COUNCIL OF THE CITY OF PHILADELPHIA COMMITTEE ON PUBLIC HEALTH AND HUMAN SERVICES - - - Room 400, City Hall Philadelphia, Pennsylvania Wednesday, May 31, 2006 10:15 a.m. - - - PRESENT: COUNCILWOMAN MARIAN B. TASCO, CHAIR COUNCILMAN MICHAEL A. NUTTER COUNCILWOMAN BLONDELL REYNOLDS BROWN COUNCILMAN FRANK RIZZO RESOLUTION 060171 - Resolution authorizing the Committee on Public Health and Human Services to hold hearings on the dramatic increase in childhood obesity nationally and locally, and to evaluate and make recommendations on the actions that local government, in conjunction with public and private partners, can take to help reduce and eliminate this public health epidemic. - - - V A R A L L O Incorporated Litigation Support Services Eleven Penn Center 1835 Market Street, Suite 600 Philadelphia, Pennsylvania 19103 215.561.2220 215.567.2670 2
Good morning. We welcome you here this morning to our public hearing on Resolution No. 060171. I'm Marian Tasco, Chair of the Public Health and Human Services Committee. We'll ask the Clerk to please read the resolution.
Resolution No. 11 060171, authorizing the Committee on Public Health and Human Services to hold hearings on the dramatic increase in childhood obesity nationally and locally, and to evaluate and make recommendations on the actions that local government, in conjunction with public and private partners, can take to help reduce and eliminate this public health epidemic.
Thank you very much. This resolution sponsor is Councilman Michael Nutter. He joins me at the table. Although he's not a member of the Committee, he is the sponsor of 3 5/31/06 - PUBLIC HEALTH - RES. 060171 the resolution. Other members of the Committee will join us. It is a resolution and not an ordinance, so we can begin the public testimony without a quorum. Other Councilmembers will join us. We now recognize Councilman Nutter for opening remarks.
Thank you, Madam Chair, and thank you so much for the timeliness of this hearing and I appreciate all of the support and cooperation. There have been any number of Councilmembers who have expressed concern about the issue of obesity, and specifically childhood obesity, and I want to thank my colleagues for their interest and for their support on such a critically important issue that we can actually do something about. I was asked most recently what legislation might come out of this, and I think at the moment this is less of a 4 5/31/06 - PUBLIC HEALTH - RES. 060171 legislative response and more of an education response and a public policy response to many of the issues that face us as we try to get young people not only through their educational career, but dealing with issues of health, nutrition, physical activity and personal well-being are all major public policy issues that I think through our advocacy as public officials, whether elected or appointed, can drive the public agenda in such a way as to positively impact the lives of the young and the not so young. As we better educate our young people about what they should be doing from a nutrition and physical education standpoint, I think also that message gets driven at home, certainly needs to be reenforced at home, because in school we only have children six to seven hours a day. There are many, many other hours that they are free to do whatever they might do, and we want to try to influence the at-home decisions that are made. 5 5/31/06 - PUBLIC HEALTH - RES. 060171 So through this process, there will be a tremendous amount of information, certainly recommendations on best practices, and hopefully out of this process will come a report from the Committee on the kinds of actions that we should be taking as government, the education community, the healthcare community and certainly the School District of Philadelphia and many other providers who are part of this process to positively impact the lives of young people here in the City. And I appreciate all the coordination and cooperation of everyone who has been involved in this process. Thank you, Madam Chair.
Thank you very much, Councilman Nutter. The Chair recognizes the first panel. Would you please introduce yourself for the record and begin your testimony.
Sure. Gary 6 5/31/06 - PUBLIC HEALTH - RES. 060171 Foster, Temple University. Thanks, Councilwoman Tasco and Councilman Nutter and the Committee on Public Health and Human Services for convening this hearing. My task in the brief time today is to cover three things. One is the prevalence and scope, consequences of childhood obesity, both nationally and in Philadelphia. Second is to talk to you about the link between nutrition programs and physical activity programs and academic outcomes. And the third is to just give you a brief synopsis on some recent work that we've been doing in the City of Philadelphia. The numbers that were alluded to in the introduction are real. You can see the rapid escalation in the number of children who are obese. Now 18 percent of children across the country are obese. The next slide shows that if you break it down into overweight and obese -- so that would be over the 85th 7 5/31/06 - PUBLIC HEALTH - RES. 060171 percentile for age and gender would be overweight and over the 95th for obese -- that you can see that nearly 53 percent of children -- actually, let me take that back. Thirty-five percent of children are at least overweight. The next slide shows the thing that's particularly relevant to Philadelphia, I think, and into areas of low socioeconomic status, both urban and rural, and, that is, that obesity disproportionately affects minority children. You can see across different time frames here that it's the African-Americans and Latinos who have the highest rates of childhood obesity and far greater than those of European-Americans, whites and Caucasians. Why do we care about childhood obesity if it's rising in prevalence? Why do we care? I think why we care is because of two things. One is the medical complications of childhood 8 5/31/06 - PUBLIC HEALTH - RES. 060171 obesity, most notably Type 2 diabetes, but you can see there's a long list here, and the unfortunate part about childhood obesity is it persists into adulthood, and adult obesity has its own issues. These are, I think, very disturbing data, and I won't walk you through all the details of it, except to say that once people get diabetes, they almost inevitably get complications, whether it's retinopathy that leads to blindness, nephropathy that leads to kidney disease and dialysis. And this is one study that shows no matter when you get diabetes, whether you're years of 17 age, whether you're less than 20, 20 to 18 39 or 40, you get kidney disease at 19 exactly about the same time; that is, 20 20 years later. So as the rates of childhood obesity increase and the rates of childhood diabetes increase, this means if a child gets diabetes at 10 years of age, they're looking at dialysis at age 30 instead of people getting 9 5/31/06 - PUBLIC HEALTH - RES. 060171 diabetes at age 40 and looking at dialysis at age 60. So this isn't just a cosmetic issue. The economic and medical consequences of childhood obesity are quite real and quite staggering. Why kids are concerned about obesity -- they don't care about diabetes, they don't care about things that are years down the road -- they 11 care because they're stigmatized in 12 schools. They're the kids least likely 13 to be picked as friends by both 14 overweight and non-overweight children. 15 They're rejected by peers. They're 16 bullied, and, of course, they have a poor 17 body image in our culture. 18 So that's the scope of the 19 problem. It's prevalent. It's serious. 20 And we won't get into treatment so much today, but it's a very refractory condition. How about link to academic outcomes? I just want to show a few slides on this. This is a study actually 10 5/31/06 - PUBLIC HEALTH - RES.
060171 done by Joan Nachmani and her colleagues in Philadelphia and Baltimore, along with a collaborator, Michael Murphy, from Harvard, and showed that a simple act like providing universal feeding of breakfast over one semester, as in several schools in Philadelphia and Baltimore, could actually have positive effects on math scores, math grades, on the number of days absent and the days tardy. So you're able to see that kids who ate breakfast often did better than kids who ate breakfast sometimes, who did better than kids who ate breakfast rarely. So to Councilman Nutter's point earlier about policy changes, this may be one policy change that could happen. And there are many others that could actually have a pretty powerful effect. Not just on energy balance throughout the day, because kids won't overeat at lunch if they've had some breakfast, but also I think importantly in a school environment 11 5/31/06 - PUBLIC HEALTH - RES. 060171 on academic performance, tardiness and absenteeism. What about the relationship of PE? And Marge Wuestner and others will talk about the great work that's going on. Pam Gallagher will talk on the nutrition side, as will Joan Nachmani. My charge was to answer the question, is there a relationship between PE and academic performance. And the data aren't as compelling here, but they're still very suggestive. And what's impressive to me about this slide is that you get positive effects, whether that first study is that 4th graders perform significantly better on tests of concentration after participating in physical activity, and you can see the field study showed that high school students have significantly higher GPAs if they're high exercisers, and there is a significant correlation between, again, academic performance and PE. So these aren't just it's nice 12 5/31/06 - PUBLIC HEALTH - RES. 060171 to eat well, it's nice to be physically active. Not only does it have medical consequences, it also has academic consequences. This is a very recent study that just came out a few months ago and it's one of the first and, clearly, a very well-controlled study that shows that overweight children on the basis of their weight alone -- this is after controlling for race and ethnicity, this is after controlling for socioeconomic status -- actually had lower math and reading test scores. Frankly, we don't know why this is. Is it because they have poor attendance? Is it because somehow they're preoccupied with being stigmatized in the classroom? The why isn't known, but, again, overweight has more than just medical consequences, economic consequences, now academic consequences. Interestingly, in girls but not in boys, girls who became overweight 13 5/31/06 - PUBLIC HEALTH - RES. 060171 during the first four years of elementary school actually had significantly lower math and reading test scores. So it's not just children at baseline who are overweight have impaired test scores or lower test scores, but girls who were not overweight who then become overweight have this decrement in scores as well. I just want to end with a few comments on some recent work that we've been doing in collaboration with The Food Trust and the School District of Philadelphia. This is a policy that was started by The Food Trust and eventually modified some and adapted by the School District of Philadelphia in fact as policy. So this was a precursor study. This is a precursor policy on their beverage and snack policy, and this was a study that we did a couple years ago funded by the CDC. The intervention was funded by the Food Stamp Nutrition Education Program and implemented by The 14 5/31/06 - PUBLIC HEALTH - RES. 060171 Food Trust. We collected data on 400 kids in Philadelphia, all of whom were 4th through 6th graders. The first thing you can see are -- these are some real Philadelphia numbers. These are Philadelphia kids. These are ten schools. These are nearly 1,400 children.
And in our own City, 41 percent of children are at least overweight and nearly a quarter are obese. And those are numbers, if you can go back to the first slide -- not to go back, but if you can reference it, you'll see that those numbers are higher than the national average. So what happens if you do a policy-based intervention? You don't tell kids these are good foods and bad foods. You don't tell them to be good. You don't ask them to make better choices. You actually change the environment so better choices are easier. What happens? You can see there's a dramatic effect. These are 15 5/31/06 - PUBLIC HEALTH - RES. 060171 percentages of children who were not overweight at the beginning of the study. Again, these are 4th through 6th graders, followed for two years. And you can see after one year, if we do nothing, 7 percent of children in control schools 8 who were not overweight will be 9 overweight just one year later. If you 10 follow that red bar to the next, it just 11 escalates at two years, now 14 percent. 12 If you do a relatively minimal low-cost policy intervention, which the School District of Philadelphia has already done at this point, you can see that we basically -- or that intervention has the incidence of new cases of overweight. And what's impressive to me is, look at the difference in the yellow bars from Year to Year 2. There is no 21 escalation. Not only have the numbers 22 been halfed in that first year, they 23 actually stay stable in the intervention 24 schools, in the five intervention 25 schools, compared to that 11 to 14 16 1 5/31/06 - PUBLIC HEALTH - RES. 060171 percent increase in the control schools. Again, because I think obesity is bigger than just medical and psychosocial issues, when you talk about academic performance, these are the first data of which we're aware. Again, these come from Philly kids in Philly schools, showing that being overweight impacts attendance, that overweight kids -- you can see there's a step-wise increase here about kids who were in the, quote, normal range, 5th to the 85th percentile, and as you become more overweight, you're more likely to miss school. Again, we don't know the why's of that. We can make hypotheses, but the fact that it is we can't debate at this point. I want to end with just some future directions. Temple University is about to launch and take the lead in a national study of 42 schools that will take us to the next step, not just preventing obesity but preventing diabetes risk factors, BMI, glucose and 17 5/31/06 - PUBLIC HEALTH - RES. 060171 insulin, in 42 schools, and we're working closely with the District to try to work out the details of trying to make six of those schools in Philadelphia. And I would request that an outcome perhaps of a hearing like this is to reinforce the need for a systematic infrastructure to effectively coordinate multiple efforts in Philadelphia. You're going to hear a lot of great things today about what's happening in Philadelphia. Unfortunately, I think those efforts suffer at times because of a lack of systematic infrastructure. And, third, I want to underscore, from my point of view, that research and evaluation need to play a central role. We have to do better than to offer programs and implement them. We need to test them and to make sure that we put resources behind policies that work and tweak policies that aren't just exactly where we want them to be at this point. 18 5/31/06 - PUBLIC HEALTH - RES. 060171 Thank you very much.
Thank you very much for your testimony. Councilman Nutter.
Thank you, Madam Chair. Mr. Foster, thank you for your testimony and the slides presentation. I'd also note for the record that the young man advancing the slides is a medical school student, might be slightly overqualified for that particular job, but it's just one more example of his commitment to the effort. But if you need a recommendation about PowerPoint presentations, I will certainly write one for you. Thank you. Seriously, thank you for your support. Mr. Foster, a couple quick questions. On the ate breakfast issue and the slide, do you have any information presently on how many kids eat breakfast in Philadelphia public 19 5/31/06 - PUBLIC HEALTH - RES. 060171 schools?
I do not. I suspect Pam Gallagher or others from food service may have that information, but I do not.
The Temple study that you mentioned and the six schools, what's the status of that? And you mentioned you're trying to work through some details. What's the --
It's a big study and blood draws are involved, so I think the District --
Blood draws, with parent consent. So I think what we're doing is proceeding carefully and cautiously to make sure that any risks are minimized, and we look at the advantages like health screenings to kids who have a lack of access. And if 40 percent of the kids are overweight, a fair number of those will have some 20 5/31/06 - PUBLIC HEALTH - RES. 060171 problems that we hopefully can detect and really just -- this is happening across the country. I don't think it's unique to Philadelphia, where districts and universities have to partner together, and I think we're close to working out those details, but they're not as yet worked out.
What's your best estimate of the timing on this? You have a number of cities involved?
We do. There are seven sites across the country. Houston; San Antonio; Chapel Hill, North Carolina; Portland, Oregon; Pittsburgh, Pennsylvania; and Irvine, California. And the study will launch. It's a national study. It will launch in fall '06, and it will follow a cohort of 6th graders to seventh grade and to eighth grade and to do two assessments at baseline and two years later. And it will also look at academic outcomes and it will also look at cost issues. 21 5/31/06 - PUBLIC HEALTH - RES. 060171 One of the benefits of being in a national study like this is, you get national expertise on every part of this problem.
Sure. Do you expect that Philadelphia will be ready by the fall?
I think we will be. I think we're in discussions with that, and I certainly hope they will be, and they've been cooperative to date.
Last question. You mention that there is a wealth of activity going on throughout the City and some very positive things, but I took down a note. You said that you felt that one of the issues here was a lack of systematic infrastructure. What is that?
That's a good question. I'd have to think about exactly what it would look like, but, for example, there's not a quarterly, monthly meeting where people can sit down and 22 5/31/06 - PUBLIC HEALTH - RES. 060171 say, This is what we're doing. It would also be a way to coordinate resource efforts, so if we were going to go after federal funding, stating funding, other funding to sort of coordinate what are the priorities for Philadelphia. As you'll see, there's lots of things going on in communities and schools, at the Health Department and how can we best coordinate that so we don't step on each other's toes, but more effectively so that we effectively get gaps addressed that currently exist. And I don't think anyone has a good sense of exactly where the gaps are, exactly where the strengths are.
Last question, and maybe drawing from some experience in other cities, this is obviously a huge issue and with multiple players. As a part of this systematic infrastructure, is that also about identifying either a lead entity or a couple lead entities? I mean, 23 5/31/06 - PUBLIC HEALTH - RES. 060171 someone/someones have to drive this, I assume, and someone ultimately has to take this on as their major responsibility, with a coordination component and the maybe stature or authority, I guess might be the word, to be able to keep all the players at the table. Is that what we're talking about?
I think that's very fair. I think at the end of the day, somebody has got to take responsibility for doing it, and I think efforts that have been successful in the City have been ones that had a committed task force, worked on it, met regularly just to sort of keep the flow going. But at the end of the day, somebody does have to take responsibility, I agree.
I have a couple of questions. During the study for the three-year period or more, as you study 24 5/31/06 - PUBLIC HEALTH - RES. 060171 these young people, are there interventions going on at the time or are you just following them in terms of their being a part of the study? What's happening with them? Is there anyone trying to help them overcome the problems?
Yes. Of the 42 schools nationally, will be randomly 11 assigned to get the intervention. The 12 intervention consists of changing the 13 quality and quantity of PE, so the number 14 of minutes and how that's done. Food 15 service will be changed. There will be a 16 social marketing program or a 17 communications program, and there will 18 also be some programs that are done in 19 the context of a homeroom setting, about 20 ten to 15 minutes once a week around goal 21 setting, of decreasing TV viewing, of increasing water as opposed to sweetened beverages like juice and soda. I think the fortunate part of trying to do a study like that in 25 5/31/06 - PUBLIC HEALTH - RES. 060171 Philadelphia is that Philadelphia is already on the cutting edge from a PE perspective and a nutrition perspective, so that tweaks may be relatively insignificant. Nationally, most districts are not at the place that Philadelphia is right now. So, indeed, there is an intervention and half of the 42 schools no intervention, except that they get a health screening for the other 21, and the outcomes will be looked at at the end of two years. And the NIH and Congress, frankly, is actually looking at this study as, does this dictate a change in policy in the way we do business in schools.
Are there school food programs still going on in the public schools?
Food programs. They used to give the 5/31/06 - PUBLIC HEALTH - RES. 060171 breakfast in the morning.
I think Pam Gallagher is going to give a nice overview of what's happening with food service, so I want to defer that, if that's okay with you.
Thank you for taking time to come down to share. The next panel will consist of Kate Maus; Chad Lassiter; the City Controller, Alan Butkovitz; Dr. Shiriki Kumanyika. Good morning. How are you?
Good morning. Fine, thank you. How are you? I'm Kate Maus. I'm the Director of Maternal, Child and Family Health for the City Health Department, and I have a few things to say this morning about breastfeeding. One of the things that Dr. Foster mentioned was how difficult 27 5/31/06 - PUBLIC HEALTH - RES. 060171 obesity, childhood obesity, is to treat once it is established, and so as the Health Department is all about preventions, one of the strategies that we know to be effective in preventing pediatric obesity, childhood obesity, is breastfeeding, and I have a little bit of science here to quote you. There is evidence that not breastfeeding is a risk factor for childhood obesity, and it seems that there's a dose-dependent effect. Babies who are breastfed for at least six months have a lower risk of obesity compared to those breastfed for three months or less. We know that artificially fed babies, formula-fed babies, gain more weight in the first year, and overweight at the first year correlates with childhood and adult obesity. So if you're fat as a baby, you're likely to be fat as a kid and as an adult. The research is showing that exclusive breastfeeding and the duration 28 5/31/06 - PUBLIC HEALTH - RES. 060171 of breastfeeding and the delay in introducing foods until the baby is six months old all contribute to the decreasing risk of overweight at age one year. And here's the science: So why would breastfeeding reduce obesity? Currently, the thinking is that components in human milk contribute to the metabolic programming that encourages response to satiety so the baby feels full and, thus, appropriate food intake. Human milk is constantly adjusting to provide the needed hormones, carbohydrates and fats in a manner that supports appropriate intake. Also, the baby's body learns how to utilize sugars and cholesterol in human milk more readily than in formula. And we know that early appropriate growth can contribute to appropriate weight in childhood and adulthood. And I can tell you about some of what the Health Department is doing 29 5/31/06 - PUBLIC HEALTH - RES. 060171 around promoting breastfeeding. I actually brought -- and I think we sent all of you copies of this. We have a nifty publication called The Philadelphia Breastfeeding Resource Handbook. We do it every year, and it's distributed throughout the region, certainly to all our providers, hospitals, medical care providers, pediatricians. In addition, the Health Department, through a variety of programs, Healthy Start, our home visiting programs and our support of prenatal care at all our district health centers, is working to encourage breastfeeding among our clients, our patients. We conduct breastfeeding support groups once a month at Health Centers 2, 4 and 9. We bring our breastfeeding moms back three days after delivery into pediatric clinics so that they can get support around breastfeeding. It doesn't always go like clock work, especially for first-time 30 5/31/06 - PUBLIC HEALTH - RES. 060171 mothers and mothers who are new to breastfeeding. We publish health education and informational materials, I understand as of this morning, in seven languages that our agencies use and that we distribute widely throughout the region to help inform women who are interested in breastfeeding and their providers who are interested in supporting them around breastfeeding. We have peer counseling going on around breastfeeding in home visits with our Healthy Start program. And I'm very proud to say that -- because we know that breastfeeding is much lower in the highest risk populations, highest risk for a lot of things, obesity, sudden infant death syndrome, particularly African-American populations. Our Healthy Start program serves primarily African-American women, mothers, and their infants, and we're now up to about 50 percent of our mothers breastfeeding 31 5/31/06 - PUBLIC HEALTH - RES. 060171 their babies through six months, which is a real achievement for us.
We're really very proud of that. We've done things for our providers, like create reference materials, including drugs for our prenatal clinical providers, a reference including drugs that are safe for use in breastfeeding mothers. People get concerned that if you have to give a mother an antibiotic, you should tell her to stop breastfeeding. We have technical assistance to help you make those decisions. And that might be all.
Thank you very much. We'll save the questions until after all have made their presentations. Mr. Lassiter.
Good morning. I'm from the Children's Hospital of Philadelphia. We have the first study of its kind in the country that's looking at 32 5/31/06 - PUBLIC HEALTH - RES. 060171 Type 2 diabetes and obesity in adolescents. It's called the TODAY Study, which is an acronym for Treatment Options for Type 2 Diabetes in Adolescents and Youth. One of the amazing things about this study is that it's broken down in three different respective formats. We have one group of adolescents that we put on a diabetic drug called Metformin. We have a second group that's on Metformin plus Rosiglitazone, and the third group, we give them Metformin and intensive life-style intervention. One of the amazing things about intensive life-style intervention is that we work with youth as well as their parents. We've called their parents FSP, family support person. The reason why we want the parents to be involved is because we want the parents to be able to model appropriate behavior around eating, around nutrition and around exercise, as well as the youth. We give them 24 33 5/31/06 - PUBLIC HEALTH - RES. 060171 psychoeducational chapters that run the gamut of nutrition, calories, how to make a healthy life-style living, how to shop appropriately when going to the supermarket. We also engage them around exercise. The most basic thing that we talk to them about is getting started by walking. We give them pedometers. We take them swimming. We also take them bowling. We do a lot of physical activity with them. And for me, there are four reasons why being overweight is a problem in Philadelphia as far as youth. One, obese children are more likely to become obese adults. Almost 70 percent of obese pre-adolescent children will become obese adults, which is six times the percentage of the lean pre-adolescent children who will become obese. Two, obese children may begin to show signs of diseases related to obesity, like insulin resistance, which 34 5/31/06 - PUBLIC HEALTH - RES. 060171 can lead to diabetes as well as high blood pressure, and increased levels of cholesterol in their blood that lead to heart disease. Three, obese children could develop low self-esteem, poor social skills and may become socially withdrawn due to teasing and exclusion by peers. And I see this with a lot of the kids that I counsel at the Children's Hospital of Philadelphia. Obese children experience accelerated growth and early puberty. Obese children grow faster and often begin puberty earlier than their lean peers. While they are not necessarily taller as adults, they do grow into their height sooner and often choose to associate with older children who are closer to their size. These older children may expect the obese child to act older than their age, which can present unusual challenges for the obese child and may accelerate their 35 5/31/06 - PUBLIC HEALTH - RES. 060171 development or cause them to skip important developmental milestones. One of the things that we see with the TODAY Study at the Children's Hospital of Philadelphia is that a lot of our youth in the City of Philadelphia display with a lot of sedentary behavior. One of the main causes of obesity that we've been able to see is that they engage in a sedentary life-style. Television, movies, computer games all contribute to being sedentary. Sedentary activities, as we know, compete with being active. The more time spent watching television and playing computer games, the less time for physical activity. Sedentary behaviors have had bad effects on development as well. They compete with homework, reduce the amount of time children interact with other children and decrease the amount of time children and their parents spend in social interaction. Therefore, for me, 36 5/31/06 - PUBLIC HEALTH - RES. 060171 one of the things that I think is advantageous is a life-style activity. Life-style activity is highly recommended for youth in the City of Philadelphia.
The goal is to make getting physically active a habit by incorporating physical activity in your daily routine. So it's looking at things like maybe vacuuming, walking, pulling out weeds in the backyard and things of that nature as physical activity. Some of the barriers that youth in the City of Philadelphia face is the shared environment. An example, the home. The home is a shared environment that often facilitates overeating and being sedentary. Also, the unshared environment, outside the home, fast food, larger portions, aggressive advertising of high-fat food. The use of food as a reward and socializing around food make it challenging for many youth in the City of Philadelphia to attain a healthy 37 5/31/06 - PUBLIC HEALTH - RES. 060171 weight. And then the unshared environment, peer group. Peer groups influence children's eating and physical activity. So for me and for my colleagues at the Children's Hospital of Philadelphia, some of the recommendations are to introduce activity reference guides to youth in the City of Philadelphia. An activity reference guide is a list of activities grouped according to their intensity. So it could be swimming, it could be playing pool, it could be playing darts. What we want to do is get youth in the City of Philadelphia active. We want to get them moving. Also, introduce life-style activity programs to youth. Going to the museum, but also making it culturally relevant, but also to a point where they could do some walking as they're doing these outings. Also, introduce structured recess and physical education in school. I know some schools have it, 38 5/31/06 - PUBLIC HEALTH - RES. 060171 but also look at cultural implications. Often times as dieticians, as social workers, as practitioners, we often articulate to poor families of color as well as to families in general that we want them to eat healthy, but if one was to do ethnography in the inner City, there are not readily available a lot of supermarkets for these families to eat healthy. And so one of the things is, how do you talk to families about not maintaining the status quo even though the status quo is unhealthy. So one of the ways that we've been able to do that is talking to families about going to the area grocery truck. Also, what we do is actually go to the supermarket with them and we actually help them pick out groceries that are healthy for them. And then, lastly, change the toxic environment. And I think that's one of the things that all of us are coming together to try to do with the TODAY Study, as well as many others who 39 5/31/06 - PUBLIC HEALTH - RES. 060171 have spoken before and will speak today. The environment is very toxic, but one of the things we have to really do is work with families around portion sizes, making a healthy life-style change and basically get them moving. Thank you.
Good morning. The issue of obesity in our children is a serious concern here in Philadelphia and in our nation. 4 percent of young people in Pennsylvania are currently overweight. The prevalence of children who are overweight between the ages of 6 and 11 has more than doubled in the past 20 years, and among adolescents between the 40 5/31/06 - PUBLIC HEALTH - RES. 060171 ages of and has more than tripled. While the prevalence of overweight and obesity has increased in all segments of society, it is particularly common among minority groups and is increasing at faster rates. Overweight and obesity, which is influenced by poor diet and inactivity, are directly linked to an increased risk of diabetes, high blood pressure, high cholesterol, asthma, arthritis and a host of other ailments related to poor health status. In fact, Type 2 diabetes, formerly known as adult onset diabetes, is becoming increasingly prevalent among children and adolescents as rates of overweight and obesity rise. A CDC study estimated that one in three American children born in 2000 will develop diabetes in their lifetime. And we know that if not handled correctly, that can lead to blindness, it leads to very strong chances of heart disease and heart attack and amputation, disability, 41 5/31/06 - PUBLIC HEALTH - RES. 060171 early death. As a diabetic myself, I understand the importance of preventing and controlling diabetes where we can, and it begins with educating our young people in proper diet and exercise. It's quite simple. People must burn more calories than they consume, and in the case of diabetics, they also have to balance insulin, either naturally produced or injected, with carbohydrates. S. dietary guidelines for consumption of saturated fat, and almost 80 percent of young people do not eat the recommended number of fruits and vegetables. In addition, by the time a child graduates from high school, he or she will have spent more time in front of the TV or computer than in school. We must begin to educate our children and society about proper diet and its consequences and ensure that 42 5/31/06 - PUBLIC HEALTH - RES. 060171 physical education and exercise routine are implemented in every school and in every grade. Last year, the School Reform Commission implemented a district-wide policy that eliminated all sodas and other sweetened drinks from vending machines in cafeterias. Presently the only beverage allowed to be sold in the School District vending machines and cafeterias are water, 100 percent fruit juices and milk. While I commend the School Reform Commission for taking this, and it was a well-meaning first step, the School District failed to consider that pure fruit juices with their high sugar and carbohydrate content can be as harmful as sugared sodas. We have to do better. To begin to reverse the tide and get our children in a healthy life-style, I would recommend that the following measures be implemented. First, as with any diet or exercise plan, school districts and all 43 5/31/06 - PUBLIC HEALTH - RES. 060171 other entities in charge of our children must first consult with the medical community, including pediatricians, nutritionists and endocrinologists, whether implementing a plan on what to do with vending machines or food service or anything else. Common sense by non-professionals is insufficient in this realm.
That low fat and non-fat regular and flavored milk and bottled water be sold in all grades; that no and low-calorie beverages, light juices and sport drinks with no more than 66 calories per eight ounces be available in high schools; that schools offer more fresh fruit and vegetables at lunch and snack time; that after-school programs only provide snacks and drinks that are deemed to be healthy; the implementation of a rigorous physical exercise program at every school and in every grade; the creation of a health education program to provide children and their parents with 44 5/31/06 - PUBLIC HEALTH - RES. 060171 the resources and information necessary to develop and maintain a healthy life-style; ensure our children have physicals on a yearly basis and that a part of that physical include having their blood sugar level checked; and those children who are deemed to be seriously overweight or obese, that a monitoring program be developed with their parents and their physician to reverse the process. We must do everything to address this issue now, because the life of every child is important. In addition, if we fail to address this concern, we will experience long-term financial consequences to society as a whole and, in particular, to the City of Philadelphia, which must bear the cost of providing healthcare to those who cannot afford it. Currently, there are approximately 160,000 people in Philadelphia with diabetes. In 2005, 45 5/31/06 - PUBLIC HEALTH - RES. 060171 almost 8,000 people with diabetes were seen in Philadelphia health centers at a cost of other $7 million. As of 2002, the total healthcare expenditures per diabetic nationwide was $15,803, with a total current nationwide cost of over $132 million per year and rising. Through public education, we can prevent the onset of diabetes in most cases, and if we succeed, we all benefit, especially our children. I commend Councilman Nutter and Councilwoman Tasco in bringing light to this very important issue. I would like to work in cooperation with you in addressing this problem. Thank you very much for this opportunity.
Thank you. I had to learn how to produce that name, too, when I changed it. 46 5/31/06 - PUBLIC HEALTH - RES. 060171 I've given a two-page --
I'm Shiriki Kumanyika from the University of Pennsylvania School of Medicine. There I do research on obesity and also have some international activities in this area, and I would like to take the discussion out of Philadelphia for a moment, if you'll indulge me, to put it in a larger context. I've given a twostatement. I'm not going to follow that at all. I've also provided, I see you have it, an issue of the future of children on this issue, and we have a paper in there about the special issues and low-income minority children. I want to make four points. The first point is that it is possible not to succeed in the area of obesity and that we've already failed once, and so 47 5/31/06 - PUBLIC HEALTH - RES. 060171 we're coming on a second wave of trying to address this issue. We had set some national goals for addressing obesity, but because the situation actually worsened, David Satcher, who was the Surgeon General in 2001, put out a call for action on this topic. These are the data that show sort of that we failed. If you look at the black line going down the middle of this bar graph, that was the target of five percent of children the healthy people -- 2010 target was five percent of children to be in the overweight range. That would have been a tolerable range. So the idea is that we should be moving towards making the dark part of these bars shorter. You have at the top the total population and then white, black, Mexican-American children or male or female. These are 6- to 19-year-old children. So instead of this bar getting shorter closer to five percent, it's six, 48 5/31/06 - PUBLIC HEALTH - RES. 060171 and we're still at the level we were ten years after the goals were set, which was to essentially go the right number of points in the wrong direction on the issue of obesity. We're trying to bring it back by about seven percent. We went forward. So we need to be very careful that we put enough energy into this so that we don't actually miss the chance to succeed at this, because the forces that are in the population -- and this is a global issue -- are actually driving us in the wrong direction even when we set goals to address the issue.
Doctor, I'm sorry. I want to make sure I'm understanding the chart. First, the vertical line at the five percent, that was the goal?
That's the 49 5/31/06 - PUBLIC HEALTH - RES. 060171 goal. It's been the goal. It's still the goal for 2010, right.
And do I understand when this started -- I don't know if I'm using the right terminology, but with the baseline on the total, that might be like about 12?
Where we were in 2000, right. So instead of going from 12 -- you're reading it exactly right. Instead of going from 12 back to five, we went from 12 up to 16, and it's probably still going up. And then if you look at the black children, for example, already much farther away from the target and the Mexican-American and black children --
So now it's going up to the 20, percent. And as 25 Dr. Foster showed you, this is also seen 50 5/31/06 - PUBLIC HEALTH - RES. 060171 in the children of Philadelphia. So we're moving steadily opposite to the goals that we've set. So while we've been putting all these things into place, it hasn't really hit hard enough to roll the problem back.
Right. I understand the concept at times you might fail, but how do we fail so badly?
Well, I'll go through the rest of my slides and maybe you can come to your own conclusion. I think --
I think I know how we failed so badly. This is just the second point, which is to show that we're not alone. Whatever we're going through here in the U.S. and in Philadelphia, this is what happened in England to obesity in children between 1970 and around 2000. Just go back for one minute. 51 5/31/06 - PUBLIC HEALTH - RES. 060171 And I can show data like this for many other European countries, which are the closest to ours, for cities within different European countries. If you go to the next and just keep going until you fill in the slide. So this is a causal web that I'm going to show you. This is the International Obesity Task Force causal web of the forces that are impacting on obesity, and I think this is actually the answer to how we have failed so badly. We thought that it was a health problem that could be addressed by more education and getting kids checkups and so forth, and what we recognize is that even though health is big in our minds when we look at obesity, there's several other sectors and levels that influence what kids eat and the calories they take in and the calories that they put out. So you can see at the work, school and home level, anything that affects leisure or activity, work patterns, infections, 52 5/31/06 - PUBLIC HEALTH - RES. 060171 which would go in the opposite direction -- so we can take care of infections and the kids don't lose weight there -- work site, school, family and home, all of these things are impacting -- these environments are impacting our children's weight. The other levels in the larger community nationally and internationally are impacting on the things that are in the communities. So I think the reason why we failed is that we underestimated how complex this was and we thought that it was a narrow health problem. We didn't realize that almost every sector in the economy is involved leading to the obesity levels. I think the good news, and this is the next point, is that we have succeeded in some very large and seemingly overwhelming health problems before. These are examples that the CDC has put forth of where we've seen a 53 5/31/06 - PUBLIC HEALTH - RES. 060171 problem that looked that large, that looked like it required a big social transformation, and we've made major in-roads in many of these areas. So that we've analyzed some of these, IOM panel and another research project, to see what were the elements present when we succeeded on these. Just to show you some data from the current national health statistics, seatbelts is one of the areas that we've analyzed. You can just look at the left panel. Kids who never wear seatbelts were low in 1991, both male and female, and they were going down over until 2003. When I was a kid, there were no seatbelts in cars and people thought it was laughable that you would actually get people to strap in. And so it just shows over time that if you have the right kind of a plan and a sufficiently comprehensive initiative, you can actually make progress in one of these big public health problems. 54 5/31/06 - PUBLIC HEALTH - RES. 060171
Doctor, just for the record, and I appreciate your honesty on the topic, but it is hard for me to believe that when you were a child 30 years ago that there were not seatbelts in cars. So, look, if that's a part of your story, that's fine and it sounds good, but I happen to know better, that there were seatbelts in cars 30 years ago.
Thank you so much. These are some of the elements of success, and you've heard about them from other speakers and you'll hear more. We need evidence, although it's not necessarily the type of evidence that we always think about, but we do need a science base. We need very much public awareness, advocacy, enabling legislation, attention to this by the media. We need a win-win for some part of the economic sector. When we've analyzed the other 55 5/31/06 - PUBLIC HEALTH - RES. 060171 successes, there was always an industry that could benefit. And so far with obesity, we know which industries don't benefit, but we haven't quite identified the ones that benefit. But we haven't ever succeeded unless somebody could make some money at it, basically. So that's an element. We need to shift the social norms about eating and physical activity. We definitely need to keep the focus on children, because people agree that children cannot be responsible for this problem themselves and can't be blamed, and so we need to keep the focus on children. And then we need a plan, partly because we will encounter strong opposition. This is just a headline from a fight with the sugar industry that I was involved in through some international activity. The people who will lose money will have a plan and they will fight very hard. So we need a plan 56 5/31/06 - PUBLIC HEALTH - RES. 060171 to go forward with our initiatives. There are the elements of a plan in this report from the Institute of Medicine. There's a lot of free downloadable material on the website. I've given you that website. Some of the things -- and I was on the committee, but some of the things that we've said about plans and this and other initiatives are that, one, no 12 single approach will solve the problem. We need a plan with something for everybody working together. It has to be comprehensive and flexible, because the landscape changes. Not just the health sector, I said before. We need all levels of government and society and a very clear focus on what we think the scenario should look like if we're successful. And this is the last slide. Recommendations from the Institute of Medicine report at the community level. Coalitions have been successful before 57 5/31/06 - PUBLIC HEALTH - RES. 060171 and they're needed, especially the barriers for high-risk populations need to be addressed, and I think we'll hear a lot about that this morning. Develop and evaluate community programs. And then the last section is, we have to enhance the built environment. A lot of the problems are in the environment, and even though the environmental changes by themselves may not solve the problem, the programs won't work unless we fix the environment. No program, the TODAY Study, no program is strong enough to overcome the environment. So we need to make the current a little bit softer so that people can swim upstream and succeed. Thank you.
Doctor, why don't I start with you, coming right off the tail end of that. 58 5/31/06 - PUBLIC HEALTH - RES. 060171 When you talk about the planning and there was something about capital improvements or infrastructure -- I don't remember everything that was on that slide -- what kinds of things are you talking about?
Well, if you look at physical activity, you come up with one set of built environment factors. If you look at food, you come up with another set. But we're looking at everything that relates to whether people can transport themselves without needing to get into a car, which means they'll spend more energy. So the whole -- like the SEPTA system. You could have a policy intervention to lower fares to try to encourage more people to use public transportation, because they'll walk to and from that public transportation. When you zone for what can be in the neighborhood, mixed land use causes people to walk more, because they 59 5/31/06 - PUBLIC HEALTH - RES. 060171 have to get to things. There's lists that I can't go into here, but there are all kinds of lists of recommendations of things you can do with transport, urban design, requiring that daycare/child care centers have green space, cleaning up school playgrounds, almost everything -- putting in stairwells, like this beautiful one in City Hall so I can actually walk up here without going into a dark corner or having to ride the elevator. So that's the built environment piece, and there are many aspects to it. From food, I think what you'll hear from The Food Trust, getting food to people where they live of the right type at a good price.
In one of the earlier slides you mentioned having a plan, and I guess a couple things come to mind. Your work, of course, is primarily at the University of Pennsylvania and, of course, you're published. Have you had 60 5/31/06 - PUBLIC HEALTH - RES. 060171 some involvement or ability to interact with some of the other players, whether the School District or the City Department of Health, in developing a plan?
I have been involved with, in the beginning, the School Nutrition Task Force and some of the activities that have gone on with the schools. I don't know if I've identified a coalition here. Health Promotion Council tried to convene a group to start a coalition about maybe a year ago and had a big press conference and an all-day meeting. So I think that since I serve on that Board and on The Food Trust Board, I know the people who would be a part of a plan, but I don't think we've sat down, except for schools, to say, Let's get a plan that encompasses the whole City. I could be wrong about that. Maybe someone will correct me, but I haven't been here. Nationally and internationally 61 5/31/06 - PUBLIC HEALTH - RES. 060171 I've been a part of a lot of planning efforts, and the elements are always the same whatever level you're dealing with. The hardest part is to convince people who don't think they have anything to do with obesity that they are a player in this and to find the win-win from recreation people and others, so forth.
Going back to previous panelist Gary Foster, we talked about the systematic infrastructure and the kind of leadership role that some organization or coalition of organizations, but someone is, again, taking this concept of -- someone has to take ownership of this particular issue. Would you share that particular view, and do you have examples of other places where that has happened?
I agree that there has to be ownership. I mean, at the state level, there's the PANNA Coalition, and CDCs put efforts in through the state. I think who takes the 62 5/31/06 - PUBLIC HEALTH - RES. 060171 lead differs in different communities. That's the one thing about these problems. The problem is the same everywhere, but the solutions are very local. Sometimes it's a champion, a layperson who takes responsibility, finds the funding. Sometimes it's a local organization. But I think the coalition has to be broadly based. It couldn't be just one organization. So the host has to be some group that can build bridges across all the different players.
Excuse me just a moment, please. Let me recognize two Councilmembers who are here. Councilwoman Blondell Reynolds Brown, who is a member of the Committee, and Councilman Rizzo, who is a member of Council but is not a member of the Committee.
Ms. Maus, I 63 5/31/06 - PUBLIC HEALTH - RES. 060171 took down some quick notes. Did you have any copies of your statement or testimony?
That would be helpful. I took down some notes from what you had mentioned earlier about home visits and breastfeeding specifically with regard to the minority population. I think the number you laid out was 50 percent; is that correct? Could you give us some context for that particular number? Is that high? Is that low? How does it compare to other major cities or national averages?
I'm probably going to need to get back to you with more specifics, but, in general, breastfeeding among African-American populations is low. It's quite low in Philadelphia. So our 50 percent among the families whom we actually touch with our Healthy Start 64 5/31/06 - PUBLIC HEALTH - RES. 060171 program is a great cause for celebration.
I think there are a variety of reasons. I think that as women have needed to go back to work early in order to support their families, breastfeeding and managing a job is a little bit difficult. I also think that the norm in the community has not been in support of breastfeeding. Formula feeding was seen as the modern way to do things and much more scientific, and I think that, unfortunately, that's hung on to some extent. I also think that we don't do as much as we might around helping women during the couple of days, or less now, that they spend in the hospital after delivering their babies, and one of the things that we've been able to show -- we have a paper in publication at the moment showing that if a hospital has a lactation consultant actually on staff 65 5/31/06 - PUBLIC HEALTH - RES. 060171 and available all the time to new mothers, the rates of new mothers, particularly African-American, teenage and low-income mothers, initiating breastfeeding at the hospital are much higher.
There are a number of what I guess are considered birthing hospitals in Philadelphia.
Nine. Do all of them have this, what do you call, lactation specialist?
They don't. Many of them do. Some of them have people part time. That's one of the areas that we'll be working with the birth hospitals. We've been working with them. Fifteen years ago none of them had lactation consultants. Due in part to our efforts, many of them now do.
Do you know which ones do and which ones don't? 66 5/31/06 - PUBLIC HEALTH - RES. 060171
And the whole formula issue, is that something that is heavily promoted either at the hospital? How are they kind of taking over almost in the breastfeeding area?
Well, harking back to my years as a maternity social worker in a couple Philadelphia hospitals, the drug companies are very generous in their willingness to supply nurseries with formula, and the drug companies are also very generous in sending new mothers home with gift packs that include samples of their formula, and at this point, I think the gift packs also include a little something that says, Of course you're encouraged to breastfeed your baby, but on those occasions when you might want to formula feed your baby, here is a formula that you can try. And, in fact, the World Health Organization has a designation called Baby Friendly for 67 5/31/06 - PUBLIC HEALTH - RES. 060171 hospitals. Very, very, very few hospitals in this country and none of the hospitals in the City have actually attained Baby Friendly status. One of the reasons being that they would be required to not accept formula from the formula companies, and that's a huge policy issue for the hospitals. It would represent a tremendous change.
What's the incentive for the hospitals? I mean, what's the impact on the hospitals if they were to go the other route? Why do they care?
The formula companies actually supply formula in the hospital. And, again, my OB days were a while ago, but the system had been that each formula company supplied the formula for a three-month period on a rotating basis. And I'm not sure exactly what the financial arrangements are at this point, but it would certainly represent a change in practice in the hospitals. 68 5/31/06 - PUBLIC HEALTH - RES. 060171
I don't mean to make it sound so simplistic, but I guess if the hospitals decline to take the formula, it's almost, I guess, implicit that there would have to be an encouragement of breastfeeding.
Yes, and that would have implications for training of hospital staff and nursing staff and having enough nursing staff to -- we've got a lactation consultant and that's great, but you also need somebody available bedside as problems come up to coach a new mother on breastfeeding. My assumption was when I had my first child, you pick the baby up and you say, Here, baby, and the baby knows what 69 5/31/06 - PUBLIC HEALTH - RES. 060171 to do, and sometimes that happens, but absolutely not all the time. And as so many of our mothers bottle fed rather breastfed their babies, there's not the necessary culture through which support for breastfeeding is easily provided. That's one of the reasons we have breastfeeding support groups at a number of the health centers and we include this information in our home visits.
I'm going to be funny here, not really funny, but just bring in --
Well, this is an incident I saw on television. Recently -- and I don't remember which of the programs -- where the mother was breastfeeding her daughter. I think the child was four years old, because she believed that it helped her with her figure. Is that a myth? 70 5/31/06 - PUBLIC HEALTH - RES. 060171
The mother's figure? Yeah, there are certainly benefits to mothers. Mothers' bodies return to normal in many ways much faster and more readily if they breastfeed their babies. Breastfeeding is also not a hundred percent effective, but it's a moderately effective natural contraceptive. So that if we can get mothers to breastfeed optimally for two years, but if we're going to use it as contraceptive. But, yes, it's helpful for the mother and tremendously helpful for the baby.
I guess just lastly on this point, it seems to be somewhat of a conflict within the hospital or medical community that on the one hand we know that breastfeeding helps reduce obesity, yet the hospitals are involved in some kind of arrangement with the pharmaceutical companies that ends up promoting formula, which contributes to 71 5/31/06 - PUBLIC HEALTH - RES. 060171 obesity, for which the hospitals then directly or indirectly or the healthcare system ends up paying for after a laundry list of other bad outcomes as a result of obesity. So that is sightly convoluted.
I think it's very complex, and there certainly are instances where breastfeeding is contraindicated. There are conditions in the mother, conditions in the newborn, fewer than we used to think, but where breastfeeding is not a good idea, and so thank God for formula. Formula feeding is absolutely necessary in some cases. But it's a very complex relationship and it's going to be a while getting changed.
I just want to thank and commend our City Controller Butkovitz for your participation in this hearing. Your testimony, both on the specific issue and again, as you have in the past, the sharing of more personal experience, lends significant weight and credibility to your views on the topic, 72 5/31/06 - PUBLIC HEALTH - RES. 060171 and I think regardless of official position, you have a voice and a platform for which to speak and I want to thank you for the detail of your testimony and the sharing in such a personal way.
Thank you, and I would like to add one other thing. The New York Times did a series on the subject earlier in the year, and one of the things that was noted is although our insurance and our health delivery system will pay for people to have their feet amputated or treatment for the severe outcomes of diabetes, they will not provide for the routine maintenance and care which is so productive. I get regular treatment from an endocrinologist, and you're able to balance very precisely the amount of insulin with the amount of carbohydrates based on your own body and basically achieve normal numbers. So that there are many people who are facing health consequences that they shouldn't have to 73 5/31/06 - PUBLIC HEALTH - RES. 060171 face in this day and age because of the inefficiencies about the way the insurance and the health delivery system operate. So if there is a way through the Philadelphia health centers that you can make that kind of knowledge and constant monitoring of blood sugar for people who have diabetes and understanding of what kind of insulin injection -- it's relatively routine for people when they begin treatment to think that there's a set dosage they take no 14 matter what, and the more current thinking is that you manage it precisely to what you eat. It's a relatively simple step that could do a lot of good.
Thank you. Thank you. Mr. Lassiter, let me just, of course, thank you for your testimony and the good work over at the -- I'll just call it the University of Pennsylvania complex. With regard to CHOP, of course 74 5/31/06 - PUBLIC HEALTH - RES. 060171 the premiere children's hospital in the country, if not the world, can you give us some information with regard to the food choices and food options at CHOP that, of course, kids and naturally their parents might be exposed to? I read a story not too long ago about a change in the food service.
Yeah. We went from Sadesco to Aramark, which is a food carrier, in trying to attempt to make the environment healthy and conducive for the workers at Children's Hospital as well. One of the things that amazes me is that Children's Hospital of Philadelphia is the number one ranked pediatric hospital in the country, but on the bottom level of the Children's Hospital of Philadelphia you have a McDonald's.
Yes. You have a 75 5/31/06 - PUBLIC HEALTH - RES. 060171 McDonald's at Children's Hospital of Philadelphia. So one of the things I've often observed, a lot of kids come from our diabetes care clinic and then they go right down to McDonald's and they get a hamburger or they get a cheeseburger or they'll get french fries.
In the hospital, first floor. As soon as you come in the main entrance, adjacent to the main entrance there's a McDonald's. So one of the challenges for me has been more education as kids who are Type and Type leave our clinic, and particularly my particular patients, it's articulated to them not to go to the McDonald's or if they're going to go to the McDonald's, go with a small burger, go with a diet soda or try to go to our cafeteria to get more healthy food. And with the introduction of Sadesco 76 5/31/06 - PUBLIC HEALTH - RES. 060171 leaving -- well, actually the ushering in of Aramark, we have healthier food in our cafeteria. Typically we would have Pizza Hut. We would have bacon cheeseburgers and things like that. There are more healthier choices now. We have broccoli, we have string beans, we have a lot of baked foods now. But that has been a challenge for not just patients who are diabetic but just for workers in the hospital. On any given day, you can observe colleagues of yours who are obese and are at risk for heart disease and things of that nature going to McDonald's and coming back with four or five cheeseburgers and things of that nature. So right there, at a hospital that prides itself on getting people healthy, we have a toxic environment.
Is this a franchise operation or is this a corporate entity? Has it been there for a long time? 77 5/31/06 - PUBLIC HEALTH - RES. 060171
It's been there for a long time. It's been there, as far as I know, since 1994 when I first started at the Children's Hospital of Philadelphia.
Does the administration understand the -- I know they're trying to get into the salad thing and all that because they're worried that the feds are going to come in and treat them like the tobacco companies, so the fast-food people are trying to stay one step ahead of federal regulations, but that seems a bit bizarre.
I'm not really certain where the administration stands at the present time, but I know that there's definitely a need of advocacy around having a McDonald's at a hospital. But I'm not certain what status the administration has taken at the present time, but we can definitely find out.
I'd be very 78 5/31/06 - PUBLIC HEALTH - RES. 060171 interested, if you could forward that information to the Chair. I've got enough health-related fights going on at the moment, but that just seems a little unusual, a significant conflict in major public policy certainly. Thank you.
Maybe it's related to the fact that the Ronald McDonald House is there.
Well, the Ronald McDonald House actually sits on Chestnut, which is nowhere near Children's Hospital at the present time.
So that's like maybe four or five blocks up closer towards Walnut.
This is just a business decision that was utilization of space and somebody made a proposal and signed a lease. 79 5/31/06 - PUBLIC HEALTH - RES. 060171
It probably also came before the issue of healthy food, the idea of trying to provide healthy foods came about. Certainly you don't want to take a business out of a facility, but maybe there could be some discussion about changing the entire menu. Thank you all very much for your testimony and for your time. Next we have the School District, Joan Nachmani, Pam Gallagher, Marjorie Wuestner. Good morning. Ms. Nachmani, would you like to proceed. Identify yourself, please, for the record.
I'm Joan Nachmani. I'm the Program Director for the Nutrition Education Program of the School District of Philadelphia. As you have heard, childhood obesity is a growing national problem. The public schools are playing a central role in fighting childhood obesity 80 5/31/06 - PUBLIC HEALTH - RES. 060171 despite both political and financial constraints. Eating healthy at meals, as well as snacks, involves guidance and education. There are a multitude of media messages bombarding our children daily, making it difficult for them to decipher what is truly healthy and what is not. Saturday morning cartoons viewed by young children advertise foods of little or no nutritional value. Therefore, it is essential that we start early with positive nutrition messages and education to combat any misinformation from the media. Teaching nutrition basics of healthy eating empowers our students to make better food choices for their good health. The School District of Philadelphia recognizes the importance of instilling healthy eating habits and life-style changes in our students. Over the past two years, the District has made progressive changes in support of 81 5/31/06 - PUBLIC HEALTH - RES. 060171 promoting a healthy life-style, such as passing a beverage policy eliminating all beverages with the exception of 100 percent fruit juice, water and milk. Additionally, the District is in the process of passing a healthy snack policy as part of the July 2006 Wellness Policy and implementing new recreation and exercise programs for students and their families. NOW Nutrition Education Program's goals and objectives for nutrition education and looks forward to further expansion of the program in the future. The major goal of the program is to increase the likelihood of making healthy food choices consistent with the most recent dietary advice, as reflected in the Dietary Guidelines for Americans and the My Pyramid Food Guidance System recently revised. Entering its sixth year, this 82 5/31/06 - PUBLIC HEALTH - RES. 060171 unique program is funded by the United States Department of Agriculture Food Stamp Program. Outreach is free to public school students, teachers, staff, administrators and parents. Some basic messages include nutritious snacking, increasing fruit and vegetable consumption, understanding food labels and teaching the importance of breakfast. Recent research also provides compelling evidence that poor nutrition during any period of childhood can have detrimental effects on the cognitive development of children and their later productivity as adults. National studies have shown the importance of eating breakfast for improving academic performance. Harvard conducted this study, in part, with children in our own district, as Dr. Foster has referred to in the beginning, several years ago and concluded that children who eat breakfast often have significantly higher math scores, decreased rates of absence and 83 5/31/06 - PUBLIC HEALTH - RES. 060171 tardiness, have fewer disciplinary problems, demonstrated higher overall scholastic achievement and have improved psychosocial behaviors. NOW Nutrition Education Program was able to reach over one and a half million children and adults during the 2004-2005 school year. With the recent expansion of this program by adding several community partnerships for greater outreach, it is estimated that the 2005-2006 school year has the potential to reach over 7 million. Our District is the only district in the state fortunate enough to have extensive nutrition education outreach in our schools and the community. We are looked upon by the state as a model program. The 2004-2005 NEP, or Nutrition Education Program, Evaluation Report, which is included in your folder that I've provided for you, documents the impact and successful outreach of the 84 5/31/06 - PUBLIC HEALTH - RES. 060171 comprehensive nutrition education programs to students, families, teachers and nurses in the school community this past year.
Our outreach methods are diverse in order to engage students from kindergarten through 12th grade. The proposed Wellness Policy addresses the importance of nutrition education by outlining the following goals: The District aims to teach, encourage and support healthy eating by students through classroom teaching as part of a sequential, comprehensive, coordinated health education standards-based program. Nutrition education will be taught across the curriculum. And, by the way, these are things that are already in place and happening in our District. Nutrition education activities will include enjoyable, developmentally appropriate, culturally relevant participatory activities such as 85 5/31/06 - PUBLIC HEALTH - RES. 060171 contests, promotions, taste testing, farm visits and school gardens. Nutrition education will promote fruit, vegetables, whole grain products, low fat and fat-free dairy products, healthy food preparation techniques and health-enhancing nutrition practices. Nutrition education will emphasize caloric balance between food intake and energy expenditure, key for maintaining optimal body weight. Nutrition education will provide links with school meal programs, other school foods, nutrition-related community services and home and school council. Nutrition education will teach media literacy with an emphasis on food marketing, and education marketing and promotions outside the classroom will be linked with schools. Teachers will receive professional development to enhance their skills in teaching nutrition. With a sound nutrition 86 5/31/06 - PUBLIC HEALTH - RES. 060171 education program and a Wellness Policy established, I see the future of the children being guided towards better health. The School District of Philadelphia is moving aggressively to ensure that our students are receiving the nutrition education they need to achieve in the classroom and in order for them to work towards becoming healthy teenagers and adults. Thank you for giving me the opportunity to provide testimony today.
Yes, it is. My name is Pam Gallagher. I'm a Field Services Coordinator for the Division of Food Services with the School District of Philadelphia. And just for the record, Councilman Nutter, the McDonald's at CHOP has been there since 1979. I did my internship there from a diabetic student at Community College of Philadelphia and 87 5/31/06 - PUBLIC HEALTH - RES. 060171 remember that being a part of the big promotion of opening CHOP. And so it's been there since 1979.
It is the Division of Food Services' mission to make a significant contribution to the general well-being and mental and physical capacity and learning ability of each student and afford them the opportunity to fully participate in the education process. This is achieved by providing students with the wholesome, nutritious and appetizing meals served in a courteous manner in a sanitary and pleasant dining environment. This mission has been and will continue to be pursued in the most efficient and most cost-effective means possible and in accordance to the regulatory and policy guidelines of the National School Lunch Act, the Pennsylvania Department of Agriculture and Education, the Philadelphia 88 5/31/06 - PUBLIC HEALTH - RES. 060171 Department of Health and the School District of Philadelphia. Many children eat two-thirds of their meals at Philadelphia schools. Some come to school hungry or malnourished and the school may be the only place where these children can eat a healthy, well-balanced meal. This is why it is critical to a child's health that the food available in our schools is kept to the highest standard and to help develop life-long healthy eating habits. In addition to offering nutritious breakfasts and lunches, we provide meals at alternative times to enable students to eat throughout the entire day. We offer after-school snacks, twilight meals and Saturday feeding. This service allows the children the opportunity to maintain healthy eating habits outside the traditional school day. And I'd like to add at this point that Philadelphia was elected to be 89 5/31/06 - PUBLIC HEALTH - RES. 060171 involved in a pilot program from the USDA Fresh Fruit and Vegetable Program, which in two of our schools, Bartram High School and HR Edmunds Elementary School, we are participating in a fresh fruit and vegetable program which enables students to be introduced to fresh fruits and vegetables all during the day, any time, anywhere. So that that promotes healthy eating. It promotes students' recognition of vegetables and fruits that they may not normally be accustomed to. Our menus are analyzed on a weekly basis to ensure that we are meeting all the guidelines and requirements set by USDA. All of the food served is purchased from reputable suppliers and manufacturers to ensure that we offer our students the best possible food available. To develop our menus, we utilize systems which use meal patterns, age and grade groups as planning tools. The lunches we provide offer one-third of 90 5/31/06 - PUBLIC HEALTH - RES. 060171 the recommended dietary allowances as set by USDA, and the breakfast meets one-fourth of the recommended dietary allowances. Nutrient standards are an integral part of the menu planning process. The USDA has set the required minimum levels of calories and key nutrients to help us to achieve the nutritional goals for specific age and grade groups of children. We specifically monitor calories, also called energy allowances, and five key nutrients - proteins, calcium, iron, vitamin A and vitamin C - total fat, which is not to exceed 30 percent of calories over the school week, and saturated fat, which is to be less than ten percent of the calories over a school week. We ensure that our students eat a well-balanced meal by following the National School Lunch Act and Breakfast Programs. These programs enforce that 91 5/31/06 - PUBLIC HEALTH - RES. 060171 our students take a mix of food groups, which include meat or meat alternatives, fruit, vegetables, grains and breads and milk. In June 2004, the School District of Philadelphia adopted nutrition standards for all snack and a la carte food items. These standards are maintained for all snack and a la carte items sold in the school, including vending. Our policy limits the snack product line to a total fat content that must be less than or equal to seven grams per serving. The saturated fat content must be less than or equal to two grams per serving.
The sodium content must be less than or equal to 360 milligrams per serving. The sugar content must be less than or equal to 15 grams of sugar per serving. And candy will not be sold or served during the school day. The Division of Food Services also established a beverage policy in June 2004, which Joan mentioned, which 92 5/31/06 - PUBLIC HEALTH - RES. 060171 sets forth guidelines for beverage products allowed for sale in all Philadelphia elementary, middle and high schools. All beverages sold in the school must comply with the beverage policy. And our beverage policy, once again, only allows for milk, water and 100 percent fruit juice to be sold in our schools. This is for any part of the school, including the cafeteria, vending, fundraising and school stores. The Division provides continuing professional development for all employees at its headquarters and in the schools. We regularly train on topics such as nutrition, merchandising and customer service. Customers, our students and associates, are the purpose of our work. In addition to providing nutritious meals, we want our students to feel comfortable in their environment. That is why we have started to update our cafeterias using a branded concept to 93 5/31/06 - PUBLIC HEALTH - RES. 060171 give them a more retail-like atmosphere. We are in the process of updating high 4 school cafeterias next year and will 5 continue to implement these new brands 6 throughout the School District. 7 In summary, schools should be 8 safe havens for children, where only 9 healthy foods are offered. Foods high in 10 sugar, salt and fat are readily available 11 to students on their way to and from 12 school and in the communities where they 13 live. The school cafeteria offers an 14 alternative to unhealthy eating and gives 15 students the opportunity to learn how to 16 nourish their bodies while enjoying 17 healthy food choices. The Division of 18 Food Services takes its responsibility as 19 stewards of the children's caloric and 20 nutritional intake very seriously. 21
Councilman Nutter, may I deviate for a second and ask your indulgence to have everyone, in 94 5/31/06 - PUBLIC HEALTH - RES. 060171 the light of good health, take a seventh inning stretch?
Only if we can get Michele, our stenographer, to play the organ and get the music that goes with it.
Just for a second. I think the folks back here would truly appreciate it. Thank you. (Pause.)
Before I begin testimony, I'd like to direct your attention, if I could, to the booklet of information and very quickly just explain what you have in front of you so that you can read it while you're on the treadmill.
The red -- we have a couple red ones. 95 5/31/06 - PUBLIC HEALTH - RES. 060171
If you open, you'll see the Philadelphia Youth Risk Behaviors, the survey, and that will give you a great deal of information about our youngsters, the behaviors, their attitudes and beliefs. And here comes the Director, Betty-Ann Creighton, to help you find it.
Thank you. I need a fair amount of assistance. Thank you.
I don't think so. Then there is Steps to a Healthier Philadelphia, which is an initiative, and we talked about the importance of having a coalition of folks working together for a common goal, and a lot of the people in the room are part of this initiative, and so that information is there. Talking about the Coordinated School Health Program Model, which is a 96 5/31/06 - PUBLIC HEALTH - RES. 060171 CDC initiative, and I'm pleased to say -- and it has taken us about ten years, I guess, to get to this point -- that the School District of Philadelphia has adopted this model. The last piece on your left-hand side is about a system-wide initiative called the Fitness Gram, and I'll talk to that shortly. On the right side, you'll find the testimony and then some information about the shape of the nation regarding our national standards for physical education. Also, I thought what was interesting, and that's why we placed it in here, was how the State of Pennsylvania compares to other states and what the requirements are for physical and health education. And then you have a couple articles, again, for your treadmill. Thank you.
Reflect for a 97 5/31/06 - PUBLIC HEALTH - RES. 060171 moment on your own school experience in physical education. You may remember that the fitness tests that placed you on a chart labeled you from the 99th percentile to the 10th percentile. It was great if you were in the 99th percentile, not so great if you were in the 10th. How many chin-ups, push-ups, sit-ups and squat thrusts could you do? After fitness testing, there were sport skills training and other kinds of things like this, such as how many volleyball serves would make it over the net, how many lay-up shots went in out of ten. And the best test, the one that most people truly remember from the gymnastic unit, could you climb the rope halfway up, switch to another rope, continue to the top and then climb down, as the rest of your classmates watched you do this? And for some, it was a horrible experience. Today as adults, do you do any of these things for fitness? What we do today and recommend 98 5/31/06 - PUBLIC HEALTH - RES. 060171 for life-long fitness is the following: Walking, jogging, hiking, bicycling, skating, rowing, participate in golf. We bowl, play tennis, fish, swim, sail, belong to a fitness center, and maybe sometimes we play badminton in the backyard or a gathering, volleyball or horseshoes at parties and maybe even participate in an organized softball or a basketball team. Now, compare the two. Which would you rather participate in? What are we attempting to accomplish today in schools with limited resources, limited materials, limited facilities and reduced manpower? First, we are revising the fitness testing to become more personal for students. After being tested for muscular strength, muscular endurance, flexibility, aerobic capacity and body mass index, students receive a report that is based on their age, height and weight. They receive an individualized report that states whether 99 5/31/06 - PUBLIC HEALTH - RES. 060171 or not they are in the healthy fitness zone and what they can do to improve or maintain their own level of fitness. They take the same fitness test at the end of the semester in order to see how they have improved. Now what happens in between these two tests? Students learn what they need to do to improve various components of their fitness, and the teacher knows from reading the class report what activities will best support improvement for the class as a whole. Teachers include a variety of activities based on national, state and local standards. These standards require movement education, sport skill development, self-reliance skills and adventure activities K to 12. Teachers may use aerobics, weight training, recreational activities, dance and non-traditional activities, such as rock climbing, golf and/or skating in order to accomplish these standards. Some 100 5/31/06 - PUBLIC HEALTH - RES. 060171 professional journals refer to this as the new physical education, but we in Philadelphia have been working hard to implement this program and create change in all schools since 1995. Improving student health and achievement is the top priority of the Office of Health, Safety, Physical Education and Sports Administration. There is strong research to support the connection between physical activity and academic achievement, and Dr. Foster showed this in his presentation. At one time, Philadelphia was a leader in the state, requiring physical education every year, K to 12. 5 credit for health education. 5 credit for health education. Pennsylvania law requires yearly physical 101 5/31/06 - PUBLIC HEALTH - RES. 060171 education in K to and states that physical and health education must be taught in middle and high school with certified health and physical educators. However, if you note in the information that's in your booklet, there are no stipulations as to how long or how much should be rostered.
The District continues to employ certified health and physical education teachers, but the number of these educators has been dwindling in the past few years. High stakes testing has led schools to trade physical education teachers for additional reading and math teachers. Students are now sitting at desks for incredibly extended lengths of time. Some neighborhoods have become so unstable that principals have made the very difficult decision to eliminate recess due to safety issues. No Child Left Behind dictates that students who fall below the 26th percentile in the 102 5/31/06 - PUBLIC HEALTH - RES. 060171 PSSA attend mandatory remediation after school, therefore restricting involvement in physical activity clubs. Elementary schools have an average of 45 minutes a week of physical education, in some cases sharing space with cafeterias. This reduces the number of physical education classes a school can schedule each day, because of the time needed for setting up lunch and clean-up of the cafeteria or sometimes referred to as an all-purpose room. In elementary schools that do not have certified physical education teachers, classroom teachers are charged with the responsibility of the physical education program. This may present an unsafe situation based on teachers' experience and comfort with teaching physical education. Some high schools wait until the 11th or 12th grade to schedule physical education classes because of having to employ less teachers compared 103 5/31/06 - PUBLIC HEALTH - RES. 060171 to larger 9th grade classes. The Youth Risk Behavior Survey, which we normally call YRBS, a Center for Disease Control initiative, shows a very disturbing trend. From 1991 to 2005, student participation in high school physical education classes dropped significantly. Seventy-two percent of Philadelphia students attended physical education one or more days a week in 1991, while only 38 percent did so in 2005. 5 credits of physical and health education for students within a four-year period of time. In a time of epidemic obesity rates and reduced opportunities for daily physical activity, it is time to take the leap and require a combination of increased physical education and opportunities to schedule club activity periods into the school day. The National Association for Physical Education and Sport, known as NASPE, 104 5/31/06 - PUBLIC HEALTH - RES. 060171 along with the American Heart Association, recommends that school-age youth should participate daily in 60 minutes or more of moderate to vigorous physical activity that is developmentally appropriate, enjoyable and involves a variety of activities. Secondly, all elementary school students should participate in at least 150 minutes per week, which that comes to approximately 30 minutes per day, and all middle and high school students should participate in at least 225 minutes per week of physical education for the entire year, and that comes to approximately 45 minutes per day, which is the typical teaching period in high schools. Philadelphia has the capacity to become a leader across the country in fighting childhood obesity. The School District of Philadelphia has taken the following steps which will help create greater opportunities for increased physical activity among our youth: 105 5/31/06 - PUBLIC HEALTH - RES. 060171 Refurbishing existing and building an additional school gymnasiums. 4 And, of course, we're hoping 5 that we have the capital funds to do just 6 that. 7 School clubs and other programs 8 for enrichment. This is a new program 9 that CEO Paul Vallas has asked my office 10 to undertake, and we call this SCOPE, and 11 you'll be hearing a lot more about this, 12 but right now we have approximately 13 between 14 and 16 percent of our 14 youngsters actively involved in something 15 after school.
Our goal through the SCOPE 16 program and, of course, our after-school 17 athletics and our art and music programs, 18 we hope to have at least 75 to 80 percent 19 of our youngsters participating in 20 something, and that will help to make school more meaningful for them. We have wonderful partnerships with Philadelphia Outward Bound with Ed Snider's Ice Hockey Foundation Program and Independence Blue Cross River Rink 106 5/31/06 - PUBLIC HEALTH - RES. 060171 Ice Skating Program. We offer a wide variety of professional development opportunities for teachers and administrators. We've applied for the Carol M. White Physical Education for Progress, or PEP, grant, which is a national grant, national monies, and hopefully we will be getting this, we will be successful and, if so, over three years of time for each year we'll have approximately $400,000 and then maybe 300,000 and 200,000. And we have written this specific to the 9th graders because we feel that they need that attention if we are going to change behaviors toward physical activity. We also have a BEEP education grant, a BEEP grant, which is a Bicycle Education Enhancement Program with PennDOT, and we are encouraging -- we purchase bicycles. We provide training. We encourage youngsters to ride their bikes safely to school. And, of course, through this program, we're trying to 107 5/31/06 - PUBLIC HEALTH - RES. 060171 increase more of an interest among families, too, to participate in cycling as opposed to just driving their car everywhere. The Central Level School Health Council that I mentioned before through the Steps to a Healthier Philadelphia initiative has recently developed a School District Wellness Policy, and you will be getting a copy of this as soon as the SRC adopts it, and it addresses key factors that have a direct influence on the health and wellness of youth. And I have a number of the components. I'm not going to read all of them there, but some of the key ones would be that all students enrolled K to 12 will have access to sequential comprehensive standards-based physical education programs taught by certified health and physical education teachers. And, of course, in order to have a quality physical education program, everything must be aligned and be standards based 108 5/31/06 - PUBLIC HEALTH - RES. 060171 and be aligned with our state standards and our national standards. I mentioned before that we have a centralized fitness tool. We will continue to accelerate that. And one of the things, I think, a component that many times is missing, and this is in the classroom as well as in the gymnasium, and, that is, making physical education, making learning fun, and it has to be an enjoyable experience. You know as adults if we are not happy and don't feel good about ourselves in participating in something, we're not going to do it or we will make every excuse possible not to do it, and kids are no different from this. And the Local School Health Council will apprise students, staff and families of programs that support physical activity and wellness in the community. As was mentioned earlier, I think it's vitally important that we as a group look at the problem of obesity from many different angles, and it's going to 109 5/31/06 - PUBLIC HEALTH - RES. 060171 be a collective effort in order to solve this problem. Our children deserve the very best that we can give them, and I don't think anyone would argue with that, but we should be the one who have the answers. We should have the solutions to curbing this terrible obesity epidemic. And former Surgeon General Dr. Antonia Novellos said it best, "Health and education go hand in hand. One cannot exist without the other. To believe any differently is to hamper progress. Just as our children have a right to receive the best education available, they have a right to be healthy. " And I truly applaud City Council in making the health and well-being of our present and future generations a priority. Thank you.
Good afternoon, everyone. Let me first say a huge thank you, because in your final comments, you're absolutely right, it is going to take a collective, good thinking of those of us who care about kids in general and then it's going to take the practitioners, as well as those who live and breathe the issue every day, to come to grips with this national crisis. So on behalf of the Chair of this Committee and sponsor of this measure, I welcome you personally. Secondly, by way of background, I would be remiss to not have the record reflect -- and I've learned the hard way here. Sometimes you really have to toot your own horn, but to the issue around the beverage policy, that was actually the result of the work of my office three years ago where we introduced a resolution calling for the School District to look closely at this measure, because then nationally there was the 111 5/31/06 - PUBLIC HEALTH - RES. 060171 rise of obesity. It just has not hit like a bing the way it has in recent months. And the outcome of that was a year of negotiating with the School District, and I should mention negotiations with our major local soda corporate Philadelphia, who were not happy with this measure, but at the end of the day -- in fact, I actually offered one compromise, and that was to not have any sodas in the elementary and middle schools and that high school students do what they think they can do, and, that is, exercise good judgment, but then the School Reform Commission decided otherwise and made it no sodas across the board, and here we are two years later beginning to see some of the good that has come out of that. And so this measure, this action today is, I think, again a step in the direction to do better with regards to attacking this issue of obesity. A couple of questions. One, 112 5/31/06 - PUBLIC HEALTH - RES. 060171 with regards to the nutritional educational program you spoke about, is that real right now? Is that soon to be kicked off? What's the status of that? How old is that effort?
This program has been in effect since 2000. It's real. It's in effect. If you look in your pamphlet that I passed out with nutrition education in the schools, you will see a comprehensive scope of services that we provide to our students. Not only is it real and in effect, it has grown from under a $1 million grant in 2000 to over a $10 million grant in the schools with our community partners that we have working in conjunction with delivery of services.
It is system wide. The schools that receive the nutrition education program must meet eligibility based on food stamp 113 5/31/06 - PUBLIC HEALTH - RES. 060171 eligibility. So, therefore, any school that has a blended rate of 50 percent or greater for reduced meal participation qualifies for free services. So we have services in approximately 274 schools. But at the same token, I don't deny services to those schools that don't meet eligibility. We have a wealth of information, curriculum, materials that they can call for us to provide resources to any school in the District as part of the School District. We just can't provide personnel in those schools.
And a separate question, the grant from the USDA, how did Bartram and the other school that I missed end up being the lucky two?
Yes. They were randomly chosen. 114 5/31/06 - PUBLIC HEALTH - RES. 060171
If you had to give the School District a grade right now with regards to -- let me preface the question by saying this: I've seen instances having visited schools where you have the all-purpose room and that's used for multiple reasons, and I've seen where physical education is blended in a very structured way with the overall school day, and I typically link that to a strong principal and an active home and school association who say, We want this for our kids. So what kind of discretionary factors are considered when principals opt not to either have physical education or place a heavier weight on those other discretionary factors that say, We won't have a physical education, separate from the academics portion of this, which is completely understood? They're saying that PSSA scores have to be higher, something has to be sacrificed. Typically it's arts and culture or 115 5/31/06 - PUBLIC HEALTH - RES. 060171 physical education, but what other kind of factors might lead a principal to say, We can't have physical ed?
Because principals are given a pot, and they will determine how many teachers they need to purchase in order to provide education for their particular school based on their enrollment programs in place. If it's in a high school, what type of academies they may have. A whole lot of different types of organizations. And some principals have opted to purchase a an extra reading teacher or an extra math teacher because of the pressures of trying to meet the AYP. And principals right now are between a rock and a hard place. I've talked to many principals and they've said, Margie, I don't want to have to -- 116 5/31/06 - PUBLIC HEALTH - RES. 060171
-- choose. I don't want to have to cut what I like to do. And then there were other principals who get the message that their scores will go up if they have a well-balanced educational program that includes the arts, that includes health and physical education. And you saw the statistics, and the statistics are real and they speak to the truth --
-- that if kids are participating in a quality physical education program and a quality art and music program, they will be more focused, their stress will be reduced and their scores will be higher.
But a lot of people don't understand that. They're afraid. They're afraid to take that 117 5/31/06 - PUBLIC HEALTH - RES. 060171 leap, that even if they know the statistics are there, they still feel that if I put the students -- instead of for an hour for reading, give them two hours of reading, well, if you're teaching reading the same way for those two hours, those students are not going to progress. It comes down to a whole variety of things that's being used in the classroom. I can't begin to tell you how important the teacher competence is in whether or not the youngsters meet their AYP. And it's not time so much as the type of teaching and the commitment of the teacher. So I, for one -- and I've heard Paul Vallas say this, too -- know how vitally important it is for the kids to have opportunities to be physically active.
And one of the 118 5/31/06 - PUBLIC HEALTH - RES. 060171 things that we're looking at -- because, again, looking at the statistics that shows a positive movement in the scores and providing for physical activity that will help us in our obesity fight would be somehow going back to scheduling different clubs during the school day. This is a hook for many kids to come to school. If you're going to have an inventor's club, if you're going to have some type of physical activity club or if you're going to have a photography club, ballroom dancing -- I've been getting lots of requests for ballroom dancing, and we're looking into that kind of thing now -- a fishing, a boating -- you know, Michael, how important it is for the Outward Bound initiative. When we have sent youngsters on Outward Bound expeditions, which is probably one of our best programs that has partnered with the School District, we have seen tremendous change in youngsters' self-esteem, in their leadership capabilities, and they 119 5/31/06 - PUBLIC HEALTH - RES. 060171 have excelled in classrooms to such an enormous extent beyond what the classroom teacher would expect, and we have documented a number of these incidents. So I can't speak strongly enough -- and as you can tell, I am very passionate as the Executive Director of this wonderful Office of Health, Safety, Physical Education and Sports Administration -- that we have an important role to play in fighting obesity and making kids just feel better about themselves. And even though I looked at the chart and I saw how we have failed terribly, my glass is half full and I do believe that we can counteract the rate of obesity, and it will take a number of people coming together from all different groups to do this, but I truly believe we can do it.
My final question is, I need your opinion because I'm at a crossroads on a different measure I introduced a year ago calling 120 5/31/06 - PUBLIC HEALTH - RES. 060171 on fast-food restaurants to actually show the nutritional value of their entire menu selection. We ran into a hurdle with the Law Department on one end, and so, as I said, my office is at a crossroads on whether or not we want to push forward with that or actually put more teeth in it so that it becomes something more than just a sheet of paper that folks get when they walk into a restaurant. You actually see it on the -- not billboard. Help me out
The menu board. So do you think that would be useful? Do you see any value in that as we talk about the big picture of obesity in children? Do you believe parents would tune in, if you will? Do you think that would make a difference, given your professional experience in this area? Any or all of you could comment.
I definitely 121 5/31/06 - PUBLIC HEALTH - RES. 060171 think it would help. Again, we have to saturate in order for us to, I think, be successful in that, saturate the population, help parents understand more about nutrition, exercise, encourage families to do more together, because, again, it has to be enjoyable. But if they go into a fast-food restaurant and they see -- I see this as a learning opportunity. I see the schools getting involved with this initiative. Joan's programs, the NEP program, is part of our health and physical education initiatives, and together we would be able to accomplish so much more than just posting those menus for people to see. Maybe having large menus on the board of doing some type of an analysis. And, again, here you go, you're looking at health and then you're taking the math skills that the kids are learning and you're combining, you're integrating the math and the health education piece. 122 5/31/06 - PUBLIC HEALTH - RES. 060171 I just don't think we can do enough when we -- one of the examples was about the safety belts. It's true. And, Michael, when I was younger, I didn't have safety belts in my car either. And many people were nay-sayers and thought -- it's a behavior. And that's what we're doing, and that's what our health education is all about, is trying to change behaviors so that they become very positive in scope. We want to look at the negative behaviors and do it. And it's not going to happen overnight, obviously, or we would have been successful before now.
But I think that would be one of the steps that may be helpful.
In collaboration with the other types that come out of this hearing. 123 5/31/06 - PUBLIC HEALTH - RES. 060171
In collaboration. Again, it takes a village, and I think this is very true when we're talking about this fight that we have in front of us.
I'd also like to add that Dr. Kumanyika mentioned about the economic win, the win-win, and you spoke about the fast-food restaurants, and I'm sure you've been into a restaurant where they mark the healthy meal with a heart or a star or something like that.
We need to look at portion distortion along with our snack policy. I didn't mention this, but we don't sell anything that is more than one single serving either. So that if a package says there's two servings in this package, we don't sell that. And that 124 5/31/06 - PUBLIC HEALTH - RES. 060171 helps students recognize that there is moderation and that when we learn to do that, that's part of overall being healthy. So I think that economic piece goes along with that, and I think that your idea of putting the nutritional value or even marking the healthier choices would help parents and students make a decision when they're at a fast-food restaurant.
I'd just like to add also that by posting the information, it creates awareness. It's very difficult for the layperson to really understand what all those numbers mean, and the understanding that there's concern at the fast-food restaurant enough to post that information will create the awareness, but I wouldn't count on people to really comprehend what's up there. So as was referenced before, portion control, everything is okay in 125 5/31/06 - PUBLIC HEALTH - RES. 060171 moderation. That message is not getting across from the fast-food industry. But showing a serving size, teaching the nutritional values of things in our program and also giving them the guidance and education and making better food choices when they're entering a fast-food restaurant is really one approach that we try to use. We do teach calories and we do incorporate the math and science concepts, as Margie referred to, in our program, especially for high school children, but we try to get them to make better choices, select baked instead of fried, look at the salads and the dressings and are they really lower in fat than a fast-food burger. And there are many surprises when you go through the education of fast-food restaurants to see that what appears to be may not actually be reality when it comes to better choices in foods. So it's good because it creates awareness to post these things and create 126 5/31/06 - PUBLIC HEALTH - RES. 060171 the interest, but there needs to be a lot of education that goes along with it. And I know that many of the fast-food restaurants have their own educational pieces that they do put out and market for school-based use as well, and we have taken a look at those and tried to incorporate them in our education process along with regular nutrition education programming.
Well, again, let me thank all of you for your testimony, those before and after you. I guess I can assure you that there's a real keen interest by members of this Committee, along with the sponsor, to figure it out and do better going forward. Thank you very much. Thank you, Councilman.
Just a couple of quick items. Margie, you mentioned we certainly know what to do and it's being 127 5/31/06 - PUBLIC HEALTH - RES. 060171 done in some schools, but then apparently there's some amount of discretion and as we kind of constantly battle the centralization versus decentralization in terms of how decisions are made, the securing of certain services, is it the reading aide or is it the health or physical education person hopefully certified. And I guess not to start a big fight within the house, but it seems to me that for some of these things that we know, we would never find ourselves in a trade-off between math and something else. And I know that certain things are required, of course, by the School Code, but that doesn't stop the School District from setting certain policies and --
-- establishing certain baselines for ourselves. The state guideline says you only need a credit and a half of physical activity. I think there's probably 128 5/31/06 - PUBLIC HEALTH - RES. 060171 nothing to stop the District -- I think your testimony or someone else's testimony indicated that 10, years ago 5 or some period of time ago, it was two, 6 plus and a half on health. 7
So, of 9 course, we can't go lower, but we can go 10 higher and this balance between our great 11 education and the 8 million tests that 12 kids have to take, but if the end result 13 is they are heavier or overweight -- they 14 may be a little smarter, maybe, but 15 unhealthy at the same time -- doesn't seem to be a really good choice. And this discussion about principals, some want to take the leap of faith, some don't want to take the leap of faith, I think as the District expands, as you go through the capital program, as we move to separating gyms and cafeterias and multi-purpose, it's breakfast in the morning, somebody is having gym at 9:15, back to lunch, and as we try to change 129 5/31/06 - PUBLIC HEALTH - RES. 060171 our school buildings around, I think -- we have the kids. We kind of have the bodies. We get to do certain things for about seven hours a day.
In fact, the majority of it is on us, and it is all about School District of Philadelphia policy. The previous administration had cut our 2.5 to this 1.5, and for years, we were able to provide a much more comprehensive program to our youngsters. And I think we are truly doing a disservice to our students in Philadelphia, because in many cases, a youngster going into high school will not have physical education until they're a senior. Now, that's horrible.
That is absolutely inexcusable. And we want 130 5/31/06 - PUBLIC HEALTH - RES. 060171 policy to be changed. We think we have the information to help guide this change. And when we say that it's a state mandate to be able to address all of the benchmarks and standards in physical education, it is literally impossible to do so with the limited amount of rostered physical and health education. You just cannot.
And I can't say that we do. So I think we are really giving a disservice to our youngsters by allowing this current policy to stand.
Two last questions and then I am going to have to, unless Councilwoman has another question, move to the next panel. Ms. Nachmani, it came up in your testimony and then it came up in Ms. Gallagher's testimony. I just need to ask this question. Councilwoman Reynolds 131 5/31/06 - PUBLIC HEALTH - RES. 060171 Brown laid out the great work that she and her office had done with regard to sodas, and I was, of course, a supporter of the District's policy, and there were some challenges back and forth, as all of this unfortunately just comes down to money versus health. We're experiencing that in another endeavor. So we made the right decision there, but I do have the question. One hundred percent fruit juice, how many grams of sugar in a serving of 100 percent fruit juice?
Well, I know what you're getting at. The fruit juice sugar is higher than some other beverages.
It depends of the fruit juice, yeah. But the idea of doing 100 percent fruit juice with the policy was to give the children the idea that 100 percent pure fruit juice is a 132 5/31/06 - PUBLIC HEALTH - RES. 060171 better source of nutrients. We weren't looking at sugar content at that point. We were looking at the nutritional value of the juice. And we know that in reality, it's not good to consume large quantities of 100 percent fruit juice, especially some juices as opposed to others which are even higher in sugar content, but we felt that as an educational facility at the schools that are providing -- and we wanted the policy to be part of an educational process. We wanted to have the children understand that 100 percent fruit juice is a much better alternative nutritionally than a drink which is maybe a minimum of ten percent fruit juice and then the rest is sugar and water. So in the ideal situation, we don't want them consuming large amounts of 100 percent fruit juice and we've tried to limit that with the sizes that are offered in the cafeteria, but you're right, it does have a lot of sugar, and 133 5/31/06 - PUBLIC HEALTH - RES. 060171 we are really trying to emphasize the drinking of plain water.
Okay. Ms. Gallagher, two quick items for you. Given the earlier presentation, 40 percent of the Philadelphia kids are overweight and the items that you laid out in terms of programs that you're utilizing, what regular assessment tools do you have available to monitor how this program activity is affecting what's really going on with kids in school in terms of their diet and other physical education components? Are we seeing any change over any period of time?
No. I'm not sure exactly what you mean. The items that we offer at the meal times?