Last week, a multidisciplinary group of experts joined us for a Great Challenges live online event to discuss whether it truly takes a village to prevent conditions such as childhood obesity. With NPR Correspondent Allison Aubrey moderating, these experts took a close look at community-based prevention initiatives that have led to sustainable health solutions, including reductions in childhood obesity, and discussed how those approaches can be applied elsewhere.
If you weren’t able to join us, check out the recast below.
Thanks again for sending your questions and comments via social media! We had such great questions that an hour did not leave time enough to address them all. So, we asked our panelists, Angela Diaz, Karen Peterson, Belinda Reininger and Risa Wilkerson to offer their thoughts on the remaining questions. Here’s what they had to say:
Conditions such as childhood obesity are more prevalent in lower income areas – these are precisely the ones that may not have the resources to take meaningful action. How can these communities create a program that might have an impact?
Angela: In the absence of additional resources, collaboration becomes even more important. One may build new program opportunities on top of tasks you need to do anyway. For example, a graduate program may need to place students to practice nutrition education or physical education and could be added to the resources available at a local early education center. Or changing the way an organization conducts their regular business may not require additional funding, but instead, a consideration to do things differently. For example, a daycare center offers daily snacks to their kids. An activity that requires no additional resources is setting standards for types of snacks served.
Risa: The Healthy Kids, Healthy Communities initiative supported 49 partnerships to increase children’s access to healthy foods and opportunities for physical activity through changes in policies, systems and environments in those communities at greatest risk for childhood obesity based on race, ethnicity, income and geographic location. The Growing a Movement report provides insights on what is achievable in low-income communities through collaboration among community-based organizations, residents, decision makers and other partners. Much was achieved by these partnerships. I realize that being part of a grant-funded program provides many advantages and yet there are ways communities can replicate some of these efforts, even if on a smaller scale or a longer time frame.
The examples cited (Brownsville, Blue Zones communities) are affiliated with large organizations – they are very special circumstances that many communities cannot replicate. Can a community take steps to better prevent chronic conditions without the backing of a powerful organization?
Angela: When you set the table for collaboration, any individual, small organization, tenant association or civic group can contribute towards health: a scout working on is Eagle project can mark trails in a local park that is used by families during the weekend, thus providing more opportunities for physical activity. A tenant association can organize a “Play Street” during the summer staffed by neighbors and summer youth employment participants from a local multi-service agency.
Belinda: Preventing chronic disease in a community takes more than one large organization – it takes numerous large and small organizations coming together. Large organizations can be helpful when you have grants where costs are reimbursed after the work is done, simply because these organizations tend to be more able to float those costs more easily than smaller organizations. However, smaller organizations are usually able to be more nimble in hiring and purchasing. The strengths of both types of organizations move things forward.
Risa: Any community can take steps toward better conditions even without a large funder behind the scenes. Perhaps there is an existing community coalition or partnership that can help organize efforts. If not, start small to develop one. It is important that coalitions meaningfully engage those residents whom are most affected by the current conditions. A first step can be assessing the situation by looking at health and safety data (most county health departments can help with this) and talking to residents about the barriers they face to eating healthy food and being physically active. From there, choosing small steps toward change to help built trusting relationships and to build energy toward change. This can include collective efforts to invest in improving (even cleaning up) a local park or starting a community garden.
What’s the single most important piece to the puzzle of preventing chronic disease on a community level?
Angela: When neighbors are socially and civically active, they can turn a community around. If neighbors have an opportunity to work together and achieve a small win, like getting a street clean, getting together and watching “Weigh of the Nation” or a similar documentary at a local community center, they may be inspired to take the next step to get more deeply involved with other issues in their neighborhood, like rallying to bring more healthy options to their local grocers.
Risa: There is no single solution. It’s a complex issue and one that requires work at the systems level. What is important is that we don’t rely only on programs, promotion and education to move the needle. We also have to work on changing policies and the social and built environments to support people’s desire to make healthy choices.
In your opinion, is it possible that childhood obesity is not the problem but a symptom of a larger issue at hand? What might that issue be?
Angela: Letting the food industry produce, market and profit from unhealthy, overly processed, high calorie-low nutritional food in the name of corporate freedom, with little regard for health is part of the larger issue. Some subsidies favor the over-production of some crops, for example, corn. Over-diversified crops result in a product flooding the market and then the need for that product to be put to use.
How can lessons learned from Brownsville or the Blue Zones be best applied to other communities? Is it a matter of policy change? Health education? Is it a community-driven process?
Angela: Again, I cannot stress enough that a good place to start is setting the table for people to come together, build relationships and start to talk about what they are doing and where there are opportunities to build on each other’s agenda. This community-driven process can be more powerful than any externally imposed, single lead program or intervention you can think about.
Belinda: Yes – it is all of that. Any community can use the evidence-based Community Wide Campaign approach. It includes media, risk factor screening and health education, policy and environmental changes.
Community leaders in Brownsville and in Blue Zones could be thinking: “Hey, we’ve found a big piece of the puzzle to solve childhood obesity! Now all we have to do is tell the world and everybody will follow our example!” How much has this actually happened? Why isn’t it happening, or happening more?
Angela: We, in public health, are obsessed with replication. There may be some principles that can be used to guide others, but at the end of the day, the relationships and the process are going to be more important and transformative than any specific content we seek to replicate from one place to another.
Based on the success stories we’ve discussed today, what’s the most important step a community looking to improve the health of its population and encourage behavior focused on prevention needs to take?
Angela: Community building is about relationship building. It is relationship, relationship, relationship. One of the most important things for the wellbeing of a community and its members is to feel connected, to be socially and civically engaged, to have common goals and work toward those goals. A good place to start is setting the table for people to come together, build relationships and start to talk about what is important to the community, what are they doing and where there are opportunities to build on each other’s agenda. Another good thing to do is to build shared history – like neighborhood traditions of health related activities that become part of a shared culture. Finally, we must always remember that community-based work is an iterative process: we advance and win some, but sometimes we need to go back to the drawing board as we fine-tune our work in response to input from our community partners.
Karen: Take the long view to developing engaged, sustained community partnerships using the organizations that are active in different community settings. Community success stories often involve not only a focus on “evidence-based behaviors” such as decreasing screen time and sugar-sweetened beverages, but also the use of “evidence-based interventions” (tested with sound evaluation designs) put together to impact all parts of a child’s day – using a community based participatory approach or alternatively, a partnership model. The interface between communities and other “levels of influence” should be considered. In particular, communities are in a position to make sure the organizations most directly responsible for caring for children (schools, childcare, etc.) have the resources they need and that they are active participants in providing their views and expertise in how to solve obesity.
Belinda: Assemble a strong and action-oriented group of partners to establish a plan with short and long-term goals based on needs of the community. Definitely use an evidence-based approach to select strategies. Get started and don’t take no for an answer. You may have to regroup at times, but keep moving forward towards goals as a group.