By Joene Hendry

NEW YORK (Reuters Health) – Elderly, community-dwelling men and women appear more likely to obtain preventive health care when they live with their spouse, as opposed to living alone or with an adult child, researchers report in the American Journal of Public Health.

Still, “colorectal cancer screening, routine dental check-up, and influenza vaccination remain well below national targets according to the Centers for Disease Control’s Healthy People 2010,” report Drs. Denys Lau of Northwestern University in Chicago, Illinois, and James Kirby with the Agency for Health Care Research and Quality in Rockville, Maryland.

Their findings call attention to elders’ underuse of preventive health care screenings, the researchers say.

Moreover, Lau told Reuters Health, the findings of this study suggest that “healthcare providers should not assume that elderly patients living with their adult offspring will have adequate family resources to obtain preventive services.”

Lau and Kirby assessed medical expenditure information from 2002 to 2005 for 13,038 community-dwelling men and women at least 65 years old.

Most (94 percent) reported needing help with at least one activity of daily living. Seventy-five percent reported having at least one chronic health condition such as angina, asthma, coronary heart disease, diabetes, emphysema, high blood pressure, or had a previous heart attack or stroke.

Overall, 52 percent lived only with their spouse, 38 percent lived alone, 5 percent lived with adult offspring and another 5 percent lived with their spouse and adult offspring.

Those living only with their spouse were more likely than those in other living arrangements to obtain influenza vaccinations, cholesterol screenings, colorectal cancer screenings, routine physical check-ups, and routine dental care. Living arrangements did not alter elders’ screenings for high blood pressure, however.

Factoring in the employment and disability status of adult offspring offered no explanation as to why living with adult offspring “had no benefits to elderly persons in terms of accessing timely preventive care,” Lau said.

The two researchers call for additional investigations of barriers to the utilization preventive health care by the elderly, and increased education about the benefits of obtaining such care.

SOURCE: American Journal of Public Health, July 2009.

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By Laura MacInnis

GENEVA (Reuters) – Cigarette packages should show graphic images of yellow teeth, blackened gums, protruding neck tumors and bleeding brains to alert smokers to their disease risks, the World Health Organization said on Friday.

More than 20 countries, including Britain, Iran, Peru and Malaysia, already use visual warnings on their tobacco products, the head of the WHO’s Tobacco Free Initiative said.

“Although some people question the need for such pictures, the evidence is absolutely clear that they convince people to quit,” Douglas Bettcher told a news conference ahead of World No Tobacco Day, to be held on Sunday.

Bettcher pointed to a warning that read “smoking causes brain strokes” and showed blood oozing from a brain.

He has called for such images to be printed on all tobacco product packages and on tags to water pipes that are popular in the Middle East. Bettcher added that the “disgust, fear, sadness or worry” from the warnings can discourage smoking.

The WHO, which requires all its staff to be non-smokers or to agree to try to quit, has been campaigning for more than two decades to discourage smoking and fight efforts by big companies such as Philip Morris International, Imperial Tobacco, Japan Tobacco and British American Tobacco to attract new customers.

Bettcher said the tobacco industry opposed visual warnings, viewing them as a threat to profits.

Tobacco is the world’s leading preventable cause of death, killing more than 5 million people a year, the WHO says,

Around 80 percent of smokers live in developing countries, where smoking rates have risen sharply in recent years alongside a ramping-up of tobacco marketing and production in poorer states, Bettcher said.

In addition to package warnings, the WHO supports bans on tobacco marketing and sponsorship, prohibitions of smoking in public buildings, and high taxes on tobacco products.

The recent emergence of designer cigarette pack-holders and other accessories to cover up health warnings showed the warnings were having an impact, Rob Cunningham of the Canadian Cancer Society said.

“That is a good indication, because smokers are noticing enough that they feel that they must not look at them,” Cunningham said.

(For images from the WHO’s World No Tobacco Day campaign, see: www.who.int/tobacco/wntd)

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By Matthew Bigg

ATLANTA (Reuters) – When Seema Shrikhande goes to work, she drives. When she takes her son to school, they drive. And when she shopping, to the bank or to visit friends, she gets into her car, buckles up and hits the road.

Driving is a way of life for Americans but researchers say the national habit of driving everywhere is bad for health.

The more you drive, the less you walk. Walking provides exercise without really trying.

Ideally, people should take 10,000 steps a day to maintain wellness, according to James Hill, professor of pediatrics at the University of Colorado.

But for those who only walk from their home to the car and from their car to an office and back again, that figure can sink to only 1,000 steps.

A car culture forces people to make time to exercise and driving long distances reduces the time available to work out.

“If it (Atlanta) was a city where I walked more I would automatically get a lot of the exercise I need. Now I have to … schedule it into my life. Sometimes it’s very difficult because I’m busy,” said Shrikhande, a professor of communications at Oglethorpe University in Atlanta.

Obesity and heart disease are two of many problems associated with a sedentary lifestyle.

Car dependence makes it harder to get the 75 minutes of intense weekly exercise or the 150 minutes of moderate exercise the government recommends, said Dr. Dianna Densmore of the Centers for Disease Control and Prevention.

Lawrence Frank of the University of British Columbia has even quantified the link between the distance people drive each day and their body weight.

“Every additional 30 minutes spent in a car each day translates into a 3 percent greater chance of being obese,” he said. “People who live in neighborhoods with a mix of shops and businesses within easy walking distance are 7 percent less likely to be obese.”

READJUSTING THE BALANCE

Older cities such as New York, Boston and Chicago contain neighborhoods built around a grid of densely populated streets and tend to have more public transport.

But fast-growing newer cities like Atlanta, Dallas and Phoenix are surrounded by sprawling suburbs that can only be navigated behind the wheel, not least because fiercely hot summers limit the attraction of walking.

Shrikhande said that as a student in Philadelphia she didn’t own a car and walked a lot but in Atlanta car reliance was a small price to pay for a lifestyle whose benefits include better weather and living in a leafy suburb.

Health is just one factor that has caused town planners to seek alternatives to driving-only towns. High gas prices, a desire for more tightly knit communities and environmental concerns also play a role.

Atlanta is seeing a rise in inward migration as people move back into neighborhoods around the city center.

But the question of how to readjust the balance away from car dependence and toward sidewalks, cycle lanes and denser communities is intensely political.

Groups worried about climate change and others promoting a healthier lifestyle are lobbying for a new federal transport bill that shifts policy toward alternatives to car use.

“We have designed cities to suppress walking,” said David Goldberg of Smart Growth America, a coalition of nonprofit groups that works to improve town and city planning. “It’s much easier to widen highways in an … exurb than to get money to retrofit an over-wide highway for non-driver.”.

In a country where the car is a symbol of freedom, efforts to promote alternatives are caricatured as social engineering or a bid to undermine the country’s spirit by powerful lobbies representing the transportation and construction industries.

Even so, efforts are underway. In Atlanta, local governments have devised strategies to promote urban living, said Dan Reuter of the Atlanta Regional Commission.

The city is also exploring building light rail to connect northern suburbs with the center and has embarked on a project to link a disused “Beltline” tram loop around the city center with parks, communities and business, he said.

“A CULTURAL THING”

In interviews, commuters reflected on the impact of spending hours each week in their cars.

“It’s a total drain on my children,” said Krystal Barrett, who drives her two sons to school each morning across Atlanta’s northern suburbs — a 45 minute journey on a good day.

Barrett and her husband want to move closer to work, school and church. Meanwhile, she often breaks the long journey home to let her two mall boys burn off energy at a playground.

But other commuters said they drove out of habit so ingrained it became a state of mind.

Francis Charfauros, a coffee shop manager in Scottsdale, Arizona, said he would drive to work at his previous job even though it was just a few yards away.

“I don’t know why,” he said. “It’s a cultural thing.”

(Additional reporting by Tim Gaynor in Phoenix; Editing by Alan Elsner and Pascal Fletcher)

© Thomson Reuters 2009 All rights reserved

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By Claudia Parsons

NEW YORK (Reuters) – The United States could authorize emergency use of some currently unapproved immune system boosters called adjuvants to make a swine flu vaccine more effective, an official at the U.S. Centers for Disease Control and Prevention said on Thursday.

A big challenge facing manufacturers of a vaccine for the new H1N1 flu will be making sufficient quantities of vaccine from a limited supply of active ingredient, or antigen.

One option to extend supply is to use an adjuvant to increase the body’s immune response and reduce the amount of antigen needed in each shot. Several companies are working on this approach, including GlaxoSmithKline and Switzerland’s Novartis AG.

Michael Shaw, associate director of the CDC’s Laboratory Science Influenza Division, told Reuters on the sidelines of a conference on swine flu in New York that a vaccine could be “stretched” to make more doses by using an adjuvant.

“There are a couple of adjuvants that are being looked at now,” he said. “There’s nothing that’s been approved for use in the United States, but there are several that could possibly get emergency use authorization if it appeared it was called for.”

Philip Dormitzer, senior director of viral vaccine research at Novartis Vaccines and Diagnostics, said at the conference that the company had submitted to the U.S. Food and Drug Administration a large file on its MF59 adjuvant, which is already licensed in Europe.

The CDC said earlier on Thursday companies were starting preliminary work on a vaccine for the new H1N1 flu and should begin clinical trials this summer, though the new vaccine would not be ready for widespread use until October.

So far, there have been 8,585 probable and confirmed U.S. cases of the new H1N1 strain, commonly called swine flu, with 12 deaths and 507 hospitalizations, the CDC said.

Dr. Anne Schuchat of CDC said in a telephone briefing the CDC had shipped virus samples for making vaccines to different manufacturers several days ago.

Clinical trials will need to answer a number of questions, including whether one or two injections will be needed, whether vaccinating different age groups yields different results and whether an adjuvant would be needed to get a good response.

(Editing by Mohammad Zargham)

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WASHINGTON (Reuters) – Researchers using a new gene-scanning method have found a potential way to fight cancer by silencing genes that tumors need to stay alive.

They found a previously unknown gene that keeps tumor cells from killing themselves but that does not appear to be needed by normal, healthy cells. A second team found another new genetic process that also appears to be unique to tumors.

Both discoveries relate to a gene mutation involved in as many as 30 percent of cancers, the researchers reported in two studies in the journal Cell — an attractive target for a potentially useful and profitable drug some day.

The studies also point to a quick and effective new way to look for ways to fight cancer, using RNA interference or RNAi, itself a hot area in biotechnology.

Both teams of researchers focused on a known cancer-causing gene called KRAS. Mutations in KRAS are involved in 30 percent of cancers including leukemia, pancreatic and lung cancers. But so-called targeted cancer drugs do not work well against these tumors.

“It’s been a real frustration,” said Gary Gilliland of Harvard Medical School, who led one of the studies. “We know the mutation but we haven’t been able to do a thing about it.”

One important field of cancer therapy has been angiogenesis inhibition — stopping tumors from building blood vessels to feed themselves. Gilliland’s team and another group led by Stephen Elledge of Harvard and the Howard Hughes Medical Institute looked for other things tumor cells need.

“Cancer cells aren’t super cells,” Elledge said in a statement. “They are very sick cells that have needed to make a lot of compromises.”

To find these compromises Elledge and Gilliland, who now works at Merck Research Laboratories, used high-throughput RNAi. The employed small stretches of genetic material called RNA to slow down genes systematically.

“This strategy allows us to ask what the best targets are, with no preconceived notions,” Elledge said.

Scanning the entire human genome, Elledge’s team found some genes that KRAS cancers depend on to survive. One group they found are on what is known as the PLK1 pathway.

Gilliland’s team focused on a type of gene known as a kinase, already targeted successfully by cancer drugs. They found one called STK33 that appears to keep cancer cells from self-destructing when they are supposed to.

“The beauty of the strategy is that it would take only 50 to 70 percent knockdown of STK33 to kill a cancer cell,” Gilliland said. “It relies on a unique frailty of the cancer cell that normal cells don’t have.”

The work is highly experimental and will take years to translate into human research. But, Gilliland said, “We were looking at genes that we thought we could target easily with drugs.”

(Editing by Bill Trott)

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By Deborah Charles

WASHINGTON (Reuters) – When Jim Hann learned he would be laid off, he scheduled surgery to donate a kidney to his wife.

Steve Drake rationed his asthma medicine after he was let go while two-time cancer survivor Roberta Furchak had to draw on precious retirement savings to ensure her tests were covered after she lost her job.

All three were trying to compensate for losing health insurance in a country where unemployment often means going without coverage.

With unemployment rising to its highest level in more than a quarter century, more Americans are confronting the double crisis of losing both their jobs and their employer-sponsored insurance, which covers 177 million people.

Many unemployed Americans say they cannot afford the high premiums insurance companies charge for personal policies. People like Furchak and Drake who have pre-existing medical conditions have a tough time even finding coverage.

A recent study by the Robert Wood Johnson Foundation said the number of uninsured Americans could jump to more than 65 million in 10 years as healthcare costs more than double. The U.S. Census Bureau says about 46 million Americans are currently without insurance.

President Barack Obama has vowed to reform the healthcare industry and lawmakers are struggling to figure out a compromise all can agree on.

Hann, a 51-year-old plant worker from Coolville, Ohio, pushed doctors at Georgetown University Hospital to speed up a transplant operation so he could donate his kidney to his ailing wife Hannah while he was still covered.

“They were kind of dragging their feet — said she had to quit smoking,” said Hann, who found out in January he would soon be laid off from his job at a plastics factory.

“I called and said ‘I’m losing my job. I’m going to lose my insurance. We’ve got to get this done.’”

On February 13, the Hanns had the surgery, even though Hannah, who has had an intestinal transplant and multiple bowel operations in recent years, had not quit smoking.

The couple sold their newly-built house when Jim Hann found out he was being laid off and now rent an older home. Their friends and neighbors have helped raise money to cover the costs of traveling to Washington for treatment, but the combined impact of major surgery, losing his job and worrying about insurance has taken its toll.

“It’s just tough sometimes,” said Jim Hann, sitting by his wife’s hospital bed as a tear slid down his cheek.

“She’s my wife. You do what you have to do,” added Hann, who faces the prospect of having no insurance once the extended healthcare his employer offered after the layoff runs out.

TOTAL LOSSES

Furchak of White Lakes, Michigan, keeps hoping for healthcare reform to pass.

“For me, health insurance is the most important thing. I have to have that or I’d lose everything,” said Furchak, who after two bouts of lung cancer needs constant monitoring.

Furchak, 60, lost her job last November and opted for a costly continuation of her health coverage under a U.S. program called COBRA, which requires former employees to pay the whole cost of insurance but at least allows coverage to continue for a limited time.

The $430 monthly bill took up a big chunk of her $774 unemployment check, forcing her to dip into retirement savings. Recently Furchak’s monthly COBRA bill fell to $150 as part of a subsidy provided under Obama’s economic stimulus plan.

This has made a “huge difference”, said Furchak, who had part of her lung removed and two rounds of chemotherapy and radiation when her cancer recurred.

Her coverage runs out in May 2010. “When that finishes, I don’t know what I’m going to do,” she said.

“At that point I might very well have to make the decision not to carry insurance until my Medicare kicks in,” she added, referring to the health program for the elderly and disabled that covers Americans 65 and older.

“And that’s going to be very scary but I don’t know what else to do,” she said.

CONSTANT CHOICES

Drake often delays taking asthma drugs until his chest starts to tighten.

“I am constantly making a choice,” said the 57-year-old from Sherwood, Oregon who worked for a consulting company in financial services until he was laid off last July.

“I put off my medicines until I start to feel it then I get them refilled,” said Drake, whose family insurance eats up half his monthly unemployment check.

Drake, who has also been taking money out of his retirement funds to make it to the end of the month, says he cuts some of his pills in half to make them last longer.

A study released by the American Cancer Society Cancer Action Network showed that a quarter of people surveyed who have had a cancer diagnosis have had to delay health care because of costs.

“It’s always something,” said Drake, who recently tore his rotator cuff but can’t afford to get it fixed. “So it’s like I’m walking around with one and one-half arms.”

(Editing by Alan Elsner and Maggie Fox)

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By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) – A steady 15-year decline in the U.S. death rate from cancer translates to about 650,000 lives over that time, the American Cancer Society said on Wednesday.

But cancer will kill 1,500 Americans every day on average — with 1.47 million cases diagnosed and 562,000 deaths in 2009, the group said in its annual report on cancer statistics.

Cancer, which causes one in four deaths in the United States, is the No. 2 killer after heart disease.

“A drop of one or two percent per year in the cancer mortality rate may sound small, but as this report shows, that adds up to 650,000 cancer deaths avoided over 15 years,” John Seffrin, the group’s chief executive officer, said in a statement.

“And because the rate continues to drop, it means that in recent years, about 100,000 people each year who would have died if cancer death rates had not declined are living to celebrate another birthday.”

For men, the cancer death rate fell by 19 percent between 1990 and 2005, mostly because of fewer cases of lung, prostate, and colon cancer, the group said. Cancer deaths fell by 11 percent among women because of decreases in breast and colon cancer.

The rate did not fall more for women primarily because of smoking-related cancers. As men began to smoke less in the 1960s and 1970s, women started smoking more and their rate of kicking the habit lagged men’s by about 20 years. “Lung cancer is expected to account for 26 percent of all female cancer deaths in 2009,” the report said.

Lung cancer is the biggest cancer killer by far, and the American Cancer Society projects that 219,440 people will get a lung cancer diagnosis in 2009 and 159,390 will die from it.

Colon cancer is the second biggest cancer killer in the United States — with 49,920 deaths projected and more than 106,000 cases.

Breast cancer will be diagnosed in 194,280 women and men and will kill 40,610 — including 44 men, the group projects. Prostate cancer will be diagnosed in 192,280 men and will kill 27,360. “Prostate cancer alone accounts for 25 percent of incident cases in men,” the report said.

But it said 91 percent of these prostate cancer cases will be diagnosed early, giving men a 100 percent chance of surviving at least five years.

The group, which projects its statistics based on a variety of sources, said overall rates of cancer fell by 1.8 percent per year from 2001 to 2005 among men and 0.6 percent per year from 1998 to 2005 among women.

Separately, a team at the University of Texas M.D. Anderson Cancer Center found that 30 percent of people with colon cancer that had spread now survive their disease for at least five years, compared to just 8 percent of such patients in 2004.

They credited better surgical techniques and new drugs, both traditional chemotherapy drugs and new biological agents such as monoclonal antibodies.

(Editing by Vicki Allen)

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By John Whitesides

WASHINGTON (Reuters) – The U.S. Congress has started work on a broad overhaul of the healthcare system in a rare spirit of optimism, but brewing battles over its cost, scope and structure could still scuttle hopes for a solution.

From President Barack Obama’s declaration that “the stars are aligned” on healthcare to a recent cost-cutting pledge by a half-dozen industry groups, momentum has built steadily on an issue that has eluded consensus for decades.

The first test comes in a few weeks when Congress unveils legislation, launching months of expected wrangling over the specifics of tax hikes, spending cuts and the government’s role in a revamp that could cost as much as $1.5 trillion.

“It’s true that the planets are aligned for healthcare as never before, but there are still big obstacles,” said Drew Altman, president of the Kaiser Family Foundation, a nonpartisan health policy group.

“We are about to enter a very different stage of the debate once everyone sees the specifics and how it will be paid for,” he said. “Getting a comprehensive agreement is a high hill to climb. We have failed many times.”

The push for reform is still haunted by the most spectacular of those failures, the collapse of the Hillary Clinton-led effort in 1994. But analysts say Obama so far has avoided some of the pitfalls that doomed that plan.

Obama has pursued a more open approach than Clinton in developing the legislation, which he hopes will curb costs and expand coverage to many of about 46 million uninsured Americans.

He asked congressional leaders to put together the bill, rather than presenting it to them as a finished package, and brought to the table many of the groups like insurers who helped kill the Clinton plan.

Congressional leaders have backed a quick timetable for approval, limiting time for opposition to mount. The first proposal will be unveiled in the next few weeks and Obama wants to sign a final bill before the end of the year.

‘TACTICALLY SUPERIOR’

“The whole approach has been eminently superior, tactically, to 1994,” said Ed Howard, executive vice president of the Alliance for Health Reform, a non-partisan health policy education group.

Obama has a strong political hand after a decisive White House win in November over Republican John McCain, and has large majorities of fellow Democrats in both houses of Congress to work with.

Obama and McCain backed dramatically different approaches to healthcare reform. But the issue rarely won the spotlight in a 2008 campaign dominated early by the debate over wars in Iraq and Afghanistan and late by the collapsing economy.

Since then, the economic pain of the recession has strengthened the drive for reform, spotlighting worries about spiraling costs and bolstering Obama’s argument that reform is vital to an economic cure.

“The status quo has been shown to be unsustainable right before our eyes,” said Len Nichols, director of the Health Policy program at the New America Foundation. “Healthcare is an economic issue again. How do you go out there and tell people we will not do anything about this?”

But economic concerns will fuel what is likely to be the biggest battle over the plan: How much will it cost and how is it paid for?

OPPOSITION EXPECTED

Lawmakers have floated a variety of possible tax proposals to help pay for covering the uninsured. Nearly any tax hike will run into opposition from interest groups, and many could drain public support.

“A lot of middle-income people who have insurance are probably going to read an article soon saying they are going to have to pay a lot more for this at a time when they are economically hurting,” said Bob Blendon, a health policy and political analysis professor at Harvard University.

“And they are going to say, ‘That’s not what I mean by health reform’,” he said.

Republican opponents have been slow to organize and uncertain how to proceed as they search for the proper way to frame their warnings that Obama’s approach could reduce choice and lead to a government-run healthcare system.

“We’re dealing with shadows. No one knows what is going to be in the bill so it’s impossible to assess,” said Gary Ferguson, a Republican pollster who specializes in healthcare.

The leader of the first organized campaign against the overhaul is Rick Scott, a multimillionaire ousted as head of the huge healthcare firm Columbia/HCA during a fraud investigation that eventually led to $1.7 billion in judgments against the company.

But the insurance industry, which helped kill the Clinton plan, could still spring to life if the legislation includes a public insurance plan favored by Obama and many Democrats that would help cover the uninsured and create competition for private insurers.

Opponents say it could drive companies out of business. But Blendon said given the economy, it will be easier to find a compromise on the issue of a public plan than on the money.

“Because of the problem of finding the money to pay for it, the bill could wind up being more modest in the beginning or it could be phased in over a longer period of time,” he said.

“There are so many options here. The one option Obama can’t accept is to go back to Democrats and say ‘I couldn’t get a bill passed.’”

(Editing by Alan Elsner and Maggie Fox)

© Thomson Reuters 2009 All rights reserved

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By Lisa Baertlein

LOS ANGELES (Reuters) – School cafeteria meals like low-fat pizzas with whole grain crust don’t taste too bad to Paola Villatoro, a 17-year-old at Downtown Magnet High School in Los Angeles.

“Some of it is pretty good,” she said.

But West Adams Preparatory School student Alfredo Segura doesn’t like them. “It tastes like prison food,” said Segura, 16, as he and other students ate snacks at a fast-food joint near the school.

Los Angeles Unified School District is an anti-junk-food pioneer, but the obstacles it faces show how difficult it is to change habits shaped by decades of unhealthy eating promoted by the mammoth fast-food industry.

The district’s food services department has thrown out deep-fat fryolators, added more fresh foods and reduced sodium in cafeteria meals. It also has outlawed sugary sodas and banished junk food vending machines on campus.

But enforcement has been spotty and fast-food chains and convenience stores wait outside school gates, eager to provide students with a fix.

Even though she likes some of the school meals, Villatoro joins friends for weekly lunches at a fast-food outlet across from the school.

The number of U.S. fast-food restaurants exploded to about 220,000 in 2001 from 30,000 in 1970. And over the last three decades, spending on fast food hit $110 billion from $6 billion, according the public-health focused nonprofit Trust for America’s Health and the Robert Wood Johnson Foundation.

As working parents turned to restaurants for cheap super-sized meals, the eating habits of adults and children alike changed and waistbands expanded.

At the same time, schools dropped recess and physical education classes that used to burn off calories, to carve out more time for lessons.

Obesity rates for school-age children have tripled to 17 percent since 1980. At that rate, there is an “epidemic in the United States,” according to the U.S. Centers for Disease Control and Prevention.

Experts worry about soaring rates of diabetes, heart disease and other chronic conditions as these children grow up, further adding to the country’s health crisis.

In Los Angeles County 23 percent of school children were obese and another 19 percent were overweight in 2007, the county’s health department said.

OUTDATED NUTRITIONAL STANDARDS

The U.S. government spends about $11.7 billion a year on school programs that provide lunch for over 30 million children and breakfast for more than 10 million — but has not updated nutritional standards and meal requirements since 1995.

States have tried to act without waiting for the federal government. As of last August, 18 states had adopted tougher nutritional standards than the U.S. government — but most lack enforcement power and cannot punish noncompliance, says the Trust for America’s Health, a nonprofit organization that works to raise community health standards.

Recent data suggests that childhood obesity rates may be leveling off. Some experts say programs like healthier school lunches are starting to work, but others are skeptical.

President Barack Obama wants to increase funding for U.S. child nutrition programs by $1 billion per year to prevent children from going hungry in a recession that has sent unemployment to a 25-year high.

“We’re hoping it comes our way,” said Laura Benavidez, deputy director of the Food Services Department for the Los Angeles school district with 690,000 students.

Its food services budget of $325 million this year covers not only meals, but also staff salaries, benefits, insurance utilities and utensils. It spends about 70 cents per meal, excluding milk, which costs 18 to 20 cents per serving. The district currently loses money on every lunch it serves.

At Castelar Elementary in Los Angeles’ Chinatown section recently, students rushed a salad bar, scooping up orange slices and half bananas, green peas and salad — a fair portion of which actually went into stomachs instead of trash cans.

Still, the healthy message is often undermined by school fund-raising events where selling junk food raises money for sports teams or academic clubs.

“We can’t undo a lot of habits,” said Dennis Barrett, who oversees the district’s food services operations.

In the battle between veggies and burgers, burgers may be hard to beat.

(With additional reporting by Chuck Abbott in Washington, editing by Alan Elsner)

© Thomson Reuters 2009 All rights reserved

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By Andy Sullivan

WASHINGTON (Reuters) – Countless workers in the United States are trapped in jobs they would like to leave because they cannot get health insurance elsewhere, calcifying innovation and mobility in the world’s largest economy.

Daunted by health-care costs, a would-be technology entrepreneur in Texas decides not to start her own business. A communications expert in Washington decides not to strike out on his own. And a freelance magazine editor in Brooklyn decides to take a less satisfying corporate job.

“I would rather be freelancing, no question,” said Jessica Tolliver, a former editor who now works in public relations. “I got my work done in less time, because once I finished what I had to do, the time was my own.”

Economists call this phenomenon “job lock,” and studies suggest that it keeps between 20 percent and 50 percent of workers from leaving their current jobs.

Because health insurance is tied to employment in the United States, workers who leave their jobs can see health bills skyrocket if they strike out on their own or take a position with a company that offers fewer benefits. Workers who would like to retire early stay on, unable to qualify for the government’s Medicare program until they turn 65.

And those who have existing health problems may not be able to get coverage at all.

Job lock is difficult to measure because many employees don’t like to advertise their unhappiness. But economists and small-business advocates say it takes an enormous toll on productivity.

SLOWING INNOVATION

“We can definitely say that it’s slowing down the rate of innovation,” said Tim Kane, an economist with the Kauffman Foundation which promoted entrepreneurship.

For Mike, a Washington-based communications professional who did not want to use his last name, health costs may force him to pass up the chance to be his own boss at a time when he could easily pick up several major clients.

With two children at home, Mike said he was reluctant to abandon the generous benefits he gets at the trade group where he currently works. Self-employment would probably mean spending more for fewer benefits.

“I don’t want a bad event to knock me and my family out of the box,” he said. “It’s a real hurdle.”

As head of the National Federation of Independent Businesses, Todd Stottlemeyer frequently encountered would-be entrepreneurs who let their ideas go stale and their products languish on the workbench because they did not want to shoulder their own health care costs.

When he asked audiences if health insurance has affected their employment decisions, often half the hands in the room would go up.

“There are lots of factors that go into why somebody starts a business or doesn’t start a business: Do I have a good idea, do I have capital, do I have risk tolerance?,” said Stottlemeyer, now an executive at a hospital chain. “Being able to get health insurance … should not be one of those determinant factors.”

Making insurance more affordable for the self-employed could lead to a wave of new businesses, one study suggests.

New Jersey saw a 14 to 20 percent rise in entrepreneurial activity due to a 1993 law making it easier for the self-employed to afford health insurance, a study by Philip DeCicca of McMaster University in Hamilton, Ontario found.

Roughly 60 percent of the U.S. population now gets its health coverage through work, but the system is increasingly strained due to rising costs.

Congress is working to overhaul the troubled system. The Democratic majority hopes to pass a law which President Barack Obama can sign by the end of the year. However, employer-based care is likely to remain a bedrock of any new approach.

The link between healthcare and jobs evolved during World War II, when the government imposed wage controls but allowed companies to adopt health-insurance plans to lure employees.

Small-business groups have often complained this unfairly tilts the playing field toward large employers that have the clout to negotiate rates that are 18 percent lower on average, according to the Commonwealth Fund.

Consequently, workers at small firms are much less likely to have health insurance. While 99 percent of companies that employ more than 200 employees offer health coverage, only 49 percent of companies that employ between 3 and 9 workers do so, according to the Henry J. Kaiser Family Foundation.

Part-time workers are also less likely to get benefits than full-time employees, according to Kaiser.

Self-employed workers face a further disadvantage because they cannot deduct health-insurance payments from their income taxes, unlike companies that maintain a payroll.

As a freelancer, Tolliver could work from wherever she and take playground breaks with her daughters. But a $1,200 monthly healthcare bill ultimately led her to take a job where insurance only costs her $200 per month.

“It would be obnoxious to say were struggling to put food on the table. But that said, it was a lot of money.”

(Editing by Alan Elsner)

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