New York State’s Going to Get Healthy

This week, New York state Governor Eliot Spitzer today announced the initiation of a program make New York the healthiest state in the nation. This is going to be accomplished through a comprehensive disease prevention program.

“For years, the health care debate has focused almost exclusively on institutions that deal with various health problems, such as HMOs, hospitals and nursing homes,” Governor Spitzer said. “By shifting focus to the prevention of disease, we can significantly improve public health and help bring exploding health care costs under control.”

AAAUUGH, I can’t see – I was just hit by something blindingly obvious.

As the writer of an environmental health blog, it is very gratifying to hear the announcement of a state sponsoring a disease prevention program. I wish them luck. It’s something that probably needs to be done. Healthcare reportedly is 16 percent of the economic output of the country, A good chunk of that expense is avoidable suggesting that most people apparently can’t or won’t manage disease prevention on their own. All the Presidential candidates are vaporing about the broken healthcare system – principally from the perspective of how to fix health insurance, though disease prevention and quality of life just don’t seem to enter into the political discussion.

I hope the state of New York can make disease prevention interesting and compelling. There’s something so liberal, earnest and dull about public health. Water treatment and smoking cessation isn’t nearly as entertaining as catching criminals or blowing up terrorists. I wonder if part of the appeal of neocon philosophy has been that sowing war and chaos are more fun than behaving responsibly and spreading civilization, especially if you’ not the one fighting in the war, and you’re on the winning side. Candidates for political office also try to appear tough on crime or strong on national defense, not public health. Telling voters that you’re going to be tough on Type 2 diabetes just makes you look weird.

New York State’s agenda is ambitious, and appears to hit all of the high points:

- New public health campaigns targeting cancer, diabetes, obesity, asthma, stroke and heart disease and depression;

- A new program requiring Body Mass Index reporting in schools;

- New legislation requiring healthier school lunches;

- New anti-smoking initiatives, including aggressively promoting tobacco cessation treatment to all Medicaid, Child Health Plus and Family Health Plus enrollees;

- Expanded access to cervical cancer vaccine;

- Enhanced programs to combat HIV/AIDS in minority communities;

- A directive that all state agencies make the elimination of trans-fat a condition of future food service contracts;

- A new program to improve the quality of provider skills in mammography interpretation, colorectal screening and infection control;

- Implementation of a prenatal/postpartum home visitation program for high-risk communities;

- Expanded use of incentives to encourage physical fitness by state employees;

- Expanded childhood lead poisoning prevention efforts;

- Creation of a new Pollution Prevention Institute in the Department of Environmental Conservation to assist businesses in reducing the use of toxic chemicals;

- A new “Green Cleaning” initiative that will help reduce exposure to harmful chemicals in state facilities, schools and worksites; and

- Administrative directives encouraging the use of non-toxic pest control at state facilities, schools and other institutions.

In addition to these disease prevention and environmental measures, the agenda also includes a concerted effort to address infection control in hospitals and nursing homes and other institutions. This effort includes stockpiling of anti-viral medications and public health emergency preparedness exercises across the state.

Funding for the initiatives is reportedly more than $200 million. The governor’s 2007-2008 budget proposal also includes expansion of a program to provide affordable health insurance coverage to the uninsured in the state.

Expect the usual conservative wingnut blogger allusions to food fascism and anti-smoking Nazism. Some of the wingnuttery have even directly compared health promotion advocates to the Nazis.

An agenda is one thing – implementation is another. There will need to be some out-of-the-box thinking to keep this from turning into another juiceless, marginally effective government program. One possibility might be to give it a social marketing spin. There’s more on social marketing as a tool for health communications here and here. I’ve written before about a program sponsored by New York City that appeared to be working for helping diabetics manage their diet, exercise and meds, that is, before the clinics went out of business. More money to be made in amputations than nutritional counseling. . . . Anyway, the story in the New York Times chronicled a client of the program, who was slipping back into her high-risk habits, without the support system provided by the clinic. Perhaps these clinics were providing a social network beyond the medical supervision. Maybe there will be a few dollars to start them back up again, Governor Spitzer?