zontal integration are the coordination of obesity prevention interventions through a local WIC program, a community youth agency, and a local business or a corporate-sponsored community-based program. Vertical integration is also used when partners work at different levels—the national, regional, state, county, and community levels—to deliver interventions planned at a higher level and delivered at a lower level in a coordinated way. The use of both the vertical and the horizontal integration approaches allow maximum synergy to facilitate effective collaboration.
The USDA’s State Nutrition Action Plans have promoted horizontally and vertically integrated efforts across agency lines by local health departments, school districts, county extension agencies, and social service departments (USDA, 2006c). For example, the members of the Florida Interagency Food and Nutrition Agency include the Florida Department of Children and Families, the Department of Health, the Department of Education, the Department of Agriculture, and Consumer Services, among others, that coordinate nutrition campaigns and activities (FIFNC, 2006). Utah’s Blueprint to Promote Healthy Weight for Children, Youth, and Adults addresses actions by families, schools, communities, worksites, health care, media, and government that are needed including forming a team of leaders to assume active roles in addressing issues of overweight and obesity (Bureau of Health Promotion, 2006).
At times, however, the division of authority among governments at the federal, state, and local levels has led to inconsistencies, ineffective resource allocation, and uncertainty about the respective roles and responsibilities of the units at each level that is challenging for the task of effective coordination (Baker et al., 2005; TFAH, 2006). A sustained effort that includes adequate planning and cooperation among governmental agencies and departments and other stakeholder groups is needed so that the units at each of these levels can effectively work together.
In addition, the overall capacity to address childhood obesity is not enhanced when increases in federal funding are responded to by decreases at the state level. Current funding for obesity prevention is also often tied to funding for other public health issues; thus, decision makers at the state and local levels are challenged by coordinating funds from a variety of funding strategies and sources (Finance Project, 2004).
Similar to other states, California has only recently begun to recognize the need to develop policies related to nutrition, physical activity, and food security and an infrastructure to enhance those provided by the federal government or to fill gaps where the federal government does not meet the state’s needs in these areas. Like the federal government, California is starting to integrate the efforts of its categorical programs and establish cross-cutting approaches to address obesity prevention. Some federal requirements, however, do not allow programs to address crosscutting problems,