Columbus Public Health (CPH), one of the first nationally accredited public health departments in Ohio, is the local public health agency for the City of Columbus, which has a population of 822,553 (2013 US Census). Established in 1904, the department employs 400 full- and part-time employees that are charged with protecting the health and improving the lives of city residents. The department does this through distinct programs, which provide a wide range of services including clinical, community health and environmental health programs, as well as community assessment and surveillance. CPH monitors the health status and behavioral risk factors of Columbus residents and uses this information to identify critical community health needs and guide departmental decisions with regard to addressing those needs.
CPH's Growing Healthy Kids Columbus (GHKC) coalition brings together over 40 organizations and that serve pregnant women and children from birth to kindergarten entry in the city of Columbus to address the public health issue of childhood obesity. Obesity affects children of all ages, including 12.4% of 2- to 5-year olds in Ohio.(1) In the city of Columbus, 32% of preschoolers and 28% of kindergarteners were overweight or obese during the 2013-14 school year. Early childhood obesity is especially concerning because obese children are more likely to become obese adults and develop obesity-related diseases such as diabetes, metabolic syndrome and cardiovascular disease.(2)
The GHKC obesity prevention coalition implements evidenced-based strategies to impact the city's youngest age group birth to five years old. The GHKC coalition was first convened in April 2009 to help develop and carry out the City of Columbus Early Childhood Obesity Prevention Plan (ECOPP). Through resources, policies, and education, this plan was intended to: 1) increase the initiation and duration of breastfeeding for infants 2) increase access to healthy foods for pregnant women and children birth to kindergarten entry 3) increase opportunities for daily activity for pregnant women and children birth to kindergarten 4) increase screening and referral to promote awareness and action in the community
This coalition evolved around the ECOPP and continues to use the social ecological model as a framework for implementing multi-level strategies that target policy, system and environmental changes (PSEC), as well as individual behaviors. Monthly meetings are held to share information, to plan and report on PSEC activities, and provide professional development related to both content and PSEC implementation. Efforts to implement PSEC have included the development of the Water First for Thirst†campaign in 2013, An Hour a Day to Play†campaign in 2014, and the current 2015-2016 Healthy Gatherings†campaign. The coalition has developed materials, online resources, toolkits, sample policies, and technical assistance plans to support these campaigns. The coalition's focus on PSECs has resulted in increased awareness of and self-efficacy for implementing PSEC strategies and substantial implementation of policy and practice changes—both small and wide-ranging—among member organizations.
After the first year of implementing the ECOPP, GHKC coalition quickly realized that they could meet broader goals; therefore additional objectives were added. It also created a steering committee which holds annual strategic planning sessions to set specific objectives for the upcoming year based on best practices and current literature. Consistent messaging, collective impact and continued education on PSEC have led to the successes of the GHKC coalition.
Year-end assessments from 2015 indicated that 16 new policies around nutrition, physical activity, reduced screen time and breastfeeding have been adopted by partner organizations. In addition, 315 policies were implemented by early care and education settings through technical assistance provided by coalition member organizations. Examples of PSECs related to coalition participation include: food pantry re-organization of product displays to encourage produce and other healthy selections; family-style meals implemented at YMCA; YMCA of Central Ohio childcare adapting 9 policies (reaching 437 children); and system change facilitated by a regional foodbank resulting in 11,650 pounds of fresh produce being distributed to families, serving an estimated 362 children.
These success indicators measure the current goals and objectives of the GHKC coalition by December 31, 2016:
1. GHKC members will develop at least 12 new resources to support obesity prevention education and practices
2. GHKC members will implement at least 3 consistent messaging activities
3. At least 75% of GHKC members will report learning/gaining new ideas based on workshops and presentations given at the meetings
4. GHKC members will identify 3 new and sustained Policy, system and environmental changes
5. GHKC members will identify 3 significant successes related to PSECs and consistent messaging related to GHKC efforts
GHKC Coalition website link: https://www.columbus.gov/ghkc/.
The public health issue the Growing Healthy Kids Columbus (GHKC) Coalition seeks to address is childhood obesity. Obesity is a major public health problem and is the second leading cause of preventable death in the United States. In the past 30 years, obesity has more than doubled in children and quadrupled in adolescents, and in 2012, over a third of these groups were overweight or obese. In 2011-2012, 35% of adults and 17% of children were obese.(3) Obesity affects children of all ages, including 12.4% of 2- to 5-year olds in Ohio.(1) In the city of Columbus, 32% of preschoolers and 28% of kindergarteners were overweight or obese during the 2013-14 school year. Early childhood obesity is especially concerning because obese children are more likely to become obese adults and develop obesity-related diseases such as diabetes, metabolic syndrome and cardiovascular disease.(2) Children who are obese also experience social, emotional, and sleep problems related to their weight. Financial costs are overwhelming, with obese adults spending 42% more on health care than normal weight adults, accounting for an annual cost of $147 billion.4 Additionally, obese adults cost their employers an estimated $73 billion per year in terms of increased absenteeism and presenteeism.(5)
Early childhood is a critical period during which children learn behaviors and establish habits that either prevent or promote obesity.(2) Evidence suggests that preventing childhood obesity begins at the time a woman becomes pregnant. Achieving a healthy weight gain during pregnancy, breastfeeding through the first year of life and establishing healthy eating and physical activity habits early in life are all essential to obesity prevention.
GHKC coalition brings together organizations that serve pregnant women and children from birth to kindergarten entry in the city of Columbus. CPH reaches 100% of the 45 participating GHKC organizations and programs through education, professional development, networking and technical assistance to support policy, system, and environmental changes (PSEC) and health promotion educational efforts. These 45 organizations and programs, in turn, are reaching pregnant women, children and their families in the tens to thousands within central Ohio.
In the past, education has been the main focus but without sustainability. Education alone can change knowledge but does not change the options of which the individual has to choose, which is where PSEC comes into play, and its impact often does not extend beyond the individual. Utilizing The Community Guide's Community Toolbox: Developing Strategic and Action Plans, GHKC coalition has made PSEC promotion and implementation its primary focus.
The utilization of The Community Toolbox: Developing Strategic and Action Plans is what formed the structure of GHKC coalition and is a leading contributing factor to the coalition's strength and successes. This section of The Community Toolbox outlines the key steps needed to develop strategic and action plans, including development of a vision, mission, objectives, strategies and action plan for the initiative.(6) GHKC coalition's vision is that Columbus is a community in which all children have daily opportunities for active play and access to nutritious foods that lead to children entering kindergarten ready to live, learn and play at their best. The GHKC steering committee guides the coalition's work and includes high level stakeholders from public health department, university, public school district, Head Start sponsor, children's' hospital, non-profit meal program organization, and youth recreation program. An annual steering committee meeting is held to develop the action plan and outline SMART objectives for the upcoming year based on community needs identified by its members. Additional quarterly meetings are held to review the progress of the action plan, identify education and resources needed for the coalition members, outline upcoming agenda items for the monthly coalition meetings, select individuals to carry out specific tasks, and determine potential partners missing from the table.
GHKC coalition's primary focus is PSEC promotion and implementation through collective impact. Grounded in the Health Impact Pyramid(7), PSEC involves examining the policies, systems and environments that impact individual behavior and modifying them as necessary to make healthy choices the easy choices for individuals and communities.(8) In short, PSEC is a way of modifying the environment to make healthy choices feasible and available to community members. It is based on the idea that people cannot make healthy decisions unless presented with realistic, healthful options from which to choose. The National Academies of Science, Engineering and Medicine points out that simultaneous implementation of environmental changes in numerous settings (schools, food venues, recreation, health care, and marketing) would reinforce, amplify and maximize progress in obesity prevention.(9)
Cross-sector community coalitions play an important role in population-level strategies to promote health and wellbeing. Coalitions often use PSEC strategies to improve the health of individuals and communities.(10) In the past two decades, many communities across the nation have formed coalitions to advance PSEC efforts with support from the Centers for Disease Control and Prevention (CDC) and large organizations such as the Robert Wood Johnson Foundation, Nemours, the W.K. Kellogg Foundation, and the California Endowment.(8) Whereas many coalitions implement some PSECs, few make this their primary focus.
There is growing interest in the determinants of food and beverage selection, the role of food and beverage environments, and ways to guide consumers to make healthier choices. According to the social-ecological model of health behavior, various factors influence choices across multiple domains: the individual level (demographic, knowledge, ability, preferences, etc.), social level (family, friends, peers, co-workers, etc.), organization level (schools, stores, faith-based and nonprofit organizations; places where people get food/beverages), and policy level (laws, regulations, organizational guidelines, etc.). Diet-related policy and environment interventions can reach larger numbers of people on a more cost-effective basis than individual behavior change strategies. Environment changes may also have more widespread and lasting effects because they are assimilated into policies, systems, and cultural norms.(11)
Coalitions accomplish PSEC by mobilizing communities and engaging a wide variety of people in issues that affect health.(12) Community mobilization efforts occur at multiple levels and in multiple sectors of the community involving individuals, families, organizations, businesses, and institutions with an interest in the wellbeing of the community.â€(13)
The GHKC coalition's approach of making PSEC the coalition's primary focus is a new and innovative approach using evidence-based strategies. The consistent promotion, professional development, networking, and resource sharing at each meeting have resulted in collective impact. Each GHKC campaign involves consistent messaging and changes to environments, policies and practices designed to increase access to breastfeeding, healthy eating and physical activity opportunities for pregnant women and children 0-5 years across the community, and provide in-depth descriptions of selected PSEC successes.
Nutrition, Physical Activity, and Obesity
Columbus Public Health's (CPH) Growing Healthy Kids Columbus (GHKC) coalition is an evidenced-based childhood obesity prevention coalition designed to impact the youngest age group – birth to five years old. GHKC Coalition is comprised of representatives from 45 community, faith-based, service, industry, early childhood education and healthcare organizations or programs that serve pregnant women and young children and is co-chaired by CPH and The Ohio State University (OSU) Extension. GHKC Coalition was first convened in April 2009 to help develop the City of Columbus Early Childhood Obesity Prevention Plan (ECOPP). Through resources, policies, and education, this plan was intended to: 1) increase the initiation and duration of breastfeeding for infants 2) increase access to healthy foods for pregnant women and children birth to kindergarten entry 3) increase opportunities for daily activity for pregnant women and children birth to kindergarten 4) increase screening and referral to promote awareness and action in the community.
The Early Childhood Obesity Prevention Plan (ECOPP) that brought this coalition together was originally a 5-year plan and ended December 31, 2015. Although the goals of the plan were met early on, the coalition continued to move forward in a collaborative effort maintaining the focus on policy, system, and environmental change (PSEC) strategies that lead to significant policy and environmental changes around consistent messages.
Efforts to implement PSEC have included the development of the Water First for Thirst†campaign in 2013, An Hour a Day to Play†campaign in 2014, and the current campaign of 2015 rolling into 2016 Healthy Gatheringsâ€. The coalition has developed materials, online resources, toolkits, sample policies, and technical assistance plans to support these campaigns. The coalition's focus on PSECs has resulted in increased awareness of and self-efficacy for implementing PSEC strategies and substantial implementation of policy and practice changes—both small and wide-ranging—among member organizations.
Initially each message was intended to be on a one-year time frame; however it was learned that each campaign takes about two years to develop, educate and implement change. Even after the two years, work is continuously being done around these messages by members of the coalition and other local and state health departments as the message spreads therefore continuous tracking of results is needed and collected through documentation of monthly report outs and end of the year surveys.
These success indicators measure the current goals and objectives of the GHKC coalition by December 31, 2016:
6. GHKC members will develop at least 12 new resources to support obesity prevention education and practices
7. GHKC members will implement at least 3 consistent messaging activities (data collected in end of year survey)
8. At least 75% of GHKC members will report learning/gaining new ideas based on workshops and presentations given at the meetings (data collected in end of year survey)
9. GHKC members will identify 3 new and sustained Policy, system and environmental changes (collected through monthly report outs and end of the year surveys)
10. GHKC members will identify 3 significant successes related to PSECs and consistent messaging related to GHKC efforts (qualitative data collected in end of year survey)
Steps to achieving our objectives start with the adaptation of a key message form CPH's Healthy Children Healthy Weights (HCHW) program. HCHW has 13 evidence based key messages based on current research and recommendations from the American Academy of Pediatrics, Academy of Nutrition and Dietetics, National Academy of Medicine, National Association of Sport and Physical Education, Nutrition and Physical Activity Self-Assessment for Child Care, Caring for our Children, Child and Adult Care Food Program, American Heart Association, Dietary Guidelines for Americans, and The Child Trauma Academy. Established in 2004, the HCHW program was recognized by Center of Disease Control and the Robert Wood Johnson Foundation as being evidence based and theory sound program.
Each campaign message adapted by the GHKC coalition is selected by the steering committee and based on current momentum and need in the community. The steering committee than drafts the objectives for the campaign, education needed for the coalition and outlines the work to be completed by the members. Agendas for each coalition meeting are developed by the co-chairs and include education, current research and recommendations, and development of resources needed for implementation of PSEC indicated by the input of the steering committee and coalition members.
The GHKC coalition collaborative work is completed through monthly meetings held at CPH. At each meeting, members of the coalition share information, plan and report on PSEC activities. Presentations for professional development related to both content (dietary guideline updates, etc.) and PSEC implementation (finding and using evidence-based strategies, talking with decision-makers, etc.) are also provided. The development of resources for each campaign is completed during these monthly meetings and is based on the needs of the members. Resources are then reviewed, tested and finalized by the members and compiled into a toolkit made available online for print. Workshops on the utilization of the resources created and implementation of PSEC are held for coalition members and their organization's policy and decision makers.
For example, resources developed in 2015/2016 by GHKC Coalition for the Healthy Gatherings†campaign include:
Healthy Gatherings landing page: www.columbus.gov/healthygatherings
DIY Potluck Sign-up sheets
Potluck Fun and Games
Guidelines for Healthy Gatherings
Handout for Healthy Celebrations in the classroom
Healthy Gatherings Scorecards
Savor Before you Flavor Signage
Advocacy letter - making water the default beverage on children's menus and party menus where children play and/or celebrate
Evidence based articles on Healthy Celebrations and Snacks
Additional links for Healthy Celebrations and Snacks
Healthy Gatherings toolkit that includes a binder of resources, a Water First for Thirst pitcher, serving bowls and spoons to be used for the DIY potlucks, and educational signage to place on tables around food and beverage stations. 50 kits were purchased through City of Columbus General Fund dollars at the cost of $2,540, about $51 per kit. Toolkits will be made available to the first 50 organizations who sign-up and attend the 2017 Workshop.
Presentations given in 2016 for professional development and PSEC implementation include:
Education of HCHW key messages and supporting evidence
Healthy beverage advocacy letter
Coffee stations and policy language
St Stephens Food Pantry: Making the environment match the message
Franklin Park Conservatory events and resources
Farm to Preschool
Child and Adult Care Food Program (CACFP) final rules
2015 Dietary Guidelines
3-part educational series on artificial sweeteners – recommendations, current research, and where they are found in food
YMCA implementation of family style dining in their early care program and working with their food vendor, Himes Vending
Education on PSEC using the Community Change Game developed by OSU Extension
Trying New Foods – education on early food preferences, taste buds, and recommendations on activities and variations of introducing new foods to children
Monthly breaking news segments to keep up-to-date on current events happening in childhood obesity prevention as it relates to PSECs
Workshop evaluations from the 2014 GHKC Coalition 2-part workshop titled Environmental Change and Messaging: A Winning Combination for Healthy Behaviors indicated that Coalition members wanted messages to be broader to make them easily adaptable in making the environment match the message within their own organization and not just the pregnant women and children they serve. Therefore, to help broaden the message of our current campaign of Healthy Gatheringsâ€, GHKC coalition has recruited the help of other CPH-facilitated coalitions including the Chronic Disease Prevention Advisory Board and the Minority Health Advisory Board. Each board has reviewed the resources created and provided feedback, which has led to the addition of culturally appropriate food and activity suggestions as well as tobacco-free signage and education in making the environment smoke-free when outdoors.
To ensure cultural appropriateness, GHKC coalition is working in collaboration with CPH's minority health team who identified Hispanic/Latino and Somali communities as the largest immigrant and refugee populations in the city of Columbus. CPH strives to provide the best service to all community members. CPH provides interpretation and translation services to eliminate access to care barriers faced by Limited English Proficient community members. The top languages requested for Interpretation Services include Spanish and Somali. Population in Columbus for Hispanic/Latino is 47,000 and Somali is 45,000, a population second only to that in the greater Minneapolis area (2015 Census). Community leaders in both communities state that due to the fact that data collection in minority communities is a challenge, it is safe to add 5,000 additional community members to each community group. In order to communicate our messaging within these two communities the coalition's Program Manager and minority health team will be organizing focus groups in the Hispanic/Latino and Somali communities in January 2017 to ensure our resources and messaging of the campaign relates to their cultural needs.
As a result of this collaboration GHKC coalition will be extending the Workshop invite list to include members of the Chronic Disease Prevention Advisory Board and the Minority Health Advisory Board, in addition to the GHKC coalition members. Each Workshop invite is also extended to the decision and policy makers of the participating organizations to show buy-in from other organizations who have already implemented PSEC strategies utilizing the resources made available through the Healthy Gatherings†campaign. The Workshop agenda will include education on PSEC, tools and resources (listed above) available to implement changes, and presentations that include YMCA of Central Ohio childcare classroom implementation of a healthy celebration policy and the City of Columbus employee wellness program's, Healthy Columbus, implementation of environmental changes by providing each city building with a Healthy Gatherings toolkit to be rented out by staff.
GHKC coalition campaigns would not be possible without its sustained structured and stakeholders. GHKC coalition's current structure includes a steering committee, which meets quarterly comprised of committed members who guide the full coalition. The steering committee includes key stakeholders from public health department, a university, public school district, Head Start sponsor, children's' hospital, non-profit meal program organization, and youth recreation program. The steering committee sets goals for the coalition each year based on community need identified by its members. In addition to the steering committee, active and supporting members include non-profit, recreation, service, industry, early childhood education and healthcare organizations or programs that serve pregnant women and young children. Membership is defined as follows: active members are participating organizations or programs who have attended at least 4 meetings in a calendar year; and supporting members are participating organizations or programs that attend 3 or fewer meetings in a calendar year and/or contribute directly to the work of the coalition. Below is the list of current 2016 members:
Steering Committee
? Columbus Public Health's Healthy Children Healthy Weights (HCHW)
? Ohio State University Extension
? YMCA of Central Ohio
? United Way of Central Ohio
? Columbus City Schools
? Child Development Council of Franklin County Head Start
? Nationwide Children's Hospital
? Children's Hunger Alliance
? Ohio State University Life Sports
? Franklin County WIC
Active members
? American Heart Association
? Columbus Recreation and Parks
? Franklin County Public Health
? Franklin County Family and Children First
? Columbus Urban League Head Start
? Personal Fitness Navigators
? Church Partnerships Mount Carmel Health
? Columbus Public Health's Creating Healthy Communities
? Kroger Grocery Store
? Columbus Public Health's Strategic Nursing Team
? Columbus Public Health's Institute of Active Living
? Franklin Park Conservatory
? Ohio State University's Extension Franklin County
Supporting members
? American Academy of Pediatrics, Ohio Chapter
? Cardinal Health Foundation
? Columbus Public Health's Office of Minority Health
? Columbus Public Health's My Baby & Me
? Council on Healthy Mothers and Babies
? Mid Ohio Food Bank
? Local Matters
? St Stephen's Community House
? Molina Healthcare
? Columbus Neighborhood Health Clinic
? Debi's Day Care
? Jump Bunch
? Joyful Beginnings
? Ohio State University's Department of Human Sciences
? Ohio State University's Ohio Expanded Food and Nutrition Education Program
? Hilltop Preschool
? Community Development 4 All People
? Indianola Children's Center
? Central Community House
? A Mother's Love Play Café
? Ohio Childcare Resource and Referral Association
? Ohio Department of Health
Members of the coalition play a major role in helping to shape all of the additional features added each campaign, such as signage and its design, educational resources, and policy language. Further, members are the major communicators of the campaign and are responsible for linking campaign messages to events occurring in each of their organizations and the community they serve, helping to deepen the outreach.
CPH plays the role of Program Manager and convener. Program management involves organizing monthly meetings, gathering ideas to form resources, implementing campaign promotions and communications, organizing and generating presentations to keep coalition members up-to-date on current standards and programs, attending internal and external meetings to represent the coalition, present and extend outreach of the campaign. CPH works in collaboration with OSU extension as convener to address current childhood obesity issues, facilitate meetings and collection of ideas, liaison with external groups to promote the work of the coalition, and identify key stakeholders for the coalition and steering committee members. Most important job in both roles is listening.
GHKC coalition began in April 2009 with funding received from the Ohio Department of Health (ODH). CPH received $96,984 in funding from ODH for one year ending June 30, 2009. This funding included $57,460 for 1.0 FTE Project Manager and a 120-hour Project Assistant to implement a gardening program for local child care centers. The Project Manager was responsible for coordinating all grant activities, form a coalition to coordinate grant activities with other regional efforts, and develop the ECOPP. To maintain the coalition, a 0.5 FTE was added to CPHs general fund and has been maintained for the past 7 years. This contribution is evidence to the commitment CPH has in childhood obesity prevention. Additional funds for printing of meeting materials, i.e. sign-in sheets, agendas and handouts, are used to facilitate meetings.
Estimated yearly expenses:
Columbus Public Health staff time
Average .5 FTE (20 hours per week) $27.44/hr x 20hrs/wk x 52 wks = $28,537.60 + $7,134.40 (25% fringe) = $35,672.00
Ohio State University Extension – Co-chair
Average .025 FTE (4 – 5 hours per month) = $5183.00 In-Kind
Printing Expenses
Sign-in sheets ($0.30 per 44 color 8.5 x 11 documents) = $13.20
Agendas ($0.30 per 25 color 8.5 x 11 documents x 11 meetings per year) = $82.50
Handouts – average 2 sheets per meeting ($0.15 per 50 black and white 8.5 x 11 documents x 11 meetings per year) = $82.50
Total Yearly Expenses = $41,033.20
Growing Healthy Kids Columbus (GHKC) coalition promotes the adoption of policy, system and environmental changes (PSEC) through professional development, networking, and resource sharing. GHKC campaigns involve consistent messaging and changes to environments, policies and practices designed to increase access to breastfeeding, healthy eating and physical activity opportunities for children 0-5 years across the community, and provide in-depth descriptions of selected PSEC successes.
These success indicators measure the current goals and objectives of the GHKC coalition by December 31, 2016:
1. GHKC members will develop at least 12 new resources to support obesity prevention education and practices
2. GHKC members will implement at least 3 consistent messaging activities (data collected in end of year survey)
3. At least 75% of GHKC members will report learning/gaining new ideas based on workshops and presentations given at the meetings (data collected in end of year survey)
4. GHKC members will identify 3 new and sustained Policy, system and environmental changes (collected through monthly report outs and end of the year surveys)
5. GHKC members will identify 3 significant successes related to PSECs and consistent messaging related to GHKC efforts (qualitative data collected in end of year survey)
To promote progress towards the objectives, each monthly coalition meeting includes:
PSEC progress report-outs
Professional development related to nutrition and physical activity, including current research, updated rules and regulations, and current events
Professional development related to PSEC implementation
In-depth descriptions of successful policy and practice changes
Numerous methods are used to collect data about coalition member knowledge, needs, initiatives, and progress related to PSEC implementation:
Survey research (beverage practices and policies, client experience, and administrator satisfaction.)
Monthly report-out summaries
End-of-year inventories of practice and policy changes
Resource development inventories
Learning activity evaluations
Other (documentation of facilitated discussions, etc.)
Each campaign consists of a PSEC Professional Development Workshop with the intention to increase knowledge and implementation of PSECs. Upon completion of the 2014 GHKC 2-part workshop titled Environmental Change and Messaging: A Winning Combination for Healthy Behaviors, 89% of 20 attended participants, reported enhanced knowledge of PSEC. On implementing nutrition policy changes, 25% said they would start in the next 3 months and 41.7% in the next year. Further evaluations from PSEC implementation trainings and on-going education indicated that collaboration around one common goal or key message laid foundations for larger changes and policies to be established. Due to staff turnover, additional follow up to track implementation was not gathered.
Year-end assessments from 2015 indicated that 16 new policies around nutrition, physical activity, reduced screen time and breastfeeding have been adopted by partner organizations. In addition, 315 policies were implemented by early care and education settings through technical assistance provided by coalition member organizations. Examples of PSECs related to coalition participation include: food pantry re-organization of product displays to encourage produce and other healthy selections; family-style meals implemented at YMCA; YMCA of Central Ohio childcare adapting 9 policies (reaching 437 children); and system change facilitated by a regional foodbank resulting in 11,650 pounds of fresh produce being distributed to families, serving an estimated 362 children.
2016 year-end assessments will be collected during the month of December and January. A few key successes as it relates to PSECs gathered from monthly report outs in 2016 include a water only policy at any Columbus City School pre-k event, YMCA's update to their food bid contract for child care and afterschool programming that will maximize produce variety, reduce sugar in cereals, reduce fried food options to no more than once a week, and eliminate highly process meats, and the City of Columbus employee wellness program, Healthy Columbus, implementation of environmental changes by providing each city building with a Healthy Gatherings toolkit to be rented out by staff.
GHKC local efforts have been utilized statewide through the Ohio Department of Health's (ODH) Creating Healthy Communities Program grant and the Maternal and Child Health Program grant. These grants fund other local health departments to implement Water First for Thirst messaging and Ohio Healthy Programs. This year, ODH released their Healthy Meeting Guidelines and utilized resources developed from the GHKC coalition, including the Healthy Gatherings†scorecards and Do-it-yourself (DIY) Taco Bar sign-up sheet. Most recently, the Center of Disease Control (CDC) requested the use of the DIY potluck sign-ups as a resource to use and share.
Overall, these data demonstrate that community health organizations benefit from on-going professional development related to PSECs, and that a coalition focus on PSEC strategies can lead to significant policy and environment changes around consistent messages.
Growing Healthy Kids (GHKC) coalition has learned the value of its' members ability to come together in a collaborative effort to create policy, system, and environmental changes (PSEC). Members' input is valued and executed in the development of each campaign, tools and resources, and educational pieces given at each coalition meeting. Constant evaluation and record keeping is needed to track all outcomes and successes. Presentations on current events, rules and regulations keep members updated on best practices and informed on the environment around nutrition and physical activity.
One major lesson learned is that implementation of a campaign can take longer than expected. While meeting objectives, each campaign has taken longer than a year for the development process and additional time is needed for implementation and education of resources. Since the process is a collaborative effort, many of the elements suggested by stakeholders, internal and external groups, make it difficult to coordinate when implementation will take place. Additionally, each GHCK coalition member has their own views of educational needs and resources and they are not always the same. Listening to the needs and wants of the Chronic Disease Prevention Advisory Board and the Minority Health Advisory Board proposed additions to the Healthy Gatherings†campaign, such as resources for older audiences, tobacco cessation, additional languages, and use of culturally appropriate foods.
GHKC coalition recognizes the strength of utilizing a multi-level strategy. The social ecological model recognizes that individuals are embedded within multiple, larger social systems (14) and therefore effective health interventions should also operate at multiple levels.(15) Many funders now require that grantees implement multi-level strategies(16), which include not only those that address the individual level, but policy, systems, and environmental changes (PSEC). PSEC strategies are endorsed as being more sustainable and impactful than individual behavior change efforts.(17; 8; 18) Despite this emphasis, a recent review found a high prevalence on individual-focused and single-level interventions(19), indicating that there may be a need for professional development on this topic.(13)
GHKC coalition is stronger together because of the collaborative work. The assumption behind any collaborative effort is that the collaboration will achieve goals in a more efficient, effective, and sustainable way than any one individual or organization could accomplish on its own. Advantages of the collaborations created by the coalition include: (20)
More effective and efficient delivery of programs
Elimination of duplication and reduced competition
Improved communication and trust building
Improved public image and increased credibility
Improved needs assessment
Consistency of information
More opportunities for professional development
Increased availability of resources
Improved outreach to stakeholders
Increased support from stakeholders
CPH is dedicated in sustaining the GHKC coalition through continued funding of a Program Manager to continue organization and facilitation of the coalition. The Program Manger ensures the success of the coalition by following the elements of a successful coalition: (20)
A common goal
A clear mission
Good communication
Equal opportunities for participation
Group ownership
Efficient, effective meetings
Shared or situational leadership
Sharing of resources and information
Ongoing evaluation of coalition activities
The collaborative effort of GHKC coalition is sustained by the commitment of CPH and the GHKC coalition members. The sustainability of the work is met through the principles of the collective impact framework, including a common agenda through each campaign, common progress measures established by yearly objectives and campaign outcomes around PSEC, mutually reinforcing activities given as next steps at the end of each meeting, continuous communication provided in monthly meetings, and CPH as the backbone organization with a dedicated Program Manager to act as coordinator, facilitator, and organizer of the GHKC coalition.
References:
1. CDC Division of Nutrition, Physical Activity, and Obesity (2010). Pediatric Nutrition Surveillance System, Table 6 (PedNSS). Available at http://www.cdc.gov/pednss/pednss_tables/tables_health_ indicators.htm.
2. Birch, L.L., Parker, L. & Burns, A. (Eds.). (2011). Early childhood obesity prevention policies.†Washington, DC: National Academies Press.
3. Ogden, C.L., Carroll, M.D., Kit, B.K. & Flegal, K.M. (2004). Prevalence of childhood and adult obesity in the United States,†2011-2012. Journal of the American Medical Association, 311, 806-814.
4. Finkelstein, E.A., Trogdon, J.G., Cohen, J.W. & Dietz, W. (2009). Annual medical spending attributable to obesity: Payer-and service-specific estimates.†Health Affairs, 28(5), w822-831.
5. Finkelstein, E.A., DiBonaventura, M., Burgess, S.M. & Hale, B.C. (2010). The costs of obesity in the workplace.†Journal of Occupational and Environmental Medicine, 52(10), 971-976.
6. CDC The Community Guide. Community Toolbox: Developing Strategic and Action Plansâ€. Available at http://ctb.ku.edu/en/developing-strategic-and-action-plans.
7. Frieden, T. R. (2010). A framework for public health action: the health impact period.†American Journal of Public Health, 100(4), 590–595.
8. Bunnell, R., O'Neil, D., Soler, R., Payne, R., Giles, W.H., Collins, J. & Bauer, U. (2012). Fifty communities putting prevention to work: Accelerating chronic disease prevention through policy, systems and environmental change.†Journal of Community Health. DOI 10.1007/s10900-012-9542-3.
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