www.YaleRuddCenter.org The Role of States 50 opportunities to try - - PDF document

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www.YaleRuddCenter.org The Role of States 50 opportunities to try - - PDF document

Mar 14, 2024 249 likes •715 views

www.YaleRuddCenter.org The Role of States 50 opportunities to try new things Less industry influence More rapid turnaround Connection with Attorneys General Precedent (e.g., tobacco) State Legislation Near Term Wins School

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www.YaleRuddCenter.org

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The Role of States

  • 50 opportunities to try new things
  • Less industry influence
  • More rapid turnaround
  • Connection with Attorneys General
  • Precedent (e.g., tobacco)
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State Legislation

Near Term Wins

  • School nutrition
  • Menu labeling
  • Trans fat
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Further Off

  • Change food economics
  • Harness agriculture policy
  • Regulate marketing to children
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Pop Quiz

Melts in your mouth, not in your hands

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They’re Grrrreat!

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I’m lovin’ it

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Break me off a piece of that _____ bar

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I go cuckoo for _________

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Krebs-Smith, Cancer, 1998

25% of all vegetables eaten in the U.S. are

French Fries

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Cases of Diabetes Projected for 2030 (millions)

Yach, Stuckler, Brownell Nature Medicine, 2006

10 20 30 40 50 60 U.S. China India

13.4 25.1 58.9

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% Increase in Diabetes, 2000 - 2030

Yach, Stuckler, Brownell Nature Medicine, 2006

25 50 75 100 125 150 Developed Countries Developing Countries

19.8% 124%

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So, What’s Wrong?

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  • Suboptimal defaults
  • Failure to follow the science
  • Traditional thinking
  • Conflicts of interest
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The Classic Start to Modern Public Health

http://www.ph.ucla.edu/epi/snow/lifejohnsnow.html

August, 1854 - great outbreak of cholera in London Miasma (spontaneous generation) theory prevailed

  • disease came from spontaneous life forms from swamps

and putrid matter

Alternative was germ theory

  • disease from microorganisms inside the body
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Enter John Snow

(father of modern epidemiology)

Anesthesiologist Ministered to Queen Victoria during childbirth

(1813-1858)

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Snow….

Suspected transfer was through water Did geographic mapping Sept, 1854 - convinced leaders to remove handle Most deceased were near Broad Street pump Stopped the spread

http://www.ph.ucla.edu/epi/snow/lifejohnsnow.html

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Upstream Upstream Metaphor Metaphor

Medicine works here Public health works here

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Is There a Pump Handle Equivalent For Poor Diet? Is Anyone Even Looking?

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Knowledge

The Individual

Motivation

How Best to Make Change? Educate Implore Medicate Operate

Better Health

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CDC, BRFSS

% of US Population Getting Recommended Physical Activity (1986-2000)

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Knowledge

The Individual

Motivation

How Best to Make Change? Educate Implore Medicate Operate

Less Obesity

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The Individual

Optimal Defaults

Economics Legislation Environment Regulation

Better Health

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The Individual

Optimal Defaults

Economics Legislation Environment Regulation

Better Health

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Another Example – Organ Donation

Johnson & Goldstein, Science, 2003 “Do defaults save lives?”

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Economics of Food

Highly accessible Less accessible Convenient Less convenient Good tasting Worse tasting Promoted heavily Not promoted Inexpensive More expensive Poor Foods Healthy Foods

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Funding Distortion

Pyramid % USDA Funding % Meat, poultry, fish, eggs 14% 52% Fruits, vegetables 33% 5%

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Annual NCI budget for 5-a-day nutrition education

$ 3 million peak

McDonald’s “we love to see you smile” campaign

$ 500 million

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The Cost of Calories

Drewnowski & Specter Am J Clin Nutr, 2004

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200 400 600 800 1000 0.01 0.1 1 10 100 1000 Energy cost (Euros/1000kcal)

Energy density (kcal/100g)

  • il

butter sugar desserts milk grains cheese fruit fish/shellfish vegetables nuts pasta

Energy density (kcal/100g) and energy cost (€/1000kcal) –

Data from INCA nutrient database; analyses by Drewnowski, Maillot, Darmon

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200 400 600 800 1000 0.01 0.1 1 10 100 1000 Energy cost (Euros/1000kcal)

Energy density (kcal/100g)

  • il

butter sugar desserts milk grains cheese fruit fish/shellfish vegetables nuts pasta

Energy density (kcal/100g) and energy cost (€/1000kcal) –

Data from INCA nutrient database; analyses by Drewnowski, Maillot, Darmon

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Relative Changes in Costs

(using Consumer Price Index)

From 1980 - 2000

3.8% average increase in inflation rate Food prices rose less (3.4%) This is 14% drop in relative price of food

Council of Economic Advisors 2004 Report

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% Increase in Costs from 1985-2000

Putnam et al. Food Rev, 2002

25 50 75 100 125 Soft Drinks Sugar & Sweets Fruits & Vegetables

20% 46% 117%

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Big Mac Extra Value Meal $5.19 Double Quarter Pounder Meal $6.19 Sesame Ginger Salad w/ lg drink $6.58

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The Power Grid is in Chaos

Power

High Low

Impact

Positive Negative

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The Reality

Power

High Low

Impact

Positive Negative

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Local Grid Changes

Power

High Low

Impact

Positive Negative

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Legislative Opportunities

Near Term

  • School nutrition
  • Menu labeling
  • Trans fat

Longer Term

  • Change food economics
  • Harness agriculture policy
  • Regulate marketing to children
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Trends in Public Opinion

2001 2004 2003 Favor taxing foods 33% 54% 40% Favor restricting children’s food advertising 57% 73% 56% Favor required calorie labeling in restaurants 80% 74% Favor soft drink/snack food bans in schools 47% 69% 59%

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www.YaleRuddCenter.org