The U.S. population is facing an obesity crisis wrought with severe health and economic costs. Because social and environmental factors have a powerful influence over lifestyle choices, a national obesity prevention strategy must involve population-based interventions targeted at the places where people live, study, work, shop, and play. This means that policy, in addition to personal responsibility, must be part of the solution. This article first describes the emergence of and theory behind the obesity prevention movement. It then explains how government at all levels is empowered to develop obesity prevention policy. Finally, it explores eight attributes of a promising state or local obesity prevention policy and sets the obesity prevention movement in the context of a larger movement to promote healthy communities and prevent chronic disease.

This paper looks how health systems can go beyond clinical care to address the social determinants of health and considers why this approach might be particularly relevant for Accountable Care Organizations (ACOs) touted by the Affordable Care Act. ACOs make profits by reducing the medical expenses of patient populations. The leading causes of death in the United States are tobacco use, insufficient physical activity, and an unhealthy diet. These risk factors are linked to increased incidence of a wide range of chronic diseases, the treatment of which places a tremendous financial burden on our health care system. Health care delivery and access are just a small part of the solution to our chronic disease crisis. Increasingly, strategies that address the social determinants of health--"the conditions into which people are born, grow, live, work, and age"-- are the ones that hold the most promise. In Massachusetts, Steward Health Care System supports a number of initiatives to address the social determinants of health in its patient population. Steward provides an example of how a hospital system can address the health of its patient population by moving beyond clinical care. The varied initiatives have also resulted in cost savings for the system.

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America is in the grips of a diabetes epidemic. Underserved communities disproportionately bear the burden of diabetes and associated harms. Diabetes self-management education and training (DSME/T) may help address the epidemic. By empowering patients to manage their diabetes, DSME/T improves health outcomes and reduces medical expenditures. However, participation in DSME/T remains low. Insurance coverage offers 1 approach for increasing participation in DSME/T. The impact of DSME/T insurance coverage on advancing diabetes-related health equity depends on which types of insurers must cover DSME/T and the characteristics of such coverage. We conducted a legal survey of DSME/T coverage requirements for private insurers, Medicaid programs, and Medicare, finding that substantial differences exist. Although 43 states require that private insurers cover DSME/T, only 30 states require such coverage for most or all Medicaid beneficiaries. Public health professionals and decision makers may find this analysis helpful in understanding and evaluating patterns and gaps in DSME/T coverage.