Dr. Michelle Berger Testifies on Public Health Priorities

House Public Health Committee
Feb. 24, 2009
Testimony of Michelle Berger, MD
Texas Medical Association



Good morning, madam chair and members of the committee. I am Dr. Michelle Berger, an ophthalmologist here in Austin, and I am testifying on behalf of the nearly 44,000 members of the Texas Medical Association. I want to thank the members of the committee for the opportunity to speak about public health and the importance of your work to the health of Texas and our patients - your constituents.

TMA's complete public health priorities and legislative strategy are found in  Doctors Orders: TMA's Prescription for a Healthy Texas .

I have been asked to speak about public health in Texas, and I am focusing on TMA's top three priority areas. In general, for policy makers, my prescription for the health of the state is to invest in prevention. This truly is an investment: our physical health affects our fiscal health … as individuals, as businesses, as a state … in so many different ways.

As a physician I am very concerned about the health status of the next generation of wage earners in this state.

Texans are not as healthy as they were just 10 years ago. Much of this stems from our unhealthy lifestyles: tobacco use, poor diet, and lack of exercise. In 2005, the leading causes of death in Texas were diseases of the heart, cancer, stroke, accidents, and chronic lower respiratory disease. Together, they accounted for almost two-thirds of all deaths in 2005. We know that many of these deaths are preventable, yet more recent data shows an increase in the number of Texans dying before the age of 65.

More and more Texans face obstacles to accessing health care. The state continues to be the Uninsured Capital of the United States. And we've seen what started as a shortfall of primary care physicians transition into a shortage of many specialists. Because of the size of our state, these shortages include broad geographic regions and cover both densely and sparsely populated locations.


We have an obesity epidemic in this state. Last month, the state demographer and state epidemiologist reported to the legislature that adult obesity rates have increased for all ages and ethnic groups. Most alarming is that obesity rates for young adults in their 20s have more than doubled in just seven years!

Texas already ranks 15th in the nation for obesity; 27 percent of adults are obese. The recently released research projects that number will reach 43 percent by the year 2040.

The future does not look much brighter for our children. For starters, they are less physically active than we were growing up. One out of three teens in Texas is overweight or obese and out of shape. Last session, TMA strongly supported Senate Bill 530, which mandated a physical fitness assessment or Fitness Gram. The first results, released this summer, show that Texas children become less and less physically fit as they go from elementary school to high school. By the time we get to high school seniors, just 8 percent of girls and 9 percent of boys met health standards in the six-part fitness assessment.

Think about the future for a heavy teen or someone in his or her 20s who is obese. Such a person is at higher risk for heart disease, diabetes, cancer, and other chronic conditions … all of which consume resources from our overburdened health care system. Per capita, health care costs for people who are obese are 37 percent more than costs for people of normal weight.

How will we maintain our economic competitiveness? How will employers be able to offer health insurance to pay for their employees who are sicker and in need of chronic care from conditions that are preventable through healthy eating and physical activity? How will the state manage the extra burden that obesity-related conditions place on our Medicaid program?


We know that tobacco is the leading cause of preventable death in Texas. About 20 percent of adults and youth still smoke, and this leads to about 24,000 deaths related to tobacco. We also know that for every person who dies from smoking, 20 more are suffering with at least one serious illness caused by smoke.

TMA actively supports a statewide smoking ban because of the known health benefits from reductions in smoking and exposure to secondhand smoke. Secondhand smoke is especially harmful to children because their lungs are not fully developed, yet fewer than 30 cities in Texas have adopted comprehensive smoke-free policies.

In 2004, Texans spent roughly $5.8 million on direct medical expenses due to smoking. The cost to the Medicaid program was $1.6 billion. In times of tight fiscal conditions and market downturns, a statewide smoking ban will save the state a lot of scarce dollars, improve worker productivity, and save lives.


Immunizations are among the greatest public health strategies to protect children and adults from preventable and sometimes deadly diseases. The return on investment in significant. According to the U.S. Centers for Disease Control and Prevention, for each dollar spent on immunization, the direct and indirect savings range from $2 to $24.

In 2007, Texas ranked 22nd in the country for childhood immunization rates. More than three out of four children are fully immunized in Texas. We need to keep up the improvements in immunization rates.

Although a number of diseases like polio are for the most part gone here, Texans still contracted 13,000 cases of vaccine-preventable infectious diseases in 2007.

Texas Public Health Coalition

In 2006, TMA helped to create the Texas Public Health Coalition, whose mission is to improve the health of all Texans by advancing core public health principles through a unified voice and collaborative actions at the state and community levels.

The coalition includes more than 20 statewide groups representing a broad constituency of advocates from the American Heart Association and American Cancer Society to the Texas PTA and United Way of Texas. Our top priorities should start to sound familiar: physical activity and healthy eating, tobacco-free living, and immunizations.

Details on the coalition's legislative agenda are found in the enclosed packet.

In conclusion, the bad news is that we have much work to do.

The good news is that we can expect great things for Texas from this committee over the next few months. You have the opportunity to make decisions that can help Texans stay healthier and live longer, help Texas businesses prosper, and save state and local taxpayers significant amounts of money. And that really is good news.

Last Updated On

July 14, 2010