Healthy Reform, Healthy Cities: Using Law and Policy to Reduce Obesity Rates in Underserved Communities

Article excerpt

 I.  The Obesity Epidemic and Social Determinants of Health
       A. Rising Obesity Rates
       B. How the Social Determinants of Health Drive Obesity
 II. Using Law and Policy to End the Obesity Epidemic
       A. The Power to Regulate Public Health
       B. How the Affordable Care Act Supports Community-Based
          Obesity Prevention Strategies
          1. The Affordable Care Act Establishes a National
             Prevention Strategy .
          2. The Affordable Care Act Creates a Prevention and
             Public Health Fund
          3. The Affordable Care Act Strengthens the
             Community Benefit Requirements for Nonprofit
       C. State and Local Policy to Address Obesity .
          1. Addressing Disparities Through Obesity
             Prevention Policy
III. A Policy Framework for Addressing Disparities in Obesity
     A. Evidence for Policymaking
     B. The Framework .
        1. General or Universal Policies
        2. Policies Based on Demographic Groups
           a. Policymaking Based on Race or Ethnicity .
           b. Policymaking Based on Income
        3. Policies Based on Health Indicators or Unhealthy
           Products and Practices
           a. Policies Based on Health Indicators
           b. Policies Targeted at Practices and Products that
              Cause Negative Health Conditions
        4. Policymaking Based on Neighborhood
           a. Policies that Encourage Integration
     C. Unintended Consequences


South Los Angeles is a low-income African-American and Latino neighborhood with disproportionately high obesity rates--35% of the adult population is obese, compared to 22% in Los Angeles County as a whole. (1) South Los Angeles was once a thriving middle class African-American neighborhood, but it became impoverished when, as in many cities, jobs and higher-income residents left the urban core. (2) Fast food restaurants were abundant, yet residents had no access to a grocery store. (3) In 2008, residents decided to change that by pushing the Los Angeles city council to place a moratorium on new fast food restaurants in the neighborhood, while also offering a package of incentives to attract a new grocery store. (4) The incentive package successfully attracted at least four grocery store developments to the neighborhood. (5) The targeted strategy was considered controversial by some because it focused on an African American and Latino neighborhood and was perceived by outsiders as paternalistic. (6) But what many didn't realize is that neighborhood groups supported the fast food restrictions. (7)

The South Los Angeles example illustrates the challenges urban communities across the United States face. Obesity is one of many chronic conditions that people of color experience disproportionately, putting them at greater risk for many serious preventable diseases such as diabetes, heart disease and cancer. (8) In this Article, we focus on the national obesity epidemic and discuss ways to use policy interventions, such as those that improved access to healthy food in South Los Angeles, to reduce disparities experienced by underserved communities and specific racial and ethnic groups.

We start with an overview of the obesity epidemic and its underlying causes--the social determinants of health. Next, we review the role of government in ending the obesity epidemic, including a discussion of Affordable Care Act (ACA) provisions that support population-level interventions to address the epidemic. Enterprising local and state governments have been leading the way on obesity prevention for a decade. A number of provisions within the ACA, however, provide an unprecedented opportunity to "scale up" obesity prevention activities. The ACA specifically calls on policymakers in states and localities to identify strategies to reduce obesity rates among populations bearing the brunt of the epidemic, namely people of color and low-income people. …