The Q&A: Baker Harrell

^{* Correction appended.}

With each issue, Trib+Health brings you an interview with experts on issues related to health care. Here is this week's subject:

Baker Harrell is the CEO of It’s Time Texas, a nonprofit organization devoted to studying and promoting health in Texas, with a focus on preventable chronic disease. The organization recently came out with a white paper, Building a Culture of Health in Texas, discussing obesity and chronic disease in the state.

Editor's note: This interview has been edited for length and clarity.

Trib+Health: Could you highlight what the most important findings of the white paper project were?

Baker Harrell: The purpose of the project really was to establish where we are from a health crisis standpoint in Texas. Our focus as an organization is on preventable chronic disease — those diseases that are correlated strongly with inactivity and poor diet. The overarching objective was to solidify and explain where we are as a state and then collect perspectives from across sectors and across the state on what’s working, what’s not, what the challenges are, what are some emerging solutions, and then as an organization, cohesively translate all of that into some key findings and key recommendations.

For us, there wasn’t really anything new that we learned as an organization through the process. It really confirmed our beliefs about what’s needed in the state and our reason for existing as an organization. It confirmed what the latest science tells us about what works, and that’s that you have to work at all levels. You have to take a systems-change approach, because this is a complex, societally rooted problem. You have to focus not on just individuals, but communities, because you can’t really have healthy people if they live in unhealthy communities. And you have to work collaboratively, because the problem is so complex. It really takes all sectors, all stakeholders, pulling together with a common purpose to be successful.

For the broader public, I think it does a really good job of synopsizing where we are as a state and where we need to go and what’s preventing us from making the kind of progress that we need to make. But we also tried to strike a really positive tone in that there are a lot of incredible individuals and organizations and leaders across the state that are working every day to turn the tide for better health, and we as a state need to recognize and support them, and empower others to join the fight.

What we didn’t want to do was create just a standard, static white paper that people just consume and move on. We wanted to create a much more dynamic resource, which is why we’ve paired the white paper with case studies that we’re going to be making available through our website. We're going to continue to curate case studies across the state where individuals are translating the content of the white paper into action that’s making a difference across the state. We wanted it to be a living, breathing document, and the case studies are a primary way in which we’re doing that.

Trib+Health: Could you summarize what the statistics look like?

Harrell: [Nearly] seventy percent of all [adult] Texans are overweight or obese. One in 10 have diabetes. Right now, Texas businesses spend more than $10 billion a year on obesity and related complications. That number is projected to go up to $32.5 billion by the year 2030. Our state is one of the top 20 most overweight and obese states in the country. We’re No. 11.

The stats are really bad, they’re getting worse, and we’re effectively running out of time to turn the tide for better health, which is why we named our organization It’s Time Texas, because the message that we’re trying to convey is: Obesity is often discussed as the crisis. Obesity is actually a symptom of the crisis. It’s an important symptom, but it’s a symptom of the crisis. The crisis is that we have engineered health out of our daily lives, we’ve engineered it out of our communities, over the last 40 years. That’s why we see the high rates of chronic disease that we’re seeing.

Another scary stat is that kids born in Texas in the year 2000, one-third of them are projected to develop type 2 diabetes in their lifetime. And it’s one out of every two Native American, African-American, and Hispanic kids born in Texas in the year 2000. When you extrapolate that, 20 years, 30 years, our health care system implodes. We can’t, financially, take care of people with those high rates of preventable chronic disease.

We’re literally talking about the solvency of our businesses, our communities, our state and our country. That is not hyperbole — that’s math. That’s what we’re trying to do as an organization, and that was the purpose of the white paper: To say, look, we have a crisis. The crisis is not looming. It’s here. The good news is that we know what works, we know how to turn the tide, but we all need to get focused on this. Regardless of who you are or what you do, we all have a stake in this, and it will require all of us pulling together to turn the tide.

Trib+Health: Can you speak to how those numbers got to be that high?

Harrell: It’s literally every aspect of our social fabric, as a country, as a state. In public health we talk about our social fabric — our social structure, our culture — as being obesogenic, which means it favors the development of obesity; it’s an engine of obesity. It’s a very, very long list, but some examples include our food system changing significantly so that we began to favor fast and processed foods. We started eating less meals at home. We became consumers of foods that are loaded with sugar, fat and salt. We completely changed our diet — we changed not only the composition of our diet, but the quantity. We eat a lot more. Portion sizes have ballooned over the last 30-plus years.

We work longer hours, and we often live further distances from where we work and where we play and where we shop, so we’ve become much more of a car culture. We walk much less than we used to, we bike much less than we used to. We’ve engineered physical education largely out of schools, especially middle and high school. Because it’s not treated as a core subject, kids aren’t learning how to move and an appreciation for movement. They’re not learning how to eat, they’re not learning how to prepare food. Home ec is out of schools, and so people don’t know how to cook or prepare food anymore.

There are policies at the federal and the state level that make it more difficult for people to consume healthy products, healthy goods; we favor corn, for example, as opposed to fresh produce.

Correction: In answering a question, the interview subject misspoke in identifying the percentage of adult Texans who are overweight or obese. Clarifying language has been added to convey what he meant to say.