Calorie Counting in NYC

Posted on: November 5, 2009  |   Author: Karla
Filed Under: Legislation, Public Health Policy   |   Leave a Comment

New York City was the first city in the United States to legally require caloric content to be posted clearly next to menu item prices in chain restaurants.  Since this “ground-breaking calorie labeling law” was passed, 16 states and localities have passed similar laws.  Two recent studies reported findings that contradict one another.  However, the discrepancies are due to variations in study focus and size.

The first study focused on low-income, minority neighborhoods.  Researchers assessed the effect of calorie labeling on individuals purchasing chain food within these neighborhoods.  The results of the low-income neighborhood study show that the calorie labeling law had no effect on the meals purchased at chain restaurants.  “We looked at a population that’s much more price sensitive, so calorie information could have taken a backseat to pricing in our group,” said Brian Elbel, assistant professor of medicine and health policy at New York University School of Medicine and author of the study.  Elbel also noted that he would have liked to have seen a larger impact on this population because obesity rates tend to be higher within the low-income, minority neighborhoods.

The health department’s study assessed the effect of the calorie labeling law on a citywide level.  The results of this study showed little change in the amount of calories purchased at 8 of 13 chain restaurants surveyed.  People purchased fewer calories at Au Bon Pain, Kentucky Fried Chicken, McDonald’s and Starbucks. Despite the lack of change among the majority of chain restaurants, there were two interesting findings.  First, the amount of calories purchased at Subway has increased significantly.  Researchers attributed the increase to the ongoing “$5 footlong” sandwich promotion. Secondly, the number of calories purchased at coffee shops decreased by nearly 10 percent.  In 2007, the average amount of calories purchased at coffee shops was 260.  Now, the calorie average is down to 237 calories.

Among chain restaurant customers, only 56% said they noticed the calorie information posted with the prices.  An even smaller number, 15%, used the calorie information when deciding what to order.  On average, the 15% of individuals that take the calorie information into account purchased 106 fewer calories than consumers who did not notice or use the calorie information.  “Dietary changes come slowly,” said Dr. Lynn Silver, an assistant commissioner in the city’s Department of Health and Mental Hygiene, while explaining the results.

Commentary: Although New York City’s calorie labeling law has not achieved significant results in reducing caloric consumption throughout the city and within low-income, minority neighborhoods, the law has made an impact in a short amount of time.  This law was the first of its kind, and it is promising to see that 16 other states and localities have followed in New York City’s footsteps.  Further, the 10 percent decrease in the amount of calories ordered at coffee shops is a step in the right direction.  Many of the calories that people overlook are liquid calories, such as those found in flavored lattes and blended coffee drinks.  Unfortunately, the results from the low-income neighborhood study show that caloric content is less influential than lower prices.  In order to decrease caloric intake in low-income neighborhoods, healthy foods need to be more affordable and available.  Despite these challenges, the law is still young and could make a larger impact in the years to come.

The New York Times, November 2, 2009

Controversial Abortion Procedure Reporting Laws Under Fire

Posted on: October 31, 2009  |   Author: Tiffany
Filed Under: Access to Care, Legislation, Other, Public Health Policy   |   Leave a Comment

An Oklahoma judge has temporarily barred a controversial new law related to the reporting of abortions. Originally set to be enacted on November 1st, the legislation will now be the subject of a December 4th hearing. HB 1595, or the Statistical Reporting of Abortion Act, requires all physicians who provide a woman with abortion services to submit an “Individual Abortion Form” to the state Health Department. The Health Department, in turn, will post the aggregate information on its website. The form includes 37 items, which include: the county in which the abortion was performed; the mother’s educational background, race, age, and marital status; the reason for having the abortion; and the method of payment.

Opponents have sharply criticized the law, claiming that it is designed to intimidate women who are seeking abortions and constitutes an invasion of privacy. Advocates claim that there are no privacy issues because the Health Department will be required to ensure that “personally identifiable information” does not appear on the website and that the questionnaires themselves will be kept private. The House drafters and supporters of the bill claim that the information garnered from the mandatory forms will provide a much clearer picture of abortion trends and aid the state in reducing its abortion rate.

Although the law has fueled the abortion debate, it is being challenged on the grounds that it violates a provision of the state constitution which mandates that bills pertain to one subject only. (In addition to the Statistical Reporting of Abortion Act, HB 1595 also contains a provision prohibiting gender-selective abortion as well as some modifications to definitions in the current state abortion statutes.)  Legislators have stated that they will likely rectify the problem by submitting the reporting provision as a separate measure next session.

Commentary: Despite the fact that the law is being challenged on constitutional grounds that have nothing to do with abortion, the heart of the controversy is obviously the state’s creation of another hurdle that women must clear in order to lawfully obtain an abortion.  Although the state website will publish the information in aggregate form, there is still room for concern over the potential for identification based upon particularly unique answers.  Moreover, it is questionable just how much some of the form’s questions contribute to the legislature’s stated goal of reducing the number of abortions.  While having certain socioeconomic data may help to target “at-risk” groups with family planning campaigns, one could argue that the questionnaire as a whole is over-reaching.  There are 38 options (including “other”) for a question pertaining to why the woman wishes to have an abortion.  The form instructs that all applicable choices should be selected.   A woman may be understandably hesitant to paint such a detailed picture of her life circumstances and it is dubious that some of the responses (i.e. - “Mother has completed her childbearing.”) would provide any meaningful data to the state.

The law further provides that a physician must submit a form for any woman to whom he/she provides the state-mandated pre-abortion information even if no abortion is performed.  (In Oklahoma, a number of materials must be provided to any woman before she undergoes an abortion.  They include information about the development of the fetus at various stages, the available methods of abortion, the risks involved, and the state aid available for pre-natal care, labor & delivery, and the general needs of the child.)  In theory, a woman could consider an abortion, discuss it seriously with her physician, decide against it, and still be subjected to the reporting requirements.  It seems that this could deter women from even speaking with a healthcare provider, for fear of having their information passed along to the state.  The provision also does not appear to aid in the state’s purported effort to compile abortion trend statistics.  Integrating the data of women who ultimately do not elect to have an abortion does not paint an accurate picture and ends up only showing how many women had unwanted pregnancies.

Although the majority of states do have abortion reporting requirements, Oklahoma’s law is far greater in scope and seems to be an undue invasion of privacy and, arguably, a legislative effort to hinder women seeking an abortion.  Regardless of its controversial nature, pre-viability abortion is legal and it is concerning when a state attempts to circumvent that with questionable law-making.  It will be interesting to see what becomes of the Statistical Reporting of Abortion Act in the future.  Given lawmakers’ stated intentions to reintroduce the Act on its own if HB 1595 is struck down, the issue could be on the table for quite awhile

Trick or Treat: House Democrats Finally Unveil Health Bill!

Posted on: October 29, 2009  |   Author: Yolonda
Filed Under: Healthcare Reform, Legislation, Medicaid, Medicare, Other, Tax & Finance   |   Leave a Comment

Today, House Democrats released a health bill amounting to 1,990 pages and costing around $894 billion. The bill broadly expands the Medicaid program by offering subsidies for moderate-income families to buy insurance from a government-run plan or from the private insurance industry. Members of the House estimated the bill would provide coverage to up to 36 million people and save more than $150 billion over 10 years from payments to private Medicare Advantage Plans.  Further, the government would sell health insurance in competition with private insurers with the intent to create more competition and force the private market to lower prices. This government insurance plan would negotiate rates with doctors and hospitals.

The bill also includes a provision that requires the secretary of HHS to negotiate drug prices on behalf of Medicare beneficiaries and would requires Americans to obtain insurance. Moreover, employers would be required to provide health benefits to workers, although small businesses would be exempt if their payroll was less than $500,000/year. Additionally, insurers could not deny someone based on pre-existing conditions and could not charge sick people with higher premiums. Children would also be able to stay on their parents’ insurance through the age of 26. Republicans criticize the bill as creating new unsustainable financial obligations and contend that the government with its Medicare fund already diminishing cannot afford supporting the bill. Additionally, opponents of the bill argue that a public option will drive private insurers out of the market. They further criticize Democrats for not listening to the American people and designing the bill to appease liberal special interest groups.

Commentary: The 1,990 page bill seems lengthy and daunting, and it is likely that more Americans will continue to express confusion and difficulty in being able to form valid opinions about the health bill since it is not easily comprehensible. I believe that both Republicans and Democrats have been trying to gain some input from the American people, but any opinions they may be receiving are either half-formed or invalid due to the complexity of health reform in general, and the fact that our lawmakers are introducing very lengthy and convoluted bills. Moreover, interest groups have tended to “fog” the facts or interpret the language of the provisions in a way that may be more biased towards the interests they are protecting, thereby making it harder for people to get an honest sense of the bill. It is highly doubtful that the average American will wake up on a Sunday morning with a cup of coffee and read the 1,990-page bill. Even if someone were to attempt to wade through the bill it is unlikely that they will easily understand what the provisions fully entail and how the provisions apply to them as an individual, parent, employer, or senior citizen.

The American people need something that consolidates and simplifies the provisions written within the bills. The Kaiser Family Foundation has created an online chart that outlines the previous provisions of the Senate Finance Committee, HELP Committee, and Tri-Committee bills. Although this tool is very helpful, it still requires going back to the actual bill text to get definitions for terms like “qualified health plan” or “essential benefits.” Who really has the time and energy to spend countless hours sifting through 1,990 pages of verbose legislative language? Hopefully, lawmakers or educators develop a way to provide the American people with an unbiased, detailed, and easily understood summary of the bill’s provisions so that Americans can become more proactive and educated about health reform and how it will impact them and their families.

New York Times, October 29, 2008

[Ed: For an excellent overview, see Saint Louis University School of Law Professor Sidney Watson's concise briefs regarding the iterations of the bill that have emerged thus far, posted at this blog within the "Related Links" sidebar.]

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