Transcript APHA Annual Meeting 2012 Lessons from Latino Communities: Policy and Systems Change to Prevent Childhood Obesity George R.

APHA Annual Meeting 2012
Lessons from Latino
Communities: Policy and
Systems Change to Prevent
Childhood Obesity
George R. Flores MD, MPH; Emma Sanchez-Vaznaugh DrPH;
Lisa Goldman-Rosas PhD; Liz Schwarte MPH; Sandra Viera MPH;
Robert Garcia JD; Seth Strongin; Amanda Navarro DrPH
Presenter Disclosures
George R. Flores
(1)
The following personal financial relationships
with commercial interests relevant to this
presentation existed during the past 12 months:
No Relationships to Disclose
Chapter One
LATINO CHILDREN’S HEALTH
AND THE ENVIRONMENT
George R. Flores, Emma V. Sanchez-Vaznaugh, Lisa
G.-Rosas, Liz U. Schwarte, Robert Garcia, Sandra R.
Viera, Mariah S. Lafleur, Manal J. Aboelata, Seth H.
Strongin and Amanda M. Navarro
. . . If you grow up in a neighborhood with a good
school, where it’s safe, where you can walk and
play outside, where you have a regular doctor and
where you have access to good food, you are more
likely to live a long and healthy life. On the other
hand, if you grow up in a neighborhood where
you’re not safe, where your school is failing you and
where you do not have a place to go when you are
sick or need a basic grocery store, then you are far
more likely to live a shorter life, to earn less money,
to be party to or victim of violence and to be far less
healthy emotionally and physically. If you are . .
Latino, you are likely to face not just one of those
challenges, but many or all of them at once.
(Policy Link, 2010)
Introduction
• Relative to non-Hispanic whites, Latino children
that experience less favorable environments are
at risk for poorer health outcomes.
• The co-epidemics of type 2 diabetes and obesity
are largely driven by adverse environmental
conditions that are preventable.
• It is reasonable to expect that improving
environments to support healthy nutrition and
physical activity can lead to better health
outcomes
Purpose
• Identify factors in the physical and social
environments of children living in Latino
communities that shape risks and opportunities
for healthy nutrition and physical activity.
• Identify practices and interventions in Latino
communities that show promise for changing
policies and conditions to improve opportunities
for healthy nutrition and physical activity.
Methods
• Scan of peer-reviewed publications, foundationfunded research, evaluations, community project
reports, and key informant interviews to identify:
– environmental conditions commonly experienced
by Latino children that have bearing on their
nutrition and physical activity;
– promising practices in Latino communities
working toward healthier environments.
Place Matters
Results: Unhealthy Food and Activity Environments
•Latino children are more likely to live in poverty and poverty is
associated with greater consumption of energy-dense foods and
lower quality diets.
•Poor Latino neighborhoods often have fewer structural resources to
support healthy behavior such as grocery stores and parks, schools
that are over-crowded and under-funded, and safety and violence
problems.
•Remote rural areas are at risk of economic and food insecurity with
limited access to essential services and healthy food sources.
•Children in Spanish-speaking households are more likely to be
exposed to adult content and advertising of unhealthy foods like
sugary drinks and fast food.
•Sugary beverage companies target Hispanic kids, teens.
•Lack of access to safe parks is a common barrier to physical activity
for Latino children and youth.
Social and Place Inequities lead to…
Health Inequities
Segregation
Housing
Transportation
Income & Employment
Air Quality
Physical Activity & Neighborhood Conditions
Access to Healthcare
Education
Food Access & Liquor Stores
Criminal Justice
Social Relationships & Community Capacity
Health Happens in Latino
Communities
Results
Improved Food Environments
– Mercado La Paloma (LA) – healthy menus
– Healthy Bodegas (NYC)– healthy corner
stores
– CCROPP Farmers Markets (CA Central Valley)
– Buen Provecho promoting fresh produce
(Chicago)
– Denver Urban Gardens
Results
Improved Physical Activity Environments
– Albuquerque Alliance for Active Living –
bike trails
– Alianza de los Pueblos del Rio (LA) – parks
– PE and Civil Rights LAUSD
– Active Living in Logan Square (Chicago)
– Greenfield Walking Group (Bakersfield)
– Reclaiming Lauderbach Park (Chula Vista)
Healthy
Communities
Leverage
Partnerships
Health &
Equity
Advocacy
COMMUNICATIONS
Change the
Narrative
Build
Resident
Capacity
Youth
Leadership
CCROPP Farmers Markets and Produce Stands
 Increases access to fresh produce in lowincome communities
 Creates opportunities for collaboration
between community, schools, public health
departments, farmers/vendors
 Keeps locally grown produce local
Collaborative Efficacy
• Santa Ana --60 Latino adults and 61 Latino youth
involved in civic discourse on neighborhood
improvement
• Arvin / Lamont – 300 Latino residents push for closure
of nuisance recycling plant ; 250 for school wellness
policies
• Greenfield – 75 Latinas secure approval and funds to
improve parks
• Boyle Heights – 500 youth organize for improved
school food, access to health services, reduced
community violence
• Coachella – 150 Latino residents training to participate
in public land use and transportation decision-making
Impact
• Santa Ana – joint use at 2 schools; 2 new parks; community
garden; walking and exercise groups
• Arvin-Lamont – new parks and sidewalks, abate pollution,
improved school nutrition, PE, and water access
• Coachella – health and wellness element in general plan;
farmers market; improved school food and access to drinking
water; school clinic
• West Fresno – walking / jogging trails; revitalization and smart
growth; school discipline;
• South Merced – community garden; farmers market; joint
use;
• East Salinas – violence reduction; “health in all places” policy
in city -county planning;
• South Sacramento, Coachella, South Kern, City Heights /San
Diego --school wellness policies
Discussion
• We found a growing body of scientific evidence and real-life
examples of environmental conditions that shape the
health and well-being of Latino children.
• Descriptive and cross-sectional studies show that Latino
children confront multiple inequitable conditions within the
social and physical environments that surround them
where they live, go to school, and play.
• Foundation and government-funded programs that address
social determinants, target environmental change, and
employ community capacity-building, cross-sector
collaboration, and policy advocacy, are found to improve
opportunities and conditions for healthy nutrition and
physical activity in Latino communities.
Conclusions
• Critical examination of the impact that adverse environments can have
on health outcomes suggests that the health and wellness of millions
of Latino children is being compromised.
• Projects demonstrating community-driven measures to create
equitable and health-supportive nutrition and physical activity
environments in Latino communities constitute a growing body of
promising practices ripe for broad replication.
• Policy and systems changes that inherently address root factors of
social and environmental inequities have the potential to prevent
obesity and its complications in Latino communities.
• Co-benefits such as improved attendance and performance in school,
community safety, and positive youth development have been
reported, suggesting further investigation is merited.
• Replication of and scaling-up these models require sustaining resources
to assure institutionalization, lasting community change, and
improvement in health status.
• The Affordable Care Act’s Prevention and Public Health Fund supports
this type of approach and is a potential resource for sustainability.
MONEY & POLITICS, HEALTH & WELFARE | DAILY REPORT
Beverage lobbyist funds 'community'
campaign against soda tax
June 13, 2012 | William Harless, California Watch
RICHMOND – A powerful Washington, D.C., trade organization that
represents PepsiCo, Coca-Cola and other major beverage companies is
helping fund a Richmond group that is fighting a November ballot measure
to raise taxes on soda and other sweetened beverages, interviews and
records show.
A Richmond resident, Rosa Lara, is going door to door identifying herself as
an organizer with the Community Coalition Against Beverage Taxes and
collecting signatures on a petition. Although Lara doesn't mention it unless
specifically asked, her group is supported by the American Beverage
Association, the industry's main trade organization.
Housing
Medical
Care
Childcare
Jobs
Healthy
Food
Clean Air
We each have a role
Parks and
Activities
Policy
Makers
Economic
Justice
Education
Residents
Safe
Neighborhoods
Preschool
Transport
ation
Resources
• www.calendow.org