NHs Healthy Eating and Active Living Initiative

1
NHs Healthy Eating and Active Living Initiative
Sponsored by a Collaboration of Foundations and
State Agencies committed to promoting health and
wellbeing for all NH residents.
2
Overview

• Goal of the HEAL Initiative
• Participating Partners
• Developing the HEAL Plan
• Identification of Priorities
• Implementing the Plan

3
Goal for HEAL Initiative

• To improve personal
• wellness of all NH
• residents through
  implementation of effective interventions to
  promote healthy eating and active living.

4
Participating Partners

• Convening Partners
• a collaboration of foundations and state agencies
  supporting the planning and implementation
  process
• Steering Committee
• expert advisory group representing diverse
  organizations committed to promoting healthy
  eating and active living with responsibility for
  developing the statewide plan
• Implementation Partners
• Everyone

5
Developing the Plan

• Planning Process
• Timeframe
• Framework

6
Planning Principles

• Planning is good but implementation is better!
• The planning process can be facilitated by
  building on the extensive work that has been done
  nationally and locally.
• Success depends upon obtaining resources to
  support implementation, implementing
  recommendations and, ultimately, achieving
  positive and demonstrable impact on individual
  behaviors.

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From Planning to Implementation

• June 2007 Steering Committee first convened to
  develop vision and approach for HEAL Initiative
• July-August Steering Committee members
  participated in working groups to identify
  recommended interventions for NH
• September Steering Committee met to finalize
  recommended interventions and develop a plan for
  implementation
• October Presentation to community partners and
  stakeholders for input and approval
• November-December Draft and finalize HEAL Plan
• January Begin implementation of Plan

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Multi-sector Approach

• Research shows that a multi-sector approach to
  implementing intervention strategies is most
  effective in supporting individuals to achieve
  improved wellness through healthy eating and
  active living (HEAL).

9
Intervention Settings (Spheres of Influence)
Communities and Municipalities
Health Care Industry
Schools
Individuals and Families
Built Natural Environ
Worksites
Food Recreation Industries
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Intervention Strategies

• Recommended intervention strategies to change
  knowledge, attitudes, skills, behavior, policies
  and environmental factors include
• Policy Strategies Policies, regulations, laws as
  well as informal rules and understandings of
  government and organizations.
• Educational and Communication Strategies
  Educational programming and messaging targeted to
  audience.
• Practices and Programs Promising practices and
  programs

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Developing Recommendations

• Expert Work Groups
• Reviewed a long list of interventions
  identified from the literature for each setting
• Prepared a short list of recommended
  interventions based on feasibility and
  appropriateness for NH
• Identified priorities for implementation and
  helpful resources.

12
Reference Documents

• A Pound of Prevention. NH Citizens Health
  Initiative January 2007
• Strategic Plan for the Prevention and Control of
  Overweight and Obesity in NE. NECON 2003.
• Improving the Health and Quality of Life of NH
  Residents Affected by Diabetes. NH Action Plan
  for Diabetes. 2006
• NH Childhood Obesity Report. Foundation for
  Healthy Communities. 2007.
• Preventing Childhood Obesity Promoting Physical
  Activity and Healthy Eating. NH Childhood
  Obesity Expert Panel. 2007.
• US Preventive Health Services Task Force
  Recommendations for Physical Activity and
  Nutrition.
• The Surgeon Generals Call to Action to Prevent
  and Decrease Overweight and Obesity, 2001.
• Preventing Childhood Obesity Health in the
  Balance. IOM Report, 2004.
• Progress in Preventing Childhood Obesity How do
  we Measure Up? IOM Report, 2006.
• Reversing the Obesity Epidemic Policy Strategies
  for Health Funders. Grantmakers in Health Issue
  Dialogue, 2006.
• HEAL Plans from other States

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Recommended Interventions

• Priorities for
• Implementation By Setting

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Health Care Industry

• Definition Includes health care providers
  (e.g., behavioral health, primary care, tertiary
  care, etc.), health plans, professional
  organizations and health professional schools.
• Rationale The health care setting supports
  prevention education, treatment and referral to
  health promotion services.

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Key Interventions

• Increase use of Body Mass Index (BMI) to monitor
  healthy weight
• Train providers to accurately measure BMI
• Conduct BMI at all routine visits and provide
  interpretation
• Establish BMI and diagnosis of overweight or
  obesity as pay-for-performance measures
• Increase patient referrals to nutrition, physical
  activity and behavior modification resources in
  the community
• Provide providers with info on covered services
  and programs for weight control and obesity
  prevention and community resources for nutrition
  and exercise
• Educate providers in obesity prevention and
  weight management
• Train providers about high impact strategies for
  promoting weight control

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Schools

• Definition Includes public and private schools,
  grades pre-K through 12, school-based preschool
  and after school programs, and college.
• Rationale The school community shapes
  childrens current and life-long health and
  dietary patterns. Schools reach children, youth,
  young adults, faculty and staff and family and
  community members and are an important setting
  for educating the entire population.

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Key Interventions

• Adopt statewide nutrition standards
• Adopt statewide K-12 nutrition standards for all
  foods provided in venues within the schools
  control beyond the school meals program
• Increase the number of schools, after-school
  programs, childcare and pre-school facilities
  that adopt nutrition standards
• Increase awareness, commitment and resources for
  school efforts to provide a healthy eating and
  active living environment
• Provide funding and TA to school wellness
  committees for assessment and planning
• Fund activities and materials for staff, family
  and community education and communication

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Key Interventions

• Promote lifelong HEAL through integrated
  curriculum, communication, facility design,
  practices and partnerships with families and
  communities
• Increase the number of schools that implement an
  integrated curriculum for nutrition, physical
  education and media literacy
• Mobilize commitment to wellness through the
  school setting by integrating HEAL information in
  general school communications and community
  partnership activities that include students,
  staff and families
• Increase the number of schools, after school
  programs and child care settings that support
  students, staff and families in achieving
  recommended minutes of developmentally
  appropriate daily physical activity
• Provide developmentally appropriate equipment and
  safe playground facilities for active play
• Increase the number of schools/communities
  implementing a walk/bike to school program link
  with overall efforts to develop livable, walkable
  communities

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Worksites

• Definition Includes all work settings.
• Rationale Worksites reach a large number of
  adults. A healthy workforce is a more productive
  workforce. Employers can reinforce and promote
  healthy behaviors through educational programs,
  policy and environmental actions that support
  wellness.

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Key Interventions

• Encourage worksites to implement HEAL initiatives
  
• Sponsor a statewide conference targeting
  worksites, employers and business associations to
  engage in HEAL activities
• Provide worksites with tools to adopt HEAL
  initiatives
• Recruit and recognize worksites that implement
  HEAL recommendations
• Encourage employers to promote opportunities for
  employees to be healthy
• Work with their insurance carriers to reimburse
  members of the health care team for time spent
  evaluating and counseling patients in nutrition,
  physical activity and weight management
• Provide incentives to employees who engage in
  activities that lead to healthy lifestyles
  through regular screenings, health risk
  appraisals, increased physical activity and
  improved nutrition
• Provide discounted worksite wellness services
  (e.g., educational workshops and health coaching
  for disease and lifestyle management)

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Communities Municipalities

• Definition Includes community agencies (e.g.
  social service, faith, and civic organizations)
  and municipalities (e.g., town planners, parks
  and recreation, town offices, elected officials,
  public works, etc.).
• Rationale Municipalities can foster physical
  activity through increasing community
  connectivity, providing infrastructure that
  supports alternative means of transportation,
  preserving open space, providing safe,
  attractive, and accessible recreational
  facilities, and sponsoring community programming.
  Community based agencies reach people where they
  gather, shop and play. These groups can examine
  how they function and also serve as strong
  advocates for educational, policy, and
  environmental changes within the community.

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Key Interventions

• Encourage agencies and municipalities to
  implement HEAL initiatives
• Educate communities about HEAL recommendations
• Provide communities with tools to adopt HEAL
  initiatives
• Recruit and recognize communities that implement
  HEAL recommendations
• Implement initiatives to incorporate HEAL
  practices in town planning processes
• Incorporate land use polcies that promote
  physical activity and healthy living in master
  plans
• Train town planners to incorporate HEAL
  recommendations in master plans
• Support implementation of Livable Walkable
  Communities (LWC)

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Key Interventions cont.

• Implement local-level initiatives to promote
  development and access to resources that support
  active living
• Pass local zoning and planning ordinances that
  promote open space community connectivity and
  make parks, trails, and green space accessible,
  safe and inviting
• Collaborate with the Leave No Child Inside to
  promote link between nature and HEAL concepts
• Provide a community public space map on town
  website, in town office, in town annual report to
  promote the use of public parks and recreational
  facilities

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Food and Recreation Industries

• Definition Includes food industry members such
  as grocers, restaurants, farmers markets
• Includes recreation industry members such as
  for-profit sports and fitness centers, municipal
  recreation programs and sports retailers.
• Rationale The food and recreation industries
  play a critical role in providing an environment
  which supports healthy eating and active living.

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Key Interventions

• Encourage food and recreation providers to
  implement HEAL initiatives
• Educate providers about HEAL recommendations
• Provide food retailers, for-profit sport and
  fitness facilities, and municipal recreation
  programs with tools to adopt HEAL initiatives
• Recruit and recognize food and recreation
  industry members that implement HEAL
  recommendations

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Key Interventions cont.

• Implement initiatives to promote healthy eating
  and active living through the food and recreation
  industries
• Encourage restaurants to adopt HEAL concepts,
  including offering readily identifiable healthy
  choices, smaller portions, more fruits,
  vegetables and whole grains promoting physical
  activity through menus, place mats, table tents,
  advertising, websites, and walking beeper
  programs
• Encourage food retailers to adopt HEAL concepts,
  including improved placement of healthy snacks
  and promotion of physical activity
• Encourage establishments that offer fee-based
  physical activity (gyms, dance studios, martial
  arts programs, etc.) to adopt HEAL concepts
  including offering informal physical activity
  outside the facility, offering sliding fee
  structures, collaborating with existing physical
  activity programs such as Walk NH and Leave No
  Child Inside, and promoting exercise groups

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Individuals and Families

• Definition All NH residents including you and
  me.
• Rationale Ultimately, it is individuals and
  families that make the choice to eat healthy and
  physical activity.

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Key Interventions

• Increase use of Body Mass Index (BMI) to monitor
  and achieve healthy weight
• Ask your provider to calculate BMI at every visit
  and interpret results
• Monitor BMI to maintain a healthy weight
• Be a good role model
• Learn about nutrition and physical activity
  guidelines (e.g., 5210!)
• Engage in moderate to vigorous physical activity
  at least 30 minutes per day for an adult and 1
  hour per day for child.
• Eat healthy foods in reasonable portions
• Advocate for healthy lifestyle options
• Encourage schools, policy makers, food
  establishments and employers to develop social
  and environmental policies and infrastructure
  that help us be more physically active and
  consume a healthier diet.

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Recommended interventions define what needs to be
done.

• We know what to do but how
• do we make it happen?

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Strategy for Implementation

• Developing a multi-sector response

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Implementation Strategy

• Establish a Home for HEAL
• Fund a state level entity to administer the HEAL
  Initiative to assure coordination and continuity
  from planning through implementation.
• Create a community grants program
• Fund multi-sector collaboratives at the local
  level that agree to implement HEAL
  recommendations.

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Role of Coordinating Entity

• Promote HEAL recommendations with key
  stakeholders and partners
• Administer a HEAL partner program to recognize
  organizations (e.g., worksites, schools,
  municipalities, community based organizations,
  etc.) who adopt HEAL recommendations and sign on
  as a partner
• Develop resources to support local implementation
  of HEAL recommendations for specific sectors
• Monitor progress towards achieving HEAL
  objectives including reporting on outcomes

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Role of the Community Grants Program

• Engage local partners (e.g., community based
  organizations, worksites, schools, health care
  providers, local restaurants, municipalities,
  etc.) in implementing HEAL recommendations at
  local level
• Facilitate collaboration and coordination across
  sectors
• Work with partners to implement HEAL
  recommendations
• Enroll HEAL partners in statewide campaign