participation in defining what is needed. The local context—including resources, demographics, culture, geographic location, and jurisdictional authority—will drive decisions on the policies and initiatives that can be implemented and sustained. While overall strategies can be recommended, and a range of potential actions to implement those strategies can be recommended, local officials and their community partners must use their own collective knowledge, judgment, and expertise to choose the best actions for their locality. Actions chosen must be a good fit for the community, and local government officials must be able to convince supporters and funders that these steps are important.
As local government officials work to understand the characteristics, needs, and assets of their communities, it will be critically important to involve concerned community members in examining, recommending, and building support for particular actions. These community members should include, among many others, parents, youth, and health providers. In addition, it will be important to partner with neighborhood-based grassroots nonprofit organizations, since they often have established networks for communication and outreach to residents. Active leadership is also key, and many mayors, city council representatives, and others have already taken the initiative to be prominently engaged in leading community efforts and involving community coalitions in promoting access to and availability of healthy choices and a healthy environment for their community.
Particular attention should be paid to conditions that result in unequal access to opportunities for healthy foods and beverages and physical activity. Factors such as poverty, poor housing, racial segregation, lack of access to quality education, and limited access to health care can influence access to healthy food and physical activity in negative ways. Understanding this interrelationship in the case of childhood obesity could lead local officials to note that many lower-income children in their jurisdiction do not engage in physical activity, and consequently to examine the equity of access to parks and recreational opportunities and safe neighborhoods and work to end these inequities. Local officials might observe inadequate consumption of fruits and vegetables among children in some parts of the community, and then consider and seek solutions to the unequal accessibility and affordability of healthy foods in these neighborhoods. Achieving health equity—“the fair distribution of health determinants, outcomes, and resources within and between segments of the population regardless of social standing” (CDC, 2007)—requires local governments to focus their obesity prevention efforts on historically disadvantaged communities with disproportionately high rates of obesity.