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Improving Community Health Through Policy Next Steps

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Title: Improving Community Health Through Policy Next Steps


1
Improving Community Health Through PolicyNext
Steps
  • John J. Librett, Ph.D., MPH
  • Centers for Disease Control and Prevention
  • Division of Nutrition and Physical Activity
  • Physical Activity and Health Branch
  • Atlanta, GA

2
TRANSLATING RESEARCH INTO POLICY
3
Physical Activity Policy Framework
Evaluation
Make The Case
Define The Problem
Identify Solutions
Implement Programs
4
Policy Definitions
  • Organizing structure and guidance
  • Legislative or regulatory action
  • Formal and informal rules
  • Explicit or implicit
  • Formal written codes
  • Written standards that guide choices
  • Unwritten social norms

5
Policy Research
  • ? Identifying relevant policies
  • Determinants of establishing policy
  • ?Process of developing and implementing policy
  • Outcomes of implementation of policy

6
Physical Activity Policy Research Agenda
  • Public spaces
  • Safety and crime
  • Economics
  • Neighborhood walkability
  • Connectivity, land use and community design
  • Schools
  • Walk to School
  • Worksite
  • Active Commute to Work
  • Recreation, parks and trails
  • Health

7
Physical Activity Policy Framework
 
 
Outcomes of Policy
Policy
 
Develop and Implement Policy
Determinants of Policy
Identify Policies

Health
Local
Transportation
Regional
Parks/Public Spaces
State
Worksite
National
Sector Scale
School
8
How are Decisions Made in Public Health Settings?
  • Anecdote or Gut Feeling
  • Press Reports
  • Pressure from Policy Makers or Administrators
  • History

9
Barriers to Using Evidence Based Public Health
  • Lack of leadership in setting a clear and focused
    agenda for evidence-based approaches
  • Lack of a view of the long-term horizon for
    program implementation and evaluation
  • External (including political) pressures drive
    the process away from an evidence-based approach

10
Barriers to using Evidence BasedPublic Health
(cont)
  • Inadequate training in key public health
    disciplines
  • Lack of time to gather information, analyze data,
    and review the literature for evidence
  • Lack of comprehensive, up-to-date information on
    the effectiveness of programs and policies
    (overall and in special populations)

11
Triangle of Key Concepts for Optimal Support
Valid Research Evaluation
Enumerate the Problem
Triad for Policy Infrastructure
Strong Leadership
Effective Policies
Enunciate a Solution
Create the Team/Facilitate the Process
Hollander, Librett, Fenton et al., 2004
12
Preventive Effects ofPhysical Activity
  • Long-standing evidence
  • Cardiovascular disease
  • High blood pressure
  • Diabetes
  • Obesity
  • Colon cancer
  • Osteoporosis
  • Emerging Evidence
  • Gall stones Sleep Immune function, Other
    cancers Dementia
  • Substantial Evidence
  • Depression
  • Cholesterol levels
  • Fall injuries
  • Stroke
  • Functional status (ADLs)

13
Therapeutic Effects ofPhysical Activity
Clinical practice guidelines for physical
activity
  • High blood pressure
  • Chronic lung disease
  • Cholesterol management
  • Cardiovascular disease
  • Diabetes
  • Osteoporosis
  • Arthritis
  • Obesity

14
Community Developments
Suburban development, many cul-de-sacs
Well-connected urban development with mixed land
uses
15
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16
Weight and Residential Density AtlantaAs
density of households increases BMI decreases.
(SMARTRAQ N4430)Frank et al, 2004
17
Estimated Annual Costs Attributable to Obesity in
the U.S.
  • Overweight and Obesity
  • Direct health care costs 93 billion
  • 9 of all health care costs
  • Obesity- 732 more per person
  • 1,486 Medicare
  • 864 Medicaid
  • Source Finkelstein, Fiebelkorn and Wang. Health
    Affairs, May, 2003.

18
"U.S. Firms Losing Health Care Battle General
Motors Chairman SaysWashington Post, Feb.2005
  • "Failing to address the health care crisis would
    be the worst kind of procrastination the kind
    that threatens the global competitiveness of our
    nation's economy.
  • 5.2 billion to cover retirees, employees
    families.
  • 1.9 billion in prescription drugs cost .
  • 400 million projected increase this year.
  • Your interest? Corporations are seeking healthy
    environments for their employees.

19
States Cost of Obesity
  Total Population () Millions () Medicare population () Millions () Medicaid Population Millions ()
Utah 5.2 393 5.8 62 9 71
Colorado 5.1 874 5.1 139 8.7 158
Wyoming 4.9 87 5.9 15 8.5 23
Nevada 4.8 337 5 74 10.1 56
Idaho 5.3 227 5.6 40 12 69
New Mexico 4.8 324 4.6 51 8.5 84
Finkelstein, EA, Fiebelkorn, IC, Wang, G.
State-Level Estimates of Annual Medical
Expenditures Attributable to Obesity. Obesity
Research 200412(1)1824.
20
Atherosclerosis Among Children?!
  • Obesity in children is independently associated
    with arterial endothelial dysfunction and wall
    thickening, key early events in atherogenesis
    that precede plaque formation.
  • We were surprised that the children had
    developed vascular abnormalities at such a young
    age. The arteries of overweight children act like
    those of middle-aged smokers, increasing their
    risk of an early heart attack or stroke.  But the
    damage can be reversed with simple lifestyle
    measures such as diet and regular exercise,
    according to a report in todays rapid access
    issue of Circulation.
  • At 1 year, there was significantly less
    thickening of the carotid wall (Plt0.001) as well
    as persistent improvements in body fat content
    and lipid profiles in the group continuing an
    exercise program. Vascular function was
    significantly better in those children continuing
    exercise (n22) compared with children who
    withdrew from the exercise program (n19)
    (Plt0.05).

Woo, et al. Circulation. 2004 Effects of Diet
and Exercise on Obesity-Related Vascular
Dysfunction in Children, 1091981-1986, American
Heart Association.
21
Community Physical Activity Policyfor Cancer
Survivorship
"Cancer is not an inescapable fact of life.
Things we do, and social policies, make a huge
difference. "The pieces that are missing in
terms of prevention are effective ways by which
communities and social policies can help people
maintain a healthy body weight and get regular
physical activity, the big thing to tackle is,
what are the interventions that will actually
begin to turn it around? Michael Thun,
MD Vice President, epidemiology and surveillance
research American Cancer Society
22
Convinced? Now What?
Results of the reviewed studies generally
indicate that it is safe for cancer survivors to
be physically active, even during bone marrow
transplant procedures and high-dose
chemotherapy. Agency for Healthcare Research
and Quality
  • For cancer Survivors exercise results in positive
    outcomes related to
  • Increase in vigor and vitality
  • Increae in cardiorespiratory fitness
  • Increase in quality of life
  • Reduction in depression
  • Reduced in anxiety
  • Reduced in fatigue and tiredness

23
Hakim NEJM 199833894-9.
24
Diabetes Risk Reduction(Diabetes Prevention
Program NEJM, April 2002)
25
Community Physical Activity Policyfor Cancer
Survivorship
"Cancer is not an inescapable fact of life.
Things we do, and social policies, make a huge
difference. "The pieces that are missing in
terms of prevention are effective ways by which
communities and social policies can help people
maintain a healthy body weight and get regular
physical activity, the big thing to tackle is,
what are the interventions that will actually
begin to turn it around? Michael Thun,
MD Vice President, epidemiology and surveillance
research American Cancer Society
26
Cancer Survivors Need Physical Activity Research
Translated to Great Community Physical Activity
Policy
  • For cancer Survivors exercise results in positive
    outcomes related to
  • Increase in vigor and vitality
  • Increae in cardiorespiratory fitness
  • Increase in quality of life
  • Reduction in depression
  • Reduced in anxiety
  • Reduced in fatigue and tiredness

Results of the reviewed studies generally
indicate that it is safe for cancer survivors to
be physically active, even during bone marrow
transplant procedures and high-dose
chemotherapy. Agency for Healthcare Research
and Quality
27
Triangle of Key Concepts for Optimal Support
Valid Research Evaluation
Enumerate the Problem
Triad for Policy Infrastructure
Strong Leadership
Effective Policies
Enunciate a Solution
Hollander, Librett, Fenton et al., 2004
28
Some Key Characteristics of Evidence Based Public
Health
  1. Intervention approaches developed based on the
    best possible scientific information
  2. Problem solving is multi-disciplinary
  3. Theory and systematic planning approaches are
    followed
  4. Sound evaluation principles are followed
  5. Results are disseminated to others who need to
    know and take action

29
Evidence Based Policy Domains
  • Informational Approaches to Increasing PA
  • Behavioral and Social Approaches to Increasing PA
  • Environmental and Policy Approaches to Increasing
    PA

30
Summary Strongly Recommended
  • Modified physical education
  • Individualized behavioral change
  • Non-family social support
  • Create or enhance access
  • Community-wide campaigns

Summary Insufficient Evidence
  • Mass media
  • Health education
  • TV/video game turn off
  • College health education
  • Family-based social support

31
Modified Physical Education
  • Modified curricula and policies
  • Studies designed to modify the amount of physical
    activity during PE
  • Lifetime activities and games

32
School-Based Approached to Increasing Physical
Activity . . .
  • P.A.P.P.I. (?)

33
Physical Activity Promotion through Predator
Introduction
34
Kids WalkPrimary Aims
  • Analyze the scope impact of Walk to School
    programs
  • Identify key determinants that affect active
    travel to school program effectiveness

http//www.cdc.gov/nccdphp/dnpa/kidswalk/index.htm
35
Community-wide CampaignsInformational Approaches
to Increasing Physical Activity
  • Large-scale, high intensity, high visibility
  • Use of TV, radio, newspaper, information sites
  • Multi-component, multi-site
  • Combined Package

36
VERB
http//www.cdc.gov/youthcampaign/index.htm
37
Point-of-decision prompts
  • Motivational signs placed by elevators and
    escalators
  • Encourage stair use for health/weight control
  • Single component

38
StairWELL to Better Health A Worksite
Intervention
http//www.cdc.gov/nccdphp/dnpa/stairwell/
       Paint to make your stairwells bright and colorful.
       Carpet easier on the feet than concrete, and more attractive too!
       Rubber Stairtreads necessary for extra safety when taking the stairs.
       Framed Artwork gives people something to look at while they are walking up and down.
       Motivational Signs both inside and outside the stairwell.
       Music also helps create interest and increase use.
       Stairwell Use Tracking system If you are interested in tracking how much more employees are taking the stairs.
       Budget Worksheet some general guidelines to developing a budget for your
39
Behavioral and social approaches
  • Individually-adapted health behavior change
  • Other social support

40
Individually-adaptedHealth Behavior Change
  • Goal setting and self-monitoring
  • Building social support
  • Behavioral reinforcement
  • Structured problem solving
  • Relapse prevention

41
Physical Activity Counseling for Exercise
Men in Motion
PACE Counseling for Overweight Women for Diet
and Activity
PACE Counseling Adolescents for Exercise and
Nutrition
http//www.paceproject.org/homepage.html
42
Social Support in Community Contexts
  • Creating, strengthening, and maintaining social
    networks
  • Use of buddy systems
  • Contracting
  • Walking groups

43
Well-Integrated Screening and Evaluation for
Women Across the Nation
http//www.cdc.gov/wisewoman/index.htm
44
Environmental and Policy Approaches
  • Create or enhance access
  • Urban planning zoning, land use

45
Creation and/or enhanced access to places for
physical activity
  • Built environment - trails and/or facilities
    access
  • Reducing barriers - safety, affordability
  • Training incentives
  • Site-specific programs

46
Wheeling Walks
47
http//www.wheelingwalks.org
48
Street-scale Urban Design and Land Use
Intervention Characteristics
  • The interventions use policy instruments and
    practices
  • such as
  • Implementation of improved street lighting
  • Infrastructure projects to
  • Increase ease and safety of street crossing
  • Ensure sidewalk continuity
  • Introduce or enhance traffic calming
  • Enhance aesthetics of the streetscape

49
Built Environment Changes
50
Built Environment Changes
51
Built Environment Changes
52
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53
Resources Dont reinvent the wheel, pick the
wheel that fits your needs, price range, and
style. . .
http//www.healthpolicycoach.org/
http//www.centerforhealthimprovement.org/
54
  • American Planning Association
  • National Association of City County Health
    Officials
  • Expert Symposium
  • Existing and model approaches for integrating ph
    and planning
  • National Survey
  • Current and potential collaborations
  • Conference Session Tracks
  • Cross- pollination at conferences
  • Fact Sheets
  • What public health officers need to know about
    planning
  • What planners need to know about public health
  • Pilot Grants
  • Planning and PH working together

55
Opportunities for public successful private
partnerships
56
Opportunities for public successful private
partnerships
Trails for Health
  • Active Community Environments

Senior Wellness
57
Promoting Physical Activity Through Recreation in
Americas Great Outdoors
58
HealthierUS
  • Based on the premise that increasing personal
    fitness and becoming healthier is critical to
    achieving a better and longer life.

59
http//www.cdc.gov/nccdphp/dnpa/ICPAPH
60
Triangle of Key Concepts for Optimal Support
Valid Research Evaluation
Enumerate the Problem
Triad for Policy Infrastructure
Strong Leadership
Effective Policies
Enunciate a Solution
Create the Team/Facilitate the Process
Hollander, Librett, Fenton et al., 2004
61
Creating the Team
  • Whos in. . . ?

62
(No Transcript)
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