opportunities, and extended campaigns may be necessary to effect change, the panelists said.

ACTIONS BY LOCAL PUBLIC HEALTH AGENCIES

Local public health agencies have both the authority and the tools to change the built, social, and food environments, said James Krieger, chief, Chronic Disease and Injury Prevention Section, Seattle-King County Public Health Department. “We are just now beginning to understand the potential of applying these tools in the realm of obesity prevention,” he noted.

However, the influence of local public health agencies extends beyond their legal powers. Public health officials have important relationships with many sectors and stakeholders that have influence over the policies and systems that affect obesity rates. They have connections with the executive branch for which they work; the legislative branch, such as county and city councils; and local policy-making bodies, such as planning agencies, school districts, and housing authorities. They can serve as a nexus for bringing these groups together to forge consensus and move policy forward.

Public health is currently at a watershed point, Krieger said. It is transitioning to an emphasis on policy systems and environmental change, expanding its activities beyond its past emphasis on health education and direct services. Local public health agencies have expertise in assessments, communications, legislative affairs, and constituent mobilization, and thus can make significant contributions to driving a policy and a legal agenda at the local level. Krieger discussed three specific examples of this new influence: menu labeling, land use planning, and the promotion of physical activity.

Menu Labeling

In March 2008, King County, which includes Seattle and surrounding areas, became the second jurisdiction in the nation to pass a menu labeling regulation, following New York City. The county chose menu labeling as an initiative for several reasons: the obesity issue has high visibility; the leadership of the local board of health decided to take a more activist stance on the problem; a political consensus to take action was forming; menu labeling is an easier step to take than many others; and it avoids the “nanny state” criticism, since it simply provides customers with information they may need to make their own choices. Also, evidence available at the time justified the choice, although the evidence still is not conclusive. Some models indicate that menu labeling may prevent weight gain, and experiments in cafeterias and workplaces have shown that it may change choices and caloric intake. But no studies are currently available to dem-



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