SummaryThe Healthy Eating Active Living Cities Campaign supports cities in their efforts to improve the physical environment and give residents more opportunities to be physically active and eat healthful foods. The program builds awareness among city officials about the role of the physical environment in promoting healthy habits, and provides them with an array of practical support in passing policies and resolutions to make it easier for residents to engage in healthy behaviors. The program has encouraged many cities to pass such policies and resolutions, including 128 that have adopted obesity prevention resolutions and policies related to land use, access to healthy food, and/or employee wellness. Program leaders plan to conduct a more formal evaluation of the program’s impact on the prevalence of obesity.
See the Resources section for a new program Web site and new publications; the Results section for updated numbers of participating cities, resolutions, and policies; and the Use by Other Organizations section for information about expansion to other states (updated July 2012).Suggestive: The evidence consists of post-implementation data on the number of cities that have adopted policies and resolutions to support behavior change among residents or recognizing the overweight and obesity epidemic.
Developing OrganizationsCalifornia Center for Public Health Advocacy; League of California Cities
Also involved in development of the program was the Cities Counties and Schools Partnership, which is a joint effort of the League of California Cities, the California State Association of Counties, and the California School Boards Association.
Date First Implemented2008
Vulnerable Populations > Urban populations
Problem AddressedDespite the attention they have received, overweight and obesity rates continue to rise in many states. Being overweight or obese often leads to chronic illness, poor quality of life, and high health care costs. Regular physical activity and healthy eating can reduce these risks, but the physical environment in many cities does not make it easy for residents to adopt these behaviors.
- A growing epidemic: In 2007 and 2008, 33.8 percent of adults were obese, up from 30.5 percent 8 years earlier. In 2010, 63.8 percent of American adults were overweight or obese, and rates in California were only slightly lower (61.6 percent).1,2 Rates of overweight and obese children have also risen; for example, the proportion of overweight California children in grades 5, 7, and 9 increased from 26.5 percent in 2001 to 28.1 percent in 2004.3
- Increased risk of illness, poor quality of life, and high health care costs: Obesity increases the risk of many costly health conditions that lower quality of life, including heart disease, diabetes, cancer, sleep apnea, and osteoarthritis. The average annual medical costs of obese individuals are more than $1,400 higher than those individuals with normal body weight; nationwide, these extra expenses add up to $147 billion in obesity-related costs each year.4 In California alone, overweight, obesity, and physical inactivity accounted for $41 billion in extra health care costs and lost productivity in 2006, nearly twice the level in 2000.5
- Failure of communities to encourage healthy behaviors: Overweight and obesity can be prevented and treated through healthy eating and regular physical activity, but the physical environment in many communities makes engaging in such behaviors difficult. Many neighborhoods lack grocery stores that sell healthful foods or safe places to get exercise. Instead, they have convenience stores and fast-food restaurants that offer high-fat, high-calorie foods (which tend to be less expensive than healthier choices), and often have lots of traffic, high crime, and few if any sidewalks, walking trails, or parks.6 As a result, residents are more likely to be obese and/or have chronic diseases. For example, Californians who live in areas where fast-food restaurants and convenience stores far outnumber grocery stories and produce vendors are more likely to become obese or have diabetes than those living in communities with healthier retail food options.7
Description of the Innovative ActivityThe Healthy Eating Active Living (HEAL) Cities Campaign supports cities in their efforts to improve the physical environment and give residents more opportunities to be physically active and eat healthful foods. The program prioritizes cities with high childhood obesity rates but is available to all of California’s 485 municipalities. The program builds awareness among city officials about the role of the physical environment in promoting such behaviors and provides them with practical support in adopting policies and resolutions to make it easier for residents to engage in these healthy habits. Key program elements include the following:
- Awareness-building activities: Several HEAL activities promote awareness among city officials of the role of the physical environment in helping residents adopt more healthful behaviors, including the following:
- Workshops and training: Over a 2-year period, HEAL staff conducted 27 training sessions to raise awareness of the obesity epidemic and the role of cities in addressing it. Most sessions have been held at League of California Cities events, which include special programs for new mayors and council members, a planner’s institute, and an annual conference that attracts leaders from the state’s 450 cities. Other sessions have been offered as online webinars or standalone events. In all cases, HEAL staff partner with city officials who demonstrate support for the program and participate as speakers. To date, representatives from nearly 275 cities have attended training sessions, which are ongoing. HEAL staff regularly check in with attendees to gauge their progress and offer additional support.
- Educational materials: HEAL staff have published two articles on what cities can do to address the obesity epidemic for Western City magazine (a publication of the League of California Cities). The League's electronic newsletter and its many e-mail lists convey information about educational opportunities.
- Face-to-face meetings with city officials: HEAL staff meet in person with local officials throughout the state to introduce the program and open a dialogue about each city’s needs and goals related to increasing quality of life for residents. So far, program staff have visited 120 California cities.
- Practical support for passing, implementing new policies: HEAL offers a variety of practical tools to assist city officials in adopting and implementing policies and resolutions designed to make it easier for residents to engage in healthier behaviors. These include a toolkit, online resources, and technical assistance. More details on each are provided below:
- Toolkit: Available both online and in print, this kit includes a readiness assessment, fact sheets, and sample resolutions and policies to support residents in making healthier choices.
- Readiness assessment: This three-question assessment determines what stage cities are in with respect to adopting new policies [i.e., whether they are still gathering information, ready to adopt a resolution that recognizes the importance of reversing the obesity trend, or prepared to adopt specific policies to create a healthier environment (such as zoning ordinances or business incentives)].
- Fact sheets: A general fact sheet gives background on the obesity epidemic nationally and in California, while three others summarize how city policies can support residents in making healthy choices. Based on research from the California Center for Public Health Advocacy, these policy-related fact sheets cover three areas: land use, access to healthy foods, and employee wellness programs.
- Sample resolution and policies: Recognizing that cities must decide for themselves what might work in their communities, these sample policies provide boilerplate language that can be tailored to fit a particular city’s needs. The policies offer a menu of policy options in the same areas covered by the fact sheets:
- Land use: Sample policies cover support for walking and biking in city planning, equitable mixed-use and transit-oriented development, use of school property to promote physical activity, and use of vacant land to promote healthy eating. Examples include authorizing the creation of community gardens or new parks, increasing the number of locations available for farmers’ markets, requiring wider sidewalks, and improving street crossings to make the city more walkable.
- Access to healthy food: Sample policies include targeting economic development, redevelopment, and planning resources to attract grocery stores; using zoning to protect and support farmers' markets and community gardens; limiting the number of fast-food restaurants near schools and playgrounds; and encouraging local restaurants to provide information on the calorie and fat content of menu items or to remove trans fats from recipes.
- Employee wellness: Sample policies make it easier for city employees to get exercise or make other healthy choices. Options include letting workers take regular 10-minute exercise breaks, increasing the number of healthy options on cafeteria menus and in vending machines, and encouraging employees to take the stairs instead of the elevator.
- Other online resources: In addition to the toolkit, the program Web site includes an interactive map that lets users click on HEAL cities to view resolutions or policies that have been adopted. In addition, monthly e-mail newsletters outline new developments, offer links to policies adopted by California cities, and describe grant opportunities to help cities reach their goals.
- Technical assistance: After officials express interest in making changes, HEAL staff work with them to craft resolutions or policies that meet the city’s needs and goals. This technical assistance includes help with the following:
- Identifying a local “champion”: Through training sessions and meetings, a local official generally emerges as a champion who can lead the effort and serve as the local liaison with HEAL staff.
- Selecting two or three key goals: HEAL staff encourage local officials to focus on two or three achievable policy goals. Difficult economic times favor starting with resolutions that involve little or no cost, but nevertheless establish priorities and direction. For example, HEAL staff might work with cities to adopt a resolution urging city planners and parks personnel to “prioritize capital improvement projects to increase opportunities for physical activity in existing areas” or “expand community access to indoor and outdoor public facilities.” They might also work with city officials to map existing fast-food outlets, and then set limits on the issuance of future permits for such outlets in areas near schools or that already have many such establishments.
- Attending local city council meetings: HEAL staff attend local city council meetings to help present proposed resolutions or policies, answer questions, and refine proposed language to make it acceptable to the city council.
- Following up by e-mail and telephone: After a resolution passes, HEAL staff continue to support cities with its implementation and in developing new policies. These consultations generally take place by e-mail or telephone, although inperson meetings can be held as necessary.
References/Related Articles(added July 2012) More information is available at the HEAL Cities Web site: http://www.healnation.com.
(added July 2012) Kasperzak M. Act now to create a healthier community. Western City. April 2012. Available at: http://www.westerncity.com/Western-City/April-2012/Act-Now-to-Create-a-Healthier-Community/.
(added July 2012) Dickson C. HEAL Cities Campaign supports healthy communities. April 2012. Available at: http://www.westerncity.com/Western-City/April-2012/HEAL-Cities-Campaign-Supports-Healthy-Communities/.
Wright F. The HEAL Cities Campaign focuses on improving residents’ and employees’ health. Western Cities. February 2010. Available at: http://www.westerncity.com/Western-City/February-2010/The-HEAL-Cities-Campaign-Focuses-on-Improving-Residents-rsquo-and-Employees-rsquo-Health.
Dickson C. Lower your costs by adopting an employee wellness policy. Western Cities. April 2010. Available at: http://www.westerncity.com/Western-City/April-2010/Lower-Your-Costs-by-Adopting-an-Employee-Wellness-Policy.
Contact the InnovatorCharlotte Dickson, MSW
Director, HEAL Cities Campaign
California Center for Public Health Advocacy
2201 Broadway, Suite 502
Oakland, CA 94612
Phone: (510) 302-3387
Local Policy Specialist, HEAL Cities Campaign
California Center for Public Health Advocacy
1947 Galileo Court, Suite 101
Davis, CA 95617
Phone: (530) 297-6000 x208
Innovator DisclosuresMr. Tibet and Ms. Dickson have not indicated whether they have financial interests or business/professional affiliations relevant to the work described in this profile.
ResultsThe program has encouraged many California cities to pass policies and resolutions designed to make it easier for residents to adopt healthier behaviors, including 128 cities (as of July 2012) that passed resolutions and policies related to land use, access to healthy food, and/or employee wellness. Program leaders plan to conduct a more formal evaluation of its impact on the prevalence of obesity in the future.
Suggestive: The evidence consists of post-implementation data on the number of cities that have adopted policies and resolutions to support behavior change among residents or recognizing the overweight and obesity epidemic.
- Many resolutions recognizing epidemic: To date, 78 California cities have passed resolutions recognizing the extent of the obesity epidemic in the State and the local community, with most of these resolutions setting out a roadmap for the adoption of specific policies in the future. These resolutions collectively contain commitments to establish 250 policies in the areas of land use, access to healthy food, and employee wellness. For example, with HEAL’s support, as of July 2012 75 cities committed to adopting an “instant recess” policy for city employees, which provides 1 10-minute physical activity break per day to city employees and a break during any meeting that lasts more than an hour.
- Many new policies: As of July 2012, 30 of the 78 cities passed HEAL resolutions and 2 additional cities have adopted 40 specific policies, including nutrition standards for food and beverages served and sold in city facilities, and programs and events to increase pedestrian and bicycle connectivity between residential neighborhoods, schools, and retail centers. Staff expect that more HEAL cities will pass resolutions and adopt specific policies.
Context of the InnovationThe HEAL Cities Campaign is a partnership of the California Center for Public Health Advocacy and the League of California Cities. A nonpartisan, nonprofit organization, the California Center for Public Health Advocacy raises awareness of critical public health issues and mobilizes communities to enact policies to address those issues. The organization analyzes and disseminates public health information, and supports community advocates in promoting policy reforms. Established in 1898 as a nonpartisan advocacy organization, the League of California Cities represents all 482 California cities, promoting the autonomy of city governments and supporting them in efforts to better serve residents. The organization offers professional development opportunities, sponsors educational resources and conferences, and conducts research. The impetus for HEAL began in 2002, when the California Center for Public Health Advocacy called attention to the obesity epidemic in California through the report, Overweight and Unfit Children in California Assembly Districts. Several other reports followed, including Searching for Healthy Food (about the high concentration of fast-food restaurants and convenience stores and lack of grocery stores in many California neighborhoods) and Designed for Disease (about the correlation between the local environment and rates of obesity and diabetes). In 2004, the League of California Cities adopted a resolution encouraging members to embrace policies to promote healthier communities. A second resolution in 2006 called on the league to develop resources to help cities fulfill the 2004 resolution. The league and its affiliate, the Cities Counties and Schools Partnership, joined with the California Center for Public Health Advocacy to develop the HEAL program.
Planning and Development ProcessKey steps included the following:
- Laying groundwork: Before officially launching the program, program staff spent 18 months conducting formative research, meeting with stakeholders, developing fact sheets, and strategizing about the best ways to achieve success.
- Conducting formative research: Staff conducted a 9-month survey of 480 cities to determine what policies they had already developed related to land use, access to healthy food, and employee wellness. They also interviewed 25 stakeholders representing a cross-section of California cities to discuss the challenges they have faced and success they have achieved. This research formed the basis for the sample policies, fact sheets, and other elements of the toolkit.
- Convening advisory group: HEAL invited the 25 stakeholders to form an advisory committee to guide the effort. This group gave feedback on the sample policies, including which seemed most achievable. Committee members also reviewed the fact sheets, helped develop training programs, and provided input on Web site design and program branding (including the HEAL logo).
Resources Used and Skills Needed
- Staffing: For the first 3 years, paid program staff included 2.5 full-time equivalent (FTE) staff. Since that time, 2 FTEs have staffed the program.
- Costs: The annual program budget totals $300,000, which covers staff compensation, travel expenses, computers, and other operating costs.
Funding SourcesKaiser Permanente; Vitamin Cases Consumer Settlement Fund; Silicon Valley Community Foundation; San Francisco Community Foundation
Kaiser Permanente serves as the primary funder, with additional support from the other sources.
Tools and Other ResourcesThe HEAL Cities Campaign toolkit is available at: http://healcitiescampaign.org/toolkit.html.
Getting Started with This Innovation
- Develop strategic partnerships: As a long-established, nonpartisan group for cities, the League of California Cities brought credibility to the effort, with city officials being more willing to listen due to its involvement.
- Meet in person when possible: Although technology makes it easy to communicate over long distances, face-to-face sessions often prove more effective, particularly during the initial “getting-to-know-you” phase. Followup can be done by e-mail or telephone.
- Recognize uniqueness of each city: A one-size-fits-all solution will not work. City officials will be more willing to participate if they have time to explore the problem and remain free to adapt resolutions and policies to meet their city’s unique needs and strengths.
- Point to tobacco control effort as model: Local policies laid the framework for effective statewide programs and goals related to curbing tobacco use. Pointing to the success of this initiative can provide credibility and a precedent for the effort to curtail obesity.
- Align recommendations with credible sources: HEAL aligned its recommendations with those of well-known, well-respected organizations, including the Institute of Medicine, the Centers for Disease Control, the American Academy of Pediatrics, and the Robert Wood Johnson Foundation. This step made prospective participants more likely to support program goals.
- Adjust expectations to current climate: Program organizers originally expected that cities would adopt policies rather easily, based on the support shown by the 2004 and 2006 league resolutions. In a challenging economic climate, however, this expectation proved to be unrealistic. City officials suggested a two-step approach: First, cities would adopt resolutions underscoring the important role of cities in stemming the obesity epidemic and commit to pursue specific policy goals (rather than policies themselves) in the three key policy areas highlighted earlier. Next, HEAL staff would work with the cities to implement the policy goals.
- Focus on no- and low-cost policies: As recommended by its advisory committee, HEAL staff focused on ways to incorporate healthy choices through policies that did not require significant funds for program development. These policies can lay the groundwork for future projects, even in cities that presently lack funds for extensive new initiatives.
- Identify a champion in each city: A point person who believes in the project’s goals can help significantly in getting policy language adopted.
Sustaining This Innovation
- Build on success of initial cities: Program staff should help cities publicize their success and spread the word to others. For example, after hearing about HEAL’s initial accomplishments, representatives in other communities approached the organization seeking assistance in defining policy goals related to obesity prevention. Effective language used in early adopting cities can be replicated in other cities as well.
- Be willing and able to wear different hats: Depending on each city’s needs, staff may have to play the role of educator, facilitator, communicator, and/or catalyst.
- If possible, evaluate program impact on obesity rates: With funding from the California Endowment, the California Center for Public Health Advocacy plans to analyze data from 100 cities that have adopted policies to determine their impact on obesity rates. The cities will start collecting data in late 2011.
Use By Other OrganizationsInformation provided in July 2012 indicates that, based upon the success of the California HEAL Cities Campaign, Kaiser Permanente Community Benefit is supporting the expansion of the program into the states of Oregon, Maryland, Virginia, and Colorado.
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Service Delivery Innovation Profile
Original publication: July 06, 2011.
Original publication indicates the date the profile was first posted to the Innovations Exchange.
Last updated: May 15, 2013.
Last updated indicates the date the most recent changes to the profile were posted to the Innovations Exchange.
Date verified by innovator: July 20, 2012.
Date verified by innovator indicates the most recent date the innovator provided feedback during the annual review process. The innovator is invited to review, update, and verify the profile annually.