How Federal Restructuring Affects Data That Affects Health Policy

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Health Affairs' Jeff Byers welcomes Senior Editor Akilah Wise to the program to discuss the impacts of preserving the Behavioral Risk Factor Surveillance System, the effects of physical exercise on health, and how this type of data helps inform policy making.

We are hosting another live podcast recording of A Health Podyssey featuring host Rob Lott and guest Andrew Ryan where they will discuss his paper in the May 2025 edition of Health Affairs and take questions from a live audience. Sign up today.

Health Affairs is hosting an Insider exclusive event on May 29 focusing on the FDA's first 100 days under the second Trump administration featuring moderator Rachel Sachs alongside panelists Richard Hughes IV and Arti Rai.

Related Links:

• CDC's Population Health Office Is Gone (MedPage Today)
• Adult Physical Inactivity Outside of Work (CDC)
• Adult Activity: An Overview (CDC)
• How Exercise Helps You Age Well (NCOA)
• Establishing The President's Make America Healthy Again Commission (The White House)

Episode Transcript

Jeff Byers (00:39):
Hello and welcome to Health Affairs This Week. I'm
your host, Jeff Beyers. We'rerecording on 05/01/2025. As a
heads up on May 13, we have alive taping of a health policy.
The guest will be Andrew Ryanfrom Brown University to discuss
state affordability's standardsimpact on hospital prices and

(00:59):
insurance premiums.
The event is free and open forall to attend. Check that on the
show notes. And for insiders onMay 29, we are hosting an event
on the FDA's first hundred daysunder the second Trump
administration. This will bemoderated by Rachel Sachs, and
the panel will include RichardHughes the fourth and Arty Rye.
With all the layoffs andrestructuring occurring at HHS,

(01:22):
I thought it might beinteresting to hone in on
example on how those decisionsmay or may not impact an agency.
Also, kinda wanted to Trojanhorse the idea that data and
research has an influence on ourlives in some ways. So if you
follow A to B to C, and I hopeyou did, but don't think about
it too hard, We're here today totalk about the behavioral risk

(01:43):
factor surveillance system atCDC and its influence on
behavioral health. Today, I'mjoined by health affairs Akila
Wise. Akila has worked at theCDC, so I'm looking forward to
getting a behind the scenesperspective on this. Akila,
welcome to the program.

Akilah Wise (01:58):
Hi, Jeff. Thanks so much. So good to be here.

Jeff Byers (02:01):
Yeah. So we mentioned off mic, and people
love to hear about this. It'sit's getting hot these days.

Akilah Wise (02:06):
Yeah. Super hot. I'm in Georgia, and, you know, I
think it's just gonna get worsefrom here on out.

Jeff Byers (02:12):
Yeah. You know, the the weather will get worse from
here on out. I'll in inVirginia, we just, you know,
like to say the humidity iscoming, and it never stops. You
know, moving forward to thetopic at hand. So among the
layoffs at HHS, many were cutfrom the CDC.
According to MedPage Today, theagency's division of population

(02:32):
health was eliminated with oneexception, the behavioral risk
factor surveillance system wasspared. So Akila, what is this
system, and what's tracked?What's the cadence of this? Give
us a primer on this.

Akilah Wise (02:45):
Sure. So just to take a step back and, define
what behavioral health is,according to the CDC, behavioral
health refers to the state ofmental, emotional, social
well-being or behaviors andactions that affect wellness. It
also refers to support systemsthat promote well-being and
prevent mental distress and alsothat provide access to treatment

(03:07):
and services for such mentalhealth conditions. So it's
really important to understandthat and improving behavioral
outcomes means addressingfactors at multiple levels,
including social determinants ofhealth and supportive
environments. And so this leadsreally nicely into, the actual
survey.
So yet the Behavioral RiskFactor Surveillance System or

(03:29):
BRFSS or even BRFSS, some peoplerefer it to as a state based
national system of telephonesurveys and in The US. And it
collects data about healthrelated risk behaviors of US
adults, so folks who are 18 andup. And the sort of data it
collects really gets at thisbehavioral health aspect.
Cigarette smoking, fruit andvegetable consumption, chronic

(03:50):
health conditions like diabetes,arthritis, depressive disorder,
and even the use of preventativeservices like cancer screenings
and routine doctor and dentistcheckups. So the BRFSS is a
collaborative effort between theCDC and each state's health
department, and it's ongoing.
It's the nation's leadingongoing health related survey.

(04:10):
It was established in 1984 whenit started with 15 states, And
currently it completes about400,000 interviews each year in
all 50 states and the DistrictOf Columbia, as well as the
Virgin Islands, Puerto Rico, andGuam.

Jeff Byers (04:25):
Yeah. So you used to work at the CDC. We were talking
offline that you didn't work onsurvey specifically, but I kinda
wanted to get a sense of, like,how are surveys like this at the
CDC used to help create publichealth programs or policies?

Akilah Wise (04:39):
Yeah. So surveys are really powerful tools. BRFSS
is the main one that's verypowerful. I worked in two
divisions at the CDC previously.One was within the Division of
Population Health, where theBRFSS was housed before being
moved.
Within that division, I workedwith the Healthy Aging Branch on
arthritis. And the otherdivision I worked was the

(05:02):
Division of HIV Prevention, andthey conducted their own surveys
around HIV. So surveys help uscreate public health programs
and policies by providing thedata on which to base those
programs, policies andrecommendations. So federal,
state and local health officialsregularly use BRFSS. And without
these data, they would beplaying somewhat of a guessing

(05:25):
game about health issues and howthey affect people.
So for example, we know that onein four US adults have
arthritis, thanks to the BRFSS.And we can also identify which
groups of people are most atrisk, of arthritis. And so that
sort of information helps,public health officials design

(05:45):
programs and recommendations.

Jeff Byers (05:47):
Did you say one in four adults?

Akilah Wise (05:49):
Yes. One in four adults.

Jeff Byers (05:51):
So you are not alone, anyone that's listening
that's No. Rapidly aging, I'mthinking.

Akilah Wise (05:59):
Yeah. And it it affects non elderly adults as
well. Of course, there's ahigher prevalence with folks who
are older older than 65. And,you know, arthritis is just what
happens, you know, as we age andwe use our bodies. So
eventually, you know, each of uswill have arthritis at some
point.

Jeff Byers (06:15):
Yeah. I like the humidity that comes for us all
is what what I'm hearing. Yeah.Okay. So thanks for that.
Let's draw out another example.You know, on our health policy
feed, Rob Lott next week isgonna be talking to Eric Topol,
who wrote a new book onsuperaging. We can't I can't

(06:37):
really talk about that interviewtoo much because it is under
embargo until next week, socheck that episode out. But
there is some work in the bookon the intersection of exercise
and health, and I have alwaysthought that was an interesting
connection. It's always beenapparent whether overtly or not,
but more research is drawing outexactly how exercise is linked

(07:00):
to all kinds of positive riskreductions in health.
And this is also a focus on, theCDC's BRFSS survey. So what's
some of the latest evidence onthe connection of exercise and
health according to the survey?

Akilah Wise (07:16):
In general, I'll speak in general. So we know
that the benefits of physicalactivity is well documented. It
reduces chronic conditions likeblood pressure and diabetes,
some of the immediate effectslike good sleep and reduced
anxiety. We know that, the CDCsays adults need at least one
hundred and fifty minutes ofmoderate intensity physical
activity per week, includingmuscle strengthening exercises.

(07:39):
And that shakes out to be aboutthirty minutes a day for five
days a week.
And it's recommended for peoplewho are over 65 years to do
additional activities thatimprove balance, like standing
on one foot. So we did there's anew study by researchers at
Hopkins that found engaging inas little as thirty five minutes
of moderate to vigorous physicalactivity per week, compared to

(08:02):
no minutes, of activity per weekwas associated with, forty one
percent lower risk in developingdementia among adults. And this
was in The United Kingdom. Theydidn't use BRFSS, that's US
specific, but they did use datafrom the UK Biobank, which is
actually a little morecomprehensive than our BRFSS

(08:23):
because it includes genetic andhealth record data. But again,
the idea is that these surveysreally help us understand what's
going on population wise.
In this case, they use this sortof data to find that physical
activity actually helps withdementia. So there's another
study, though, that used a largeUS data set called NHANES, and

(08:44):
they found physical activity islinked to longer telomeres.
Telomeres are nucleotide caps onour chromosomes. The older we
get, the shorter our telomeresbecome. So telomere length is a
biomarker of aging, actually.
So this study found that highactivity adults, that vigorous
activity has significantlylonger telomeres than sedentary

(09:06):
adults. So this translated intoan almost nine year biologic
advantage. And they actually hada seven year advantage over
adults who were moderatelyactive. So this data, as well as
other emerging evidence, isshowing that physical activity
has this antiaging effect foradults.

Jeff Byers (09:25):
Yeah. So I think with what you're saying is we
we've always known that there's,you know, a a general link to
physical activity and health. Alot of people have been
exercising for a long time for alot of different reasons. And so
a lot of this research isdrawing out exactly how it's
impacting us physiologically.And also, you can kinda run some
parallels of like, I thinkgenerally people know what

(09:48):
healthy foods are, you know,fruits and vegetables and that
kind of thing.
So but then there's that, like,what does it look like in
practice? What are what arepeople actually doing from a
behavioral health perspective?And that's where I think the
BRFSS can come into play. So oneof the things that tracks is
physical inactivity. So takingtogether, you know, what do we

(10:08):
know about The US?
How are people, moving around?

Akilah Wise (10:12):
So I'll focus on physical inactivity because
there's a lot of data there.Yeah. So the CDC collects data
on a number of factors, as Imentioned, including adult
physical inactivity. So this isbased on a question that asks
whether someone has done anyphysical activity outside of
work. And people who answer noare classified as inactive.

(10:34):
Based on the latest CDC analysisof these data, which includes
years 2017 to 2020, the overallprevalence is twenty five point
three percent. So that means onein four adults are physically
inactive. They're not doingphysical activity outside of
work as they report, to thesurvey.

Jeff Byers (10:54):
These same people with arthritis?

Akilah Wise (10:56):
Probably. Or at least some some overlap. And and
even with that, we can combinedata to see if there's a link
between physical activity andarthritis. So you actually
introduce you know, one of theways people use these data is to
look at various factors and, youknow, you can you can look at
that and see the relationship orany trends. You know, we can

(11:17):
look at these data by states andterritory as well.
And that's where states, youknow, find it really useful
because then you can designprograms for your constituents.
So we know from this data thatstates in the South had the
highest prevalence of inactivityat 27.5 and the West had the
lowest prevalence at twenty onepercent. So you can see how

(11:39):
these data can really be helpfulfor state officials, local
officials and public health. Wecan look at individual states
and see that there are sevenstates that have physical
inactivity levels of thirtypercent or more. So that's one
in three adults, and that's WestVirginia, Oklahoma, Louisiana,
Alabama, Kentucky, Arkansas andMississippi.

(11:59):
So, you know, these data couldbecome really powerful tools.
And what we know is thatincreasing physical activity is
a comprehensive effort for manygroups. It's not just telling
someone, you know, get up andexercise. Includes individuals,
communities, our public healthagencies. And so, for example,
state and local officials canencourage and implement physical

(12:21):
activity programs and evendesign, you know, communities
that are safe and activefriendly.
So this is just one of the manyways these sorts of data has
really helped with public healthaction.

Jeff Byers (12:33):
So thanks for drawing all that out. This
dovetails in some ways with theestablishment of the Make
America Healthy AgainCommission, which seeks to,
quote, aggressively combat thecritical health challenges
facing our citizens, includingthe rising rates of mental
health disorders, diabetes, andother chronic diseases, unquote.

(12:55):
What are the avenues that theystate for that, that they're
trying to accomplish that?

Akilah Wise (13:00):
Yeah, so going strictly by the materials that
the administration has releasedso far, one of the avenues that
they're looking to meet thesechallenges of mental health
disorders, diabetes, otherchronic disease, For one, they
named fresh thinking onnutrition and physical activity,
healthy lifestyles and otherthings that affect health. They

(13:24):
talk about restoring integrityto the scientific process by
protecting expertrecommendations from quote
inappropriate influence andincreasing transparency
regarding existing data. Andquote, they also propose to
address health and healthcare byempowering Americans through

(13:45):
transparency and open sourcedata and avoiding or eliminating
conflicts of interest. They alsopropose to prioritize gold
standard research on the rootcauses of why Americans are
getting sick, as well as, havingagencies ensure the availability

(14:07):
of expanded treatment optionsand the flexibility for health
insurance coverage to providebenefits that support beneficial
lifestyle changes and diseasepromotion. And the president
also aims to create a commissionthat's chaired by the secretary
of health and human services,assistant to the president for
domestic policy, as well as thesecretary of agriculture,

(14:28):
housing and urban development,secretary of education and
other, other cabinets.
So, that's what they, proposedto do to address, these health
issues.

Jeff Byers (14:40):
And you can somewhat see the line between, sparing
the CDC survey that we talkedabout on behavioral health and
and how that could be related tosome of these, but it'll be
interesting to see how thosedevelop over time. Anything else
that we, haven't touched on thatyou might want to?

Akilah Wise (15:00):
Yeah. The one thing I just want to say is that the
BRFSS is very impactful. It'snot only, looking at these more
static, you know, chronic healthdisease and preventive issues,
it's been quite flexible inemergency public health
responses. So it's a powerfultool for establishing health
objectives, programs,recommendations, and it's very

(15:23):
useful in public health.

Jeff Byers (15:25):
Okay. Well, Akila, thank you for joining us today
on health affairs this week.It's great to learn about that
survey and how much of an impactit can make and how much it can
influence state based policiesand and other things like that
or how wide reaching some datasources can be. So thank you for
explaining all that for us. Andto you, the listener, if you

(15:48):
enjoyed this episode, pleasesend it to the ultramarathon
runner, in your life, and wewill see you next week.
Thanks. Thanks.