 - ) Menu Labeling in Chain Restaurants (2007-8) Sugar Loaded Beverages (2009 - )

OUTLINE

1. Challenges / Obstacles

2. Strategies

3. Lessons Learned

4. Your Questions

Major Public Health Movements Sanitation / Infectious DiseaseWorker Safety Clear Air / Clean Water Auto Safety Drunk Driving Lead Poisoning Violence Prevention Tobacco Control Obesity / Chronic Disease

OBSTACLES

1. Opposition (Industry) Messages

2. Opposition (Industry) Money

3. Is it Governments Role?

Obstacles

Industry Message #1

Personal Responsibility

The problem is simply a matter of

RE: legislation about child endangerment, obesity prevention, and the environment:The California State Legislature is considering a string of bills this year that would impact your life. You might as well pass a blanket law saying the Legislature of the State of California hereby outlaws stupidity."

Assemblyman Chuck DeVoreFebruary 12, 2007

RE: legislation about child endangerment, obesity prevention, and the environment:The California State Legislature is considering a string of bills this year that would impact your life. You might as well pass a blanket law saying the Legislature of the State of California hereby outlaws stupidity."

Assemblyman Chuck DeVoreFebruary 12, 2007

RE: legislation about child endangerment, obesity prevention, and the environment:The California State Legislature is considering a string of bills this year that would impact your life. You might as well pass a blanket law saying the Legislature of the State of California hereby outlaws stupidity."

Assemblyman Chuck DeVoreFebruary 12, 2007

1999

Obesity Trends* Among U.S. Adults

BRFSS, 1990, 1999, 2009(*BMI 30, or about 30 lbs. overweight for 54 person)

2009

1990

No Data

The National Restaurant Association believes that any successful effort to

address the obesity issue in the United States today must first address education.

Sheila Cohn Weis, R.D.New York City Dept of Health hearing

November 30, 2006

Every individual chooses if and how he or she will use our productsEducation and awareness are the best ways to build personal responsibility.

Anheuser-BuschFull page ads in New York Times

November, 1991.

DRUNK DRIVING

Safety and education are the main components for addressing problems of this nature. You cannot legislate against

accidents happening.

National Rifle Association, 1987Response to study of 88 children with gunshot injuries

CHILD SAFETY LOCKS ON GUNS

Nanny Government

Industry Message #1

"To let these lightweight babysitters take over would be absurd, self-destructive,

and categorically un-American.

2A. Name Calling

ConsumerFreedom.Org

2B. Government is Big Brother

We are firm believers in the right to have a good time. Defending

enjoyment is what were all about.

ConsumerFreedom.Org

2C. Big Business is Your Friend

[Menu Labeling] is just a feel good Band-Aid that ignores the true issues behind obesity ...

Jot Condie, CEO (9/12/07).

2D. Big Business Knows Best

Its the couch, not the can.

SODAS IN SCHOOLS

Tobacco executives testifying before congress that nicotine is not addictive (1994)

Ignores the Human Cost

It is unreasonable to expect that people will change their behavior easily when so

many forces in the social, cultural, and physical environment conspire against

such change.

There is one and only one social responsibility of business . . . to

increase its profits so long as it stays within the rules of the game.

Milton FriedmanNobel Prize in Economics, 1976

2. Industry Money

There is one and only one social responsibility of business . . . to

increase its profits so long as it stays within the rules of the game.

Milton FriedmanNobel Prize in Economics, 1976

2. Industry Money

Source: Los Angeles Times, 2/7/10

Soda Industry Lobbying Expenses

Response to NY State Soda Tax Proposal

Distrust of Government

1. Interested ONLY in the public good beholden to no one / nothing else.

2. Uniquely positioned: data, training, credibility, partnerships abilities

3. Opportunity to advocate for and develop upstream / sustainable solutions

Overcoming the ObstaclesUNIQUE ROLE OF PUBLIC HEALTH

ADVOCACY MODEL:7 Components

State & LocalPolicy Reforms

Research

State & LocalPolicy Reforms

Paint picture of problem from public health perspective (make it REAL)

Include specific policy solutions

Drive policy agenda

ADVOCACY RESEARCH

Three Examples

Local Data

Research

State & LocalPolicy Reforms

1. School Nutrition Standards

Funded by The California Vitamin Cases Consumer Settlement Fund

28.1%26.5%

20

30

2001 2004

Overweight Children in California(2001 2004)

28.1%26.5%

20

30

2001 2004

Overweight Children in California(2001 2004)

Benefits of Local Data Brings the problem home

Makes state and community leaders accountable to their constituents

Provides media with local angle

Supports local organizing

August 25, 2005

Final votes on bills: August 31, 2005

2. Healthy Food Access

EVERYONE EVERY SINGLE ONE OF US eats how much we eat largely because of

whats around us. . . . We are almost never aware that it is happening to us.

Brian Wansink, PhDCornell University Food Lab

EVERYONE EVERY SINGLE ONE OF US eats how much we eat largely because of

whats around us. . . . We are almost never aware that it is happening

Brian Wansink, PhDCornell University Food Lab

Fast Food Restaurants

Fast Food Restaurants+ Convenience Stores

Fast Food Restaurants+ Convenience Stores

Fast Food Restaurants+ Convenience Stores

Grocery Stores

Fast Food Restaurants+ Convenience Stores

Grocery Stores + Produce Vendors

Fast Food Restaurants+ Convenience Stores

Grocery Stores + Produce Vendors

California: 4.18

Retail Food Environment Index

COUNTY RFEISan Bernardino 5.72Sacramento 5.66Fresno 5.34Orange 5.13Solano 5.08

. . . . . .San Mateo 2.79Sonoma 2.52Monterey 2.14San Luis Obispo 2.01Marin 1.85Santa Cruz 1.84

3. Menu Labeling

Menu LabelingPublic Opinion Poll

SUPPORT MANDATORY MENU LABELING84% of all registered voters78% Republicans, 88% Democrats

Test yourfast-food

IQ

Which Dennys option has the least calories?

Ham & Cheddar Omelet 595 cal 36%

Country Fried Steak & Eggs 464 cal 11%

French Toast w/ Syrup & Marg 1,003 cal 15%

Pancakes w/ Syrup & Marg 650 cal 29%

Field Poll, 523 registered voters, April 2007

Which Dennys option has the least calories?

Ham & Cheddar Omelet 595 cal 36%

Country Fried Steak & Eggs 464 cal 11%

French Toast w/ Syrup & Marg 1,003 cal 15%

Pancakes w/ Syrup & Marg 650 cal 29%

Field Poll, 523 registered voters, April 2007

Which Dennys option has the least calories?

Ham & Cheddar Omelet 595 cal 36%

Country Fried Steak & Eggs 464 cal 11%

French Toast w/ Syrup & Marg 1,003 cal 15%

Pancakes w/ Syrup & Marg 650 cal 29%

Field Poll, 523 registered voters, April 2007

Which Dennys option has the least calories?

Ham & Cheddar Omelet 595 cal 36%

Country Fried Steak & Eggs 464 cal 11%

French Toast w/ Syrup & Marg 1,003 cal 15%

Pancakes w/ Syrup & Marg 650 cal 29%

Field Poll, 523 registered voters, April 2007

What % of people failed all 4 questions?

How many of the 523 survey respondents got all 4 answers right?

68%

0

Calorie sticker shock

Law of the Land

State & Local Data

Research

State & LocalPolicy Reforms

ScientificAdvisoryPanels

State & Local Data

Research

State & LocalPolicy Reforms

National Consensus Panel on School Nutrition

Recommendations forCompetitive Food Standards

in California Schools

March 2002

The California Center for Public Health AdvocacyP .O. Box 2309

Davis, CA 95617Phone 530-297-6000 Fax 530-297-6200

info@publichealthadvocacy.org

mailto:info@publichealthadvocacy.org

National Panel of Experts

1. Advocacy research is ONE PART of a comprehensive campaign strategy

2. Power of local data / local angle

3. Benefit of expert input into policy recs

ResearchLessons Learned

ScientificAdvisoryPanels

State & Local Data

Research

State & LocalPolicy Reforms

MediaAdvocacy

ScientificAdvisoryPanels

State & Local Data

Research