Battling Obesity through Partnerships: NewPublicHealth Q&A with Eliza Lawson

Feb 5, 2013, 11:18 AM

Creating a healthier community takes partners from all different sectors—transportation, planning, social services and more. But public health isn’t always top of mind for those with so many different competing priorities. Effectively combating obesity, diabetes and other critical issues requires showing potential partners that while they might see issues differently, their goals overlap. That means listening to their needs and reshaping the message.

NewPublicHealth spoke with Eliza Lawson, MPH, Program Manager for the Initiative for a Healthy Weight in the Rhode Island Department of Health, about the Healthy Communities Plan and her efforts to bring diverse partners to the table.

NewPublicHealth: Tell us a little about how you approached the obesity conversation so you could help to get other sectors on board in creating a healthier community in Rhode Island.

Eliza Lawson: We definitely started by talking to other people from our own perspective around obesity. We knew we had to work with some more nontraditional partners, people in transportation and planning, people working in environmental stuff. I feel like people were receptive to what we were saying, but never really thought there was a mutual benefit in working together. It was more “that sounds good, that is something we support”—but never any clear link on how the two are tied together.

Over a couple years we started to realize that obesity was our issue—it wasn’t their issue—so we said we were going to try to re-approach this. So we picked a couple partners and did some research to see what they were working on—and we started to morph. We still talked about obesity, but we tried to reframe it a little. Finally I was asked to present at a Smart Growth conference and when I saw all the other presentations, I figured I would just frame it around Smart Growth as everyone else was doing. I remember doing a chart that showed “what you say and what we do” kind of things. You are working on an initiative to get people out of their cars for environmental reasons, and we are doing an initiative to get children to walk to school because it burns calories and it is physical activity that’s good for their health. We are both kind of working on the same thing here and here is a way that we can work together on this.

NPH: Tell us about the healthy communities plan. What were the main goals and strategies, and how does health play a role throughout the whole plan and not just in a specific health section?

Eliza Lawson: What we wanted to do with the Healthy Communities Plan was give municipal planners really clear guidance about what strategies, what policies, what objectives would be appropriate to put in a municipal plan—a comprehensive plan—that would address physical activity and nutrition. So we started with the CDC community’s strategies and measures related to the built environment, because we knew that there was some research behind the link between that aspect of the built environment and health.

We had a planner on staff at the time and we sent her out to do some more digging and to kind of reframe that in terms of the Rhode Island comprehensive plan. Some of those are things such as transportation, economic development, open space and recreation. She tried to align health-related things to what goes into the comprehensive plan—so making the link, for instance, between mixed-use development and the health benefits of having mixed-use development. Then we categorized them based on a few big goals: active transportation, recreation and access to food. For awhile we struggled with making it a separate section of a comprehensive plan. We decided against that because we felt all of the others sections are really important to the planners, and this wouldn’t be and would be disregarded as the ‘fluff’ section.

NPH: Could you give a specific example of one of the typical sections of a comprehensive plan and how that area impacts health?

Eliza Lawson: Comprehensive plans are required to deal with transportation and they address things like traffic flow, traffic speed and making sure that cars can get through communities appropriately. In Rhode Island, I have to say I think most planners are also looking at getting people on foot and on bikes as forms of transportation. We try to get more specific with policies that promote active transportation, which may be anything from sidewalks to a bike lane to a bike path to better connections within the community (trying to avoid dead-ends and cul-de-sacs). I like the economic development section of the comprehensive plan because in that there are a lot of things around more of the compact mixed-use development and for us it is an opportunity to say it is a benefit to have a tight or more dense community with people living in close proximity to services because they can walk to those places. The state has been pretty progressive but they weren’t necessarily looking at it from health aspects—they were looking more in terms that getting people out of cars is good for businesses because people will be slower and walk by and stop in. It is also good for the environment and for decreasing parking and asphalt needs. I think our state planners were on that path already. You can go in with the idea that it is good for the development of the state and economic viability of the state and we will go in and say it is also good for people.

NPH: Anything you want to add?

Eliza Lawson: I think having the planner has taken us to an entirely different level. I think we had partners on board, but it was about three solid years of us just scraping the surface. It wasn’t until we had someone in there who could explain everything we were talking about that we got this whole thing to take off.

NPH: Anything else that you think folks from Public Health and from other sectors can learn from your experiences?

Eliza Lawson: The work that we have done here was based off of projects that we did in the past where we tended to work more with the community groups than with municipalities. The sticking point that we always had with the community groups when we were doing some of the built environment stuff was they would come up with a great project that was probably really needed, such as improvements around a school so kids could walk to school, but by the time they got it to a person for support or approval at the municipal level it wasn’t even on their radar.

So what we learned from those initial projects was really that we needed the support and the buy-in from the municipality at the beginning. When we did the Healthy Places by Design Project, we kind of flipped the whole thing around and said we are actually going to make the municipality the lead and kind of force them to be at the table at every step and force them to work with the community-based organizations. I say forced, but a lot of the times it wasn’t forced at all—it was a very natural partnership, but it was one that wouldn’t have been there if we didn’t required it as part of the funding. I think that was a big step for us to see that we really needed the municipality at the table with the community-based organizations. They needed to see the same data, they needed to do the same workability as us and see the same stuff together. They needed to be at the same table when they planned this stuff, because then what happened was in some communities they would come up with a plan and they could bring it to the town council and the town planner, and the community-based organization and the residents were all entirely on the same page and I think it made it a lot easier and a much smoother process.

NPH: Would you like to address briefly what The Healthy Places by Design Project is?

Eliza Lawson: We have the Healthy Community’s Plan, which is a document that is intended to guide local planners on how to integrate health-related objectives and goals into their existing comprehensive plans. It is a tool to help them think about health as they are thinking about planning, and it is really designed to illicit the support of the community as well. So we are hoping that it will not just be “copy and paste these things and stick them in your plan,” but really get them thinking about what the people in the community want and need. It is really designed for the planners to be able to go in and use it as part of a larger assessment.

NPH: You mentioned there are a lot of synergies, so why is it so important for all of these sectors to be deliberately thinking about health as they are going through these processes?

Eliza Lawson: We heard from one of the planners that we worked with—who had been a planner for years and years—that once he was part of this project he had been looking at things kind of in a new light. And that it was so natural and normal to think about health when he was thinking about planning, but it may have changed some of the decisions he had made about some of the things he was doing. So I think that while the planners may not be thinking about health, the decisions that they are making are impacting health. Something that may be really good for the environment or really good for economic development may not be the best choice for health, and I think sometimes it may not affect the decision. I think to have that discussion deliberately is worth it for the residents because sometimes they don’t realize that this is a decision that is going to impact their health, but if they knew that and if they were interested in that and it was important enough to them, it would help guide the discussion with the municipality and maybe it would help change the outcome.


>> From Lawson's presentation:

As part of a presentation at the New Partners for Smart Growth conference last year, Lawson shared examples of how she helps bring together smart growth and public health communities to improve public health.

When Smart Growth says…

  • “Expanded transportation choices”

Public Health hears…

  • “Improved air quality”
  • “Increased access to health care”
  • “Better employment opportunities”
  • “Fewer motor vehicle accidents”

This commentary originally appeared on the RWJF New Public Health blog.