Targeting Obesity Remains A Priority in Tough Budget Times

The initiative “A Vision for California: 10 Steps Toward Healthy Living,” is a strategy to change not only Californian’s eating and exercise habits, but their communities and lifestyle choices, as well.

But can the bold goals of this long-term plan outlast the reality of the current budget shortfall?

“It’s so critical right now, things are happening quickly,” said Julie Williamson, MPH, Director of California Convergence, referring both to state budget negotiations and the federal stimulus allocations. “Decisions are being made and the more we understand the more you understand how much our environment influences our health and how much that is going to save us down the road,”

Williamson cited the state’s success with reducing healthcare costs from its investment in smoking reduction programs as justification for funding current anti-obesity efforts. “The savings alone from the reduction in lung cancer and all of the cardiovascular disease associated with smoking is vast in California,” said Williamson. “It’s amazing in what a short amount of time we have seen concrete results … the diseases associated with tobacco, which I thought I’d never see [reduced] in my lifetime, these are long term results, but we are actually seeing those results now … so I think we can not afford not to do prevention.”

Of the “Dozen policy priorities that we wanted to go forward with,” Williamson said her agency will now reduce its program initiatives to just three over the next 18 months: Joint Use, Healthy Food Retail, “especially for low-income and disenfranchised neighborhoods,” and free access to potable water in every community.

“Every person should have free access to free potable water,” said Williamson. “We don’t have that in California. I think that we have an imperative to start with at least water to make sure every child, every adult, has access to free water.”

Lisa Cirill, acting chief of the California Center for Physical Activity, within the CDPH, also sees funding opportunity for the state’s physical activity initiative in the federal economic stimulus act.

“We do have a lot of opportunities at the federal level,” explained Cirill. “For physical activity, the surface transportation is our farm bill.” Cirill sees the infrastructure-targeted funds as ideal for building “pedestrian facilities, access to transit and safe routes to school.” Cirill also sees energy efficiency and conservation funds going toward improving pedestrian, public transit and transit access, to “reduce miles traveled by getting people out of their cars.”

“I think at this point we’re being forced to think big and to think structurally about how California as a state functions, and how our communities at the local level function; how our basic systems and structures of society interact with each other and, if we bring that understanding, I think we can really pull through this whole economic crisis in a way that’s going to put us on a much healthier path then we’ve been for many, many decades,” said Williamson. “I think there is real opportunity here.”

Cirill believes the $22 billion allotted for school construction and modernization funds in the state fiscal stabilization funds and Community Development Block Grants could be well-spent promoting joint use of community schools, which she said were once “the center and pride” of communities, but in the last several decades have been built on the outskirts of towns, making them inaccessible or unsafe to walk or bicycle to. Joint use, including recreation and community centers on school property, safe pedestrian access from school to home and school to school, farmer’s markets and healthy food retail access, can combine to increase “incidental physical activity,” while reducing pollution.

According to Cirill, construction of suburban California by architects and developers who threw out historic neighborhoods with corner stores and schools as the center of recreational activity and community gatherings, created a new California lifestyle of sedentary, automobile-centric living. Wide roads, unsafe for pedestrians, and miles of homes without enough parks or retail opportunities within walking distance have left Californians little choice but to abandon historically healthy habits for unhealthy alternatives designed for them by poor urban planning and community design.

“We know the reasons” for reduced physical activity, said Cirill. “Reduced recess, not enough activity in schools, lack of p.e. and just the way our communities are built, not allowing for active transport.”

The strategy of simply “promoting exercise as individual behavior … has not worked,” Cirill explained, saying the effort had “flat lined.” Cirill said that from gaining that knowledge, California subsequently learned “that environmental change and social organization change is crucial,” to increasing activity and reducing weight.

“We need to definitely address just the basics, like walking around the community. We’re not doing it because we have poor development. We have urban sprawl, we’re building our communities and what happened is ‘loops and lollipops.’ Johnny is living in the cul-de-sac. He can’t get to his friend, Tommy [a short distance as the crow flies but a long distance because of the lack of intersections], and there isn’t even an amenity, I don’t see a school, I don’t see any retail in the area. So they’re going to stay home and be isolated or ask their mom to drive them over because it’s not safe.”

“This is why we have our children are sitting inside,” said Cirill.

Lack of pedestrian safety is another issue. “Our public health data shows that our pedestrian injury rate is significant, the third leading cause of injury or death in ages 1 through 12,” Cirill claimed.

Lunch Lady Lessons

Gail Feenstra, a food system analyst with the University of California, Davis, sustainable agriculture research and education program, addressed improving nutrition in schools by empowering “the most under-appreciated and under-paid” school employees, cafeteria staff through the Farm to Schools program.

By introducing staff to local produce farmers and “freeing the reins” of staff to “bring what they already have” to cooking their own ethnic meals (which brings pride and encouragement to kitchen staff,) school lunches improve, even without an increase in per meal costs. Feenstra explained that the end result is a student inclined to prefer healthier food, using a City of Davis middle school salad bar, as an example. When the students graduated and went on to the high school, which lacked a salad bar, Feenstra said, “the students complained. They wanted their salad bar,” which eventually was added at the high school level.

National Guidelines

Presenters also provided the U.S. Department of Health and Human Services 2008 activity guidelines for American Adults as well as the supplemental guide, "Be Active Your Way."