San Diego County has a reputation as a sand and sun sort of place, peopled by slim surfers catching waves and trim Navy sailors walking the beach. But the county is much more diverse than that. It encompasses more than 4,000 square miles, stretching from the Pacific to the fertile avocado and strawberry farms further inland.
It has a population of more than three million, spread over 18 cities, suburbs and unincorporated rural areas.
And, like the rest of the country, San Diego County has its share of fast food restaurants, televisions, Xboxes and cars — and its share of excess weight. More than 21 percent of the area’s population is obese and another 37 percent are overweight.
Increasingly, public officials in the county, as well as business leaders, are realizing that this problem is more than a health issue. County supervisor Ron Roberts has been concerned about the issue for a decade. He worries that chronic illnesses such as diabetes will slow economic development.
“Looking ahead to our future workforce, these people’s performance will be severely hampered,” he said. “You end up paying for that. It is almost like a monster movie. There’s something lurking out there.”
Research backs up Roberts’ concern. A study released two years ago by the California Center for Public Health Advocacy calculated that obesity and physical inactivity cost San Diego County more than $3 billion a year in health care expenses and lost productivity.
“Obesity is a massive drain on our country’s economic productivity,” said Dr. Harold Goldstein, executive director of the group. “We need to recognize that it is not only a huge health risk, but a huge fiscal risk too.”
California state officials have also recognized the issue. “The economic cost to California of adults who are obese, overweight and physically inactive is equivalent to more than a third of the state’s total budget,” California State Controller John Chiang has said. “Think of the programs we could protect, the children we could educate and the families we could help if we could recapture those dollars by investing in prevention.”
An Ambitious Effort to Make Healthy Living Easier
Over the past five years, San Diego County has begun a major effort to reduce and prevent obesity. Last year, the county began a $16 million project to develop policies that encourage exercise and better eating. The project, known as “Healthy Works,” is part of the county’s 10-year strategic plan for improving residents overall health and reducing rates of chronic disease.
The plan lays out a broad strategy to reduce cardiovascular disease, cancer, type 2 diabetes and respiratory conditions. Because excess weight contributes to many of these problems, the plan emphasizes the need to reduce obesity.
Healthy Works, which is overseen by the county health department, focuses on making longterm environmental and policy changes to encourage physical activity and healthy eating.
For example, county health officials are working with the regional planning agency on its 40-year transportation plan to ensure that the plan includes bike trails, walking paths and other means that promote physical activity.137
As part of the initiative, the health department has focused on increasing the number of community produce gardens. These gardens increase fruit and vegetable consumption, and also help the gardeners burn calories. The department has also created five regional garden training centers to teach garden managers, school staff and volunteers about the best ways to set up a garden and grow produce. In addition, the department is working with the county government to remove barriers that have blocked people from starting gardens. For example, until recently, groups that wanted to start a garden were required to pay a $40,000 start up fee.
In addition, Healthy Works is trying to make local fruits and vegetables more accessible to members of the community. San Diego has more than 6,000 farms, more than any other county in the country. They grow a variety of fruits and vegetables, including broccoli, avocados, strawberries and oranges. But very little of this produce goes directly to San Diego stores or tables. Instead, it is trucked to processing centers 120 miles north in Los Angeles. (Some then travels south again, and ends up in San Diego stores – but it is more expensive and not as fresh.)
To increase the local availability of this produce, Healthy Works is examining several alternatives: creating a processing center in the county; starting farmers’ markets to sell produce bought directly from county farmers; and linking county farmers to schools and other institutions that want fresh, lower-cost produce.
Healthy Works is also setting up a system that allows residents who receive food stamps to redeem them at some of the county’s 50 farmers’ markets.
Those who enroll receive $20 in matching funds, allowing them to buy more fresh produce.
And, to counteract the effects of billion-dollar marketing campaigns for unhealthy foods and sedentary activities such as video games, the county is rolling out its own TV, radio and web campaign, encouraging residents to be more active and to eat more fresh local produce.
Other groups are joining in too. The San Diego Childhood Obesity Initiative, a non-profit collaboration of several local organizations, is revamping four corner stores by providing them with coolers and refrigeration units so they can store and sell fresh fruits and vegetables. In exchange, the stores, which are in neighborhoods that have little access to fresh fruit and vegetables, must promise to continue selling produce after they receive the equipment.148
The Private Sector Responds
Area companies are also realizing that improving workers’ health can reduce costs.
In 2003, the San Diego County Regional Airport Authority, which oversees the San Diego International airport, launched a wellness program for its 360 employees. The Authority built an onsite 24-hour gym (airport employees work three shifts), and added incentives, such as gift certificates and extra days off, for workers who exercise.
“People say it’s changed their lives,” said Marci Fredericksen, who directs the Authority’s wellness program. “You can see people shedding pounds.”
From 2008 to 2009, the percentage of employees with a normal BMI increased by five percent. By 2010, 10 percent of workers had reduced their BMI. The Authority calculates that the program likely saved $1 million in health insurance costs between 2009 and this year.
Software maker Intuit has also developed a vigorous wellness program. The company has about 1,400 employees in the San Diego area (its headquarters are in Mountain View, California, near San Jose).
Part of the motivation is economic, says Intuit’s Sarah Lecuna, who helps run the program.
“We’re looking to lower health care costs,” she said. “If we take preventive measures up front, we hope to see cost reductions in the future.”
The program, which is available to all of Intuit’s 7,200 American workers, offers a range of approaches to encourage healthy living. The company offers a free screening program that checks cholesterol levels, blood pressure, triglycerides and blood sugar. Employees who take part receive a $650 reduction in their health insurance premiums; 93 percent of all Intuit workers take part. The screening is also open to spouses and domestic partners.
Lecuna sees this group as a crucial part of the wellness program. “If you don’t have a support system at home, this doesn’t go very far,” she said. “It’s got to be a lifestyle change.”
In addition, workers who pledge to stay tobacco-free for the year receive another $650 discount on premiums. In addition, Intuit provides employees with free pedometers. Depending on the number of steps they take, participants are eligible for up to $300 in cash and prizes. Intuit cafeterias offer a range of healthy choices at significant discounts, and the company also offers free exercise classes, in San Diego and at several other locations.
Lecuna said that because the screening program has been so successful, Intuit’s health insurance costs have gone up slightly, because so many people see doctors after getting screened. However, she expects that over the long term, the program will lower health costs.
“Down the road,” she said, “we expect we won’t be paying as many huge claims, because people are taking better care of themselves.”
Targeting Childhood Obesity
The county is also focusing on childhood obesity, which is a costly problem. According to research published this year in Academic Pediatrics, the average obese child costs the health care system nearly $300 a year more than a healthy-weight child. Reducing the childhood obesity rate by just a single percentage point would save at least $1.4 billion a year. In addition, obese children have a significantly higher risk of growing up to be obese, and obese adults spend, on average, $1,400 more per year on health care than healthy-weight adults.
As part of Healthy Works, the county is awarding $50,000 grants to five county schools to develop Safe Routes to School programs, which encourage children to walk or bike to school.
Research shows that few contemporary students expend calories getting to and from school. In 2001, one in ten students walked or biked to school; by comparison, in 1969, the rate was four times higher. The county is also giving out several smaller grants to educate parents, students and teachers on walking and bicycle safety.
The school district is also changing its approach to food. It published new guidelines that encourage administrators, teachers and parents to have healthy food at school events and meetings.
And it is expanding its breakfast program, offering it to more students and making the food healthier. Previously, only 25 to 30 percent of eligible students ate breakfast at school and only three percent of eligible students participated in the summer breakfast program.
Roberts, the county supervisor, is optimistic about his community’s prospects. “We’re moving in an aggressive way,” he said. “I think it’s going to bring positive results. We still have a long way to go. But we’re going in the right direction.”
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