The continuous and expanded surveillance of health status in racial/ ethnic minority communities is an important measurement challenge for evaluators, yet it is needed to provide accurate disease prevalence estimates for evaluating culturally targeted prevention strategies for smaller geographic areas (e.g., for certain zip codes, school catchments areas, or census tracts). Expanding access to surveillance data would decrease the burden placed on community-based organizations, school districts, and other local government agencies to monitor and evaluate interventions, thereby allowing them to focus on the service delivery missions that motivate their activities (Yancey et al., 2005). The federal and state governments can expand their roles in collecting data by race/ethnicity and refining the definitions of race/ethnicity categories (Lurie et al., 2005).
Surveillance and monitoring systems may not provide the data needed for a comprehensive assessment of program quality. Community-based participatory research is one qualitative research approach to inquiry that emphasizes community partnerships and action for social change and the reduction of health disparities as an integral component of the research process (McAllister et al., 2003). Indeed, qualitative indicators require more precise definitions. Yet, effective programs and services will depend on the ability to measure and evaluate these indicators and integrate an understanding of the indicators into interventions. The ability to measure an array of indicators, both qualitative and quantitative, for a variety of diverse populations and outcomes is central to the elimination of health disparities and the prevention of childhood obesity in high-risk communities.
Quantitative assessment of progress over the past few years in preventing childhood obesity in diverse population groups is difficult. Examples are provided throughout the chapter of localized successes and innovative programs that are being implemented and evaluated across the nation. Large-scale initiatives focused on disproportionately affected groups are needed and should incorporate participatory approaches into their design, implementation, and evaluation.
Making progress toward closing the childhood obesity and health disparity gaps in high-risk racial/ethnic minority populations and diverse low-income populations will depend on several factors. These include a national commitment to substantially improve the social and built environments of high-risk communities; defining the contexts and mechanisms that lead to and perpetuate childhood obesity; and designing, implementing, and evaluating effective and culturally competent interventions, evaluation tools, and outcome measures.