routine part of life and pointed in the changes the-of-in the environment, putting conventions to work and the community transformation grants are fostering. a second goal, create food and beverage environments that ensure healthy food and beverage options are the routine, easy choice. mean reduced access to sugar drinks, improved restaurant options and procurement policies that improve the quality if foods available in a variety of settings. a third goal, transform messages about physical activity and nutrition, this included positive marketing efforts as well as ongoing efforts to reduce the marketing of unhealthy foods. particularly to children. it also emphasized that healthy food retail that is already, as i mentioned, incorporated in our community programs. a fourth was to expand the role of health care providers, insurers and providers in obesity prevention and control. and i meant to mention earlier that unlike many other public

health challenge, there's both a prevention side to obesity prevention and control and a clinicy side, because the individuals that have, who are already obese have such a substantial caloric deficit they really are going to neepd aggressive clinical intervention, but there's an important opportunity here as emphasized in the iom report for clinical and community partnerships to both complement, to be mutually complimentary in terms of obesity prevention and control. and the fifth recommendation was to make schools a national focal point poor obesity prevention. both the nutrition standards and in school meals kevin mentioned as well as restoration of philadelphia activity and joint use agreements for schools to be open to communities after hours so that the community can use those resources for physical activity was a mandate of the

apod, report of the ipon. the second initiative also others exceptional promise is the hbo special, we licensed hbo to use the handle of weight of the nation, and as many of you know, this is -- there are four one-hour documentaries released and available on the hbo website, if you've not been able to view them. as well as 12 short films which amplify some of the themes that are developed in the four documentaries. including small films on stigma a very powerful film, which emphasizes the discrimination that obese individuals suffer. but also films that point to community solutions. there's a film on nashville which is one of our cppw communities in which the mayor has take an leadership role to increase physical activity infrastructure, building sidewalks, extending bike trails, as well as food-based initiatives. another important film is on

latino health access. a group in santa ana, california which documents efforts to the control obesity and its major sequela, diabetes. and there's a very poignant, one of most poignant moments in any of the films, is when there's a small boy -- a young boy who's overweight who goes to a parking lot after hours because that's the only access they have to a place where he can be physically active and says in just this most striking voice, can't they build a park somewhere, somewhere for us? isn't there someplace where we can go? and that is the problem. addressing the disparities. there's another film, in fact, on disparity, another on fruit and vegetable intake, and others that i think will be useful, and in expanding what these films can do. these films were produced in association with nih and cdc.

we were, the two federal agencies were responsible for assuring the accuracy of the content of those films. the films were is a are the positived by the michael and susan foundation in kaiser permanente and they facilitated the interaction of the four partners with hbo. but part of what was invested by the michael and suzing dell foundation and kaiser permanente was an extension, to extend the film as community action strategies. there are 40,000 copies of the dvds or screening kit available for use by communities or institutions that link back to a community action kit, which, in turn, links to a variety of resources on the hbo website, and that links back to cdc and

kaiser per nemanente invested i obesity control. our hope, these films can be used to foster a discussion at the local level and begin to organize communities and institutions about what they can do to reverse this epidemic. so as i said at the beginning, i think we may be at a turning point. whether we can sustain the movement and energy that has accompanied the epidemic of obesity thus far remains to be seen, but the resources are there, and i hope increasingly the political will is there. so i think i'll close and will look forward to the discussion. >> so i have a couple of questions, and we want to open this up so it's very much of a dialog. you both talked about the increasing collaborations between your agencies. and i wondered if you could both

expand on in a a little bit more and talk about what the impact has been on this synergy? >> i can begin by saying that i spent most of my career in state governments as the health and human service director in three states. i've been with the federal government just under three years now, but the career people, the senior people i work with on a daily basis, all reflect to me, they have seen more cross the federal government interaction in this administration than over the life of their careers, and i can tell you that in the food and nutrition area, whether it's getting right down to our -- i referenced the review that cdc made and recommendations to us, more recently bill dietz' sector actually detailed or allowed someone to come up and work at our center for nutrition policy

and promotion, both to help us better understand how cdc moves its initiatives but also to share with the cdc how these policies and programs are developed on our side. howard coe was the health director in massachusetts when i was in maine. we've carried that relationship back and along with bill, we're all red sox fans as well. but that has nothing to do with health agenda. >> oh, yes, it does. our mental health. >> but we are -- we have really a strong relationship with hhs in particular, but also with the department of education, as we move forward on our healthy hunger free kids act. a lot of cross agency collaboration with us. and i often say day to day whenever i'm out on the road, everything we do in the food and nutrition arena, we do through others. we do through state

agencies or county agencies, food banks in some cases, public university extension services that provide much of the nutrition education. so it is at the core of our efforts often as i describe them. our relationships, and it is important we promote that to be good -- to be good partners with other parts of the government, but also with the private sact sector. that's how we move things forward. so i think it is very -- it has been an environment of a lot of cooperation. and for us, even internally, in the u.s. department of education, we work very closely, particularly with the economic research service, as an example. we just participated with them earlier this week, and in a wonderful stud they they did on the issue of affordability of healthy foods. we're often fighting this -- this old chestnut that says, gee, i can't afford to eat

healthy. healthy foods are always more expensive. it depends on how you define it. and i think that's at very powerful study they have done and we're interested to point out that, to chal that to say one can eat in the healthy manner. it takes planning, takes prudence, takes access, but it can be done. >> i came to cdc in 1997, and up until this administration, the principal collaborations, which worked well, were around the dietary guidelines and the national fruit and vegetable alliance, a very successful public/private partnership, but the degree of collaboration has really been extraordinary in the last three years, and kevin mention pd the inted the intera the cdc. in our department it occurred not only with the agencies to

be collaborated. a good example is the work that is going on which i didn't mention, a million hearts which is focused on aspirin, blood pressure control, cholesterol screening, and smoking cessation is a joint program with cms. the degree of collaboration around tobacco control between the cdc and are fda is a fantastic effort. another good example, work going on i didn't mention, a million hearts focused on aspirin, blood pressure, cholesterol, glad screening and smokie cessation. and the collaboration over food safety, and, you know, it's hard safety, which crosses cdc, fda and usda. and, you know, it's hard to know why that progress didn't exist sooner, because these issues have moves forward so substantially in the last couple of years. >> do we have questions out in

the audience that -- while chris is getting it, i'll ask just one more for bill and then i have one for kevin. as you look at this space, how do we achieve broader social change? what down think it's going to take? >> as i -- as i think i indicated, the changes in the food and physical activity environments really need to be transformative in order to reverse this epidemic. analogous to a social movement. and there is certainly a lot of movement, but i'm not yet sure that it's a movement, and one of the problems is the constituencies around these issues are different. so that the same group that promotes increased rates of breast feeding and is passionate about it, may be quite different than those who want to market healthy food to children.

a second factor is most social movements have not been top down the way the obesity epidemic has evolved with the government at several levels and a variety of medical groups and businesses that are driving it. it's really had a grass-roots component. and that's what's missing and what i hope the hbo documentaries will help foster. >> i think we have a question over here. >> hi, katie kiefer from heritage radio network. sorry. mr. concannon, this is really a question for you. i think we all applaud the success of the transformation of school lunch and so forth, and i know i have interviewed personally dozens of people involved in improving nutrition in the school classrooms including ann cooper, the lunch lady and wellness in the schools in new york city, a very successful program. one of the issues that comes up over and over again about improves school nutrition is that the actual kitchen

facilities themselves have been essentially dismantled so that all of the food that comes in is already pre-prepared. they put it on a sheet pan, in the fry alater, in the oven and there's actual little cooking going on and the people who work in the lunchroom, don't have culinary skills. my question is, is there funding for programs to retrain school cafeteria personnel and retrofit those kitchens and second, is there funding for programs to retrain school cafeteria personnel and retrofit those kitchens, and secondly, in an earlier session, scott faber was talking about entitlements in the upcoming farm bill, and one of the statistics you quieted, $142 billion is being earmarked as subsidies and entitlements for successful

farming operations and insurance companies, which don't need the money, but are getting it, and i'm wondering if any of the money being proposed for those entities could be allocated back toward school lunch and programs that would help improve nutrition in schools by retrofitting kitchen, training personnel and getting more fruits and vegetables from local farmers. sorry for the long question. anyway. there you go. >> the second question is a little easier for me to answer, respond to. not sure where he got those numbers. he's raising the ish issue of how we spend agricultural dollars broadly. let me say, the annual budget of the u.s. department of agriculture is in the area of around $150 billion. $105 billion of that comes to the nutrition area that i have responsibility for, so it's one of those public perception issues.

if you ask the american people where's the agriculture department's budget, where most of it goes? most of the goes to the nutrition space, and i'm very proud of that, and i think as americans we can be proud of that, it has enjoyed over the years sort of bipartisan support. i hope that holds in this more challenged environment. so i guess as i say, i'm not sure where some of those numbers came from. to your question about schools. let me say that i have -- first of all, many schools historically over the years didn't have kitchens, period, especially in older school buildings. kids brought their lunches from home. so they were never adequately equipped in the point of view in many cases of having a full-blown kitchen. we in the stimulus bill two years ago put out about $100 million in a matter of weeks to help schools equip and modernize

their school, the food service areas. within a short period of time, we had a request for $650 million. we had $100 million. we had an additional $25 million in the last budget. there is no question about the fact that schools are really challenged in terms of their infrastructure environment around cooling particularly as we get into more vegetables and fruits and salads. et cetera. you need to have cooling equipment as well. now, what many -- yet, at the same time, i've been in schools, i recall a school in denver i was at that has pretty old equipment, and they're doing all foods from scratch. actually whole grain breads, et cetera. so it can be done. it's more of a challenge. in the healthy hunger food kids act, congress appropriated $50 million to provide training and technical assistance to school nutrition folks across

the country. we're very committed to that, already engaged in that. we've been running something down in fredericksburg, virginia, the past the two years called product safety university, where we're enabling and educating school nutrition leaders on local purchasing. so that they deal with safety issues, traceability, but also ways in which school foods are presented to engage children. some of the work of brian wansik up at cornell on how you structure foods to nudge kids, make the right choice, the healthy choice. i've been able to see, out to visit many schools. about 3,000 of them, that have already met at least one level of the criteria from the healthy -- the first lady's let's move challenge. healthy u.s. school challenge. those schools are doing it. many of them not without the latest equipment.

it can be done. it will be challenging, but i don't think we should -- i wouldn't be satisfied, nor do i think it would be reasonable to think that the majority of public and private schools can't meet the challenges of healthier foods that kids would consume, even with the challenges they have in their infrastructure. >> other questions out there? while chris is doing the -- i'm going to ask -- go ahead. you got there fast. so -- >> not so far this time. thanks, chris. thanks to both of you for being here. 234is is sarah borne from food and water watch. mr. dietz, you mentioned the pro possessed voluntary guidance and that seems to be back burnered if i understand correctly. and i wonder, with the competitive foods regulations that are going to be coming out in the next couple of weeks, if

the voluntary guidance hasn't been the place where we can really push on some market creating some kind of industry standard on foods marketed to children. if the competitive foods standard might be a de facto standard if industry needs to meet their requirements to sell their foods in schools, if we'll have more widespread impact in location where is food is marketed to children? >> i'll let kevin answer the competitive foods piece, and they are really two separate issue, because the interagency working group was focused on marketing standards, and i think that the principles that we put in place were sound principles. the most important of which was that a food market that children had to contain a meaningful amount of food contained by the dietary guidelines. i think it's unfortunate that congress rirpd the required the ftc to do a cost benefit analysis before that report committed to congress. the children's food and beverage advertising initiative moved substantial until the direction

of principles that we articulated. but we weren't about to -- it made it impossible to do a cost benefit analysis, because either way we were caught. how could we project that the implementation of voluntary standards, and if we -- even if we could do that, how could we predict a what impact in would have long-term on the health of children and adolescents as they became adults and how could we possibly fix the cost of that? so if we actually did a cost benefit analysis, we would be accused of doing something we didn't have to do and, therefore, we were moving towards a regulatory approach. these were voluntary standards and only regulatory standards needed to have such a report. on the other hand, if we submitted a report, it would be attacked based on the faulty

assumptions that underlay the reasoning in the report. so we were stuck, and it's -- chairman liebowitz said that -- in a congressional hearing, that at least for the time being that report -- that we weren't going to do anything further with the report. >> but competitive foods is yet another issue. >> competitive foods, let me say, that we were talking about partnerships earlier in the federal government to an earlier question. happily, the healthy hungry free kids act had a very echeck particular and interesting group of partnerships, and among the partner participants that i highly value in a particular way is that of an organization in this town called mission readiness. ap organization of retired military senior leaders, admirals and generals, i think in excess of 250 of them, they

successfully lobbied the hill and loibd tbbied the senate agriculture committee, the original source of this. in particular to make sure we had the authority, unprecedented authority around competitive foods in all schools across the country. and they did so, because they recognize that this is a public health challenge in this country, something like 27% of young people, male and female, who would be in the typical age cohort to join the military, are ineligible, because they are so seriously overweight and at the weight of the nation last week, bill and i, the panel we were part of, a physician who is in charge of, all of the health facilitiese crossed world for active military pointed out a statistic that i was unaware of before, that something like 24% of military personnel who were actively in the military are not allowed to renew their -- the

their -- to re-up, so to speak, because they are so seriously overweight. there was a recognition here that we have to take some very broad, robust, they can't be weak in terms of impact, and i consider the competitive foods directive we have as just as important as the school meal regulations that we've already promulgated and so we've been working very hard on those and want to make sure they are, in fact, will become both the law of the land and will basically significantly alter the food environment for american children. as i say, i go out to schools. most of the schools i visit are brought to our attention as leaders. but i get into schools that, for other reasons, i happen to visit, and when i see some of the competitive foods that are

being offered to kids at the same table, with the school meal, you know, it just doesn't work that way. you wouldn't do it in your own household, or it shouldn't work that way. so we're very anxious to move forward with that. we have a mandate in that regard, but we know it's -- it's going to require the support of people in this room and beyond that as well. >> so while chris gets to the next question, i would like for those of you who are interested in this whole question of mission readiness, next week, if you want to have another conference to go to, national journal has a conference that will be next wednesday at union station. it's a summit looking at this very issue of readiness and obesity, military readiness and what affect that is having. >> my name is meg booth.

i'm whip the children mental health project, and i'm here because we work on prevention of dental disease, you know, which is the number one chronic condition of childhood, and in the youngest kids, before they enter school, it's the only portion of kids that have an increase in dental decay. the rest of kids, we're seeing a decrease because of water floor i'dation and different things. we are trying to enter the nutrition world and cross paths, especially when it comes to pregnant women and those under the age of 3. i wonder if you could answer a question. you are coming up with guidelines for kids birth to 2, and i was just curious if you have tried to engage the dent many community at all, because they're trying to focus on prevention of tooth decay because it's so diet dependent, and as a consumer generation, we would love to engage in how to join the nutrition word in those efforts. we cannot do it ourselves. and i think the 0 to 2 is

the only place we can start other than pregnant women, to do primary prevention. so i'm curious what guidelines that might be. >> very early in the process. we've basically just outlined our framework to work both again with hhs is the lead agency for the dietary guidelines, 2015, which will govern officially ages 2 and above, but by agreement, we will subsequently release guidelines for 0 to 2. and i saw just within the last week or so, the outline, the work plan that has been devised with hhs and with the center for nutrition policy, promotion and, i think, engaged undoubtedly cdc. and there are a whole series of consultations as this is developed to really hear from the academy of pediatrics and the dental community and other nutrition and health

organizations. there isn't as much, i'm told, i'm not a scientist, in this regard, but by our folks, there isn't as much science around on 0 to 2 but we certainly see, it distresses us if we see child at clinic and certainly sugar sweetened beverages and so on. i've seen this at federal relief when i've visited federalry qualified centers as a state person. so i fully expect they'll be broad consultation with groups like your own. >> i think we have another question here. >> hi. i want to thank both of you for sharing your update on the initiatives, and i can tell you from new york state, i've witnessed some great progress with the school equipment grants, farm to school. we even had a healthy food, healthy community fund for store development which the healthy

food financing initiative is very similar to. i would like to push the envelope, being from new york and a new york yankee fan. i wanted to ask about the d.o.d. fresh program and the concept of turning that into cash in lieu, or a voucher program, similar to the fresh, ffmp, the farmer's market program so students can have the option of purchasing fresh local food of the highest quality, that they can get their hands on at a more efficient, quicker, and handle it within their own districts? thank you. >> thank you very much for that. the drchlts d.o.d., which she is referring to, we have a contract to purchase fruits and vegetables for both the school program and also for feeding program on indian reservations,

it's in excess of about $100 million a year. the question, can we cash out a portion of that to allow local schools to purchase more fruits and vegetables, either locally or on their own? the short answer is, no. and the reason i say no is this. most schools -- the representation are what the dod fresh program represents as a portion of school purchases. it's at fraction. it's under 20%. where a school can spend the money that we give them. $2.77 per meal, in whatever way they wish. they can use that, buy it all locally or use a portion to buy usda commodities. we've had that question from another state, or another part of the region of the country, and our answer was, we don't want to weaken the