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L to R: Alexis Ballou, Daveon Andes, Jacob Barker Photo montage (digital composite) of 5th grade students at James Lewis Elementary School in Blue Springs, MO. These students are part of the "Jump Into Action" program which aims to help fifth-graders make healthy food choices and become more physically active. / Eli Reichman/USA WEEKEND

Too many Americans are fat. Too many have diabetes, heart disease and other chronic problems, or are well on their way to developing them. Our leaders debate solutions, but a nationwide health remedy remains elusive.

The good news? State and local solutions already are making a difference in people’s lives.

Here’s a sample of impressive results:

Missouri: Kids step it up with pedometers

Want kids to be more physically active and to choose — and actually eat — more fruits and vegetables? A low-cost school-based program has triggered those obesity-busting behaviors by giving pedometers and nutrition lessons to 45,000 children in Missouri since 2004.

The program, Jump Into Action, begins by training teachers and creating support teams of adults. Then kids learn to use a personal pedometer. Soon, they compare their pedometer readings against goals they set for themselves and compare one teacher’s steps with another’s. Imagine a formerly sluggish child saying: “Mrs. Smith has more steps than you have today, Mrs. Johnson. You’d better get moving! Let’s take an activity break. Let’s go for a walk.” Kids have even asked for healthier food on the school lunch menu.

Weekly lessons are bolstered by monthly checkups, and parent newsletters provide support at home.

Throughout the class day, activity breaks help students pay more attention and do better academically, adds Stephen Ball, associate professor of nutrition and exercise physiology at the University of Missouri. Ball and nutrition specialist Ann Cohen developed the Jump Into Action program, which was launched with a grant from the University of Missouri Extension.

A University of Missouri study showed that participating students drank less soda and other sugary drinks, were more physically active and spent less time watching TV, playing video games or using computers. They had a better understanding of nutrition, portion sizes and healthy choices so they chose — and actually ate — more healthful dairy foods and more fruits and vegetables.

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Learn more: Read Jump Into Action info for parents and teachers at extension.missouri.edu/hes/jumpintoaction. Watch a video about the program at youtube.com/ watch?v=_baamGCtOCA. The CDC also provides information about combating childhood obesity: cdc.gov/obesity/childhood/solutions.html.

Colorado: Simple tool kit controls asthma

Don’t hold your breath waiting to see an asthma specialist if you live in a poor, rural, Hispanic area of Colorado. And don’t assume the nearest primary-care doctor knows the latest in asthma care. Result: The chronic lung disease is under-diagnosed and undertreated. But a simple tool kit, delivered to rural doctors, has improved diagnosis and treatment and is projected to cut costly asthma hospitalizations by 33%.

Training rural doctors in best practices for asthma would help, but research shows that traditional training via lectures “doesn’t actually change provider behavior,” says Bruce Bender, a professor of pediatrics and psychiatry at National Jewish Health, a Denver hospital specializing in respiratory care.

Bender is director of the 6-year-old Colorado Asthma Toolkit Program, in which nurses travel to rural medical practices and teach the entire staff the latest care. Tools they leave behind include spirometers (which measure lung function and are crucial to asthma diagnosis) and peak flow meters (a self-test for patients).

Eva Muniz Valdez, a nurse, is the program coordinator for 16 counties in rural southeast Colorado. She understood how terrifying asthma can be because her son was diagnosed with asthma at age 2 — and she was recently diagnosed with asthma herself. Learning about the disease and knowing they can manage asthma is a great help to patients and families, Muniz Valdez says.

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After the program was implemented in eastern Colorado, spirometer use was up 10-fold, and more patients had asthma action plans and prescriptions for inhaled corticosteroid medicines, the most effective medicine to control asthma, Bender says, leading to a projected 33% drop in asthma hospitalizations.

“Our objective is to train all areas of Colorado,” says Bender, then other states. Vermont “has built their own asthma toolkit, using our materials and information.”

For how-to videos and information for logged-in providers, see Colorado Asthma Toolkit Program at coloradoasthmatoolkit.com/about.

For patient-friendly information about CATP and a sample Asthma Action Plan, see nationaljewish.org/education/feature/asthma-toolkit.

New York: School clinics heal the community

Too often, working parents have to gamble whether to risk their jobs by missing work to get care for their sick child. “We keep parents at work,” says David Appel, program director of the largest hospital-sponsored health program in the country. The Montefiore School Health Program gives comprehensive medical, dental and mental care to 25,000 students and their families in the Bronx, N.Y., one of the nation’s poorest and most medically underserved areas.

Centers (19 of them serving 51 elementary, middle and high schools) are staffed by physicians or nurse practitioners and nurses who provide, at no out-of-pocket cost to the child’s parents, primary-care services such as immunizations, physicals, lab tests and medicines. They also provide treatment for acute illnesses such as asthma and diabetes, and mental health services for depression, anxiety, bereavement, crisis intervention and family issues.

Program director and physician David Appel says, “School-based health was a way to reach kids who were not getting the basic services they needed. Whatever a child’s unmet needs are, we can take care of it.”

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Students are seen at the clinic and go back to class. Students in schools with health centers “had three times less loss of academic seat time” than students in schools without them, Appel says.

How’s it working? For asthma, ER visits and hospitalizations were reduced by 50% each.

The program is fully funded through a combination of renewable city, state and federal grants, Appel says, and it receives Medicaid funding for services provided.

For more information about the Montefiore School Health Program: www.montekids.org/programs/school.

New York: Less cost and hospitalization for hip fractures

Some 300,000 Americans age 65 or older were hospitalized in 2010 for hip fracture, and 20% to 30% would die within a year. Those who survive often lose their independence because they can no longer do things like walk, get up from a chair, bathe or use the toilet without assistance.

The Geriatric Fracture Center at Highland Hospital, an affiliate of the University of Rochester Medical Center in Rochester, N.Y., uses a new “whole patient” care model instead of focusing on treating only the hip fracture. They report cost savings of $18,000 per patient and reduced hospital stays (down from 6.2 to 4.6 days) compared with national average.

The key: Patients who suffer hip fractures often have medical problems that can complicate treatment. Those issues need to be addressed both before and after the fracture is repaired. Highland’s method stabilizes patients and prepares them for surgery faster.

Patients have lower risk of hospital-acquired illness, don’t undergo needless tests and treatments, receive better pain management with reduced risk of delirium, and recover faster with fewer complications and/or deaths.

Learn more at www.urmc.rochester.edu/hh/services-centers/geriatric-fracture.

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Get a free Fall Prevention Kit from Highland Hospital: www.StopFalls.urmc.edu.

Washington: Medical "homes" mean more visits, less cost

A new program in the Seattle area of Washington state is giving people access to better medical care without high health insurance premiums. Qliance direct primary-care medical home clinics work like health clubs.

Participating patients pay one low monthly membership fee to receive unrestricted access to all types of primary care. Qliance doctors routinely spend 30 to 60 minutes with each patient.

A 2010 report showed Qliance patients had 92% more primary-care visits when compared with regional benchmarks and 65% fewer ER visits, 43% fewer hospitalizations, 66% fewer specialist visits and 82% fewer surgeries because their health care needs were met at the primary-care level. This reduced use of extended services results in about 22% lower health care costs overall.

Learn more at: www.qliance.com.

Ohio: "Be Fit 4 Life" develops health, economy

Like most health and fitness programs, the first goal of Be Fit 4 Life, a spinoff of Lake Health in Lake County, in northeast Ohio, is to help people in the community improve fitness and be healthier. But its second goal is to improve economic development by reducing local health care costs to create a more business-friendly environment.

Now in its third year, the program starts with a basic assessment and screening on Jan. 1. Participants form teams of 20 and score points for fitness activities they take part in each month, which can be anything from walking to Zumba, dog sledding to kick boxing, cross-country skiing to yoga, and more.

By the time the program ends in June with a 5K half-marathon, people have been exposed to a variety of fitness activities. The organizers hope that encouraging people to try lots of activities will help them find one or more they can stick with long-term. And that will help lower health care costs and, in turn, make the community more attractive for economic development.

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Learn more at: www.gethealthylakecounty.org/bfit4life/index.html.

Minnesota: Program changes habits, cuts heart attacks

Minnesota’s historic German community of New Ulm was known for food and festivals. Locals loved their beer, brats and butter. But it was also one of the most obese places in Minnesota, with a 36% rate of metabolic syndrome in adults.

(People with metabolic syndrome have at least three of these heart attack factors: abdominal obesity, high blood pressure, low HDL cholesterol, high triglycerides, high blood sugar.)

Heart disease is the No. 2 cause of death in Minnesota (No. 1 is cancer), and an estimated 10,000 adults were at increased risk of heart attack. Then a 10-year program called The Heart of New Ulm began helping residents to change their diet, exercise, smoking and other heart-risk raising habits.

Adults and children are walking and bicycling more. People are preparing healthier meals at home and finding healthier options on restaurant menus. Smokers are quitting. And the program is working. Data presented at the American College of Cardiology in 2011 showed the community’s heart attack rate dropped by 24%. Now the 10-year goal is to slash heart attacks by 50%.

Learn more at www.heartsbeatback.org.

Illinois: Hospital begins Hispanic Transplant Program

Hispanics rank second on the waiting list for liver transplants and account for 16,000 of the 90,000 people waiting for kidney transplants.

Although the Hispanic community has a high incidence of obesity, hepatitis C and hepatitis B, all of which can lead to organ transplant, few were getting help because of language and culture barriers.

Chicago’s Northwestern Memorial Hospital created the Hispanic Transplant Program in 2006 to meet that need. It includes a dedicated liver and kidney transplant clinic that’s entirely in Spanish and is tailored to the unique needs of Hispanic patients. Since the program began, Hispanic kidney transplants have more than doubled, and patients come from as far as Puerto Rico, Texas and Florida.

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Learn more at: www.nmh.org/nm/liver-transplant-hispanic-program.

For the Spanish-language version, see trasplante.nmh.org.

Arizona: "Just-in-time" compression-only CPR

A simpler way of performing cardiopulmonary resuscitation (CPR) skips the mouth-to-mouth part and focuses on chest compression only. This method doubles a person’s chance of surviving cardiac arrest (a stopped heart).

The University of Arizona Sarver Heart Center in Tucson, in collaboration with the Arizona SHARE (Saving Hearts in Arizona Registry and Education Program in Phoenix), offers “just in time” training for 911 dispatchers to make emergency calls more efficient, and get bystanders to start CPR sooner.

Implementing the program nationwide could increase the number of people saved by CPR from the current 12,000 to more than 23,000, saving an additional 11,000 lives each year, says Gordon A. Ewy, Sarver Heart Center cardiologist and professor of medicine .

See a demo video and learn more at www.heart.arizona.edu/publiced/lifesaver.htm.

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