Health Policy

The Politics of Obesity: A Current Assessment and Look Ahead

The Politics of Obesity: A Current Assessment and Look Ahead
Milbank Quarterly 2009 Mar;87(1):295-316. doi: 10.1111/j.1468-0009.2009.00556.x.

Kersh, R.
03/03/2009

Context: The continuing rise in obesity rates across the United States has proved impervious to clinical treatment or public health exhortation, necessitating policy responses. Nearly a decade's worth of political debates may be hardening into an obesity issue regime, comprising established sets of cognitive frames, stakeholders, and policy options.

Methods: This article is a survey of reports on recently published studies.

Findings: Much of the political discussion regarding obesity is centered on two "frames," personal-responsibility and environmental, yielding very different sets of policy responses. While policy efforts at the federal level have resulted in little action to date, state and/or local solutions such as calorie menu labeling and the expansion of regulations to reduce unhealthy foods at school may have more impact.

Conclusions: Obesity politics is evolving toward a relatively stable state of equilibrium, which could make comprehensive reforms to limit rising obesity rates less feasible. Therefore, to achieve meaningful change, rapid-response research identifying a set of promising reforms, combined with concerted lobbying action, will be necessary.

Obesity burst onto the U.S. national policy agenda in 2000/2001, initially fuelled by a widely disseminated set of maps by the Centers for Disease Control and Prevention (CDC) depicting sharply rising obesity rates nationwide, followed by the surgeon general's warning that obesity had become a "new national epidemic" (Mokdad et al. 2003; Oliver 2006; Satcher 2001). A snapshot of responses since then would include alarmed reactions from medical, media, and policy actors alike. The health establishment has rushed to devise medical treatments, from surgical to pharmaceutical, for obesity and its manifold health effects. Surging media attention to obesity and overweight features reports ranging from dire health alarms ("the current generation may be the first to live shorter lives than their parents-and obesity is to blame"; Belluck 2005, p. A1; see also Daniels 2006; Olshansky et al. 2005) to economic warnings (over $120 billion lost annually to obesity-related illnesses; see e.g., Bhattacharya and Sood 2006) to "lifestyle" stories of coffins, airplane seats, and hospital beds all made larger to suit the "supersizing of America" (St. John 2003, p. A13). Public officials at all levels have decried the "epidemic," although statutory reforms have been concentrated in a few energetic local and state polities; the federal government has been noticeably slow to act. All the while obesity rates continue to rise, with thirty-seven states reporting significant year-to-year increases from 2007 to 2008, with none reporting a decrease (TFAH 2008).

This article explores obesity politics as it has evolved in recent years. First I discuss the sustained struggles over framing the topic now that public agendas have begun to solidify into an "issue regime" around obesity. Then I examine popular local and state policy options and review approaches that could have an impact on soaring obesity rates, along with an assessment of the likelihood of their widespread adoption. While promising policy approaches exist, the opportunity to take action may be closing fast. On most public health issues, policymaking features a bustle of activity followed by a period of quiescence as a regime coalesces-even when the underlying problems continue to mount. Antiobesity advocates who face declining interest from lawmakers will therefore need to devise creative ways to sustain a focus on this topic.

 

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-time Identification and Remedial Risks

Medicaid Patients at High Risk for Frequent Hospital Admission: Real-time Identification and Remedial Risks
Journal of Urban Health. 86, no 2 230-241

Goldfrank, L., Billings, J., Raven, M., et al.
03/01/2009

Patients with frequent hospitalizations generate a disproportionate share of hospital visits and costs. Accurate determination of patients who might benefit from interventions is challenging: most patients with frequent admissions in 1 year would not continue to have them in the next. Our objective was to employ a validated regression algorithm to case-find Medicaid patients at high-risk for hospitalization in the next 12 months and identify intervention-amenable characteristics to reduce hospitalization risk. We obtained encounter data for 36,457 Medicaid patients with any visit to an urban public hospital from 2001 to 2006 and generated an algorithm-based score for hospitalization risk in the subsequent 12 months for each patient (0 = lowest, 100 = highest). To determine medical and social contributors to the current admission, we conducted in-depth interviews with high-risk hospitalized patients (scores >50) and analyzed associated Medicaid claims data. An algorithm-based risk score >50 was attained in 2,618 (7.2%) patients. The algorithm’s positive predictive value was equal to 0.67. During the study period, 139 high-risk patients were admitted: 60 met inclusion criteria and 50 were interviewed. Fifty-six percent cited the Emergency Department as their usual source of care or had none. Sixty-eight percent had >1 chronic medical conditions, and 42% were admitted for conditions related to substance use. Sixty percent were homeless or precariously housed. Mean Medicaid expenditures for the interviewed patients were $39,188 and $84,040 per patient for the years immediately prior to and following study participation, respectively. Findings including high rates of substance use, homelessness, social isolation, and lack of a medical home will inform the design of interventions to improve community-based care and reduce hospitalizations and associated costs.

La Révolution Tranquille du Managed Care aux Etats Unis. (The Silent Revolution of Managed Care in the United States)

La Révolution Tranquille du Managed Care aux Etats Unis. (The Silent Revolution of Managed Care in the United States)
Ch. 21 in Tabuteau, D. Bras, P.L. and de Pouvourville, G., eds. Traité d’Economie et de Gestion de la Santé. Paris. Presses de Sciences Politiques

Rodwing, V.G.
01/01/2009

Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance

Recent Changes in Dutch Health Insurance: Individual Mandate or Social Insurance
Expanding Access to Health Care. T.F. Buss and P. Van de Water (eds.) National Academy of Public Administration. New York: M.E. Sharpe.

Okma, K.
01/01/2009

The U.S. health care system faces well-known problems: 47 million people without health insurance, rapidly rising costs that consume 16 percent of the country'e economic output, and widely uneven quality of care. Even many people with coverage are experiencing serious problems paying for the rapidly rising costs of health care and insurance.

This book--a joint product of the National Academy of Public Administration and the National Academy of Social Insurance--undertakes a sweeping analysis of the management and administrative issues that arise in expanding health care coverage. The book identifies the core administrative functions that need to be performed in assuring access to health coverage, describes how these functions are performed at present and under proposed alternatives, draws lessons from experience in the U.S. and abroad, and assesses suggested administrative approaches designed to facilitate the improvement and expansion of health care coverage.

Adequate health care is one of today's most crucial domestic policy concerns. Expanding Access to Health Care is designed to bring together in one place some of the best thinking on the subject, not as an exercise in advocacy, but rather to lay out the issues in a balanced way so that policymakers, researchers, and citizens can better understand the complex details of health care reform.

Seeing Power in Action: The Roles of Deliberation, Implementation, and Action in Inferences of Power

Seeing Power in Action: The Roles of Deliberation, Implementation, and Action in Inferences of Power
Journal of Experimental Social Psychology, 45, 1-14.

Magee, J.C.
01/01/2009

Six experiments investigate the hypothesis that social targets who display a greater action orientation are perceived as having more power (i.e., more control, less dependence, and more influence) than less action-oriented targets. I find evidence that this inference pattern is based on the pervasive belief that individuals with more power experience less constraint and have a greater capacity to act according to their own volition. Observers infer that targets have more power and influence when they exhibit more implementation than deliberation in the process of making decisions in their personal lives (Study 1a), in a public policy context (Study 1b), and in small groups (Study 2). In an organizational context, observers infer that a target who votes for a policy to change from the status quo has more power than a target who votes not to change from the status quo (Study 3). People also infer greater intra-organizational power and higher hierarchical rank in targets who take physical action toward a personal goal than in those who do not (Studies 4–5).

Environmental Justice

Environmental Justice
Encyclopedia of Quantitative Risk Assessment. Edited by B. Everitt and E. Melnick. John Wiley Publishers. New York, NY,

Restrepo, C. & Zimmerman, R.
05/01/2008

Quantitative risk assessment is a growing, important component of the larger field of risk assessment. The need to understand the risks of an activity, be it economic, environmental, public health/biomedical, or even based on terrorist or other hazardous impacts, has led to a number of methods of analysis for many different application scenarios. Indeed, all major areas of the larger endeavor - hazard identification, dose-response assessment, exposure assessment, and risk characterization - rely on and benefit from quantitative operations. Within these contexts, enhanced understanding of both the variability and the uncertainty inherent in the risk identification process is critically dependent upon proper implementation of appropriate statistical methodologies.

Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services through Medicaid and Collaborators

Jump-Starting Collaboration: The ABCD Initiative and the Provision of Child Development Services through Medicaid and Collaborators
Public Administration Review, May 2008, Vol. 68 Issue 3, p480-490, 11p.

Berry, C., Krutz, G.S., Langner, B. & Budetti, P.
05/01/2008

Many policy problems require governmental leaders to forge vast networks beyond their own hierarchical institutions. This essay explores the challenges of implementation in a networked institutional setting and incentives to induce coordination between agencies and promote quality implementation. It describes the national evaluation of the Assuring Better Child Health and Development program, a state-based program intended to increase and enhance the delivery of child development services for low-income children through the health care sector, using Medicaid as its primary vehicle. Using qualitative evaluation methods, the authors found that all states implemented programs that addressed their stated goals and made changes in Medicaid policies, regulations, or reimbursement mechanisms. The program catalyzed interagency cooperation and coordination. The authors conclude that even a modest level of external support and technical assistance can stimulate significant programmatic change and interorganizational linkages within public agencies to enhance provision of child development services.

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