Community-Wide Obesity Prevention: Re-Connecting Public Health, Urban Planning, and Public Policy in Three Missouri Communities

Article excerpt

Trailnet's Healthy, Active & Vibrant Communities Initiative (HAVC) is a model that has demonstrated significant early successes at creating environments, policies, and social networks that support and promote healthy eating and active lifestyles. The HAVC Initiative uses community engagement and community development principles to build communities' capacity to implement evidence-based and promising strategies in three diverse community settings in the St. Louis region. Trailnet works with each community to develop and institutionalize a multi-disciplinary taskforce of local leaders that coordinates and champions efforts. Taskforce members are involved at all stages, including conducting community readiness and community needs assessments that guide efforts. HAVC activities are tailored to complement the unique assets, needs, and interests of each community. Early successes and a third-party evaluation, sponsored by the Centers for Disease Control and Prevention (CDC) and Robert Wood Johnson Foundation (RWJF) have identified the HAVC Initiative as an "emerging intervention." This paper presents the underlying theory, process, and key lessons-learned from the HAVC Initiative.

Keywords: obesity prevention: public health; public policy; built environment; social networks

Introduction

The obesity epidemic is different from many other health epidemics America has experienced. Infectious diseases, such as polio or influenza, are caused by pathogens and grow to epidemic proportions because the pathogens are easily transmittable from person-to-person. Obesity, however, is wholly different it is not contagious. Rather, obesity is an individual-level physical trait caused by two primary behaviors: (1) consuming too many calories--often calorie-dense, nutrient-sparse foods; and (2) not getting adequate physical activity. Nevertheless, the individual-level trait of obesity has spread across the US and globally, with obesity rates rising in all community types along the rural-to-urban transect and among all age groups, socioeconomic groups, and races (Committee on Prevention of Obesity in Children and Youth, 2004). Based on 2007 US data, adult obesity rates have grown from 15% in 1980 to 34.3% in 2006 an estimated 72 million Americans are obese (Ogden, Carroll, McDowell, & Flegal, 2007).

Increasingly, obesity is seen as the result of "obesogenic" environments that promote unhealthy eating and physical inactivity and are common in developed countries. Swinburn and Egger (2002) note that obesogenic environments are "broader than just the physical environment and include costs, laws, policies, social and cultural attitudes, and values". Contributing factors persist at all levels of the social-ecological model including: auto-centric infrastructure: community design; regional urban sprawl; a national food system that relies heavily on calorie-dense unhealthy foods and drinks; social norms and trends that have shifted towards unhealthy behaviors; decreasing cultural knowledge regarding healthy options: and limited access to preventive healthcare (Brownson, Boehmer, & Luke, 2005). It is now widely accepted that obesity has reached epidemic proportions because unhealthy choices have become more convenient, more prevalent, socially acceptable, and less expensive than healthy choices (Christakis & Fowler, 2007: Yach, Leeder, Bell, & Kistnasamy, 2005).

As the knowledge about obesity prevention develops, suggested strategies have shifted from individual-level behavior change interventions to multilevel interventions based oi1 ecological models, including multiple components and crossing disciplines (Sallis et al., 2006) (Brownson & Jones, 2009: Satterfield et al., 2009). In particular, there has been a growing focus on community-scale interventions, which combine multiple strategies from the growing evidence-base (Centers for Disease Control and Prevention, 200%; Centers for Disease Control and Prevention, 2009b: Khan et al. …