Category Archives: Childhood obesity
Stakeholder Health, formerly known as the Health Systems Learning Group, is a learning collaborative made up of 43 organizations, including 36 nonprofit health systems, that have met for close to two years to share innovative practices aimed at improving health and economic viability of communities.
The idea for the learning collaborative came from a series of meetings at the White House Office and U.S. Department of Health & Human Services Centers for Faith-Based & Neighborhood Partnerships. The Stakeholder Health administrative team is based at Methodist Le Bonheur Healthcare Center for Excellence in Faith and Health in Memphis, Tenn., and at Wake Forest Baptist Health System in Winston-Salem, N.C. The Robert Wood Johnson Foundation provided a grant to share the group’s findings and lessons learned.
Earlier this year, Stakeholder Health released a monograph to help identify proven community health practices and partnerships. Kimberlydawn Wisdom, MD, MS, Senior Vice President of Community Health & Equity and Chief Wellness Officer at the Henry Ford Health System was a key contributor to the monograph.
NewPublicHealth recently spoke to Wisdom about Stakeholder Health’s objectives, goals and emerging successes, which she also presented on at the American Public Health Association’s annual meeting in Boston.
NewPublicHealth: What are examples of implementation of the Stakeholder Health recommendations at the Henry Ford Health System?
Kimberlydawn Wisdom: There are several. Stakeholder Health talks quite a bit about transformative partnerships and the importance of those transformative partnerships. And we have some stellar examples here in southeast Michigan of transformative partnerships, and one that I’d like to point to in particular is an effort we established called Sew Up the Safety Net, which addresses decreasing the infant mortality rate in our region, which is appallingly high.
We’ve developed a partnership with three other competing health systems within the Detroit region. So while on one level we are very strong competitors, on another level, we’ve actually joined our strategies and resources together in order to address the infant mortality challenge that we have in our communities. We also have private partners and public partners that are involved with us at various levels, but I think having that unprecedented partnership with competing health systems and getting real work done is something that we’re very proud of and work very hard to maintain.
Harvard Pilgrim Health Care Foundation’s work on childhood obesity is driven by one startling fact: one in three Massachusetts children are overweight or obese. To find out why, Executive Director Karen Voci and her colleagues went to the places where children learn and play—schools, after school programs and child care centers— and found that children were sitting for most of the day and foods were heavy on starch and sugar. With a limited budget, Voci and her team found opportunities and partners in Massachusetts, New Hampshire and Maine to improve childhood obesity rates.
“It’s hard to measure what you’re accomplishing,” said Voci at one session during the American Public Health Association (APHA) 2013 meeting. “These environments look and feel different, but it’s hard to capture this feeling in a meaningful statistic that can be used further down the road.”
As a result, most of the results shared focused on process and intermediate outcomes rather than actual health outcomes—for now—but the communities are optimistic that they’re moving in the right direction.
Voci underscored the importance of staying committed, noting that Harvard Pilgrim and its partners had been at this for years and they were in fact moving the needle. Session presenters shared successes from Massachusetts, New Hampshire and Maine.
Harvard Pilgrim partnered with the Massachusetts Department of Public Health and other foundations and businesses on the Mass in Motion initiative to combat childhood obesity in its home state. Led by their elected officials, 14 communities developed health improvement plans and received technical assistance to improve local food sources and increase physical activity. The multifaceted initiative included a “call to action” report, as well as a Governor’s Executive order establishing a nutrition standard for the food procured for the state of Massachusetts. In addition, the program implemented a body mass index (BMI) regulation that required schools to screen children’s BMI in order to identify potential issues early. The Department of Public Health worked within these communities to share information on physical activity and nutrition, all culminating in growth of the program to 52 communities in the state.
Communities in Eastern Massachusetts are showing concrete signs of progress on the childhood obesity front. Reports from this summer have shown that the obesity rate for the region’s children under six years of age has decreased by 21.4 percent—likely due in part to initiatives such as Mass in Motion, the Cambridge Healthy Children Task force and Shape Up Somerville.
CATCH Kids Club is an evidence-based, after-school environment that has been adopted by 117 sites in nine of New Hampshire’s ten counties. The CATCH program promotes exercise and healthy eating in elementary school children with a four-phased approach:
- Curriculum development
- Staff and booster training
- Staff support
- Environment and policy assessment
In the environment and policy assessment phase, CATCH found that 93 percent of participating after-school programs made four or more changes to improve children’s physical activity and healthy eating. In addition, most sites now offer programs that promote these goals between three and five times a week.
In Maine, the Let’s Go! 5210 Goes to School program offers resources to help schools create a culture of health. It aims to take the focus off of the highly charged weight management issue and shift it toward four simple and embraceable goals for each day:
- Eat 5 fruits and vegetables
- Limit screen time to 2 hours or less
- Get at least 1 hour of exercise
- Drink 0 sugary drinks
While each school decides which of these four goals it would like to adopt, they often end up promoting all four points of the program as time goes on. In fact, the 5210 initiative reaches children in all 16 Maine counties in schools, after school programs, early childhood education, doctors’ offices and more locations.
One of the key lessons learned was to engage busy school representatives at a level that made sense for them. “Don’t ask them to do something unrealistic,” said Torey Rogers of the Let’s Go! 5210 Goes to School Program and The Barbara Bush Children’s Hospital at Maine Medical Center.
Representatives from each of these programs offered insights and lessons learned when it comes to working with schools. When speaking with school representatives, organizations are often successful when they relate the goal back to the mission of schools: education. By highlighting the secondary benefits to attendance and active participation of students, organizations can engage teachers as partners in public health initiatives.
>>For more information on the successes of state and community efforts to reduce childhood obesity, view an interactive map on the signs of progress on childhood obesity.
>>NewPublicHealth will be on the ground throughout the APHA conference speaking to public health leaders and presenters, hearing from attendees on the ground and providing updates from sessions, with a focus on how we can build a culture of health. Follow the coverage here.
A community needs assessment of a Chinese-American community in New York City several years ago found multiple barriers to physical activity for children and teens including parents unable to supervise kids at play because of long work hours, unsafe neighborhoods, limited knowledge or access to existing programs, financial hardship, inadequate support for physical activity in schools, limited time due to competing priorities such as academics, and too much time in front of video games, computer screens and television. To increase exercise time and options and help to reduce obesity rates among Chinese-American youth, public health professionals from the Charles B. Wang Community Health Center sought out funding from the New York State Department of Health and Mental Hygiene to create the Chinatown JUMP (Joining Urban Partners for More Physical Activity) program.
>>Read more on New York's Health Improvement Plan, which sets out a plan for similar community health assessments and cross-sectoral collaborations in response to these findings.
Chinatown JUMP currently works with eight afterschool programs to incorporate daily physical activity into the curriculum of these academic programs, blending activity with learning. Program goals include:
- Promote healthier and fit children by educating them and their families about the correlation between exercise and staying healthy.
- Increase staff capacity to support students’ healthier lifestyle through training and technical assistance.
- Establish an afterschool culture that supports physical activity as well as academic achievement.
The program works hard to incorporate parents’ support and involvement as well. Participating students in iMove receive a community resource guide with information about free and low-cost recreational centers and public spaces in the neighborhood to share with their parents. Parents are also invited to workshops on the importance of physical activity and healthy eating habits.
NewPublicHealth recently spoke with Susan Yee, Associate Director of Programs at the Charles B. Wang Community Health Center, about Chinatown JUMP.
NewPublicHealth: What is the Chinatown JUMP program and what do you think sets it apart from other programs with similar goals?
Susan Yee: Chinatown JUMP’s goal is to try to improve opportunities for more physical activity in the Manhattan Chinatown area in order to create sustainable changes within the community.
A new report released today examines state standards for the types of snacks that can be sold in secondary schools. The report was developed by the Kids’ Safe & Healthful Foods Project, a joint initiative of RWJF and The Pew Charitable Trusts that is focused on ensuring all foods and beverages in school are healthy and safe.
Some of the findings were discussed earlier this week at a session at the American Public Health Association annual meeting, and the full report is now available online. NewPublicHealth caught up with Jessica Donze Black, the project’s director, to learn more about the report.
NewPublicHealth: You’ve just released a new report about school snacks – what did you find?
Jessica Donze Black: We found that the majority of our nation’s students live in states where less healthy snacks like full-fat chips and candy are readily available in snack bars, school stores and vending machines – but there is limited access to healthy snacks. What students are able to buy varies widely from state to state, with some offering healthy snacks and others primarily providing less-healthy snack options.
The report recommends that the U.S. Department of Agriculture issue consistent, science-based standards to ensure all students have access to healthy snacks at school, regardless of where they live. The standards will establish a baseline that will help local communities make healthy choices when choosing what snacks to offer.
NPH: Have any states had success with offering healthy snack foods in schools?
Over the past few years, many cities and states have considered taxing sodas and other sugary beverages. At the American Public Health Association meeting, Judy Jou, a PhD candidate at the University of Minnesota School of Public Health, discussed a study in which she and her colleagues interviewed stakeholders about their views on a sugary beverage tax. The study was supported by a grant from the Robert Wood Johnson Foundation through its national Healthy Eating Research program.
Most of the eleven interviews were with public health advocates and policy-makers. These stakeholders indicated that the main arguments in favor of the tax revolve around health:
- Sugary beverages contain large amounts of sugar and/or calories.
- Sugary beverages are a major contributor to obesity and related health conditions, especially for children.
- The revenue generated by a sugary beverage tax can be used to fund community health programs.
Some stakeholders said that visual representations of the sugar in these beverages were effective at communicating the first point. Stakeholders learned messaging ideas through personal networking, published documents, other sugary beverage tax efforts and—less frequently—testing from focus groups or surveys.
The most common messages used against sugary beverage taxes included:
- Government is acting as a “nanny state” and is restricting personal choice.
- These taxes would have a negative economic impact on businesses and workers.
- Soda and other sugary beverages are unfairly targeted and are not the only cause of obesity.
Citizens in two California cities, Richmond and El Monte, will vote on sugary beverage taxes on Election Day next Tuesday. In both cities, the campaigns to defeat the taxes have much more funding than the campaigns to pass them. One big challenge identified by the stakeholders Jou and her team interviewed was the vast resources the beverage companies have to fight these tax efforts.
>>The Los Angeles Times recently reported on the effort to pass a sugary beverage tax in El Monte.
>>Learn more about how pricing strategies— both incentives and disincentives—can promote the purchase of healthier foods.
Get kids active now and often was the message at a session on childhood obesity at the American Public Health Association 2012 Annual Meeting in San Francisco.
"Students are not getting enough exercise," said Christina Economos as she opened the session, though "physical education develops skills." Childhood Obesity 180 created the Active School Acceleration Project, which works to promote exercise inside as well as outside of school.
The Active Schools Acceleration Project works to increase quality physical activity in schools to combat childhood obesity and to get the beneficial health, behavioral, and academic outcomes that follow. American children today experience far fewer daily opportunities for movement and exercise because there is a decreased emphasis on physical activity in schools.
Economos noted that physical education is often one of the first programs to go following school budget cuts. Their goal is to reverse the trend of childhood obesity, one generation at a time—the benefits of which, aside from healthier, longer lives, include improved academic performance in school. This makes childhood obesity prevention a priority for schools, despite strapped budgets.
Economos and her team developed a four-pronged process—to find innovation, identify best practices, support existing and start up new interventions, and make plans for long term sustainability. They looked at grassroots programs in local schools as well as established national movements. The result was an "American Idol" type contest to solicit entries that showcase best practices for encouraging vigorous physical activity among students.
The ultimate goal is to showcase the best approaches to physical activity in schools. Practitioners hope to influence school policy change on physical activity from the bottom up.
City parks can be a cost-free venue for people of all ages and backgrounds to be physically active. Two presenters at the American Public Health Association meeting discussed programs to increase physical activity opportunities in city parks during a session on Tuesday afternoon. The two projects were funded by Communities Putting Prevention to Work grants and focused on neighborhoods that have a high proportion of low-income and minority residents.
Adam B. Becker, PhD, MPH, from Lurie Children's Hospital, spoke about the work the Consortium to Lower Obesity in Chicago Children (CLOCC) undertook to increase walking access to parks. Members of 10 community-based organizations were trained to assess barriers to park access using the Neighborhood Walkability Assessment Tool. The tool included analyses of possible recommendations to overcome any identified obstacles to walking.
CLOCC also created a guide to be used by city planners and engineers when deciding how to improve the walkability of local streets. The guide included suggestions such as improving sidewalks and installing pedestrian countdown timers and pedestrian islands in streets. Dr. Becker said that the city agencies are excited to have better data to help them identify walkabilty problems and prioritize solutions.
In the second presentation, Mary Thomas, MPH, from the San Antonio Metropolitan Health District, described a program that installed outdoor fitness equipment for use by community members in city parks. The goal of this program was to increase park use, and to increase physical activity among residents when they use parks.
In a partnership with the Parks and Recreation Department, fitness equipment was installed in 28 San Antonio parks, and the project was publicized using flyers and newspapers. A survey of park users showed that 54 percent spent more time in the park after the installation of fitness equipment, and most said that the equipment was user friendly and had clear instructions.
Park users identified the lack of water fountains and shade as the biggest barriers to using the fitness equipment more often. And, it should be noted that 88 percent of park users traveled to the park by car. San Antonio and Chicago clearly have the opportunity to learn from each other’s efforts.
A joint use agreement (or shared use agreement) allows school facilities such as playgrounds and fields, to be used by the broader community when school is not in session. Health advocates are working to implement more joint use agreements as a way to help neighborhood residents be active in their community. These joint use agreements are being used more and more around the country, but evaluations of their effectiveness are less common.
At the American Public Health Association conference on Monday, Mariah Lafleur, MPH, from Samuels & Associates, presented an evaluation of joint use agreements with schools in some low-income neighborhoods in Los Angeles County. As part of a Communities Putting Prevention to Work grant, the Los Angeles County Department of Public Health worked with seven school districts to implement joint use agreements. The program focused on school districts in areas with limited access to public parks.
One part of the evaluation showed that, following the joint use agreement, both children and adults were using the school facilities, and that males and females used the facilities pretty equally. Perhaps most criticals, about two-thirds of users were participating in moderate to vigorous physical activity.
The evaluation also revealed a 16-fold increase in the use of the facilities when there was some kind of programming available, such as organized sports. One of the more popular activities was a walking club for mothers, which was timed so that they could drop their students at school and then participate in the walking club.
Lafleur, the presenter, and the audience in attendance were not aware of any previous published studies showing the importance of including programming along with the joint use agreements. Lafleur recommends partnering with community groups, such as YMCAs, Boys and Girls Clubs, and parks and recreation departments, to greatly increase community use of school facilities. “We think it is a very cost-efficient way to increase physical activity,” said Lafleur.
>>Learn more about joint use agreements.
The Kids Safe & Healthful Foods Project, a collaboration between the Robert Wood Johnson Foundation and The Pew Charitable Trusts, recently posted a Q&A with their director, Jessica Donze Black. The Q&A about new healthy school lunch nutrition guidelines is reposted below.
Q: As the new nutrition guidelines for school meals go into effect, lunches now feature healthier foods and portion sizes. What are the new calorie limits for meals being served in schools?
Jessica Donze Black: The new nutrition guidelines make sure that meals and portions are healthy and “right sized” for kids based on their age. School lunches have always been intended to provide about a third of the recommended daily calories for the average student. Under the new standards, lunches in elementary schools range between 550 and 650 calories, middle school lunches between 600 and 700, and those in high schools have roughly 750 to 850. These numbers allow schools to serve a large variety of filling foods.
Q: Are these enough calories for highly-active students such as athletes?