Developing Healthy Eating and Active Communities in the City of Baldwin Park

SanSan Gabriel Valley and Metropolitan ServiceService Planning Area Health Office (SPAOffice 3 & 4)(SPA 3 & 4) Gabriel Valley and Metropolitan Planning Area Health

SPA 3 & 4 CASE STUDY

DEVELOPING HEALTHY EATING AND ACTIVE COMMUNITIES IN THE CITY OF BALDWIN PARK THE 2008 PUBLIC HEALTH INNOVATION AWARD

SPA 3 & 4 BEST PRACTICE COLLECTION RELIABLE INFORMATION FOR EFFECTIVE COMMUNITY HEALTH PLANS, PROGRAMS AND POLICIES

M. RICARDO CALDERÓN, SERIES EDITOR

November 2008 Los Angeles County Department of Public Health

At a Glance SAN GABRIEL VALLEY SERVICE PLANNING AREA (SPA 3) METROPOLITAN SERVICE PLANNING AREA (SPA 4)

241 North Figueroa Street, Room 312 Los Angeles, California 90012 (213) 240-8049 The Best Practice Collection is a publication of the San Gabriel Valley (SPA 3) and Metropolitan Service Planning Area (SPA 4). The opinions expressed herein are those of the editor and writer(s) and do not necessarily reflect the official position or views of the Los Angeles County Department of Public Health (LAC/DPH).

Excerpts from this document may be freely reproduced, quoted or translated, in part or in full, acknowledging SPA 3 & 4 as the source.

Internet: http://www.lapublichealth.org/SPA 3 Internet: http://www.lapublichealth.org/SPA 4

LOS ANGELES COUNTY BOARD OF SUPERVISORS

Gloria Molina, First District Mark Ridley-Thomas, Second District Zev Yaroslavsky, Third District Don Knabe, Fourth District Michael D. Antonovich, Fifth District

The SPA 3 & 4 Area Health Office Best Practice Collection fulfilled the DHS local level goal to restructure and improve health services by “establishing and effectively disseminating to all concerned stakeholders comprehensive data and information on the health status, health risks, and health care utilization of Angelinos and definable subpopulations”.1 Since September 2006, when the Los Angeles County Department of Public Health (DPH) became a serperate department from DHS, the SPA 3 & 4 Best Practice Collection continues to provide reliable infromation for the effective development and implementation of community plans, programs and policies. It is a program activity of the SPA 3 & 4 Information Dissemination Initiative created with the following goals in mind: To highlight lessons learned regarding the design, implementation, management and evaluation of public health programs To serve as a brief theoretical and practical reference for program planners and managers, community leaders, government officials, community based organizations, health care providers, policy makers and funding agencies regarding health promotion and disease prevention and control To share information and lessons learned in SPA 3 & 4 for community health planning purposes including adaptation or replication in other SPA’s, counties or states To advocate a holistic and multidimensional approach to effectively address gaps and disparities in order to improve the health and well-being of populations

DEPARTMENT OF PUBLIC HEALTH Jonathan E. Fielding, MD, MPH, MBA. Director of Public Health and County Health Officer

Jonathan E. Freedman Chief Deputy Director

Deborah Davenport, RN, PHN, MS. Director, Community Health Services

BEST PRACTICE COLLECTION TEAM M. Ricardo Calderón, Series Editor Manuscript Author & SPA 3 & 4 Area Health Officer

Clara Steimberg, MD, MHA.

Manuscript Author & Program Director, HEAC Grant

Percy Cupen, MD, MPH.

Manuscript Author & (Former) Program Director, HEAC Grant

Carina Lopez, MPH.

Project Manager, Information Dissemination Initiative

The SPA 3 & 4 Information Dissemination Initiative is an adaptation of the Joint United Nations Program on HIV/AIDS (UNAIDS) Best Practice Collection concept. Topics will normally include the following: 1. SPA 3 & 4 Viewpoint: An advocacy document aimed primarily at policy and decision-makers that outlines challenges and problems and proposes options and solutions.

2. SPA 3 & 4 Profile: A technical overview of a topic that provides information and data needed by public, private and personal health care providers for program development, implementation, and/or evaluation.

3. SPA 3 & 4 Case Study: A detailed real-life example of policies, strategies or projects that provide important lessons learned in restructuring health care delivery systems and/or improving the health and well being of populations.

Photo: Courtesy of The California Endowment.

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INTRODUCTION INTRODUCTION The California Endowment’s Healthy Eating, Active Communities Initiative: “The effects of poverty, acculturation and inequality have a dramatic effect on the ability to make changes in lifestyle, and on the healthy options that are available – especially in disadvantaged communities where social, economic and environmental disparities converge. The Healthy Eating, Active Communities Initiative (HEAC) seeks to demonstrate that by transforming the food and physical activity environments of resource-poor, low-income communities it is possible to change norms that foster unhealthy food choices and inactivity.”1 In order to achieve this, it is necessary to shift away from practices and policies that promote the proliferation of unhealthy food choices and inactivity toward policies and practices that position healthy foods and physical activity as the best options.

“The Healthy Eating, Active Communities Initiative (HEAC) seeks to demonstrate that by transforming the food and physical activity environments of resourcepoor, low-income communities it is possible to change norms that foster unhealthy food choices and inactivity.”

- The California Endowment In March 2005, The California Endowment selected six communities across the state as demonstration sites. Each HEAC site has

a collaborative consisting of a school district, broad-based communitybased organization and the local public health department. Through a variety of strategies and tactics each of these communities is working toward making sustainable changes in the school, after school, neighborhoods, health care, and marketing and advertising sectors that support healthy eating and opportunities to engage in physical activity.

The six demonstration sites funded through the Initiative are South Los Angeles, Baldwin Park (Los Angeles County), South Shasta County, San Antonio, a community of Oakland (Alameda County), Chula Vista (San Diego County), and Santa Ana (Orange County). As part of their planning process, each collaborative was charged with setting their key policy goals and strategies. Some of these goals include enforcement of physical education requirements in schools, improving school food programs so that they are in compliance with SB 12 and SB 965, incorporating nutrition and physical activity in after school programs, changing local policies that will result in improvements in parks and other public areas so as to facilitate physical activity, and bringing in farmer’s markets in communities where there are barriers to accessing healthful, nutritious foods, among other goals.

Each collaborative has access to technical assistance providers across a variety of disciplines, particularly from the Public Health Institute, to help them successfully achieve their goals. Other components of HEAC focus on local, state and national policy and advocacy, media and industry accountability, youth

leadership, research and evaluation, and strategic and integrated communications and public affairs.” 1

“Healthy Eating, Active Communities is a four-year, $26 million program sponsored by The California Endowment. It aims to fight the growing childhood obesity epidemic in California and to develop state policy changes that will reduce the risk factors for diabetes and obesity.” 1 “In July 2008, the Los Angeles County Department of Public Health (DPH) solicited nominations for the Public Health Innovation Award for the 2007-2008 fiscal year. Established in 1998, the Innovation Award recognizes individuals or teams within a Public Health program who advance public health practice through creative and new approaches to protect and improve the health of the public. The 2008 Innovation Award was the first presented since DPH became a separate department and as such will hold a special place in the awards history.”2 In response to this call for nominations, the SPA 3 Area Health Office prepared the following proposal describing the progress to date, program accomplishments and lessons learned of “People on the Move”, the community collaborative developed

by The California Center for Public Health Advocacy, the Baldwin Park Unified School District, and the SPA 3 Area Health Office to implement the Healthy Eating, Active Communities Program in the City of Baldwin Park. In turn, the SPA 3 Area Health Office received the 2008 Public Health Innovation Award.

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PROGRAM BACKGROUND AND PROBLEM STATEMENT

Description of the innovative project or practice: I. PROGRAM BACKGROUND: THE OVERVIEW People on the Move is a public/private partnership program and community collaborative working to reduce disparities in obesity and diabetes by improving food and physical activity environments for children.

The program is implemented in the City of Baldwin Park (BP) located in the San Gabriel Valley of Los Angeles County about 20 miles inland from downtown Los Angeles. BP is a suburb with over 75,000 residents predominantly young (63% under the age of 35), Hispanic (79%), more than 50% foreign-born, and where 70% of people speak a language other than English at home. People on the Move is one of six grantees of The California Endowment’s “Healthy Eating Active Communities” grant aimed to fight the growing childhood obesity epidemic in California and develop state policy changes to reduce the risk factors for diabetes and obesity.

Overweight children face a greater risk of developing Type 2 diabetes, high blood pressure, asthma, low selfesteem, poor body image, and symptoms of depression.

The three key collaborating agencies of People on the Move are The California Center for Public Health Advocacy (CCPHA), the Baldwin

Park Unified School District (BPUSD), and the Service Planning Area 3 & 4 Area Health Office of LAC/DPH. Other partners include the City of Baldwin Park, Kaiser Permanente, Citrus Valley Health Partners, CHOICES Program, the Baldwin Park Resident Advisory Committee and Healthy Teens on the Move. People on the Move is increasing opportunities for healthy eating and physical activity in children and families in Baldwin Park.

Vast racial, ethnic and socioeconomic disparities in health exist in Baldwin Park, just as in California and the United States as a whole.

2. PROBLEM STATEMENT: THE CHALLANGE Over 34% of Baldwin Park’s children are overweight and 41% are considered physically unfit according to the 2004 California Physical Fitness Test of 5th, 7th, and 9th graders. This is among the highest percentages in California.

Overweight children face a greater risk of developing Type-2 diabetes, high blood pressure, asthma, low self-esteem, poor body image, and symptoms of depression. Vast racial, ethnic and socioeconomic disparities in health exist in Baldwin Park, just as in California and the United States as a whole.

The Centers for Disease Prevention and Control estimates that 33% of children born in 2000 will develop Type-2 diabetes; however, the risk

for African-American and Hispanic children is 50%. Immense disparities exist between the nutrition and physical activity environments of communities of color, low-income populations and those of higher income whites making it difficult for many to adopt healthy lifestyles.

Therefore, health disparities cannot be addressed with conventional individual medical models and behavioral interventions.

The health status and wellbeing of children, families and communities cannot be improved with medical and public health interventions alone. People on the Move recognizes that the “place where people are born, live and work matters” since health is to a very large degree determined by social circumstances, wealth, neighborhood conditions and work life. Improving the health status of children and families in Baldwin Park, and preventing and controlling chronic degenerative diseases like heart disease, cancer, stroke, obesity, diabetes, etc., will require efforts in a broad range of areas outside the traditional public health and healthcare sectors.

3. P R O G R A M A P P R O A C H : T H E I N N O VAT I V E SOLUTION In order to address the epidemics of overweight and diabetes among children, adolescents and adults in BP it is essential that programs and policies focus on the community environment in which people live, work, go to school, and play.

The scientific literature has documented that the high prevalence of overweight, physical inactivity and poor nutrition is caused by numerous neighborhood environmental

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PROGRAM APPROACH AND ACCOMPLISHMENTS

factors such as local economic opportunities, social interactions with neighbors, the physical environment, and services such as local grocery stores where people can buy nutritious food.

People on the Move recognizes that the “place where people are born, live and work matters” since health is to a very large degree determined by social circumstances, wealth, neighborhood conditions and work life.

Consequently, People on the Move developed an innovative program practice based on the following four critical strategies: (1) Multi-Sectoral Approach: joint program design, ownership and implementation between the public, private and non-profit sectors, (2) Multi-Environmental Interventions For Problem Solving: program goals, objectives, and activities aimed at 5 different but interdependent placed-based, community environments --neighborhood sector, after-school programs sector, food and beverage marketing and advertising sector, school sector, and the healthcare sector; (3) Multi-Disciplinary Use of Human Resources: program information, education, communication, training and implementation through a variety of human resources ranging from doctors and nurses to community leaders and health promoters, to youth and parents groups, to city officials and politicians, to professional and lay personnel in the public, private and non-profit sectors; and (4) Multi-Dimensional Approach

to Service Provision: building a framework for healthy communities through social, economic, physical and service environments conducive to health promotion and disease prevention and control.

4. PROGRAM ACCOMPLISHMENTS: THE OUTCOMES People on the Move is now in its fourth year of program implementation. The strengths of its design and approach have yielded many accomplishments, lessons learned and success stories individually, at each community environmental sector, and collectively, as a City of Baldwin Park public/private partnership and community collaborative. Milestones to date include, but are not limited to, the following: • Development of a Healthy Parks

Master Plan • “Healthy Policy Yields Healthy Minds” legislation incorporating SB12 and SB965 standards • Proposition 49 funding for AfterSchool Programs at all 13 elementary school sites • Train-the-Trainer Programs for Healthcare Providers regarding Overweight and Obesity Prevention • Selection of 11 Healthcare Champions to support community environmental changes • Implementation of The California 5-aDay Be-Active Worksite Program in SPA 3 & 4 and in the City of Baldwin Park • Design and launching of interactive English, Spanish and Chinese websites (www.eatwelllivebetter.org) • Development of a cadre of over 100 health promoters on nutrition and physical activity environmental changes • Completion of audit of local food and beverage marketing and identification of respective policy solutions for the BP

City Council • Implementation of health services and screening referrals for the school sector • Training of school teachers and nurses on nutrition and physical activity including continued education • High fat items on school menus modified to reduce fat and saturated fat content • Daily vegetarian salads added to existing school menus • Low-fat turkey, lean ham and low-fat tuna sandwiches offered at all secondary schools • All a-la-carte foods modified according HEAC standards or eliminated • Quantity and quality of K-12 Physical Education Program enhanced including implementation of new Physical Education Guidelines, and • Breastfeeding Policy developed for and passed in BP on 03/19/08.

The strategic approach of People on the Move is based on the following four strategies: • Multi-Sectoral Approach

• Multi-Environment Interventions for Problem Solving • Multi-Disciplinary Use of Human Resources • Multi-Dimensional Approach to Service Provision.

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PROGRAM BUDGET AND SUMMARY II. Description of how the innovation benefits the County, the Department of Public Health, and/or the public.

1. PROGRAM BUDGET: THE SAVINGS AND COST-EFFECTIVENESS The California Endowment awarded funding over four years to the People on the Move collaborative comprising annual disbursements and overall program costs as follows: (1) $204,000 for CCPHA to mobilize and engage community members and organizations, (2) $125,000 for BPUSD as both an agent of change and an important environment for changes that improve nutrition and physical activity for children, and (3) $125,000 for LAC/DPH as the government agency charged with protecting and improving the health of the community and the essential partner for long-term sustainability and support efforts to link policy interventions and broader campaigns to reduce overweight, prevent diabetes, and eliminate health disparities. More specifically, the SPA 3 & 4 Area Health Office leveraged funding for this fouryear program reflecting direct cost savings to LAC/DPH of $500,000. This, in addition to $1,316,000 awarded to CCPHA and BPUSD, represents an infusion of $1,816,000 in public health and prevention measures for the residents of Baldwin Park. Furthermore, the unique characteristic of People on the Move is that all funding available is used to support the implementation of the same goals and objectives through mutually supportive, reinforcing and interdependent financial expenditures and a comprehensive, integrated and shared scope of work.

2. PROGRAM SUMMARY: THE BENEFITS People on the Move is implementing community environmental changes in BP to create settings conductive to healthy eating choices and behaviors, increased physical activity, and a reduction in obesity and diabetes.

The sound public/private partnership formed and the cross-collaboration between CCPHA, BPUSD, LAC/DPH and other community organizations have initiated a movement to build healthier communities in Baldwin Park.

People on the Move is promoting and spreading the critical message that investing in social, economic, physical and service environmental interventions are as much health strategies as are direct efforts to reduce smoking, improve diets, and increase physical activity.

Sustainability plans are being developed, changes in public health approaches to health promotion and disease prevention and control are being institutionalized, a grant extension is already foreseen including a Phase II of the program; replication of this model is already in place in five other communities in California; and donor and philanthropic organizations are increasingly engaging and recognizing their role in sponsoring and funding placedbased solutions to resolve placebased problems. In turn, People on the Move is promoting and spreading

the critical message that investing in social, economic, physical and service environmental interventions are as much health strategies as are direct efforts to reduce smoking, improve diets, and increase physical activity, a message for advocates and policymakers, governments and businesses, researchers and educators, city planners and community builders, professional and lay personnel, and all others who want to be a part of the movement to build healthy communities.

An initiative Logic Model was developed to guide the collaborative work in each of the following five sectors: Schools After School Programs Neighborhoods Media and Advertising Health Care Activities in these sectors include developing and implementing policies to increase nutritious food choices and access to and utilization of physical activity opportunities; engagement of health care providers in addressing child obesity prevention in practice and through advocacy; and reduction of beverage and food marketing to children.

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REFERENCES

1. The California Endowment.

“The Healthy Eating, Active Communities Inititative.”

Accessed at www.healthyWorld Health Organization. TheWorld Health Report 2000: Health Systems: Improving Performance (WHO, Geneva, Switzerland, 2000).

2. Office of the Director of HealthServices, Rathgar Retreat Minutes (Los Angeles County Department of Health Services, August 22-23,2000).

3. World Health Organization.

The World Health Report 2000: HealthSystems: Improving Performance (WHO, Geneva, Switzerland, 2000).

6. Idem.

7. SPA 4 Area Health Office.

Community Liaising Program: A DHS Restructuring and ReinvigorationInitiative (Los Angeles County Department of Health Services, 2000).

8. Gilbert, Tom, Behavioral Engineering Model.

9. Family Health International. The AIDS Control and Prevention [AIDSCAP] Project Evaluation Tools: Introduction to AIDSCAP Evaluation (USAID/FHI, Arlington, Virginia,1993).

10. Labovitz, George & Rosansky, Victor, The Power of Alignment

4. Idem.

5. Idem.

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Metropolitan Service Planning Area (SPA 4) 241 North Figueroa Street, Room 312 Los Angeles, California 90012 Tel: (213) 240-8049 Fax: (213) 202-6096 www.lapublichealth.org Š 2008 SPA 3 & 4

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