George Flores

The California Endowment's Healthy Eating, Active Communities Program: A Midpoint Review

OBJECTIVES We conducted a midpoint review of The California Endowments Healthy Eating, Active Communities (HEAC) program, which works in 6 low-income California communities to prevent childhood obesity by changing childrens environments. The HEAC program conducts interventions in 5 key childhood environments: schools, after-school programs, neighborhoods, health care, and marketing and advertising. METHODS We measured changes in foods and beverages sold at schools and in neighborhoods in HEAC sites; changes in school and after-school physical activity programming and equipment; individual-level changes in childrens attitudes and behaviors related to food and physical activity; and HEAC-related awareness and engagement on the part of community members, stakeholders, and policymakers. RESULTS Childrens environments changed to promote healthier lifestyles across a wide range of domains in all 5 key childhood environments for all 6 HEAC communities. Children in HEAC communities are also engaging in more healthy behaviors than they were before the programs implementation. CONCLUSIONS HEAC sites successfully changed childrens food and physical activity environments, making a healthy lifestyle a more viable option for low-income children and their families.

The Central California Regional Obesity Prevention Program: Changing Nutrition and Physical Activity Environments in California's Heartland

The goals of the Central California Regional Obesity Prevention Program (CCROPP) are to promote safe places for physical activity, increase access to fresh fruits and vegetables, and support community and youth engagement in local and regional efforts to change nutrition and physical activity environments for obesity prevention. CCROPP has created a community-driven policy and environmental change model for obesity prevention with local and regional elements in low-income, disadvantaged ethnic and rural communities in a climate of poor resources and inadequate infrastructure. Evaluation data collected from 2005-2009 demonstrate that CCROPP has made progress in changing nutrition and physical activity environments by mobilizing community members, engaging and influencing policymakers, and forming organizational partnerships.

Local public health departments in California: changing nutrition and physical activity environments for obesity prevention.

The purpose of this research was to assess California public health departments capacity, practices, and resources for changing nutrition and physical activity environments for obesity prevention. The researchers surveyed key public health department personnel representing all 61 health departments in California using a Web-based survey tool. The response rate for the survey was 62 percent. This represented a 93 percent health department response rate. Analysis was conducted on the individual respondent and public health department levels and stratified by metropolitan statistical area and foundation-funded versus not foundation-funded. Public health departments are engaged in obesity prevention including environmental and policy change approaches. The majority of respondents stated that monitoring obesity rates and providing leadership for obesity prevention are important roles for public health. Health departments are involved in advocacy for healthier eating and/or physical activity in school environments and the development and monitoring of city/county policies to improve the food and/or physical activity environments. Funding and staff skill may influence the degree of public health department engagement in obesity prevention. A majority of respondents rate their staffing capacity for improving nutrition and physical activity environments as inadequate. Access to flexible foundation funding may influence how public health departments engage in obesity prevention.

Community Approaches to Preventing Obesity in California

The risks of obesity are well known: life-threatening and chronic illnesses that strain an already stretched health care system, shortened life spans, and reduced quality of life—especially in low-income communities of color. For The California Endowment, designing effective obesity-prevention strategies, particularly among underresourced, diverse communities, is a deep commitment. Over the past decade, The California Endowment has recognized that building healthy communities requires addressing the underlying causes of poor health rooted in social, economic, and physical conditions that determine an individuals health risks and opportunities. In the mid-2000s—using health disparities research, extensive experience with community-level prevention programs, and evaluation findings—The California Endowment pioneered community-scale efforts aimed at preventing obesity among school-aged children by using environmental and policy change strategies to increase physical activity and promote healthy eating. Two programs were developed in communities across California with high rates of obesity, poverty, and health disparities: the Healthy Eating Active Communities (HEAC) program and the Central California Regional Obesity Prevention Program (CCROPP). The HEAC program, located in six low-income communities, is built around collaborative partnerships between a community-based organization, a school district, and the local public health department. The partnerships strive to improve nutrition and physical activity environments and policies in five settings: neighborhoods, schools, after-school programs, health care, and marketing and media. They engage local governments and nongovernmental entities and forge relationships with new partners within transportation, public safety, and urban planning. HEAC collaborations work, for example, to educate city councils on the benefits of incorporating health considerations into their development plans. CCROPP aims at increasing the reach of the environmental and policy change approach in eight agricultural Central Valley counties. Working with public health departments and community organizations, CCROPP communities work, for example, to establish farmers’ markets in neighborhoods that have no access to fresh fruits and vegetables and to open schoolyards for community use after hours. HEAC and CCROPP grantees receive technical support from experts in nutrition, physical activity, community and youth organizing, communications, and health policy. At the same time, Kaiser Permanente prepared to launch its Community Health Initiative (CHI). Kaiser Permanente wanted to explore what could be done to combine the power of a prevention-oriented delivery system with community activism and a focus on community conditions to significantly improve health in Kaiser Permanentes communities. Faced with high and rising rates of obesity—and mounting research and clinical experience indicating that clinical prevention alone is not enough to address the problem—Kaiser Permanente focuses its CHI on Healthy Eating, Active Living, or HEAL. The framework for this initiative emphasizes a multisectoral approach; a focus on practice, policy, and environmental changes; strategies that employ both community and Kaiser Permanentes own assets; long-term partnerships and investments; and a commitment to using evidence where it is available and building the evidence base where it is lacking. After testing the CHI model in other Kaiser Permanente regions, the organization brought the initiative to three low-income communities in northern California in 2004: Modesto, Richmond, and Santa Rosa. CHI communities first developed community action plans that provided a roadmap for specific interventions. The plans focused on four settings: schools, neighborhoods, workplaces, and health care. Interventions fielded by CHI communities included getting more fresh fruits and vegetables into local stores, working with community providers to implement evidence-based clinical prevention strategies, planning safe routes for kids to walk or bicycle to school, and incorporating health considerations into planning and development decisions. Although the particular strategies vary considerably, the sites are connected to each other and 37 other Kaiser Permanente–supported CHIs in five other states through a common logic model and national evaluation framework.

Active Living in Latino Communities

o w c S i t b o c t o b r o C a c S d ctive living takes on unique dimensions in Latino communities. Several papers in this special issue of the American Journal of Preventive edicine point to factors in physical environments here Latinos (Hispanics) live, work, play or go to chool, that have bearing on activity behavior. Influenial factors described here and elsewhere include SES/ overty rate, concern about safety, place of residence, ocial relationships/social support, acculturation, and ark access. As the nation’s largest, but one of the poorest, ethnic roups, many Latinos live in places that promote inacivity and unhealthy lifestyles: neighborhoods of older, vercrowded, substandard housing, high crime rates, xcessive traffic, and lack of access to parks and other acilities for physical activity. It is little wonder that atinos are the most physically inactive racial/ethnic roup in the U.S. The consequences of inactivity are eflected in Latinos’ inordinately high rates of obesity nd diabetes. Examining barriers to active living in Latino commuities provides an opportunity to consider the deep and ersistent social and environmental inequities that unerlie patterns of inactivity as well as multiple dispariies in health status. Yancey and Kumanyika remind s that “when we ask why the environments of minority nd low-income children are relatively less conducive to ealthy eating and physical activity, we confront the ll-too-familiar reality that people who are socially and olitically disadvantaged with respect to the larger ocial structure are in fact, socially and politically isadvantaged in many respects.” Many Latino communities are deeply affected by a ystematic disadvantage of power and opportunity. De acto immigrant apartheid eviscerates whole neighboroods from the American Dream. Priorities in those laces tend not to be parks and open space, but jobs, ousing, and safety/security. Workers with intimate nowledge of the community and its trust find that the athway to advocating for healthy environments starts ith assistance for the higher-level priorities. Fortunately, ome of those higher priorities are served by healthy nvironmental planning, for example, safety (improveents to street design, lighting, facility design), housing, nd air quality (land use, transportation).

Evolution in obesity and chronic disease prevention practice in California public health departments, 2010.

Introduction Local health departments (LHDs) are dedicating resources and attention to preventing obesity and associated chronic diseases, thus expanding their work beyond traditional public health activities such as surveillance. This study investigated practices of local health departments in California to prevent obesity and chronic disease. Methods We conducted a web-based survey in 2010 with leaders in California’s LHDs to obtain diverse perspectives on LHDs’ practices to prevent obesity and chronic disease. The departmental response rate for the 2010 survey was 87% (53 of California’s 61 LHDs). Results Although staff for preventing obesity and chronic disease decreased at 59% of LHDs and stayed the same at 26% of LHDs since 2006, LHDs still contributed the same (12%) or a higher (62%) level of effort in these areas. Factors contributing to internal changes to address obesity and chronic disease prevention included momentum in the field of obesity prevention, opportunities to learn from other health departments, participation in obesity and chronic disease prevention initiatives, and flexible funding streams for chronic disease prevention. LHDs that received foundation funding or had a lead person or organizational unit coordinating or taking the lead on activities related to obesity and chronic disease prevention were more likely than other LHDs to engage in some activities related to obesity prevention. Conclusion California LHDs are increasing the intensity and breadth of obesity and chronic disease prevention. Findings provide a benchmark from which further changes in the activities and funding sources of LHD chronic disease prevention practice may be measured.