A look to the future of obesity and wellness care in the news

Transitions can be unsettling when we don’t know what to expect, but the picture for public health is becoming clearer with the latest news.

Health and Human Services Secretary

Health and Human Services Secretary-Designate Tom Daschle spoke to the Senate Committee on Health, Education, Labor and Pensions last week, outlining the public health priorities for the upcoming Administration. Tim Foley at Healthcare Change Organization summarized his key goals for reform: change the focus to preventive wellness; establish a national health electronic database and interoperable health IT system; and fund a National Health Services Corp to mobilize all healthcare professionals (“all hands on deck”). Daschle ended his talk with a battle cry calling to make wellness part of the culture in everything from education to health, saying: “We need to make wellness cool, and prevention hot.”

Reading the text of Daschle’s testimony didn’t provide appreciably more detail and it was probably challenging for most listeners to know what the euphemistic language was actually saying. In discussing reforming the healthcare system, he said our current health care system is not oriented toward prevention, and therefore, fails to incentivize screenings and lifestyle changes.

He said that the Centers for Medicare and Medicaid Services could be the catalyst for instituting ‘quality measures’ to save costs (those are pay-for-performance measures), mandating “medical homes” (that's managed care) and other approaches to reduce costs surrounding people with chronic conditions.

“CMS must focus on prevention and primary care, steering its resources toward wellness rather than sickness,” he said. “To do so, it will need to work side-by-side with the Public Health Service and the human services agencies at HHS.” The CDC is critical to moving the healthcare system towards preventive services and away from sick care, he said, including programs such as reducing smoking and obesity. “The nation also faces epidemics of obesity and chronic diseases as well as new threats of pandemic flu and bioterrorism,” he said, calling for more federal funding on public awareness campaigns to “reduce unhealthful behaviors.”

He talked about increased funding for genomic research to extend healthy lifespans and reduce illness and disease and for HHS run preschool and early Head Start programs, saying: “Ensuring our children’s proper emotional, social and cognitive development is one of the greatest responsibilities of the Department.”

The overall message was one of preventive health and wellness — “wellness care, not disease care” — based on the belief that most chronic diseases of aging can be prevented by screenings and management of health indices, eating a certain type of diet and having an active lifestyle. Chronic diseases are believed to be due to “unhealthy behaviors.” These all sound good until one pins down each of the premises and finds that the science doesn’t support any of the beliefs — health risk factors are not predictive of those who will die prematurely, nor will eating a “healthy diet” prevent the major causes of death, such as heart disease, cancer or diabetes. Nor has preventive disease management programs been shown to reduce healthcare costs but, in most instances, to raise them.

Surgeon General

The next health agency position to be named, of course, was Dr. Sanjay Gupta for Surgeon General, which received widespread public attention and coverage last week. The Center for Science in the Public Interest (CSPI) applauded the nomination of Dr. Gupta, saying in a press release:

[W]e hope Dr. Gupta will use his bully pulpit both to encourage Americans to make important lifestyle changes and to advocate policies aimed at preventing health problems… One matter that certainly should be at the top of his agenda is stemming the obesity epidemic, which may lead today's children to have shorter lives than their parents. Gupta would need to meld individual, corporate, and governmental actions—education, regulations, and laws at the local, state, and national levels—into one coordinated and effective campaign.

In a January 9, 2009 letter to President-elect Obama, CSPI, along with obesity stakeholders, urged him “to take bold and urgent action to reverse the obesity epidemic.” This urgency, the letter asserted, is because:

The epidemic of overweight and obesity in children and adults is undermining the nation’s health analogous to the way global warming is undermining the planet’s health. The increased rates of obesity, almost an inevitability in a society whose wealth disfavors physical activity and whose poverty prevents healthy diets, will negate our nation’s investments in health-care and could actually lead to life spans for today’s youths that will be shorter than their parents’. Addressing obesity could be one of the most powerful means of improving the health of the nation…

What is lacking is not well-conceived ideas for policies and programs, but a national commitment to wage a comprehensive campaign to prevent and reverse overweight and obesity, a war that should begin in the womb and infancy, extend to schools, then include workplaces, doctors’ offices, and the general community.

The biggest failure to date, their letter said, is insufficient federal government spending on obesity. The U.S. “has never invested in a serious campaign,” it said. In contrast, it exampled the UK’s latest national obesity campaign, Change4Life, as one “Americans can learn much from,” for its inclusion of national and local agencies, new laws, “full use of the bully pulpit and strategic financial investments.”

As regular readers will remember, CSPI published the outline for a war on obesity and public health policy approaches nearly a decade ago. It was founded in promoting obesity as a deadly epidemic and one caused by bad foods and a sedentary modern lifestyles. Their sweeping recommendations required public health measures to change peoples’ behaviors and force them to make “healthy food choices” and follow active lifestyles. They defined healthy eating as plant-based, low-calorie, low-salt, low-fat, and low-sugar; and advised federal and state officials to institute bans and levy taxes on sodas and foods high in calories, sugar or fat. They’ve been successful in increasing the CDC’s budget 2,000% since 1999 for their health eating and activity initiatives, alone.

One of their largest sponsors is the Robert Wood Johnson Foundation (of Johnson & Johnson, the world’s largest pharmaceutical company and manufacturer of weight loss and healthy eating products, nutritional supplements, employer wellness programs, diet pills, bariatric surgical devices, and smoking cessation products), which has been the biggest sponsor of the war on obesity, patterned on its war on smoking, preventive health and health IT initiatives.

Few of us are probably familiar with most of the names on CSPI’s Board of Directors since 2004, but we are about to get to know one: William V. Corr.

Deputy HHS Secretary

Tuesday, President-elect Obama announced he had chosen Mr. Corr to the second most powerful position at the Department of Health and Human Services, deputy secretary, under Tom Daschle.

Mr. Corr, with a law degree from Vanderbilt University School of Law, is a well-known anti-tobacco activist and executive director of the private center, National Campaign for Tobacco-Free Kids. This center was established by RWJF, which reports it supported the center with grants totaling $70 million between March 1996 and March 2004. The center is also leading a World Health Organization initiative, organizing NGOs around the world to create international regulations, which RWJF supported with three grants to Mr. Corr totaling nearly $4 million between March 2001 and October 2004. According to the most recent RWJF 2007 Annual Report, it just awarded Mr. Corr $1,543,464 for lobbying efforts towards FDA regulation of tobacco products and legal services in tobacco lawsuits. Mr. Corr has extensive pharmaceutical connections and role as a key lobbyist for RWJF.

According to his biography on the center’s website, prior to joining the center, he was Chief of Staff for the Department of Health and Human Services, working under Secretary Donna E. Shalala, during the Clinton administration. Then, from 1998 to 2000, he served as Chief Counsel and Policy Director for Tom Daschle when he was minority leader. As Robert Pear for the New York Times reported today, Mr. Corr is listed as an anti-tobacco lobbyist, lobbying “not only Congress, but also federal agencies like the Food and Drug Administration, the Centers for Disease Control and Prevention and the Federal Trade Commission.” The center’s lobbying expenditures totaled $2.4 million from 2003 to 2008, according to the Center for Responsive Politics.

“As a presidential candidate, Mr. Obama often criticized the influence of lobbyists in Washington,” wrote Mr. Pear. He would appear to be referring to Mr. Obama’s campaign ethics pledge to “shine the light on Washington lobbying,” or his speeches, such as one in Des Moines, IA on November 10, 2007:

I am in this race to tell the corporate lobbyists that their days of setting the agenda in Washington are over. I have done more than any other candidate in this race to take on lobbyists - and won. They have not funded my campaign, they will not get a job in my White House, and they will not drown out the voices of the American people when I am President.

While the focus is on Mr. Corr’s smoking disclosures, no one has mentioned the larger ones that will affect everyone, especially those with diets, lifestyles or physical characteristics the HHS might see as unhealthy.

How many consumers realize the full implications of these appointments? Unless they remember history, probably far too few.

© 2009 Sandy Szwarc