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Community Health Improvement Programs

By March 13, 2018Commentary

What if local governments make an effort to do things to improve the health of residents–like add bike paths, walking paths, have parks with exercise areas, get rid of big sodas or trans-fats, tax tobacco and alcohol more, etc., etc.  (But hey, lets legalize recreational drugs.)  A central planner and progressive ideologue’s wet dream, but other than adding to the tax burden, is there any evidence that such programs actually make a difference.  A study in Health Affairs tries to answer that question.   (HA Article)   In all honesty, it is obviously very hard to evaluate the specific effects, whatever they may or may not be, from these efforts.  There are a lot of other things that affect population health statistics, good and bad.  Isolating the impact of these generic community-based wellness efforts is going to be difficult.  These authors tried to examine county-level programs and county-level health outcomes.  The conducted interviews to identify programs and characteristics of programs included in the study.  The research included programs started from 2007 to 2012 that involved multi-sector involvement, such as health plans, private funding and public health departments.  The study eventually covered four types of programs implemented at 52 sites that covered 396 counties.  They used some common surveys to link outcomes to the programs, with a special focus on obesity and tobacco cessation.

Counties with a health improvement program tended to be younger and have poorer residents.  In the counties that implemented the programs, there was less than one-tenth of a percentage point reduction in the populations that said they were in poor or fair health and less than a .15 percentage point reduction in those were overweight or obese.  There was similarly no significant change in the number of tobacco users.  And perversely, although not statistically significant, a tobacco cessation program was associated with slightly more obesity and a weight control program with slightly more tobacco use.  You just can’t win.  Adjusting these analyses in various ways did not result in any significant results.  And the results suggest that community-based programs are not particularly effective ways to create individual behavior change, and they can be expensive.  So can we have our tax dollars back, preferably directly out of the paychecks of the government boneheads who promote and run these programs?

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