Impacts of Impact Reporting: An Emphasis on Obesity Reduction Programs

1. Impacts of Impact Reporting: An Emphasis on Obesity Reduction Programs Presentation By David W. Hughes Professor, Department of Applied Economics & Statistics Clemson Institute for Economic and Community Development, Clemson Extension Service, Clemson University www.clemson.edu/public/ciecd/

2. Presentation Outline • Obesity Situation • Overview of Impact as a Concept • Application to Obesity: Key Concepts • Apply in a Logic Model Context

3. Obesity Situation

4. Obesity Situation(CDC, www.cdc.gov/obesity/index.html) • Well known national epidemic • American society has become 'obesogenic,' characterized by environments that promote increased food intake, non-healthful foods, and physical inactivity. • Body Mass Index >= 30 • (adult’s weight in kilograms divided by the square of his or her height in meters) • (5 feet, 9 inches min 203 pounds) • Overall rate 26.7% (2009) • Non-Hispanic blacks (36.8%), • Hispanics (30.7%), • < high school (32.9%) • aged 50--59 years (31.1% • 60--69 years (30.9%) • Increase from 2006-08 rate of 25.6% • 16.9% of children and adolescents aged 2–19 years are obese

7. Contributing Factors and Impacts(www.cdc.gov/obesity/causes) • Due to energy imbalance. • eating too many calories and insufficient physical activity. • genes, metabolism, behavior, built environment, culture, and socioeconomic status all play roles. • Health Impacts: • Coronary heart disease, Type 2 diabetes, Cancers, Hypertension, Stroke, Liver- Gallbladder disease, Osteoarthritis, respiratory and Gynecological problems,. • Economic Impacts:  • 9.1 % U.S. medical expenditures (1998) • Also value of lost wages.

8. Overview of Impact as a Concept

9. Overview of Related Economic Concepts • Economic Impact Analysis: • Usually policy impact or industry contribution • Mostly for economic development or agriculture • Multiplier based, turn over of $ in a given economy. • See Hughes, 2003.www.choicesmagazine.org • Cost-Benefit Analysis • Economists usually evaluate based on producer surplus (extra profits) plus consumer surplus (extra benefits beyond price paid). • Can look at program cost vs. net cost avoided or net benefits generated

10. Overview of Impact: Case Study • Programmatic effectiveness: • Can apply quantitative analysis examining a dependent variable as explained by a set of causal variables • Causal variables • The program (policy instrument to economist) • Other variables attempting to control for “external factors” • Approach is problematic concerning evaluating extension programmatic activities for obesity reduction (errors in variables issue)

11. Case Study Approach • careful study of some social unit (as a corporation or division within a corporation) that attempts to determine what factors led to its success or failure (wordnet.princeton.edu) • in-depth investigation/study of a single individual, group, incident, or community. (en.wikipedia.org/wiki/Case_study) • Does not using samples and following a rigid protocol (strict set of rules) to examine limited number of variables

12. Case Study Approach More(Barkley cherokee.agecon.clemson.edu/case_study_research.pdf) • “evaluation” of programmatic efforts with the goal of identifying potential explanations for their successes or failures. • Exploratory and descriptive case studies, examine the development and characteristics of phenomena • Objective: constructing hypotheses concerning cause– effect relationships. • Tests for causal relationships by comparing generalizations from case studies’ findings with the underlying theory

13. Application to Obesity: Key Concepts

14. Literature on Smoking Cessation to Applicable to Obesity Reduction Effort • Time value of money because benefits of cessation continued into the future. • Rational consumer and time-inconsistent behavior very pertinent. • Tendency to use gross, not net, benefits. • Advertising, product development controversial roles. • Government policy controversial (cheap food = obesity argument).

15. Time Value of Money Key Concept • Value of a stream of money overtime. • Money saved (earned) in the future less valuable than current money saved (earned). • Invest $100 today to receive $105 one year from today. • Discounting of future savings or earnings the flipside. • Over several years, can add up annual savings using discounting ($100 this year, $95.2 next year, $90.7 following, etc).

16. What are Actual Cost-Benefits? • Is over-eating by adults a rational decision? • I.e., do they weigh the costs (health) vs. benefits (satisfaction) in a rational way. • As forward-looking consumers, overeaters trade off the happiness gains from overeating against the costs of doing so. • If so, what is the justification for public $s on education and intervention? • time-inconsistent behavior • tend to realize immediate rewards and avoid immediate costs in a way that does not maximize their long run well-being. • Will loose 10 pounds next year by exercise and eating right then; when the time comes to make the choice, no follow through. Inconsistent, because the behavior I anticipated did not fit my actual future actions. • eight of ten smokers in America wish to quit but most of the intentions are not actualized, which indicates time-inconsistent smoking preferences (Gruber and Koszegi, 2002).

17. Are Benefits “Net” or Gross? • Gross benefits– aren’t benefits because do not account for alternatives. • Gross Benefits: • calculate all costs (usually in a year) due to diabetics, other obesity related health cost, count as benefit from obesity reduction program. • Net Benefits: • comparing the lifetime costs and savings of cohorts of 20-year-old obese to cohorts of “non-obese” of the same age.

18. Applying Concepts in a Logic Model Framework

19. Logic Model Output Focus Inputs Outputs Outcomes Activities Partici-pation Short Term Medium Term Long Term What we do What we invest Who we reach What the short term results are Learning What the medium term results are Actions What the long term resultsare Conditions Situation Assumptions External Factors Extension reporting focuses on outputs

20. Logic Model Outcomes Focus Inputs Outputs Outcomes Activities Partici-pation Short Term Medium Term Long Term What we do What we invest Who we reach What the short term results are Learning What the medium term results are Actions What the long term resultsare Conditions Situation Assumptions External Factors Case study allows focused on outcomes

21. Impacts from measuring outputs (Barefoot) • Measuring outcomes implies measuring a change in behavior • Imparted knowledge does not mandate behavior change • Look at program outputs as the mechanism for knowledge adoption and behavior change.

22. Evaluating Impacts: A Hypothetical Example Focusing on Outcomes(O'Neill, 2008, Feb., JOE) • Net Benefits over time • Use the time value of money • Use net benefit approach • annual health cost: • $13,243 with diabetes • $2,560 without • $10,683 savings • Assume 20% of 1,000 program participants push back onset by 6 years. • At 5% interest rate, present value of cost savings for one individual would be $56,001 • $56,001 X 200 = $11,200,200

23. Do Extension Obesity Reduction Efforts Have an Impact? • Definite Maybe • State Reports for 2007 • Noise in the data: • Nutrition, Food Safety and Healthy Lifestyles • Youth/Adult Obesity • Not possible in many cases to filter out spending on other objectives (such as food safety) • Correlated per capita spending & FTEs per capita (2007) on changes in obesity rates 2007-08. • Data available for 47 States • Spending: -0.01935 • FTE (Non-research): -0.15061 • Total FTE: -0.04702.

24. A Call for More, Better Case Studies • Opportunity Cost: • Reporting takes time and other resources • In it for the impact, not the reporting. • Case Study • Linking inputs to outputs to outcomes • Historic Asset Mapping • Use focus groups, surveys, other (?), to determine the current and past programmatic landscape (extension and other wise). • Similar tools to determine impact of current program. • Convert to monetary, other impacts using principles such as net benefits, time value of money.

25. Supporting Case Studies in an Era of Budget Challenges • Partner with research colleagues • Write case studies into grants, contracts • Use case study results to: • Publicize results, especially in the political process (this program saved state government $11,000,000 in medical spending) • Improve future programmatic efforts.

26. Questions, Comments? Thank You for Your Attention