The Legislature really is putting a promising, prevention-focused health program on a starvation diet because broad behavior change wasn't evident within two years? It took me that long to figure out which way to wear my bike helmet.
For those of you who missed the story as you rushed to work, Egg McMuffin in lap, the Statewide Health Improvement Program (SHIP) was launched in 2009 to change the way Minnesotans think, eat and move.
The program's goal was big: To save nearly $2 billion in health care costs through unsexy but effective strategies, including more sidewalks and bike trails, tobacco-free colleges, and local produce added to school lunches and corner grocery stores.
SHIP received $47 million for its first two years, which translated into 51 grants dispersed from Aitkin to White Earth. The program's been cut to $15 million for the next two years and supporters worry the ax may drop again.
Lots of good came, or at least, started to come from the groundbreaking effort. More than 8,500 children, for example, ate healthier foods in child-care sites statewide. Nearly 400 apartment buildings adopted smoke-free policies or are working toward it. And about 255 Minnesota cities began to create master walk and bike plans.
All of this despite formidable challenges, the biggest being human behavior and the struggle to change unhealthy habits for good.
Nearly two-thirds of Minnesota adults are overweight or obese, costing the state $1.3 billion annually in health care costs relating to heart disease, diabetes and other chronic illnesses. Fifteen percent of adults smoke. Childhood obesity has more than tripled in the past 30 years.
We cannot fix this in 24 months, certainly not with a budget slashed by nearly 70 percent.
"We were disappointed," said a charitable Pat Adams, director of the Office of Statewide Health Improvement Initiatives at the Minnesota Department of Health.
"We know it's a steep climb always to preserve prevention funding," she said. "It's much easier to fund crisis-oriented services." By slashing SHIP, we're headed toward that crisis.
"If we continue to do what we're doing, which is treat problems after the fact, we'll continue to see health care costs go up exponentially," cautioned Larry Cohen, founder of Oakland, Calif.-based Prevention Institute. Add to that lost productivity at work and shortened life spans.
Cohen's been watching Minnesota with great interest and admiration. SHIP, he said, "is a national model and Minnesota is one of the states that has aggressively invested in prevention. I'd hate to see the state go backwards."
An expert in behavioral change, particularly in the area of smoking, Cohen said it's "very unrealistic" to expect real change around chronic conditions within two years.
"With tobacco, in two years the changes might not have been apparent. In one generation, we cut smoking in our state in half. What we've learned is that, to advance prevention, we need norms that support healthy behaviors, not discourage it. It's easy to criticize fresh fruits and vegetables or bike racks. But they're really important catalysts to change."
Adams is happy to hear it. While $47 million might sound like a lot, she noted that it was an investment of about $4 annually per person statewide, compared to about $7,000 per person in health-care costs.
Still, she'll do what she can with what she's got. The $15 million is funding 18 SHIP grantees, including Leech Lake. Adams remains inspired by the can-do spirit of SHIP supporters, and the surprising collaborations that have developed around the effort.
"City planners who have never worked with public health officials are asking, 'How do you plan for state biking and walking trails?' Communities of color have come together. School districts are starting to work on nutrition programs.
"We hope the majority of legislators will see that great progress is being made, and that we can demonstrate health improvement change and, ultimately, a decline in health care costs. But, again, that's going to take a while."