NYC public schoolchildren are less obese than 5 years ago, but is everyone benefitting equally?

After years of relentless increase, New York City Mayor Michael Bloomberg announced last week that obesity rates for public schoolchildren in NYC have decreased over the past five years. The 5.5 percent decrease in obesity rates was the biggest decline in any large city in the country, where most rates are stagnant or rising. As NYC Health Commissioner Dr. Thomas Farley put it, “What’s impressive is that it’s dropping at all.”  

This announcement came after intensive city, state, and nationwide efforts to put childhood obesity on the public’s radar as a serious and urgent health issue. In NYC, the Department of Health, the public school system, and many community organizations have been implementing programs to reduce childhood obesity by increasing access to healthy food, teaching nutrition to schoolchildren, and increasing opportunities for physical activity.  While this decline is certainly a step in the right direction, over 20% of public schoolchildren in NYC are still considered obese and further drops in obesity rates will depend on the continuation and expansion of these efforts.

In addition, though drops were felt across all racial and ethnic groups and economic levels, it was not an equitable distribution. The results, published in a report by the Centers for Disease Control and Prevention, show that declines in obesity were sharply higher among middle-class children than low-income children. In terms of race and ethnicity, the greatest decreases were observed among white children and Asian/Pacific Islanders. Though black and Hispanic children also showed some decrease, it was to a much lesser degree. As this data indicates, there is a real need for concentrated and targeted efforts to reduce childhood obesity and improve health among low-income communities of color.

Bronx Health REACH has been working within schools and communities to reduce childhood obesity through classroom-based nutrition education, the creation of school wellness councils, and partnerships with local businesses to increase the availability and affordability of healthy food. (To read more about Bronx Health REACH’s efforts in this area, click here.) The communities in which we work are largely low-income and have majority black and Hispanic populations, which as the recent report shows, have the highest prevalence of childhood obesity in New York City. These are the areas that require the greatest intervention and increased resources. This recent report proves that lowering childhood obesity rates over a relatively short timeframe is possible, now we need to make sure that efforts to do so are equitable.

America’s Health at a Glance: Findings from the OECD report

Last week, we posted a blog entry about the observations of a group of visitors from the United Kingdom on the state of health care in the United States. Our country’s fragmented and inequitable health care system shocked our visitors and they expressed great concern that the UK’s conservative led government was leaning toward a U.S. style health care system. The recent release of Health at a Glance 2011, a report published by the Organization for Economic Cooperation and Development (OECD) on the health systems of its 34 member countries, affords another opportunity to see how the U.S. stacks up to other countries throughout Europe, North and South America, and the Asia-Pacific region.

The report looks at a variety of indicators in health status and the health workforce and breaks down key findings by country. Overall, medical care has improved in OECD countries and life expectancy has increased dramatically over the past 50 years. However, the United States suffers in comparison to other OECD countries in a number of ways. While the U.S. stands out in the area of cancer care, its rate of avoidable hospital admissions for chronic conditions, such as asthma or pulmonary disease, is much greater than the OECD average. For diabetes prevalence, only the U.S. and Mexico have more than 10% of the adult population living with the disease. The U.S. is also the most obese country in the group, with 34% of its adult population classified as obese in 2008, an increase from 15% in 1980. In childhood obesity, the U.S. ranks second only to Greece.

In health care expenditures, the U.S. ranks first by far, spending 17.4% of its GDP on health care in 2009. The next closest country is the Netherlands, which allocates 12% of its GDP to health care, but has much better health outcomes. Almost all the countries in the OECD rely on the public sector as the main source of health funding, but in the U.S. more than half of health spending in 2009 was through the private sector. In other words, the U.S. spends a larger portion of its GDP on health care than any other OECD country, but it also spends proportionately less from the public coffers than the other countries in the group. Despite these huge expenditures, health outcomes in the U.S. are mediocre at best and dismal at worst when compared to other developed nations. 

These reports should serve as a wakeup call that our health care system is failing the American people. Health spending per capita is much higher in the U.S. than any other OECD country, but yet our obesity and diabetes rates are skyrocketing. The already high hospital admission rate for chronic disease will only increase as diabetes and obesity related complications require medical intervention. And the troubling childhood obesity statistics are a dangerous omen for future generations and their impact on the system. The Affordable Care Act offers some remedies for these pressing issues, such as promoting a more integrated and coordinated model of care and providing more support and incentives for primary care doctors, but to get the U.S. to where it should be there need to be major changes in how health care is delivered. Being the richest country in the world doesn’t mean as much when its people can’t live a healthy life.