Inside the Beltway October 2021

COVID-19 and Rising Childhood Obesity Rates: The Need for APRN Advocacy and Community Collaboration

Contributed by Health Policy Committee member Audra Rankin, DNP, APRN, CPNP

Our efforts to mitigate risk associated with the COVID-19 pandemic have also had a major impact on the overall health of children. School closures, a decrease in access to healthy foods and physical activity, and an uptick in screen time and snacking have resulted in increasing obesity rates in children aged 2-17 and widening disparities within this population. Although consumers leaned towards healthier, fresh food options pre-pandemic, a reversal of this trend has occurred during the pandemic (Skerrit, et al, 2020). Increased food insecurity and a rise in shelf stable food purchases, decreased access to safe places to play, limited physical activity opportunities in schools, and subsequent sedentary lifestyle habits have all increased the risk of obesity and weight gain in vulnerable populations. (Jennseen et al, 2021, Rundle et al, 2020, Wilde, 2020).

The significant shift in healthy lifestyle habits and rising childhood obesity rates demand innovative approaches to address healthy food and physical activity options for children. In addition to implementing evidence-based guidelines, health care providers can advocate for the promotion of physical activity, ways to stay safe and active in socially distanced settings and increased access to healthy foods in community settings at local, state and federal levels. (Jennssen et al, 2021) Public health policies have indirectly influenced nutrition and physical activity for children. For example, in New York an executive order deemed farmers markets as an essential business (Van Ooyen, 2020) while the Consolidated Appropriations Act of 2021 included federal legislation to address food insecurity.

In an effort to reverse current trends, particularly in more vulnerable populations, PNPs can influence health policy and advocacy efforts that promote physical education standards at state and national levels and increase access to healthy foods and safe places to play. Health care providers can share healthy lifestyle struggles identified in clinical care settings to guide efforts that meet specific community needs. Partnerships and collaborations can be established with other professional organizations, such as the AAP, local health systems, local school systems, and child advocacy groups within the community, who are often working on similar initiatives. Working with these groups to create safe options for school-based interventions and programs that partner with parents may strengthen policy and advocacy efforts. (Browne, et al, 2021)

References:

    1. Browne, N., Snethen, J., Greenberg, C., et al. (2021). When Pandemics Collide: The Impact of COVID-19 on Childhood Obesity. Journal of Pediatric Nursing, 56, 90-98
    2. Jenssen, B., Kelly, M.K., Powell, M., et al. (2021) COVID-19 and Changes in Child Obesity. Pediatrics, 147(5).
    3. Rundle, AG., Park, Y., Herbstman, JB, Kinsey, EW, Wang, YC. (2020). COVID-19-related school closings and risk of weight gain among children. Obesity, 28(6):1008–1009
    4. Skerritt J, Mulvany L, Almeida I. Americans Drop Kale and Quinoa to Lock Down With Chips and Oreos (2020). https://www.bloomberg.com/news/articles/2020-03-21/americans-drop-kale-and-quinoa-to-lock-down-with-chips-and-oreos Accessed October 12, 2021.
    5. Van Ooyen M. (2020) Farmers Markets Deemed Essential Businesses https://www.grownyc.org/blog/farmers-markets-deemed-essential-businesses Accessed October 12, 2021.
    6. Wilde T. Online gaming surge: Steam breaks concurrent user record amid social distancing mandateshttps://www.geekwire.com/2020/online-gaming-surge-steam-breaks-concurrentuser-record-amid-social-distancing-mandates/2020. Accessed October 12, 2021.


Democrats Struggle to Unify on “Build Back Better” Policies

After setting up a process to pass a massive $3.5 trillion package of health and social spending priorities without Republican votes, moderate and progressive Democrats in Congress are struggling to agree on the size and specifics of President Biden’s “Build Back Better” agenda – a debate that’s also holding up House action on a Senate-passed $1.2 trillion bipartisan infrastructure bill that includes major public health provisions. After failing to keep a promise to moderates to vote on the infrastructure bill by Sept. 27, Speaker Nancy Pelosi reset the timetable for Democrats to reach agreement on the “Build Back Better” framework and to vote on the infrastructure bill by the end of October.

Progressives and moderates disagree on the overall size of the health and social spending package, as well as some key provisions including proposals to lower the cost of prescription drugs. Pelosi said Oct. 12 that Congress will mostly be funding policy priorities for a shorter period of time in a smaller reconciliation package in the $2 trillion range, a day after she sent a letter saying members requested fewer, but better-funded, policies in the package. She also said the House will only vote on a bill that can pass the Senate, where it will have to satisfy moderate Sens. Sens. Joe Manchin (D-WV) and Kyrsten Sinema (D-AZ) as well as strict budget rules that have already ruled out two attempts to include a pathway to citizenship for thousands of immigrants.

As drafted by House committees, provisions of the budget reconciliation bill would close the health coverage gap in states that haven’t expanded Medicaid programs, expand access to home and community-based services and postpartum coverage, and permanently authorize the Children’s Health Insurance Program, as well as provide $1 billion for nursing education infrastructure grants. The separate infrastructure bill includes $175 billion for public health initiatives from replacing lead water pipelines to upgrading zero-emissions public transit and school buses.


Mobilize to Immunize

Between Oct. 1 and Nov. 12, advocates across the country will be mobilizing in their communities to raise awareness about the lifesaving potential of vaccines and funding global immunization programs in the U.S. budget. Join our partners at the United Nations Foundation Shot@Life campaign for Mobilize to Immunize now through Nov. 12. There are simple, pre-formatted advocacy tools that take just a few minutes of your time.


December Deadlines Loom for Government Funding, Debt Limit

Congress temporarily dodged a potential government shutdown and default on the nation’s debt by passing short-term fixes that will expire in early December, setting up another pre-holiday showdown over federal spending.  Lawmakers approved a continuing resolution (H.R. 5305) Sept. 30 that extended funding for federal programs through Dec. 3 hours before they ran out of money at the end of the 2021 fiscal year. Twelve days later, the House approved a $480 billion increase in the federal debt limit, extending the nation’s borrowing authority to roughly the same December date. Senate Republicans allowed Democrats to pass the stopgap without filibustering the bill but vowed they wouldn’t do so again this fall.

The extensions will give appropriators more time to negotiate deals on fiscal 2022 spending bills, none of which have yet been agreed to. The House has passed nine of the 12 measures including the Labor-HHS-Education spending bill, providing a $50 million increase for Title VIII nursing education programs. The Senate, however, hasn’t passed any of the 2022 bills yet as Republicans demand that Democrats first agree on overall spending allocations for defense and domestic programs before approving funding for individual agencies. The result is likely to be a single year-end omnibus bill to fund the entire government – or another resolution continuing funding into 2022.


Administration Restores Family Planning Rule as Courts Review Abortion Laws

Biden agency officials released a final rule on Oct. 4 scrapping the previous administration’s overhaul of the Title X federal family planning program, which barred abortion providers from receiving the federal funds and banned all grantees from making abortion referrals. The new rule, first proposed in April, largely returns the program to the way it ran for decades prior to 2019, with some updates requiring service sites to offer “culturally and linguistically appropriate, inclusive, trauma-informed” family planning care to better serve people of color and others who have been historically underserved. The rule will officially take effect on Nov. 8, but hundreds of clinics who left the program likely won’t be able to rejoin until next year.

Separately, the Justice Department asked the Supreme Court on Oct. 18 to block a controversial Texas abortion law after the federal 5th Circuit Court of Appeals extended an order the day before that kept the law in place while litigation continues. The law, known as S.B. 8, was briefly blocked by a lower court but was reinstated by the appeals court. The Texas statute bans abortions once cardiac activity is detected, usually around six weeks, with no exemptions for victims of rape or incest, and delegates enforcement to private citizens rather than government officials.


Check Out Our Child Health Policy Learning Collaborative

All NAPANP members can log in for member-only on-demand access to meetings hosted during the last year. Recent topics have included suicide prevention legislation, environmental policies that impact child health, nutrition and food insecurity and DEI in the NP workforce. Our Nov. 3 meeting will focus on the importance of NPs serving on state boards of nursing and guiding regulatory policy.


NAPNAP, Plaintiffs Urge Administration to Rescind “Sunset” Rule

NAPNAP and other plaintiffs in a lawsuit challenging the “Securing Updated and Necessary Statutory Evaluations Timely,” or “Sunset” rule, urged the White House Office of Management and Budget Sept. 14 to approve new regulations that would rescind the rule, which would automatically impose expiration dates on all HHS regulations. NAPNAP and other litigants described the potential harm that the rule could inflict on patients and health care providers by forcing the agency to review each of tens of thousands of regulations governing Medicare, Medicaid, the Children’s Health Insurance Program, the Food and Drug Administration and the Centers for Disease Control and Prevention.  White House officials could release the as-yet-unseen new regulations within weeks.


FDA Authorizes First E-Cigarettes After Removing Millions From the Market

The Food and Drug Administration on Oct. 12 issued its first-ever authorization for e-cigarette products, arguing that they provide a benefit to adult smokers who switch to vaping. The agency granted marketing orders to Vuse, a company owned by the cigarette giant R.J. Reynolds, for its Vuse Solo closed e-cigarette device and two tobacco-flavored cartridges. Each cartridge contains 4.8 percent nicotine, a level similar to that in products that have been associated with youth vaping, including some Juul pods and Puff Bar disposable e-cigarettes, which contain 5 percent nicotine. The agency also denied marketing orders for 10 flavored e-cigarette products from R.J. Reynolds.

Earlier, the FDA and the Centers for Disease Control and Prevention released the National Youth Tobacco Survey Sept. 30, reporting that more than 2 million U.S. children and teenagers have used e-cigarettes in 2021. Use was highest among high-school students, with 11.3 percent reporting that they had used an e-cigarette at least once in the previous 30 days, while 2.8 percent of middle-school students said they had vaped.


In Other News…

Immigration Rules Aim to Address DACA, Public Charge Policies
The Biden administration on Sept. 27 renewed efforts to shield hundreds of thousands of immigrants who came to the U.S. as young children from deportation, proposing regulations intended to satisfy judicial concerns that declared the Deferred Action for Childhood Arrivals (DACA) program was illegal largely because the Obama administration bypassed procedural requirements when it took effect in 2012. The new rule mirrors the Obama-era initiative, recreating the 2012 policy and seeking to put it on firmer ground by going through the federal regulatory process.

Separately, the administration took initial steps Aug. 20 to formally replace the “public charge” rule that effectively prevented many prospective immigrants from using health and social services before and during the coronavirus pandemic. The Department of Homeland Security issued an advance notice of proposed rulemaking seeking public comments on a new regulation to define how immigration officers can determine whether green card applicants are likely to become a public charge to the federal government. The previous administration tightened the definition of public charge to reject applicants who had used, or could potentially use, services like food stamps – that policy was halted by the Biden administration in March.

Agencies Move to Bar “Surprise” Medical Bills
Federal agencies on Sept. 30 laid out the process that out-of-network providers and plans can use to settle surprise billing disputes. The long-awaited rule implements a law passed by Congress last year banning providers from sending surprise bills to patients who unknowingly received out-of-network care. The administration is expected to issue additional regulations by December implementing provisions of the law intended to prohibit health plans from discriminating against APRNs and other practitioners in forming their provider networks.

Under the new interim final rule, if an out-of-network provider and payer can’t come to an agreement over payment during a 30 day “open negotiation,” they may turn to an independent dispute resolution process. The hospital industry blasted the rule, charging that it ignores congressional intent and puts the thumb on the scale in favor of insurers, while the American Medical Association called the rule “a surprise gift to the insurance industry” that would harm independent physician practices.

Federal Officials Reset Environmental Policies
President Biden on Oct. 8 restored full protections to three national monuments that had been slashed in size by the previous administration, issuing an executive order to protect 1.36 million acres in Utah’s Bears Ears national preserve while also restoring 1.87 million acres in the state’s Grand Staircase-Escalante monument. The order also reimposed fishing restrictions in the Northeast Canyons and Seamounts Marine National Monument in the Atlantic Ocean off the coast of New England that had been opened to commercial fishing.

Separately on Oct. 6 the White House proposed restoring parts of the National Environmental Policy Act, one of the nation’s bedrock environmental laws, requiring agencies to conduct a climate analysis of major projects and give affected communities greater input into the process. Officials said the proposed rule would encourage agencies to study alternatives to projects that face opposition from affected communities.

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