D

Statements at the Workshop

During the town hall sessions of the workshop, 10 speakers made statements—summarized below by the rapporteurs—related to issues discussed by the workshop presenters.

UNDERSTANDING AND ACTING ON INEQUITY

Shavon Arline-Bradley, senior director of health programs for the naional office of the National Association for the Advancement of Colored People (NAACP), discussed the need to address historical and present issues of racism, classism, and political and social power dynamics when working for health equity. In the past, the focus on reducing disparity gaps has overlooked opportunities for movement on policy change, she said. Individuals are directly affected by the communities and institutions around them, so changing the physical environment in a community is an important step toward reducing obesity. However, that change does not affect the political and social landscape for many communities of color. Such a change requires incorporating an understanding of inequity into all actions.

The NAACP has three recommendations. First, communities of color should be informed about any policy that will affect their community and included in the process of shaping and passing legislation. Second, economic resources from a diverse portfolio—including those of the business community, government, and public health—should be included in efforts to increase physical activity in communities of color. Third, funds for improving access to parks and other opportunities for physical activity should be distributed in such a way that communities of color have an active voice in pursuing long-term policy change.



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D Statements at the Workshop During the town hall sessions of the workshop, 10 speakers made statements—summarized below by the rapporteurs—related to issues discussed by the workshop presenters. UNDERSTANDING AND ACTING ON INEQUITY Shavon Arline-Bradley, senior director of health programs for the naional office of the National Association for the Advancement of Colored People (NAACP), discussed the need to address historical and present issues of racism, classism, and political and social power dynamics when working for health equity. In the past, the focus on reducing disparity gaps has overlooked opportunities for movement on policy change, she said. Individuals are directly affected by the communities and institutions around them, so changing the physical environment in a community is an important step toward reducing obesity. However, that change does not affect the political and social landscape for many communities of color. Such a change requires incorporating an understanding of inequity into all actions. The NAACP has three recommendations. First, communities of color should be informed about any policy that will affect their community and included in the process of shaping and passing legislation. Second, economic resources from a diverse portfolio—including those of the business community, government, and public health—should be included in efforts to increase physical activity in communities of color. Third, funds for improving access to parks and other opportunities for physical activity should be distributed in such a way that communities of color have an active voice in pursuing long-term policy change. 115

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116 CREATING EQUAL OPPORTUNITIES FOR A HEALTHY WEIGHT COMMUNITY ASSESSMENTS AND TAILORED SOLUTIONS Effective public health interventions are based on thorough assessments, said Jason Pelzel, program coordinator at the International Food Information Council. Community assessments and solutions go hand in hand, and different communities have different needs, which requires tailored interventions. However, several barriers impede suc- cessful assessments, including a lack of expertise, a lack of collaboration, and a lack of technology or data. Pelzel encouraged participants to ask themselves whether untapped resources and new approaches to obesity prevention exist, such as partnerships with agents in the field who have access to valuable data. Establishing a framework for community assessment at the local level would make it possible to leverage the existing capacity for assessment while identifying the gaps and needs of individual communities. THE POTENTIAL OF FARMERS’ MARKETS As a member of the board of directors for the Ward 8 Farmers’ Market, located in a low-income community in Washington, DC, Linda Thompson, assistant professor of nutritional sciences at Howard University, has directly experienced the benefit of such markets to residents. Through a grant program allowing residents to purchase additional produce on the spot or at a later time, farmers’ markets in Washington communities at high risk for obesity double the value of vouchers from the Supplemental Nutrition Assistance Program (SNAP); Special Supplemental Nutrition Program for Women, Infants, and Children (WIC); and Senior Farmers’ Market Nutrition Program. The markets also provide nutrition education and food demonstrations so residents can learn how to prepare their produce, as well as activities to keep children entertained while their parents shop. The biggest challenge, Thompson said, is getting people to come to the market, even with a shuttle service stopping at six different sites. To address this challenge, the board is starting a texting program and working to use social media; peer education also has proven successful.

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APPENDIX D 117 THE IMPORTANCE OF SUPPLEMENTAL PROGRAMS Heather Hartline-Grafton, senior nutrition policy and research analyst at the Food Research and Action Center (FRAC), asserted that disparities in healthy eating and obesity will not be solved without higher employment rates, more full-time jobs, better wages and benefits, stronger income support and nutrition programs, and quality health care. Almost all the topics discussed at the workshop involve growing inequality, declining assets and income among those of the lowest socioeconomic status, and growing economic insecurity, and many discussions of obesity prevention ignore those issues. A major facet of obesity prevention is food access, Hartline-Grafton said. Many initiatives are in place to improve food retail availability and convenience in underserved communities, but research shows that these efforts alone will not combat inequities in food access. Federal nutritional programs are critical for success; however, benefit levels for SNAP participants are currently too low, she said. Federal nutrition programs also need to partner with retailers to ensure that they accept program benefits and support rigorous community outreach. Finally, foods offered at those retail outlets need to be affordable, of high quality, and culturally appropriate. HEALTH CARE PROVIDERS AND THEIR PATIENTS Sara Bleich, associate professor at Johns Hopkins Bloomberg School of Public Health, said a team-based approach is critical to success in health care, particularly because doctors often are pressed for time when seeing patients. Health care providers also need to understand a patient’s community. For example, global positioning system (GPS) mapping can inform counseling and increase the effectiveness of a clinical encounter. Patients and their health care providers can have differing perspectives, such that patients feel they are working hard, but the physician sees no progress. This disconnect needs to be understood and accommodated, said Bleich. Leveraging technology can help address this problem, as can openness to different ways of communicating with patients. Finally, any good idea must be sustainable to work. Two-way communication with a target population is essential to know what the

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118 CREATING EQUAL OPPORTUNITIES FOR A HEALTHY WEIGHT population needs. Also, groups with differing objectives need oppor- tunities to come together and discuss how to move forward. TRAINING FOR HEALTH CARE PROVIDERS Although not the only factor, appropriate training for health care providers in nutrition and physical activity is necessary for better prevention-oriented care, said Lisel Loy, director of the Nutrition and Physical Activity Initiative at the Bipartisan Policy Center (BPC). BPC’s report Lots to Lose: How America’s Health and Obesity Crisis Threatens Our Economic Future notes how health professionals often lack the necessary training and incentives to deliver important nutrition and physical activity counseling to patients (BPC, 2012). The center has partnered with the Alliance for a Healthier Generation and the American College of Sports Medicine to host a fall forum on innovations in medical education, where discussion will focus on several promising training models and on how providers can receive the training they need. Multiple actors across sectors—whether insurers offering reimburse- ment or community-based organizations providing complementary programs—have roles to play in improving prevention-oriented care, said Loy. Appealing to the interests of these different stakeholders is a major undertaking, but offers an important opportunity to improve the prevention and treatment of obesity. MEETING THE NEED FOR PHYSICAL ACTIVITY Nicole Keith, associate professor in the Department of Kinesiology at Indiana University, addressed the disconnect between understanding the need for physical activity and understanding how the built environment can influence physical activity. She recommended initiating a dialogue about exercise deserts to educate voters who routinely vote against bonds to improve parks and schools. She also discussed expanding partnerships between parks and school systems to include health care providers and academic departments, which could contribute programming and expertise in kinesiology. Indiana University has been involved in such a partnership for the past 11 years. Health care providers refer patients to fitness centers in public schools, and university students provide personal training, group

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APPENDIX D 119 classes, and social reporting. The collaboration also serves to give students from underserved groups exposure to physical activity disciplines as a focus for their undergraduate work. TARGETING YOUTH OF COLOR Joy Spencer discussed research from the Center for Digital Democracy, where she is project director for the Digital Food Marketing and Youth Initiative. Food marketers, she explained, are at the forefront of the digital age and often target youth of color. Their ability to access youth constantly with mobile phones and Internet ads and their ability to receive input to create better marketing are of great concern, particularly because they are focusing on groups that are disproportionately affected by obesity and obesity-related diseases. Spencer stressed the need for greater emphasis on holding companies accountable for their exploitation of the digital environment. TOOLS FOR CHANGE HTV Studio, a Los Angeles–based production company, created “The Kids Takeover,”1 a communication program with the goal of shifting the perception of food consumption and physical activity in the Latino community, said chief executive officer and executive producer Juan Carlos Aguirre. HTV Studio has been designing and producing health communication programs for the past 10 years. Its efforts are aimed at raising awareness of such health concerns as human papillomavirus, cervical cancer, and colorectal cancer. Aguirre emphasized his concern about the obesity crisis, especially in the Latino community, and his desire to contribute to solving the problem by producing a commu- nication program that would give children, adolescents, and their families the tools they need to adopt new behaviors and move toward healthy living. 1 See http://www.thekidstakeover.com.

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120 CREATING EQUAL OPPORTUNITIES FOR A HEALTHY WEIGHT REACHING LOW-INCOME CHILDREN Federal nutrition programs are critical to addressing hunger and obesity in the nation, but they are not reaching millions of low-income children, said Signe Anderson, child nutrition policy analyst at FRAC. On an average day in 2011, the summer nutrition programs served lunch to 2.8 million children, whereas 19 million relied on free and subsidized school lunches during the school year (FRAC, 2012). FRAC recommends increasing access to all federal nutrition programs and to after-school and summer programming, with strong linkages between these programs. Increasing investment in programming offered outside of normal school hours is important for children’s health, and linking those programs to funding for nutrition initiatives and standards for physical activity and nutrition will reduce disparities and create a stronger child service infrastructure. In addition, implementing the recent child nutrition reauthorization would yield healthier meals and snacks in schools and in out-of-school settings and strengthen these programs.