Nicholas D. Kristof 's two latest New York Times Op-Ed columns have focused on improving the state of health in the United States . His subject isn't Medicaid, Medicare, or health savings accounts. It's obesity.
In the January 29th column, entitled "Mike Huckabee Lost 110 Pounds. Ask Him How," Kristof writes about Arkansas Governor Mike Huckabee, who was diagnosed with type 2 diabetes and told he had 10 years left to live in 2003. Since his diagnosis, Huckabee has lost 110 pounds and is now running marathons. He has also begun a series of creative initiatives to curb obesity, such as cutting down on soft drinks in schools, informing parents of their children's BMI, giving exercise breaks at work, and paying for preventive health checks. He is also trying to give food stamps more purchasing power when they are spent on fruits or vegetables.
Knowingly or not, most parents set their children up for a life of unhealthy eating. The French fry is the "vegetable" that American infants and toddlers eat most! In his January 31st column ("Take a Hike"), Kristof gives some suggestions on how to fight obesity. Much of the focus on our health care system needs to be shifted to encouraging healthier behaviors, such as steering children away from fries. Just as government has fought smoking with higher cigarette taxes, Kristof recommends that the government tax junk foods, particularly high fructose corn syrup. He also urges our nation to ban soda and junk food from schools and discourage them in the workplace, as well as distribute fruits and vegetables to low-income people. Maine does this through its anti-poverty program FarmShare. Government should also promote physical activity, and Kristof lists several ways to do this: 1) build more bicycle and walking paths, 2) expand physical education in schools (PE has been cut down at a time when it is needed the most!), 3) give employees exercise breaks (which Governor Huckabee does for Arkansas state employees), 4) encourage stair use instead of elevator use through modified building design that makes stairs more prominent, and 5) develop televisions for kids that are powered by "Exercycles"!
At the end of his column, Kristof acknowledges that a war on obesity doesn't seem as important to politicians as the war on terrorism or corruption in Congress, but "there is perhaps no area of public policy where it would be easier to save the lives of countless Americans than in promoting public health." After all, fat kills far more Americans than terrorists or heroin.
January 29, 2006
Mike Huckabee Lost 110 Pounds. Ask Him How.
By NICHOLAS D. KRISTOF
In 2003, Mike Huckabee, the governor of Arkansas, learned he had type 2 diabetes.
His doctor told him he would probably be dead in 10 years — and that terrified him enough to start exercising, eschew sugar and lose about 110 pounds (at 5 feet 11 inches, he's now 180 pounds). His first attempts at jogging left him dizzy after a few hundred yards, but now he is running marathons.
That would be a nice, inspiring tale if it ended there, but instead it has been the starting point. Mr. Huckabee has become a health care policy wonk, and with the help of national experts he has begun a series of clever initiatives to fight obesity. They are among the most creative steps under way in America at any level of the political process.
Arkansas has become a national laboratory for using policy levers to try to encourage healthier lifestyles. Other states and the federal government should adopt the same steps — like curbing soft drinks in schools, informing all parents of their children's body mass index as a step to encouraging fitness, giving exercise breaks as well as smoking breaks, paying for preventive health checks like mammograms and prostate examinations, subsidizing efforts to quit smoking and seeking to give food stamps more purchasing power when they are used to buy fruits or vegetables.
I know all this sounds banal. Perhaps I should be using this journalistic real estate to thunder about grand issues like the Iraq war or Middle East peace or corruption in Congress. But remember that fat kills far more Americans than terrorists. Indeed, The New England Journal of Medicine reported last year that because of rising obesity, life expectancy in the U.S. might soon stop rising and could drop.
So if our government wants to keep our children safe, it doesn't just have to go after terrorists in Afghanistan. It also has to go after Twinkies at home.
Mr. Huckabee, the current chairman of the National Governors Association, is a conservative Republican (and a potential candidate for president in 2008), with whom I disagree on just about everything. But he's doing more to safeguard the lives of his constituents than just about any politician in the country. And it makes financial sense.
"I don't want to be the sugar sheriff," Mr. Huckabee explained in an interview in his office. "I don't want to be the grease police. That's not my job. But when I look at our state budget, and I see that every year our Medicaid budget is increasing by 9 to 10 percent, and I look at state employees' health plans and I see that those costs are escalating at double digits and twice the rate of inflation — as a fiscal manager, I have not only the right but frankly also the responsibility to see what can we do to improve this bottom-line cost."
Repeatedly, Mr. Huckabee came back to the same argument: Obesity is reducing not only the quality of life of Americans, but also the fiscal soundness of our government and the competitiveness of our businesses.
"This year, G.M. will spend more on health care for employees and pensioners than on steel," Mr. Huckabee noted. "Starbucks will spend more on health care than on coffee beans."
Obesity is linked to 112,000 deaths a year in the U.S., according to the Centers for Disease Control and Prevention, and leads to an extra $75 billion in direct medical costs. Mr. Huckabee argues that it would be worth paying small sums — for a session with a fitness trainer or a diet counselor — to avoid paying the far greater costs of heart disease and diabetes later.
Consider type 2 diabetes — the ailment that afflicted Mr. Huckabee (but which has now gone away, thanks to his regimen of salads and exercise). It has increased tenfold among children in just the last 20 years.
As a series in this newspaper about diabetes recently noted, one-third of today's 5-year-olds in America are projected to get diabetes at some point in their lives. It's already the leading cause of blindness, and a 10-year-old who has diabetes loses 19 years of life expectancy.
Imagine if Al Qaeda had resolved to attack us not with conventional chemical weapons but by slipping large amounts of high-fructose corn syrup into our food supply. That would finally rouse us to action — but in fact it's pretty much what we're doing to ourselves.
So what practical steps do we take? That's on the menu for a forthcoming column.
January 31, 2006
Take a Hike
By NICHOLAS D. KRISTOF
First, a quiz: What "vegetable" do American infants and toddlers eat most?
Weep, for it's the French fry. A major study conducted by Gerber found that up to one-third of young children don't eat any vegetable daily, but that the French fry is the single most common one they do consume. And among children age 19 months to 24 months, 20 percent eat French fries at least once a day.
President Bush is slated to discuss health care in his State of the Union address tonight. It's about time: it's scandalous that babies born in the United States are less likely to survive their first year than babies born in Slovenia. But the solutions to the health crisis lie less in reorganizing medical treatment than in improving public health — such as steering kids away from French fries.
Think of two of the biggest breakthroughs in improving Americans' health over the last generation or two. They had nothing to do with doctors, but arose from higher cigarette taxes and other efforts to discourage smoking, and from compulsory seatbelts and improvements in auto safety.
So what can we do? … here are my suggestions:
Ban soda, potato chips and other unhealthy snacks from American schools, and discourage them in the workplace. It's unforgivable that our schools help to send children on the road to diabetes. Obesity kills far more Americans than heroin does.
Sell cigarettes only in pharmacies and raise cigarette taxes. Smoking still kills 440,000 Americans a year, including 50,000 nonsmokers. One study found that raising the federal excise tax on cigarettes by 75 cents a pack would generate $13.1 billion in additional revenue per year and cut youth smoking by 13 percent and adult smoking by 3 percent, saving 1.2 million lives. Let's do it.
Tax junk foods. Some 19 states already impose taxes on particular junk foods, like soda, and a nickel-a-can tax on soft drinks would generate $7 billion in revenues. In particular, we should tax high-fructose corn syrup, which is used as a sweetener in a vast array of products and is a major culprit in the fattening of America.
Promote jogging and biking. Since we pay for all the consequences of inactivity (like those heart bypasses), we should encourage exercise. We should build more bicycle paths and turn more streets over to bikers, skaters and pedestrians — starting with Sixth Avenue in Manhattan.
Encourage exercise breaks. Governor Huckabee gives state employees a 30-minute daily "exercise break" that is modeled on the smoking breaks that smokers take. It's a good idea.
Distribute fruits and veggies to certain low-income people, as Maine does in FarmShare, a potent antipoverty program.
Expand P.E. It's ridiculous that schools have been cutting back on P.E. when students need more of it. Likewise, kids should be encouraged to walk to school. When my eldest son attended a Japanese elementary school in Tokyo, the school required him to walk or bike to school beginning in the first grade.
Design better stairways. The default system for getting from one floor to the next in America (but not the rest of the world) is the elevator. Let's encourage stair use instead, by having new buildings constructed with open and appealing stairs that are actually meant to be used — while perhaps making elevators dark, dingy and out of the way.
I'm sure there are other creative approaches. I've thought of subsidies for running shoes, which make more sense than subsidies for corn. And since the average American child spends 24 hours a week sitting in front of a television, how about developing televisions for kids that are powered by Exercycles?
Look, personally I'm convinced that we need universal health care based on a single-payer system. But that is not politically feasible now, while a systematic assault on the causes of American ill health could make a big difference.
Granted, a War on Sloth isn't as dramatic for the Bush administration as a War on Terrorism. And for Democrats, attacking junk food isn't as attention-grabbing as denouncing corruption in Congress. But there is perhaps no area of public policy where it would be easier to save the lives of countless Americans than in promoting public health.
