SUBSTANTIVE CHANGE TAKES TIME, AND IS EXCITING:
The Fiscal Year 2016 budget for the Centers for Disease Control and Prevention (CDC) proclaims: “Obesity has increased substantially over the past few decades. An estimated 36% (78.6 million) of adults and 17% (more than 12.7 million) of children have obesity. Americans with obesity are at higher risk for developing hypertension, high cholesterol, type 2 diabetes, heart disease, and certain cancers especially earlier in life, and for premature death.” Obesity is projected to result in $147 billion in annual health care costs to the U.S. economy. Today 61% of military personnel are either overweight or obese. In May of 2010, the White House Task Force on Childhood Obesity submitted its report to the President entitled Solving the problem of childhood obesity within a generation. The Task Force reported that overweight and obese children are more likely to become obese adults and estimated that obesity caused 112,000 deaths per year in the United States. They further proffered that the current generation may be on track to have a shorter lifespan than their parents. The President of the American Medical Association (AMA) recently described their proactive initiatives in this area at the Uniformed Services University of the Health Sciences (USUHS), having served more than 23 years in the U.S. Navy. Addressing obesity should be a national priority for all health care professions.
More than a decade ago, in April, 2004, the then-Director of the National Institute of Environmental Health Sciences (NIEHS) of the National Institutes of Health (NIH) testified before the U.S. Senate on the relationship between obesity and the environment. “Environment and behavior intersect in fundamental ways, intersecting with our biology but also with each other. In no area of public health is this more apparent than with the problem of obesity. There is a growing body of literature that illustrates the negative physical and mental health effects of unregulated and poor urban, rural, and suburban development and planning. These studies have documented increased rates of obesity, diabetes, depression, anxiety, and heart disease in these poorly developed areas….
“The NIEHS is designing a program as part of the trans-NIH obesity initiative which is designed to examine how the built environment affects obesity and the effectiveness of changes in community planning, design, and development in reducing the extent of obesity and associated comorbidities. These intervention research projects will develop tools to characterize and measure individual and population-level indicators of healthful communities – and of residents’ lifestyles and behaviors – that prevent or reduce obesity.”
From a public policy perspective, the Director’s 2004 public health-oriented testimony was visionary. This was at a time when psychology was working diligently to convince the leadership of the NIH that the behavioral sciences, and psychology in particular, could significantly contribute to the underlying NIH mission of advancing the health of the nation. Over the past decade there has been an increasing acceptance of behavioral issues within NIH, even if some of it was a reluctant or grudging acceptance. Much of the acceptance was fueled by the constant messages from Congressional champions of behavior, expressing their belief that behavior was a critical factor in health. At the heart of this effort to convince the Congress to support behavioral health research was Alan Kraut, formerly with APA and recently retiring as CEO of the Association for Psychological Science (APS). For decades, Alan was a most impressive, if not almost constant, presence on Capitol Hill, truly “making a difference.”
On September 15, 2015, President Obama signed the Executive Order “Using Behavioral Science Insights to Better Serve the American People,” which Ron Wood thoughtfully brought to our attention. “A growing body of evidence demonstrates that behavioral science insights – research findings from fields such as behavioral economics and psychology about how people make decisions and act on them – can be used to design government policies to better serve the American people. Where Federal policies have been designed to reflect behavioral science insights, they have substantially improved outcomes for the individuals, families, communities, and businesses those policies serve…. By improving the effectiveness and efficiency of Government, behavioral science insights can support a range of national priorities, including helping workers to find better jobs; enabling Americans to lead longer, healthier lives; improving access to educational opportunities and support for success in school; and accelerating the transition to a low-carbon economy.”
The President went on to encourage his executive departments and agencies to identify policies, programs, and operations where applying behavioral science insights may yield substantial improvements in public welfare, program outcomes, and program cost effectiveness. He urged, where possible, rigorously testing and evaluating the impact of behavioral science input and strengthening agency relationships with the research community to better use empirical findings from the behavioral sciences. [The parallel to RxP with its long history of providing quality care at the federal and state level should be evident to the Division’s membership.]
Learning From The Past: One of the most exciting aspects of being personally involved in the public policy process is the constant exposure to individuals who have “made a difference” because of their personal vision, dedication, and commitment to a seemingly “impossible” goal. Former APA President Nick Cummings was unable to attend this year’s convention in Toronto due to a previous commitment for the inauguration of his newest educational adventure. Without question, one of Nick’s most lasting contributions to the field has been the establishment of the California School of Professional Psychology (CSPP), now Alliant International University, with their alumni representing nearly half of the practicing psychologists in California. “In August, the newly provisionally licensed free-standing doctoral graduate college in mental health, the first such in 23 years, began world-wide classes on the internet. Our daughter Janet heads the Cummings Graduate Institute (CGI) which is the successor to Arizona State University’s (ASU) Nicholas A. Cummings Doctor of Behavioral Health (DBH) program. After seven highly successful years of turning out DBHs, with a spectacular employment rate in which four graduates are now CEOs of huge healthcare companies, a new ASU administration began moving the program more and more back into academic provincialism. We successfully recreated our DBH into its free-standing status, and accomplished this within a year rather than the 10 years that had been predicted. To apply a psychologist, social worker, counselor or nurse must have a master’s degree, be licensed, and have at least seven years of successful practice. The interest has been enthusiastic, allowing CGI to accept only the best of the best applicants.”
After returning from Toronto, we had the unique opportunity to hear Capt. (Ret.) Guy D. Gruters, USAF, share his experience with the USUHS community having been a Prisoner Of War in Vietnam for five years and three months, including at the notorious “Hanoi Hilton.” A graduate of the Air Force Academy, he has been awarded more than 30 combat medals having flown over 400 combat missions during the Vietnam War, and was twice shot down – the second time being captured by the Viet Cong. As he described the torture he and his colleagues (including U.S. Senator John McCain) underwent -- physical and emotional -- and especially the extraordinarily long periods of isolation, the audience could well appreciate that very few could survive. “You have heard of being kicked around or slapped around. I never knew what that meant until prison camp.” “There were slightly over 3500 aircrew members shot down over North Vietnam in the years 1964 to 1973 who were not rescued. In 1973, 591 POWs came home from all services and all countries in Southeast Asia of which 472 came home from North Vietnam. The Russians and North Vietnamese tortured to death or killed in one way or another six out of every seven of us in North Vietnam.” Belief in God and family were the key to survival. Ever so humble, after his talk Capt. (Ret.) Gruters had lunch with several faculty and students, including two Doctor of Nursing Practice (DNP) mental health nursing students, and agreed to be interviewed by psychology graduate students for a forthcoming publication. The importance and relevance of psychology for those who put themselves in “harm’s way” cannot be overstated. Nick was a WWII paratrooper and since our last Division column, we learned that former APA and Division 55 President Ron Fox served in the National Guard. Psychology should be proud of its uniformed services heritage. Our colleagues have served the nation admirably.
Closing Reflections: When I reflect upon the vision and inner strength of these dedicated public servants, it gives me pause that today some seem to be trying to “punish” several of our academic colleagues, including destroying their careers, perhaps for example, for publicly accepting the invitation of the Department of Defense to visit Guantanamo Bay, per the Hoffman Report, without the APA governance having found any wrongdoing or malfeasance. Universities are where ideas are to be critically debated; not where scholars or students are to personally attacked. Equally important, providing everyone with Due Process – especially if one passionately disagrees with them -- is a fundamental value which psychology should never forsake. Aloha,
Pat DeLeon, former APA President – Division 55 – October, 2015
