Public health extras: News on medical spending, air pollution, nutrition, recession and weight gain
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* Kim Krisberg

## Mental health captures most medical spending

In 2013, mental health disorders topped the list as the costliest health conditions in the U.S., finds a May *Health Affairs* study.

In analyzing data from the federal National Health Expenditure Accounts and the Medical Expenditure Panel Survey, researchers found that mental health disorders were the costliest health problems in 2013, with spending at $201 billion, of which 40 percent was due to institutionalized populations.

After mental health, the costliest health problems were heart conditions and trauma, at $147 billion and $143 billion, respectively. In fourth place was cancer, at $122 billion, and in fifth place were pulmonary conditions, at $95 billion. In contrast, the study noted that in 1996, the costliest health problem was heart conditions, with spending at $105 billion. Mental health disorders came in a distant second in 1996 at $79 billion.

The study also found that personal health spending grew at an average annual rate of 5.9 percent between 1996 and 2013. And while spending on mental health disorders had a growth rate lower than many other conditions, “because it is such a large category, it contributed the most in terms of excess dollars spent: $38 billion,” the study stated.

The researchers cautioned that mental health spending will likely increase as medical advancements help people live to older ages, when issues such as dementia become more common.

## Economic downturn tied to weight gain in kids

Among the many negative impacts that came with the Great Recession was an increased risk of weight gain among children, according to a recent study.

Published in June in the *Journal of Epidemiology and Community Health,* the study found that a rise in unemployment in California during the Great Recession was associated with a higher risk of weight gain among 1.7 million public school students. To conduct the study, researchers analyzed data from the California Department of Education, which collects height and weight information for children in fifth, seventh and ninth grades, and compared it alongside county-level unemployment data.

The study found that for every 1 percentage-point increase in county-level unemployment between 2008 and 2012, children faced a 4 percent increased risk of becoming overweight. The average change in unemployment during the study period was 5.4 percentage points, which put the increased risk that a child would become overweight at 21 percent. The study noted that even small changes in a child’s weight can increase the risk of chronic disease later in life.

Researchers hypothesized that the economic downturn could have led families to change their grocery shopping habits or to cut back on after-school activities that involve physical activity. Researchers also noted that the study’s findings underscore the importance of social safety net programs, such as unemployment benefits and food assistance.

## APHA opposes bill that reduces nutrition oversight

APHA is calling on Congress to use science and research to guide its regulation for children’s nutrition.

In a May 17 letter to the leadership of the House Committee on Education and the Workforce and Subcommittee on Early Childhood, Elementary and Secondary Education, APHA joined more than 750 other organizations to oppose H.R. 5003, known as the Improving Child Nutrition and Education Act of 2016. The bill contains provisions that would “roll back years of progress,” including making school-provided meals less healthy and reducing the number of low-income children eligible for reduced cost or free school meals, APHA said.

In particular, the bill would significantly weaken the Community Eligibility Provision, a 2-year-old federal option that increases school lunch and breakfast access in schools with high levels of poverty. The bill would end services for 7,000 of the 18,000 schools currently enrolled in the program, and would block an additional 11,000 eligible schools from participating in the future.

The bill would also weaken evidence-based school nutrition standards for meals, snacks and beverages, APHA said. Nearly 99 percent of schools are meeting current updated school lunch nutrition standards, improvements that Harvard University researchers estimate will prevent more than 2 million cases of childhood obesity and save up to $792 million in health care-related costs over a decade.

The letter was developed by the National Alliance for Nutrition and Activity and the Child Nutrition Forum.

The committee approved H.R. 5003 on May 18.

## APHA fights to keep Clean Air Act strong

APHA is opposing legislation that would weaken the Clean Air Act.

In a May 10 letter to Congress, APHA argued that H.R. 4775, the Ozone Standards Implementation Act of 2016, would make implementation and enforcement of “all lifesaving air pollution health standards” weaker and harder to enforce, including those for carbon monoxide, lead, nitrogen dioxide, ozone, particulate matter and sulfur dioxide. The bill would impose delays and “sweeping changes” that affect enforcement of the Clean Air Act and will threaten health, particularly the health of children, APHA said.

H.R. 4775 was referred to the House Committee on Environment and Public Works on June 9.

*Lindsey Wahowiak contributed to this report*

*   Copyright The Nation’s Health, American Public Health Association