The Challenge

• Childhood obesity in New York has quadrupled since the 1970s, and tripled in the past 10 years; today, nearly one in four children in New York State is obese. Childhood obesity is associated with serious health problems, including heart disease, cancer, osteoarthritis, asthma, and Type II diabetes – a condition which until recently was seen only in adults. Further, childhood obesity is associated with academic problems and low self esteem.
• Childhood obesity is directly related to poor nutrition and inactivity. Children spend nearly one-third of their day in school, and many eat several meals a day there. We must recognize the important role that schools play in establishing and maintaining a healthy lifestyle, just as they do in learning.
• Type II diabetes has reached epidemic levels in New York, with a 100% increase in diabetes diagnoses since 1994. In 2004, NYS Medicaid spent $5.5 billion to treat 284,000 New Yorkers with diabetes.
• Asthma is also an epidemic in New York. One in twelve New Yorkers have asthma and, in some areas in New York, up to one in five children have asthma. One in five adults and children with asthma is seen in the emergency room for asthma.
• Heart disease continues to be the number one killer of New Yorkers.
• According to a report released by the Commonwealth Fund, New York ranks 39th among states on avoidable hospital use; 32nd on the use of emergency rooms or urgent care for asthma, and 30th on a range of quality measures, including appropriate receipt of preventative care for adults and children. If New York performed at the level of the highest rated states, over 450,000 more adults would have received recommended screenings, such as mammograms; over 43,000 more children would be up-to-date on their immunizations; over 300,000 diabetic adults would have received recommended exams and testing to prevent or delay complications.

Our Approach

• Enact the Healthy Schools Act: Last year, Governor Spitzer introduced a bill to dramatically improve the food in schools. The Governor will submit similar legislation with the Executive Budget, but this time it will accommodate many of the recommendations made by the Legislature during last year’s debate. The proposal will include funding in the Executive Budget. The proposal:
• Requires the State Education Department, working with the Department of Health, to promulgate regulations establishing nutritional and dietary standards for foods and beverages sold, served or offered in elementary and secondary schools;
• Requires the standards to set limits on cholesterol, sodium, fat, sugar, and calories, will determine appropriate serving sizes, and will ban artificial trans fatty acids;
• Requires that fruit with no added sweeteners be offered at breakfast and lunch, non-fried vegetables be offered at lunch, and half of grain products served be whole grains;
• Prohibits the sale of soda and candy in schools;
• Requires school districts to establish a school breakfast program in middle schools and high schools that participate in the federal school lunch program; and
• Requires school districts to develop local school wellness policies to ensure community involvement in considering ways to create healthier schools, including how to increase opportunities for physical activity during the school day.
• Measure Results: Last year, the Governor and Legislature enacted a requirement to add Body Mass Index (BMI) and weight status (based on BMI) to the health forms that doctors complete for school entry and in grades K, 2, 4, 7 and 10. As a result, the State will have, for the first time, the necessary tools to assess community-based levels of childhood obesity, overweight and /or underweight.

• As a first step to implement the BMI reporting, this year the Department of Health has provided more than 25,000 BMI toolkits to health care providers statewide, including recommendations for the prevention of pediatric overweight and obesity.
• Five hundred schools volunteered to participate in pilot-testing an electronic reporting system to collect the information in aggregate from schools.
• In 2009, a sampling of schools will be required to provide BMI reports to the State.

• Comptroller Audits: The Governor will ask Comptroller DiNapoli to help enforce the state’s strong, but widely ignored, physical education requirements by including them in his regular school district audits.
• Increase Funding for Diabetes Self-Management Education: Self-management education is a proven effective strategy in assisting individuals to control their blood sugar through dietary changes. It takes only a small reduction in blood sugar over time to achieve a 40% reduction in complications such as blindness, kidney disease and nerve damage.
• Increase Funding for Asthma Self–Management Education by Certified Asthma Educators: Evidence is now abundant that asthma self-management education is effective in improving outcomes.

• These educators will support people who have asthma in the self-management skills of self-assessment, use of medications, and actions to prevent or control exacerbations.
• We will expect to see reduction in urgent care visits and hospitalizations, reduction of asthma-related health care costs, and improvement in health status.

• Award New Funding for Community Coalitions: To promote environmental change, new funding will be provided for public/private partnerships that promote community policies supporting access to healthy affordable food in grocery stores, convenience stores and restaurants, and accessible safe environments for physical activity and play.
• Improve Medicaid Protocols: New York’s Medicaid program will implement programs that provide expert clinical management, provider and patient education, and support for evidence-based clinical protocols to ensure that patients get the right type of care to properly prevent and manage chronic diseases.

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