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NHs Healthy Eating and Active Living Initiative


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Title: NHs Healthy Eating and Active Living Initiative

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

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

Participating Partners
  • Convening Partners
  • a collaboration of foundations and state agencies
    supporting the planning and implementation
  • 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

Developing the Plan
  • Planning Process
  • Timeframe
  • Framework

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

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
  • October Presentation to community partners and
    stakeholders for input and approval
  • November-December Draft and finalize HEAL Plan
  • January Begin implementation of Plan

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).

Intervention Settings (Spheres of Influence)
Communities and Municipalities
Health Care Industry
Individuals and Families
Built Natural Environ
Food Recreation Industries
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
  • Practices and Programs Promising practices and

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.

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
  • 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

Recommended Interventions
  • Priorities for
  • Implementation By Setting

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.

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
  • 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

  • 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.

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

Key Interventions
  • Promote lifelong HEAL through integrated
    curriculum, communication, facility design,
    practices and partnerships with families and
  • 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

  • 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

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
  • 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)

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.

Key Interventions
  • Encourage agencies and municipalities to
    implement HEAL initiatives
  • Educate communities about HEAL recommendations
  • Provide communities with tools to adopt HEAL
  • 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
  • Train town planners to incorporate HEAL
    recommendations in master plans
  • Support implementation of Livable Walkable
    Communities (LWC)

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

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.

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

Key Interventions cont.
  • Implement initiatives to promote healthy eating
    and active living through the food and recreation
  • 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
  • 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

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

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.

Recommended interventions define what needs to be
  • We know what to do but how
  • do we make it happen?

Strategy for Implementation
  • Developing a multi-sector response

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

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

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
  • Work with partners to implement HEAL
  • Enroll HEAL partners in statewide campaign
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