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Health Affairs This Week places listeners at the center of health policy’s proverbial water cooler. Join editors from Health Affairs, the leading journal of health policy research, and special guests as they discuss this week’s most pressing health policy news. All in 15 minutes or less.
Hello and welcome to Health Affairs This Week. I'm your host, Jeff Beyers. We're recording on 05/01/2025. As a heads up on May 13, we have a live taping of a health policy. The guest will be Andrew Ryan from Brown University to discuss state affordability's standards impact on hospital prices and insurance premiums.
Jeff Byers:The event is free and open for all to attend. Check that on the show notes. And for insiders on May 29, we are hosting an event on the FDA's first hundred days under the second Trump administration. This will be moderated by Rachel Sachs, and the panel will include Richard Hughes the fourth and Arty Rye. With all the layoffs and restructuring occurring at HHS, I thought it might be interesting to hone in on example on how those decisions may or may not impact an agency.
Jeff Byers:Also, kinda wanted to Trojan horse the idea that data and research has an influence on our lives in some ways. So if you follow A to B to C, and I hope you did, but don't think about it too hard, We're here today to talk about the behavioral risk factor surveillance system at CDC and its influence on behavioral health. Today, I'm joined by health affairs Akila Wise. Akila has worked at the CDC, so I'm looking forward to getting a behind the scenes perspective on this. Akila, welcome to the program.
Akilah Wise:Hi, Jeff. Thanks so much. So good to be here.
Jeff Byers:Yeah. So we mentioned off mic, and people love to hear about this. It's it's getting hot these days.
Akilah Wise:Yeah. Super hot. I'm in Georgia, and, you know, I think it's just gonna get worse from here on out.
Jeff Byers:Yeah. You know, the the weather will get worse from here on out. I'll in in Virginia, we just, you know, like to say the humidity is coming, and it never stops. You know, moving forward to the topic at hand. So among the layoffs at HHS, many were cut from the CDC.
Jeff Byers:According to MedPage Today, the agency's division of population health was eliminated with one exception, the behavioral risk factor surveillance system was spared. So Akila, what is this system, and what's tracked? What's the cadence of this? Give us a primer on this.
Akilah Wise:Sure. So just to take a step back and, define what behavioral health is, according to the CDC, behavioral health refers to the state of mental, emotional, social well-being or behaviors and actions that affect wellness. It also refers to support systems that promote well-being and prevent mental distress and also that provide access to treatment and services for such mental health conditions. So it's really important to understand that and improving behavioral outcomes means addressing factors at multiple levels, including social determinants of health and supportive environments. And so this leads really nicely into, the actual survey.
Akilah Wise:So yet the Behavioral Risk Factor Surveillance System or BRFSS or even BRFSS, some people refer it to as a state based national system of telephone surveys and in The US. And it collects data about health related risk behaviors of US adults, so folks who are 18 and up. And the sort of data it collects really gets at this behavioral health aspect. Cigarette smoking, fruit and vegetable consumption, chronic health conditions like diabetes, arthritis, depressive disorder, and even the use of preventative services like cancer screenings and routine doctor and dentist checkups. So the BRFSS is a collaborative effort between the CDC and each state's health department, and it's ongoing.
Akilah Wise:It's the nation's leading ongoing health related survey. It was established in 1984 when it started with 15 states, And currently it completes about 400,000 interviews each year in all 50 states and the District Of Columbia, as well as the Virgin Islands, Puerto Rico, and Guam.
Jeff Byers:Yeah. So you used to work at the CDC. We were talking offline that you didn't work on survey specifically, but I kinda wanted to get a sense of, like, how are surveys like this at the CDC used to help create public health programs or policies?
Akilah Wise:Yeah. So surveys are really powerful tools. BRFSS is the main one that's very powerful. I worked in two divisions at the CDC previously. One was within the Division of Population Health, where the BRFSS was housed before being moved.
Akilah Wise:Within that division, I worked with the Healthy Aging Branch on arthritis. And the other division I worked was the Division of HIV Prevention, and they conducted their own surveys around HIV. So surveys help us create public health programs and policies by providing the data on which to base those programs, policies and recommendations. So federal, state and local health officials regularly use BRFSS. And without these data, they would be playing somewhat of a guessing game about health issues and how they affect people.
Akilah Wise:So for example, we know that one in four US adults have arthritis, thanks to the BRFSS. And we can also identify which groups of people are most at risk, of arthritis. And so that sort of information helps, public health officials design programs and recommendations.
Jeff Byers:Did you say one in four adults?
Akilah Wise:Yes. One in four adults.
Jeff Byers:So you are not alone, anyone that's listening that's No. Rapidly aging, I'm thinking.
Akilah Wise:Yeah. And it it affects non elderly adults as well. Of course, there's a higher prevalence with folks who are older older than 65. And, you know, arthritis is just what happens, you know, as we age and we use our bodies. So eventually, you know, each of us will have arthritis at some point.
Jeff Byers:Yeah. I like the humidity that comes for us all is what what I'm hearing. Yeah. Okay. So thanks for that.
Jeff Byers:Let's draw out another example. You know, on our health policy feed, Rob Lott next week is gonna be talking to Eric Topol, who wrote a new book on superaging. We can't I can't really talk about that interview too much because it is under embargo until next week, so check that episode out. But there is some work in the book on the intersection of exercise and health, and I have always thought that was an interesting connection. It's always been apparent whether overtly or not, but more research is drawing out exactly how exercise is linked to all kinds of positive risk reductions in health.
Jeff Byers:And this is also a focus on, the CDC's BRFSS survey. So what's some of the latest evidence on the connection of exercise and health according to the survey?
Akilah Wise:In general, I'll speak in general. So we know that the benefits of physical activity is well documented. It reduces chronic conditions like blood pressure and diabetes, some of the immediate effects like good sleep and reduced anxiety. We know that, the CDC says adults need at least one hundred and fifty minutes of moderate intensity physical activity per week, including muscle strengthening exercises. And that shakes out to be about thirty minutes a day for five days a week.
Akilah Wise:And it's recommended for people who are over 65 years to do additional activities that improve balance, like standing on one foot. So we did there's a new study by researchers at Hopkins that found engaging in as little as thirty five minutes of moderate to vigorous physical activity per week, compared to no minutes, of activity per week was associated with, forty one percent lower risk in developing dementia among adults. And this was in The United Kingdom. They didn't use BRFSS, that's US specific, but they did use data from the UK Biobank, which is actually a little more comprehensive than our BRFSS because it includes genetic and health record data. But again, the idea is that these surveys really help us understand what's going on population wise.
Akilah Wise:In this case, they use this sort of data to find that physical activity actually helps with dementia. So there's another study, though, that used a large US data set called NHANES, and they found physical activity is linked to longer telomeres. Telomeres are nucleotide caps on our chromosomes. The older we get, the shorter our telomeres become. So telomere length is a biomarker of aging, actually.
Akilah Wise:So this study found that high activity adults, that vigorous activity has significantly longer telomeres than sedentary adults. So this translated into an almost nine year biologic advantage. And they actually had a seven year advantage over adults who were moderately active. So this data, as well as other emerging evidence, is showing that physical activity has this antiaging effect for adults.
Jeff Byers:Yeah. So I think with what you're saying is we we've always known that there's, you know, a a general link to physical activity and health. A lot of people have been exercising for a long time for a lot of different reasons. And so a lot of this research is drawing out exactly how it's impacting us physiologically. And also, you can kinda run some parallels of like, I think generally people know what healthy foods are, you know, fruits and vegetables and that kind of thing.
Jeff Byers:So but then there's that, like, what does it look like in practice? What are what are people actually doing from a behavioral health perspective? And that's where I think the BRFSS can come into play. So one of the things that tracks is physical inactivity. So taking together, you know, what do we know about The US?
Jeff Byers:How are people, moving around?
Akilah Wise:So I'll focus on physical inactivity because there's a lot of data there. Yeah. So the CDC collects data on a number of factors, as I mentioned, including adult physical inactivity. So this is based on a question that asks whether someone has done any physical activity outside of work. And people who answer no are classified as inactive.
Akilah Wise:Based on the latest CDC analysis of these data, which includes years 2017 to 2020, the overall prevalence is twenty five point three percent. So that means one in four adults are physically inactive. They're not doing physical activity outside of work as they report, to the survey.
Jeff Byers:These same people with arthritis?
Akilah Wise:Probably. Or at least some some overlap. And and even with that, we can combine data to see if there's a link between physical activity and arthritis. So you actually introduce you know, one of the ways people use these data is to look at various factors and, you know, you can you can look at that and see the relationship or any trends. You know, we can look at these data by states and territory as well.
Akilah Wise:And that's where states, you know, find it really useful because then you can design programs for your constituents. So we know from this data that states in the South had the highest prevalence of inactivity at 27.5 and the West had the lowest prevalence at twenty one percent. So you can see how these data can really be helpful for state officials, local officials and public health. We can look at individual states and see that there are seven states that have physical inactivity levels of thirty percent or more. So that's one in three adults, and that's West Virginia, Oklahoma, Louisiana, Alabama, Kentucky, Arkansas and Mississippi.
Akilah Wise:So, you know, these data could become really powerful tools. And what we know is that increasing physical activity is a comprehensive effort for many groups. It's not just telling someone, you know, get up and exercise. Includes individuals, communities, our public health agencies. And so, for example, state and local officials can encourage and implement physical activity programs and even design, you know, communities that are safe and active friendly.
Akilah Wise:So this is just one of the many ways these sorts of data has really helped with public health action.
Jeff Byers:So thanks for drawing all that out. This dovetails in some ways with the establishment of the Make America Healthy Again Commission, which seeks to, quote, aggressively combat the critical health challenges facing our citizens, including the rising rates of mental health disorders, diabetes, and other chronic diseases, unquote. What are the avenues that they state for that, that they're trying to accomplish that?
Akilah Wise:Yeah, so going strictly by the materials that the administration has released so far, one of the avenues that they're looking to meet these challenges of mental health disorders, diabetes, other chronic disease, For one, they named fresh thinking on nutrition and physical activity, healthy lifestyles and other things that affect health. They talk about restoring integrity to the scientific process by protecting expert recommendations from quote inappropriate influence and increasing transparency regarding existing data. And quote, they also propose to address health and healthcare by empowering Americans through transparency and open source data and avoiding or eliminating conflicts of interest. They also propose to prioritize gold standard research on the root causes of why Americans are getting sick, as well as, having agencies ensure the availability of expanded treatment options and the flexibility for health insurance coverage to provide benefits that support beneficial lifestyle changes and disease promotion. And the president also aims to create a commission that's chaired by the secretary of health and human services, assistant to the president for domestic policy, as well as the secretary of agriculture, housing and urban development, secretary of education and other, other cabinets.
Akilah Wise:So, that's what they, proposed to do to address, these health issues.
Jeff Byers:And you can somewhat see the line between, sparing the CDC survey that we talked about on behavioral health and and how that could be related to some of these, but it'll be interesting to see how those develop over time. Anything else that we, haven't touched on that you might want to?
Akilah Wise:Yeah. The one thing I just want to say is that the BRFSS is very impactful. It's not only, looking at these more static, you know, chronic health disease and preventive issues, it's been quite flexible in emergency public health responses. So it's a powerful tool for establishing health objectives, programs, recommendations, and it's very useful in public health.
Jeff Byers:Okay. Well, Akila, thank you for joining us today on health affairs this week. It's great to learn about that survey and how much of an impact it can make and how much it can influence state based policies and and other things like that or how wide reaching some data sources can be. So thank you for explaining all that for us. And to you, the listener, if you enjoyed this episode, please send it to the ultramarathon runner, in your life, and we will see you next week.
Jeff Byers:Thanks. Thanks.