PERSPECTIVE: Unhealthy Options Persist in Fast Food; Voluntary Efforts Falling Short

Fast-food consumption is associated with poor diet quality in youth. Therefore, improving the nutritional quality of fast-food meals consumed by children is an important public health objective. In response to public health concerns, several of the largest fast-food restaurants have introduced policies to offer healthier drinks and/or sides with their kids’ meals. However, few research studies have examined the menu items that parents purchase for their children at fast-food restaurants or their attitudes about healthier kids’ meal offerings.

The primary purpose of [a study by the UConn Rudd Center for Food Policy & Obesity] was to document parents’ reported fast-food purchases for their children (ages 2-11) and examine changes over time.  [The] findings indicate numerous reasons for continued concern about the impact of fast-food consumption on children’s diets and health.

In 2016, we identified 10 different fast-food restaurants where at least one-quarter of parents reported that they purchased food for their child(ren) weekly or more often. In addition, more than 90% of parents surveyed reported that they visited at least one of the four largest fast-food restaurants to purchase lunch or dinner for their child (ages 2-11) in the past week, and they purchased food for their child at 2.4 of these restaurants on average.

These numbers are high, but they correspond to previous research showing that on any given day, one-third of children consume fast-food… Furthermore, parents’ purchases of fast-food for their children increased significantly during the years examined, with parents reporting increased frequency of visits to most individual fast-food restaurants from 2013 to 2016…

These results also suggest that healthier kids’ meal policies could result in unintended public health consequences if they lead parents to view the restaurants more positively and increase their visits, but continue to order the unhealthy items for their child.

These findings indicate numerous opportunities for restaurants to enhance their efforts to improve the nutritional quality of fast-food consumed by children.

First, restaurants should introduce healthier kids’ meals that are also appropriate and appealing to older children… In addition, restaurants must discontinue the increasingly common practice of offering unhealthy sides together with healthier sides, and/or they should remove unhealthy sides from their kids’ meal menus altogether, as they have pledged to do with kids’ meal drinks…

Finally, since parents often choose restaurants that are convenient and that their kids like (more than for healthy options), restaurants should make the healthier items the most appealing options for children to choose. They should also make the healthier items the easiest options for parents to order, for example, by making them the default for kids’ meals. Given parents’ positive attitudes about healthier kids’ meals, there appears to be a substantial marketing opportunity for restaurants to introduce and promote healthier kids’ meals that appeal to both parents and children…

If restaurants do not implement further improvements voluntarily, advocates should continue to work with state and local municipalities to introduce public policies to improve the healthfulness of kids’ meals. Policy makers should follow the lead of communities in California and Colorado and consider legislation or regulation to require that all restaurants serve healthier kids’ meals…

Unhealthy options, including main dishes, sides, and desserts, remain on kids’ meal menus at most restaurants, and purchases of a kids’ meal plus another menu item for their child have increased. Although future research is required to explain the reasons for these trends, they do indicate that restaurants’ voluntary pledges, as currently implemented, are unlikely to substantially reduce children’s fast-food consumption overall, or increase their selection of available healthier drink and side options.

Furthermore, parents’ positive attitudes about restaurants’ healthier kids’ meal policies indicate that such policies could backfire for public health and increase the frequency of purchasing fast-food for their children without increasing healthier purchases. These findings demonstrate that restaurants must implement more effective healthier kids’ meal policies to avoid additional state and local regulations that would mandate healthier options for children.

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This is an excerpt from Parents’ Reports of Fast Food Purchases for Their Children:  Have They Improved?, published in September 2018 by the Rudd Center for Food Policy & Obesity at the University of Connecticut.  The report’s authors are Jennifer L. Harris, Maia Hyary, Nicole Seymour and Yoon Young Choi.  The full report is available here.

https://youtu.be/2Ng_X4D4SSA

Record-Setting Travelers Championship Nets $2 Million for Charity

The 2018 Travelers Championship generated $2 million for more than 150 local charities throughout the region, the largest amount for charity generated in the history of Connecticut’s premier sporting event.  The record-setting total includes a $200,000 contribution from three-time Travelers Championship winner and 2018 champion Bubba Watson. Charity representatives joined officials from Travelers and the tournament in Hartford this week for the annual Travelers Championship Charity Celebration, where funds were distributed to each organization.

“This is always a special day because it signifies the hard work everyone puts into the tournament,” said Travelers Championship Tournament Director Nathan Grube. “Through the support we receive from volunteers, fans, players and businesses, we’re able to help charitable groups across the region make the community a better place.”

This year’s effort brings the total amount generated for charity by the tournament to more than $16.7 million since Travelers became title sponsor in 2007. The tournament donates 100 percent of its net proceeds to charity.

“Reaching the $2 million mark is an important milestone, and it will have such a meaningful impact on so many local organizations,” said Andy Bessette, Executive Vice President and Chief Administrative Officer at Travelers. “Bubba’s generosity mirrors our charity-first approach, and follows a similar sentiment that runs through the PGA TOUR and many of its players.”

Watson, who became just the second player to win the Travelers Championship more than twice – he also won in 2010 and 2015 – is representing the United States this week at the Ryder Cup in France. He recorded a video message that was played during the Charity Celebration.

“Wish I could be there. I just want to say thank you to Travelers for their hard work and their dedication to the community and all the charity dollars they’ve raised over the years,” Watson said. “Especially this year; $2 million dollars, what an achievement.”

The Hole in the Wall Gang Camp was the primary beneficiary of this year’s tournament, with three campers also serving as honorary co-chairs. Watson directed his $200,000 donation to Camp, which is naming the trading post at the Travelers Mini Golf Course on its campus in Ashford, Connecticut, as “Bubba Watson’s Trading Post,” in recognition of the 12-time PGA TOUR winner. Back in December, the 2017 Travelers Championship was honored by the PGA TOUR winning the prestigious “Tournament of the Year” award, along with recognition as the “Most Fan-Friendly Event,” “Best Sales” and the inaugural “Players Choice.” Award.  With approximately 4,000 volunteers working over 80,000 hours, the 2017 event generated more than $1.7 million for 165 deserving charities – totals that were exceeded this summer at the 2018 tournament. 

An economic impact study last year found that The Travelers Championship has an annual economic impact on the state of Connecticut of $68.2 million.  The study, conducted by the Connecticut Economic Resource Center, Inc. (CERC), found that the economic impact had more than doubled between 2011 and 2017, due to two primary factors; a much larger total number of spectators, especially the increased number of individuals from outside the state, and increased spending by the tournament in preparing for and administering the increased number of events that occur during the tournament week.

At least 750 charities have benefited over that time. Since the tournament’s debut in 1952, more than $40 million has been distributed to local charities.

Never an effort to reset on its laurels, preparation has already started for the 2019 Travelers Championship, which will be held June 17-23 at TPC River Highlands.

CT Is 6th Oldest State in the Nation, with Projections Pointing to Even Older Population, Economic Ramifications

Considered the 7^th oldest state in the nation for the past few years, Connecticut is getting older relative to other states, according to newly released analysis.  The state is now seen as being the 6th oldest in the nation, following Maine, New Hampshire, Vermont, West Virginia, and Florida. The analysis, by S&P Global Ratings, found that the median age of the U.S. increased to 38.0 from 37.2 from 2010-2017. It is projected that by 2030, all baby boomers will be older than 65, and the size of the older population will be such that one in every five residents will be of retirement age.

Connecticut’s median age is 40.9, among a list of “oldest states” that is dominated by New England.  S&P declared that “Northeast States Face A Substantial Old-Age Wave That Is Verging On A Crisis,” highlighting the economic impact of the aging population.

“This aging population has contributed to diminished economic growth, with Connecticut being one of only four states in the country with contracting output. This occurred while its population growth was nearly at the bottom for all states, along with having one of the largest contractions of prime working-age adults,” S&P noted in their analysis.  “The outlook is equally dim. We expect the state's higher concentration of middle-aged and elderly residents compared with young adults and children to worsen.”

Connecticut’s State Department on Aging (SDA), re-established in 2013, is a cabinet-level agency, which developed in August 2017 the state’s 2018-2020 State Plan on Aging, entitled “Growing Older Together”, to serve as a blueprint for the agency’s work. It outlines the activities and strategies the state will pursue to navigate the issues arising from a growing older population.

Citing U.S. Census Bureau data, the report pointed out that “the nation’s population is aging, but not as fast as Connecticut’s.”  At the time, it noted “Connecticut is the 7^th  oldest state in the nation, in terms of median age, with the third longest lived constituency.”

The 100-page report described Connecticut as “one of the slowest-growing states. The state’s total population grew by only 11,169 people from 2010 to 2015. Connecticut had just fewer than 3.6 million residents last year” (2016).

It went on to explain that “upon further look, there is a profound distinction among the projected population shift when broken down by age. Between 2010 and 2040, Connecticut’s age 65 years and over population is on pace to increase by 57%. However, its population between the ages of 20-64 is projected to grow less than 2% and the population age 18 and under is projected to decline by 7%.”

The Connecticut Commission on Women, Children and Seniors, in a presentation titled “Connecticut’s Aging Landscape: State Policy Overview” issued last year, also noted the state’s 7^th oldest status.  Looking ahead, the report cited data developed by the former Legislative Commission on Aging and the Connecticut State Data Center that shows that by 2020, the vast majority of Connecticut municipalities will have populations that include more than 20 percent individuals age 65 and older.  Only six towns are projected to have less than 13 percent of their populations in that age bracket, reflecting the anticipated aging of the population throughout the state.

By 2050 the number of people in Connecticut aged 85 and older is projected to increase to 260,052, according to an analysis by the AARP Public Policy Institute in 2015. This age cohort will more than double in 2050 when it will represent 6.3 percent of state’s overall population compared to 2.6 percent in 2015.

Suicide Numbers Increasing; Efforts Intensify to Respond, Prevent

The Centers for Disease Control and Prevention (CDC) released a report this year that suicide rates nationally jumped by 25 percent since 1999, a finding that “shocked” even experts who believed the rate had been flat. Each year, more than 41,000 individuals die by suicide, leaving behind their friends and family members to navigate the tragedy of loss, according to the National Alliance on Mental Illness. Connecticut's rate, 9.7 deaths per 100,000, rose 20 percent during that time, and 49 states saw an increase, according to the CDC. Connecticut’s suicide rate, is ranked number 46 in the country.

Suicide is the 10th leading cause of death in the U.S. with one occurring on average every 13.3 minutes. September is National Suicide Prevention Month.

For every suicide, there are 30 people who made the attempt, Dr. James F. O'Dea, vice president of the Behavior Health Network of Hartford Healthcare, recently told the Meriden Record-Journal.  The U.S. Health Resources & Services Administration reports that “approximately 45% of suicide victims had contact with primary care providers within 1 month of suicide.”

“Connecticut suicide rates may have not have increased as much in comparison to other states, but isn’t the real question, ‘Why is it increasing at all?’” Luis Perez, president and CEO of Mental Health Connecticut, told The Hartford Courant earlier this year.

“It’s been well-researched that most people who die by suicide do so because they want the pain to stop — and they don’t see any other way,” Perez said. “Prevention is critical. Knowing the safe and right way to talk to someone who may have thoughts of suicide and letting people know they are not alone, that millions of people struggle with suicide ideation is key.”

According to the state Department of Public Health, approximately 31 percent of victims had a history of treatment for mental illness and 42 percent had previously attempted or thought about suicide or disclosed their intent to commit suicide. The CDC offers 5 steps to help someone at risk: 1. Ask. 2. Keep them safe. 3. Be there. 4. Help them connect. 5. Follow up.

The U.S. government’s anti-bullying website, stopbullying.com, points out that “many issues contribute to suicide risk, including depression, problems at home, and trauma history. Additionally, specific groups have an increased risk of suicide, including American Indian and Alaskan Native, Asian American, lesbian, gay, bisexual, and transgender youth.”  The site indicates that “this risk can be increased further when these kids are not supported by parents, peers, and schools. Bullying can make an unsupportive situation worse.”

Matt Riley, Chief Operating Officer of the Connecticut-based Jordan Porco Foundation, recently told WTNH-TV that suicide is the second leading cause of death for Americans ages 15 to 24. One in ten college students and one in five high school students consider suicide. Young people considering suicide are most likely to talk to peers, so the Jordan Porco Foundation focuses on peer-to-peer outreach and awareness, with a series of successful program initiatives on college campuses in Connecticut and across the country.

In recent years, a new student-driven primary prevention program was piloted to help high school students develop positive coping skills and enhance protective factors in preparation for life beyond high school. Schools and organizations participating included Manchester High School, Immaculate High School in Danbury, Enfield Public Schools, Capital Preparatory High School in Hartford, Institute of Living in Hartford, Jewish Family Services in West Hartford, Wilton High School, Boys & Girls Club of Bristol, and Guilford Youth & Family Services.

Numerous organizations across Connecticut offer Mental Health First Aid, an 8-hour training to teach participants how to help someone who is developing a mental health problem or experiencing a mental health crisis. The evidence behind the program demonstrates that it helps trainees identify, understand and respond to signs of mental illnesses and substance use disorders.  The course is often offered to participants free of charge.

https://youtu.be/TT_HLG5FkKA

https://youtu.be/jl87bmuCTdM

Bender-Fromson to be Honored for Community Involvement; Public Service Career Included Historic Run for Lt. Gov.

In December, the Hartford Public Library’s Caroline M. Hewins Medal will be presented to Sandra Bender Fromson and Howard Fromson, longtime supporters of the library and numerous community organizations. It is the third year the award will be presented to a person (or persons) who have had a transformational impact upon and legacy of service to Hartford, according to library officials. Sandra Bender’s service to her community dates back more than a quarter century, where it flourished in the suburbs, was reflected in organizations across the Capitol City, and was part of an historic election year in Connecticut - the first time two women were candidates for Lieutenant Governor on the same November ballot.  Decades ago, she had a role in a series of unanticipated and groundbreaking political events that contributed  to increased prominence of women at the highest echelons of politics and public service in Connecticut.

Sandra Bender served as Mayor of South Windsor 1975-77, when relatively few women served in that role in Connecticut, rising to prominence in the financial services industry, also very much a male bastion at the time.

Just over a decade later, her business acumen and history of public service put her on a ticket for statewide office.  In 1990, New Haven-area Congressman Bruce Morrison won a primary to be the Democrats choice for Governor, former U.S. Senator Lowell Weicker started his own political party to launch is comeback with a candidacy for Governor, and Republicans nominated another Congressman, John Rowland of Waterbury.

Morrison selected Bender as his running mate, Weicker chose Hartford corporation counsel Eunice Groark, and Rowland decided on then-House Republican leader Robert Jaekle.

That year, the Weicker-Groark ticket was elected with 40.4 percent of the vote, narrowly defeating the Rowland- Jaekle ticket, which received 37.5 percent of the vote.  Finishing third in the unusual three-way race, the Democratic ticket of Morrison-Bender was the choice of only 20.7 percent of voters making their way to the polls on November 6.  Groark, not Bender, became the state’s first female Lieutenant Governor.  Only Ella Grasso, elected Governor in 1974 and 1978, had risen higher in statewide office.

Rowland ran again four years later, facing then-Lieutenant Governor Groark when Weicker chose not to seek re-election.  His choice as a running mate in his second run at the state's top job was a woman - M. Jodi Rell, a member of the state House of Representatives.

The Rowland-Rell ticket’s victory in 1994 meant Connecticut would have its second consecutive female Lieutenant Governor, rather than its second female Governor.

Rell later earned that distinction as well, succeeding to the office when Rowland resigned amidst a scandal and impeachment hearings, announcing on June 21, 2004 that he would step down on July 1.  Rell went on to be elected in her own right in 2006.

Bender-Fromson’s recognition later this year affirms her contributions over many decades to the Hartford Public Library and numerous other organizations.

She is also remembered as the Democratic candidate the first time two women were on the November ballot for Lieutenant Governor of Connecticut.  That occurred again in 1994 and 2014.   At least one woman has been a candidate for Lieutenant Governor or Governor - or both - in every election cycle since 1986, and Connecticut's voters elected Nancy Wyman to serve as Lieutenant Governor in 2010 and 2014, following one term of a man in that role, the only such term since 1990.  This year, Susan Bysiewicz is on the ballot for that office.  A woman has been elected either Governor or Lieutenant Governor in Connecticut in every election since 1990.

The Caroline M. Hewins Medal recognizes an individual who embraces the City of Hartford and its people, who breaks the mold and provides service of a revolutionary kind, who stretches the boundaries of a social or cultural institution with a humanistic approach to public service, and who shows strong guardianship of and advocacy for the basic right of equal access to information and opportunity.

PERSPECTIVE: Patient Protections Fall Short in Proposed Plan for Pre-existing Conditions

Our 33 organizations, representing the interests of the millions of patients and consumers who live with serious, acute, and chronic conditions, have worked together for many months to ensure that patient voices are reflected in the ongoing Congressional debate regarding the accessibility of health coverage for all Americans and families. In March 2017, we identified three overarching principles to guide and measure any work to further reform and improve the nation’s health insurance system. Our core principles are that health care must be adequate, affordable, and accessible. Together, our organizations understand what individuals and families need to prevent disease, manage health, and cure illness. Individuals and families with pre-existing conditions rely on critical protections in current law to help them access comprehensive, affordable health coverage that meets their medical needs. Unfortunately, the arguments of the plaintiffs in Texas v. U.S. – a lawsuit brought by 20 states and two individual plaintiffs – represent a serious threat to these protections. In this case, the plaintiffs argue that the court must invalidate the entire Affordable Care Act (ACA) due to Congress’ repeal of the individual mandate. We are further troubled that the Department of Justice has also declined to defend the constitutionality of many of the ACA provisions that directly protect people with pre-existing conditions.

While we are pleased to see that you share our concerns about the potential impact of Texas v. U.S. on people with pre-existing conditions, as evidenced by your recent introduction of the Ensuring Coverage for Patients with Pre-Existing Conditions Act (S.3388), the safeguards presented in this legislation fall far short of the patient protections encompassed in existing law. This bill as written is far from an adequate replacement for the protections for individuals with pre-existing conditions that are provided under current law.

Current law requires issuers to comply with a set of provisions which work together to promote adequate, affordable, and accessible coverage for people with pre-existing conditions. Specifically, community rating, guaranteed issue, essential health benefits, cost-sharing limits, and the ban on pre-existing condition exclusions protect people with serious health care needs from discriminatory coverage practices. These policies are inextricably linked and removing any of them threatens access to critical care for people with life-threatening, disabling, chronic, or serious health care needs.

Adequacy

Health care must be adequate, covering the services and treatments patients need, including patients with unique and complex health care needs. It is paramount that protections including the Essential Health Benefit (EHB) requirement, the ban on annual and lifetime caps, caps on out-of-pocket costs, and restrictions on premium rating be preserved in all health care plans to which they currently apply.

We were particularly disappointed that S. 3388 fails to include an outright ban on pre-existing condition exclusions. While a consumer with pre-existing conditions can gain coverage, the bill would allow issuers to underwrite plans to exclude any type of care based on medical history or health status. For example, under S. 3388 a patient with a history of cancer may be able to gain coverage, but an issuer would still be allowed to exclude coverage for screenings or treatment for a reoccurrence. Continuing to allow issuers to sell plans that undermine access to comprehensive coverage directly contradicts the presumed intent of this legislation, puts consumers at risk for catastrophic healthcare costs or being forced to delay care, and creates additional confusion for consumers and patients.

Affordability

Our second principle recognizes that illness and disease impacts individuals across the economic spectrum. We believe that everyone – regardless of their economic situation – should be able to obtain the treatment they need to manage, maintain, or improve their health. This means that coverage should be affordable, including reasonable premiums and cost-sharing, and that individuals with pre-existing conditions should be protected from being charged more for their coverage.

Although this legislation protects against higher rates based on health status, we remain concerned that it leaves patients and consumers exposed to higher premiums based on other factors that can be used as proxies for health status, such as age, gender, or occupation. For instance, there is no limit on how much more insurers in the individual market could charge a 50-year-old with heart disease because of his age. Insurers could also charge higher rates to a woman of childbearing age because of her gender. This legislation would exacerbate the affordability challenges facing many Americans today by neglecting to maintain current protections and subjecting patients to even higher premiums should the ACA be completely invalidated.

Accessibility

Lastly, health care coverage must be accessible. All people, regardless of employment, health status or geographic location, should be able to gain coverage without waiting periods or undue barriers to coverage. While we appreciate that the legislation would continue to prohibit insurers from denying coverage to individuals with pre-existing conditions, we are deeply troubled that, absent other quality and financial protection standards, this provision would offer only minimal assurance to consumers.

Conclusion

While we do not yet know the outcome or scope of the ruling in the Texas v U.S. case, failure to preserve key ACA provisions could have catastrophic implications for both the insurance markets and the millions of patients who rely on them. Partially restoring only two (guaranteed issue and some rating protections) of the multiple provisions that currently protect patients is inadequate and would leave many people without the level of coverage they need and deserve. Should the ACA be struck down and this legislation implemented as a replacement, consumers with pre-existing conditions would face significant financial and coverage barriers. In short, for people with pre-existing conditions, the bill would provide access to coverage in name only.

We share your interest in continuing to make health insurance accessible to Americans with pre-existing conditions and appreciate your efforts to preserve certain protections in law, regardless of the outcome of Texas vs. US. However, the “Ensuring Coverage for Patients with Pre-Existing Conditions Act” as currently drafted, falls far short of providing coverage and security to your constituents, including those who are or will face significant health care needs. We urge you and your Senate colleagues to reconsider your approach to S. 3388 and ensure that any future legislation provides protections for people with pre-existing conditions that are the same or better than those included in current law.

Our organizations stand ready to work with you on solutions that serve the patients we represent and would be pleased to meet with you about how this legislation can be improved to meet the needs of people with pre-existing conditions.

___________________________________

This is the complete text of correspondence sent on September 19, 2018 to 16 members of the U.S. Senate, on behalf of 33 organizations including Danbury-headquartered National Organization for Rare Disorders (NORD) and many others with active chapters in Connecticut. Signatories also included Adult Congenital Heart Association, Alpha-1 Foundation, ALS Association, American Cancer Society Cancer Action Network, American Diabetes Association, American Heart Association, American Liver Foundation, American Lung Association, Arthritis Foundation, Chronic Disease Coalition, COPD Foundation, Crohn’s & Colitis Foundation, Cystic Fibrosis Foundation, Epilepsy Foundation, Family Voices, Global Healthy Living Foundation, Hemophilia Federation of America, Leukemia & Lymphoma Foundation, Lutheran Services in America, March of Dimes, Mended Little Hearts, Muscular Dystrophy Association, National Alliance on Mental Illness, National Coalition for Cancer Survivorship, National Health Council, National Hemophilia Foundation, National Kidney Foundation, National Multiple Sclerosis Society, National Patient Advocate Foundation, Susan G. Komen, United Way Worldwide, and WomenHeart: The National Coalition for Women with Heart Disease.

308 Structurally Deficient Bridges Across CT: Average Age 69 Years

Just last month, it was revealed that more than 1,500 of California’s bridges are structurally deficient, meaning there is significant deterioration of the bridge deck, supports or other major components. More than half – 56 percent – of California’s bridges are at least 50 years old – the eighth highest rate in the nation. Yesterday, it was announced that 59 percent of Connecticut’s more than 4,000 bridges are 50 years or older, the fourth highest rate in the nation. The average age of all Connecticut’s bridges is 53 years, while the average age of the state’s 308 structurally deficient bridges – seven percent of the total - is 69 years.  Structurally deficient bridges in Connecticut are crossed daily by 4.3 million vehicles.

Both reports were done by TRIP, a national transportation research group, based on an analysis of Federal Highway Administration National Bridge Inventory (2017).  The organization did a similar report about Wisconsin, also released this week.  It found that nine percent of Wisconsin’s locally and state-maintained bridges are structurally deficient.

Connecticut has 4,252 bridges (20 feet or longer), compared with 14,253 in Wisconsin and 25,657 in California.

The 20-page Connecticut report indicated that “To retain businesses, accommodate population and economic growth, maintain economic competitiveness, and achieve further economic growth, Connecticut will need to maintain and modernize its bridges by repairing or replacing deficient bridges and providing needed maintenance on other bridges to ensure that they remain in good condition as long as possible.”

The report also noted that “annually, $489 billion in goods are shipped to and from sites in Connecticut, largely by truck,” adding that “approximately 731,000 full-time jobs in Connecticut in key industries like tourism, retail sales, agriculture and manufacturing are completely dependent on the state’s transportation network.”

Hartford, Fairfield and New Haven counties each have 60 or more structurally deficient bridges, with 65, 61 and 60 respectively.  Litchfield County has 39; New London County has 32.  The report listed Middlesex County with 22, Windham County with 17 and Tolland County with 12.

The report also sounded an alarm for Connecticut, a state seeking to attract and retain businesses to bolster a sluggish economy:  “Increasingly, companies are looking at the quality of a region’s transportation system when deciding where to re-locate or expand. Regions with congested or poorly maintained roads may see businesses relocate to areas with a smoother, more efficient and more modern transportation system.”

Highway accessibility, the report pointed out, was ranked the number one site selection factor in a 2017 survey of corporate executives by Area Development Magazine.

“Without a substantial boost in federal, state and local funding, numerous projects to improve and preserve Connecticut’s bridges will not be able to proceed, hampering the state’s ability to improve the condition of its transportation system and to support economic development opportunities in the state,” the report concluded.

This summer,  CT by the Numbers reported on a ranking developed by CNBC, found that 73 percent of Connecticut roads are in bad shape, giving the state a grade of D, while noting that nearly 8 percent of Connecticut’s bridges are deficient.

Cigna Looks to Invest in Start-up Insurance Ventures, Establishes $250 Million Fund

Health services organization Cigna has launched Cigna Ventures, a corporate venture fund with an infusion of $250 million in capital to be invested in healthcare technology startups and early-stage companies. Cigna has committed $250 million of capital to Cigna Ventures, according to officials, to invest in promising startups and growth-stage companies that are unlocking new growth possibilities in health care and will bring improved care quality, affordability, choice, and greater simplicity to customers and clients. Cigna Ventures is focused on companies across three strategic areas: insights and analytics; digital health and retail; and care delivery/management.

“Cigna’s commitment to improving the health, well-being and sense of security of the people we serve is at the front and center of everything we do,” said Tom Richards, senior vice president and global lead, strategy and business development at Cigna. “The venture fund will enable us to drive innovation beyond our existing core business operations, and incubate new ideas, opportunities and relationships that have the potential for long-term business growth and to help our customers.”

Cigna Ventures was created to help Cigna identify, assess and sponsor early-stage innovation ideas that warrant deeper exploration through focused pilot and test-and-learn activities with the goal of realizing meaningful business value.  The initiative’s newly launched website suggests that “Cigna Ventures is the strategic corporate venture capital partner of choice in the health care industry. We work closely with entrepreneurs to accelerate growth and innovation through strategic use of capital and deep partnerships.”

Companies in the portfolio, according to published reports, include Omada Health, a digital therapeutics company treating chronic diseases; Prognos, a predictive analytics company for healthcare; Contessa Health, a home-patient care service; Mdlive, which provides remote health consultations; and Cricket Health, a special kidney care provider.

CIGNA’s interest in the rapidly-evolving health care field is also reflected in the company’s membership, presence, and investment in insurance technology start-ups at Upward Hartford, the co-working and innovation center in Hartford that was the site of the city’s inaugural Insurtech Hub earlier this year, and is now home to the winning participants in Hartford’s first annual insurance accelerator, held in April.

Amidst the start-ups are a number of Hartford’s longstanding insurance giants, including Cigna.

Bloomberg reported last week that overall investment in health-care startups has increased this year. According to the MoneyTree Report from PricewaterhouseCoopers and CB Insights, $10.6 billion was invested in health-care deals in the first half of this year. Two of the seven largest venture-capital rounds in the second quarter involved health-care firms, the report shows.

“Our partnership with Cigna has been about so much more than capital,” said Sean Duffy, co-founder and CEO of Omada. “The ability to collaborate with, learn from, and integrate deeply with a health services company so dedicated to delivering a 21st-century care experience to its customers and clients has enabled us to accelerate innovation, advance our capabilities, and grow our customer base.”

Cigna Corporation and Express Scripts received approval this week from the Antitrust Division of the United States Department of Justice for their pending $50 billion plus merger, which is expected to close by year’s end. “Quality health care and competitive pricing for health care services and pharmaceutical drugs is critical to U.S. consumers,” said Makan Delrahim, the head of the antitrust division, in a statement announcing approval of the deal.

CT Has 10th Lowest Obesity Rate in the Nation, Research Finds

Connecticut has a lower adult obesity rate than most other states, according to new national data, which found that 26.9 percent of adults living in Connecticut have obesity, ranking the state 42nd among the 50 states and the District of Columbia.  The state has slipped slightly from four years ago - the obesity rate was 25 percent and ranking was 9th lowest in the nation in the 2014 edition of the annual survey. The state's top 10 least obsese status was in the new report came in the 15th annual State of Obesity: Better Policies for a Healthier America report  by Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation (RWJF).  Findings include:

• Adult obesity rates vary considerably from state to state, with a high of 38.1 percent in West Virginia and a low of 22.6 percent in Colorado. No state had a statistically significant improvement in its obesity rate over the past year.
• Adult obesity rates are at or above 35 percent in seven states; for the first time in Iowa and Oklahoma, and at least the second time in Alabama, Arkansas, Louisiana, Mississippi, and West Virginia.
• Six states — Iowa, Massachusetts, Ohio, Oklahoma, Rhode Island, and South Carolina — saw their adult obesity rates increase significantly between 2016 and 2017.
• Adult obesity rates are between 30 and 35 percent in 22 states and 19 states have adult obesity rates between 25 and 30 percent.
• Over the past five years (2012 – 2017), 31 states had statistically significant increases in their obesity rate and no state had a statistically significant decrease in its obesity rate.
• There continue to be striking racial and ethnic disparities in obesity rates. In 31 states, the adult obesity rate among Blacks is at or above 35 percent.  Latino adults have obesity at a rate at or above 35 percent in eight states.  White adults have obesity rates at or above 35 percent in one state. Nationally, the adult obesity rates for Latinos, Blacks and Whites are 47.0 percent, 46.8 percent and 37.9 percent respectively.

The least obese states are Colorado (22.6 %),District of Columbia (23.0%),  Hawaii (23.8 %), California (25.1%), Tie Montana and Utah (25.3%), New York (25.7%), Massachusetts (25.9%), Nevada (26.7%) and Connecticut (26.9%).

“Obesity is a complex and often intractable problem and America’s obesity epidemic continues to have serious health and cost consequences for individuals, their families and our nation,” said John Auerbach, president and CEO of Trust for America’s Health. “The good news is that there is growing evidence that certain prevention programs can reverse these trends.  But we won’t see meaningful declines in state and national obesity rates until they are implemented throughout the nation and receive sustained support.”

Obesity is a problem in virtually every city and town, and every income and social sector.  But its impact is most serious in communities where conditions make access to healthy foods and regular physical activity more difficult, such as lower income and rural areas, including many communities of color.  The national costs of obesity are enormous, officials point out.  Obesity drives an estimated $149 billion annually in directly related healthcare spending, and an additional $66 billion annually in lowered economic productivity. Also, one in three young adults is ineligible for military service, due to being overweight, officials noted.

The report offers 40 recommendations for federal, state and local policymakers; the restaurant and food industries; and the healthcare system.  Among them:

• Medicare should encourage eligible beneficiaries to enroll in obesity counseling as a covered benefit, and, evaluate its use and effectiveness. Health plans, medical schools, continuing medical education, and public health departments should raise awareness about the need and availability of these services.
• Food and beverage companies should eliminate children’s exposure to advertising and marketing of unhealthy products.
• Hospitals should no longer sell or serve sugary drinks on their campuses; they should also improve the nutritional quality of meals and promote breastfeeding.

PERSPECTIVE – Nonprofit Board Members: Take Off Your “Stupid Hats”

by Jack Horak The National Association of Nonprofit Organizations and Executives (NANOE) is a relatively new and modest organization, but that hasn’t stopped it from challenging nonprofit sector dogma at the most fundamental level. A case in point is its suggestion that the “volunteer governing board” model should be upgraded to a “paid board” model.

As NANOE sees it, nonprofits adopting this practice would have a line item for “directors fees” in both their budget and their fund-raising literature – and they would do this proudly to let the world know that they are so committed to the mission that they have raised the money necessary to attract and retain the best talent available to fill seats on their governing boards.

The objective is not simply to start paying current volunteers to attend board meetings, but to induce very talented people to join the board where they will be expected to do real work in return for the money. After all, nonprofits pay their management team in exchange for work, so why not follow the same protocol with board members?

This is a sweeping reversal of sector orthodoxy — which presupposes that directors donate both their time and their money to the organizations they serve. Consequently, it’s no surprise that some of the more prominent sector voices were quick to dismiss NANOE’s message as it was rolled out. See, for example, the March 30, 2017 Chronicle of Philanthropy (New Nonprofit Puts Money over Mission and Ethics) and the April 18, 2017 Nonprofit Quarterly (NANOE’s Approach to Nonprofit Leadership: An Insult to your Intelligence).

The negative reaction is understandable to some extent. NANOE’s paradigm turns conventional wisdom on its head so criticism in defense of the status quo is expected. However, after nearly 40 years as a legal and business advisor in the sector, I respectfully disagree with NANOE’s critics. I suggest that if they take their analysis to a deeper and broader level they will find considerable insight in NANOE’s suggestion, and perhaps conclude, as I have, that the paid professional board model may be the optimal choice for some, but not all, organizations.

Here’s why.

We start with a fundamental question — what is a board of directors – and answer it with some history. The concept (and law) of what we commonly refer to as “charity” emerged in medieval England as part of the law of trusts. A charitable trust is an organization governed by a board trustees who hold and manage assets in their names for the benefit of a charitable purpose.

The trust form was predominant for centuries. While it still works well for organizations with activities limited to grant making, it is poorly suited for operating organizations which have service contracts, payrolls, real estate, borrowed money, licensure requirements, and much more. Consequently, as the sector grew and modernized in the middle of the last century, the trust form was pushed aside in favor of the corporate form because corporations have a bifurcated governance structure specifically designed for operating activities.

Corporations have both a board of directors (our topic), and a group of officers who comprise management (such as the CEO or CFO). Corporate law vests all power and authority of the organization in the board, which then delegates power and responsibility to management to conduct operations, but with the board overseeing management’s performance. In other words, the board of directors is at the top of the chain of command. It is not there for show.

Second, operating a nonprofit has become amazingly complicated over the last fifty years. The complexity has fallen on the backs of management, which must deal daily with everything from public expectations, to the morass of state and federal regulation which touches upon everything from HR policy and plans, credentialing, licensing, financial reporting and other challenges that are simply part of the modern turf. Management cannot take this on without board members rolling up their sleeves and doing some real work. Talented CEOs have told me how they long for a strong board to back them up -while expressing their frustration with the common fare offered by “volunteer board recruitment” efforts that don’t always deliver what is needed.

Finally, there is the “Stupid Hat Syndrome.” I first heard this expression from a successful businessman, famously generous with both his money and his volunteer board service. He coined the phrase to express his frustration after years of observing “some of the smartest and most successful business people he knew join a nonprofit board and immediately put on their Stupid Hat.” In other words, they habitually checked their immense brain power and experience at the door. The Stupid Hat metaphor may be hard edged, but the phenomenon is real and all too commonplace in the sector. It’s the 800-pound gorilla in the corner, and it’s as true as the truism that in general “you get what you pay for.”

In contrast, when you pay someone, even a modest amount, you demonstrate respect for what they have to offer; and in return you can comfortably tell them that they are expected to do real work -show up at meetings, read the circulated minutes and financial reports before the meetings, ask informed questions and offer ideas, chair important committees, have calls and meetings with management between meetings to discuss how things are going, and more as necessary. Paying someone for their service is a commercial exchange of value, not an expense. The brain power, experience and work of talented directors who keep their smart hat on at board meetings is worth the money.

I’ll close by saying that there is a lot more to this question than space permits, and by noting that modern nonprofit corporation law is very flexible and allows for use of committees, advisory boards, and other structures that would keep an organization tightly bound to its community while giving this alternative model a chance in appropriate cases —indeed, NANOE’s New Guidelines for Nonprofits may revealed what could be the wave of the future and we should be willing to give it a chance.

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Jack Horak joined The Alliance for Non-Profit Growth and Opportunity (TANGO) in 2016 after a 36-year legal career at the Hartford office of the law firm Reid and Riege, P.C. He was a member of the firm’s Business Law Practice, where he created the firm’s Nonprofit Organization Practice Group. He was the principal author of the Reid and Riege Nonprofit Organization Report, a quarterly publication distributed throughout the United States; and also regularly published articles and editorials on legal and policy issues in Philanthropy Magazine, The Hartford Courant, Connecticut Law Tribune, and the Hartford Business Journal, where he writes a regular editorial column entitled “Rule of Law.”  This column first appeared in InsideCharity and the TANGO newsletter.