1. Community Action Partnership at 45: Keeping Our Promise Why is Obesity Prevention an Important Anti-Poverty Strategy Dolores Barrett Director of Partnerships and Services Community Action Partnership of Orange County September 4, 2009

2. Prevent

3. Obesity Trends* Among U.S. Adults BRFSS, 1985 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

4. Obesity Trends* Among U.S. Adults BRFSS, 1986 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

5. Obesity Trends* Among U.S. Adults BRFSS, 1987 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

6. Obesity Trends* Among U.S. Adults BRFSS, 1988 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

7. Obesity Trends* Among U.S. Adults BRFSS, 1989 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

8. Obesity Trends* Among U.S. Adults BRFSS, 1990 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14%

9. Obesity Trends* Among U.S. Adults BRFSS, 1991 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

10. Obesity Trends* Among U.S. Adults BRFSS, 1992 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

11. Obesity Trends* Among U.S. Adults BRFSS, 1993 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

12. Obesity Trends* Among U.S. Adults BRFSS, 1995 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

13. Obesity Trends* Among U.S. Adults BRFSS, 1996 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19%

14. Obesity Trends* Among U.S. Adults BRFSS, 1997 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

15. Obesity Trends* Among U.S. Adults BRFSS, 1998 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

16. Obesity Trends* Among U.S. Adults BRFSS, 1999 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

17. Obesity Trends* Among U.S. Adults BRFSS, 2000 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% ≥20%

18. Obesity Trends* Among U.S. Adults BRFSS, 2001 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

19. (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) Obesity Trends* Among U.S. Adults BRFSS, 2002 No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

20. Obesity Trends* Among U.S. Adults BRFSS, 2003 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

21. Obesity Trends* Among U.S. Adults BRFSS, 2004 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% ≥25%

22. Obesity Trends* Among U.S. Adults BRFSS, 2005 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

23. Obesity Trends* Among U.S. Adults BRFSS, 2006 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

24. Obesity Trends* Among U.S. Adults BRFSS, 2007 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

25. Obesity Trends* Among U.S. Adults BRFSS, 2008 (*BMI ≥30, or ~ 30 lbs. overweight for 5’ 4” person) No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

26. 1999 Obesity Trends* Among U.S. Adults BRFSS, 1990, 1999, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

27. In 1990, among states participating in the Behavioral Risk Factor Surveillance System, ten states had a prevalence of obesity less than 10% and no states had prevalence equal to or greater than 15%. By 1999, no state had prevalence less than 10%, eighteen states had a prevalence of obesity between 20-24%, and no state had prevalence equal to or greater than 25%. In 2008, only one state (Colorado) had a prevalence of obesity less than 20%. Thirty-two states had a prevalence equal to or greater than 25%; six of these states (Alabama, Mississippi, Oklahoma, South Carolina, Tennessee, and West Virginia ) had a prevalence of obesity equal to or greater than 30%.

28. Health Risks Diabetes Coronary Heart Disease Dyslipidemia (high cholesterol, high triglycerides) Stroke Gynecological problems (abnormal menses, infertility) Hypertension (high blood pressure) Cancer (endometrial, breast, colon, pancreatic) Liver and Gallbladder Disease Sleep Apnea and respiratory disease Osteoarthritis

29. Costs Obvious Costs Costs in health care doubled in less than a decade to $147 billion (CDC) Hidden Costs Transportation and fuel costs Insurance Premiums Physical Environment

30. Health Disparities The proportion of adolescents from poor households who are overweight or obese is twice that of adolescents from middle- and high-income households. Obesity is especially prevalent among women with lower incomes and is more common among African American and Mexican American women than among white women.

31. Health Disparities Compared with white youth, black and Hispanic youth have higher prevalences of asthma, overweight, and type 2 diabetes. Among youth aged 10–19 years, American Indians have the highest prevalence of type 2 diabetes of any racial/ethnic group. In 2005, after adjusting for population age differences, Mexican-Americans were 1.7 times more likely to have diabetes than non-Hispanic whites

32. Health Disparities In 2000, rates of death from diseases of the heart were 29 percent higher among African American adults than among white adults, and death rates from stroke were 40 percent higher. During 2003-2004, 24% of non-Hispanic black females aged 2-19 years were overweight, compared with 15% of non- Hispanic white.

33. “Despite obesity having strong genetic determinants, the genetic composition of the population does not change rapidly. Therefore, the large increase (obesity)…must reflect major changes in non genetic factors.” Hill & Towbridge, Childhood Obesity future directions and research priorities. Pediatrics 1998

34. Food/Calories – energy in Physical Activity – energy out Weight is a simple equation

36. Framing the Issue

37. The issue is not individual weight loss.

38. PLACE MATTERS

39. Individual & Environment Success – Policy, Systems & Environmental Change

41. California Dreamin’ *Adapted from NC Energizers

42. Climb up a redwood tree. Climb up a Redwood Tree

43. Do a touchdown dance like a 49’er.

44. Swim like a fish in the Monterey Bay Aquarium

45. Wave and pose for your fans like an actor in L.A.

46. Surf the Pacific in the O.C.

47. Swing your golf club in Palm Springs

48. Sit down in your beach chair and enjoy the sunset on a San Diego Beach

49. If given enough time, people can walk anywhere. WALKING

50. But why would they? Unless…

51. … it was NICE

52. … were places to walk TO… … there were places to walk TO…

53. Dan Burden … and getting there was safe and fun for all!

54. What’s wrong with this picture?

55. …and this one?

56. Ready, Set, Go! And this picture?

57. e Can you spot the pedestrian ? Overbuilt Roads …

58. Can our streets encourage walking? Yes! How? Scenery Maintenance Accommodation Variety of Uses Activity Connectivity Aesthetics & Beauty Safety

59. Dan Burden Before

60. Dan Burden After Pedestrian Refuge Bike Lanes Bus Shelter In-Pavement Warning Lights Ped-Scale Lighting

61. Before

62. After

63. Cost Savings - ROI Prevention is an Investment $1 spent - $1 return in 1 year $1 spent - $5.60 return in 5 years $10 per person for prevention – $16 billion saved annually in 5 years

64. ACHIEVE-Action Communities for Health, Innovation, and EnVironmental changE CDC program that funds national organizations to work through local affiliates to advance local community leadership in the nation’s effort to prevent chronic disease and related risk factors.

65. ACHIEVE National Organizations Community Funding National Association of Chronic Disease Directors National Association of County and City Health Officials-NACCHO National Recreation and Park Association YMCA of the USA Translation and Dissemination –National Association of County and City Health Officials –Society for Public Health Education

66. Creating a National Movement

67. CHART – Community Health Assessment Response Team La Mirada: City Parks & Recreation, LA County Public Health, Nonprofit, Community Hospital, Community Action CHANGE – Community Health Assessment aNd Group Evaluation Community, Worksite, School, Healthcare, and Community Organization/Institution CAP – Community Action Plan 3 Year plan to implement PSE change

68. Partnerships

69. Orange County Nutrition and Physical Activity Collaborative, NuPAC 10 Years Leadership roles, Chair, Chair of the Policy Committee, Leadership Team Multiple Events, Trainings List Serve – 250, Active Membership 75 Orange County Obesity Prevention Plan

70. Kid Healthy, Steps to Healthy Living Campaign 6 years Public Awareness Campaign – 7 Counties, direct intervention for 100,000 children 2009 Partners- ABC7, Kaiser Permanente, Power Play (CAPOC), CVS, Sav-On Power Play in OC provided over 100,000 nutrition education and physical activity lessons

71. Network for a Healthy California (Nutrition Network- 5 a Day) 9 years Represented OC in state meetings of regional collaboratives 6 years contract -Power Play, Latino campaign, California Assoc. of Food banks State and County Public Health Nutrition and Physical Activity Education and Health Promotion

72. Community Building Initiative 5 years Community Leadership Development Low Income Community driven Policy, Systems, Environmental Change 6 Communities Playground equipment, 25 streetlights, community input in street widening and development process, etc.

73. More Partnerships California Convergence Santa Ana Building Healthy Communities

74. Existing Movements Prevention – Gang, Drug and Alcohol, Teen Pregnancy, Tobacco, Violence Environment – Bike/Transportation, Slow Growth, Parks, Organic, Energy, Green Physical Activity – Sports, Professional & Recreational, PE, Parks, Recreation Food – Grocery Stores, Health food Industry, Agriculture, Food Industry

75. Planning Departments Transportation Agencies Public Works Traffic Engineers Planning Commissions Developers Smart Growth Environmentalists Farmers, Agriculture Public Health Department (Chronic Disease, Injury Prevention) Schools (PE Dept./Teachers, Food Service) Restaurants Grocery Stores Employers, Businesses Healthcare

76. What are your next steps?