North Carolina’s Approach to Communicating with Policymakers

Jimmy Newkirk

Dave Gardner, D.A.

Lexie Wolf, M.A.

Today’s talk

• Introductions

• Strategic Focus of PAN Branch

• PAN’s role with statewide movement

• Eat Smart Move More Overview – Including Policy Platform

• Lessons learned for communicating with policy makers

Our mission

• The mission of the Physical Activity and Nutrition Branch (PAN) Branch is to reverse the rising tide of obesity and chronic disease among North Carolinians by helping them to eat smart, move more and achieve a healthy weight.

Strategic Focus

• Impact: Decrease obesity rates and related chronic diseases

• Outcomes:– Increase Physical Activity– Increase consumption of fruits and vegetables– Decrease consumption of energy dense foods

Strategies (to achieve outcomes)

• Enhanced land use and transportation policies• Creation of or enhanced access to places for PA,

combined with informational outreach activities• Promote food policy councils• Increase access to healthy foods including corner

stores, farmers markets, community gardens and at worksites

Our work is …

• Across all levels of the socio-ecological model with an emphasis on policy and environmental change

• In all “settings” with an emphasis on community environment, school aged children, and worksites

• Always with partners!

Our work:

• Enables us to be technical experts for issues in the General Assembly, educating policy makers (advocacy)

• Supports local efforts of health departments, partners, and coalitions who may also be advocates

PAN’s role

• Statewide movement: Eat Smart Move More North Carolina

• Over 60 agencies formally signed on, many more informally involved

• NC Division of Public Health is one partner

• PAN provide staff support to the movement

Eat Smart Move More (ESMM)

• Executive Committee

• Leadership Team – reps from all member agencies

• Ad Hoc Committees:– Policy / Advocacy– Key Measures– Surveillance

Eat Smart Move More NC

• Eat Smart Move More: North Carolina’s Plan to Prevent Overweight, Obesity and Related Chronic Diseases 2007 – 2012

• ESMM Policy Strategy Platform *• Many policy tools and curricula• Website:

– www.EatSmartMoveMoreNC.com– www.MyEatSmartMoveMore.com

Policy Strategy Platform

• Focal Point for Policy Action• Platform: focused but at a strategic level

– Tactical level (e.g., specific language and sub-components of policy issue) is supported by partners such as the NC Alliance for Health

• Includes 20 policy strategies – organized with frame from CDC’s Community

Strategies and Measurements Guide

– state and local; legislative and organizational

Platform includes strategies to:

• Promote the Availability of Affordable Health Food and Beverages

• Support Healthy Food and Beverage Choices

• Encourage Breastfeeding

Platform includes strategies to:

• Encourage Physical Activity or Limit Sedentary Activity Among Children and Youth

• Create Safe Communities that Support Physical Activity

• Develop Capacity and Support for Obesity Prevention

Each Policy Strategy:

• General Action – organizational actions that can advance the strategy

• Legislative Action – legislative actions that can advance the strategy

• Cost - summary of any costs identified • Sources – list of where strategy has been

recommended by Task Forces, Organizations, etc.• Evidence - references to key evidence• Current Status - (dynamic document)

Partners use of Platform:

• Common focal point for NC policy action

• Incorporated into organizational platform (e.g., one agency can “own” specific issues)

• Educate decision makers (i.e., advocate)

• Some partners able to communicate directly with policy makers with specific policy “asks” (i.e., lobby)

Next Steps for Platform

• One pagers to support each policy strategy– Include success stories

• Enhance “alignment” with behavioral messages

• Public tracking system (for “current status”)

• Increase distribution and partners use

Childhood Obesity Childhood Obesity Prevention Lawmaker Prevention Lawmaker Information Gathering Information Gathering

ProjectProjectDr. Jodie Abbatangelo-Gray, Sc.D., M.S., M.A.Dr. Jodie Abbatangelo-Gray, Sc.D., M.S., M.A.

Dr. Jill Fromewick, Sc.D., M.S.Dr. Jill Fromewick, Sc.D., M.S.Lexie Wolf, M.A.Lexie Wolf, M.A.

A project of The North Carolina Center for Health and Wellness (NCCHW) at A project of The North Carolina Center for Health and Wellness (NCCHW) at University of North Carolina AshevilleUniversity of North Carolina Asheville

Funded by the Blue Cross and Blue Shield of North Carolina FoundationFunded by the Blue Cross and Blue Shield of North Carolina Foundation

Project goal:Project goal:

To learn more about North Carolina To learn more about North Carolina policymakers’ attitudes about childhood policymakers’ attitudes about childhood

obesity including:obesity including:

knowledge & gaps in knowledgeknowledge & gaps in knowledge what they believe are the causes of what they believe are the causes of

childhood obesitychildhood obesity opinions about policy areas that could opinions about policy areas that could

prevent childhood obesityprevent childhood obesity how they research and make policy how they research and make policy

decisionsdecisions

Project design:Project design:

Survey distributed through Survey Survey distributed through Survey Monkey to members of the North Monkey to members of the North Carolina General AssemblyCarolina General Assembly

In-depth interviews with 14 North In-depth interviews with 14 North Carolina policymakers (3 municipal Carolina policymakers (3 municipal lawmakers, 6 county commissioners, lawmakers, 6 county commissioners, and 5 state representatives)and 5 state representatives)

Identification & recruitment Identification & recruitment of interview subjects: of interview subjects: municipal and county municipal and county

lawmakerslawmakers

Used websites to obtain biographical Used websites to obtain biographical information when available; selected a information when available; selected a pool of prospective interviewees that pool of prospective interviewees that was diverse with respect to geographic was diverse with respect to geographic locale, age, gender, ethnicity, party locale, age, gender, ethnicity, party affiliation, and exposure to issues affiliation, and exposure to issues related to childhood obesityrelated to childhood obesity

Identification & Identification & recruitment of interview recruitment of interview subjects: state legislatorssubjects: state legislators

Spoke to representatives who did Spoke to representatives who did not have a history of involvement in not have a history of involvement in childhood obesity or related issueschildhood obesity or related issues

Sought variation with respect to Sought variation with respect to party affiliation, gender and location party affiliation, gender and location of districtof district

Subject areas:Subject areas:

Magnitude of problem: how serious?Magnitude of problem: how serious? Causes of problemCauses of problem Role of lawmakers and policy in Role of lawmakers and policy in

childhood obesity preventionchildhood obesity prevention How they make policy decisions: How they make policy decisions:

where they get information, how where they get information, how they do research, etc. they do research, etc.

Magnitude of problemMagnitude of problem

10 out of 15 lawmakers termed 10 out of 15 lawmakers termed childhood obesity “serious” or “very childhood obesity “serious” or “very serious”serious”

2 lawmakers: “extremely serious” 2 lawmakers: “extremely serious” and “crisis making”and “crisis making”

2 lawmakers: “not earth-shaking” 2 lawmakers: “not earth-shaking” (mayor) and “not a huge problem” (mayor) and “not a huge problem” (state legislator)(state legislator)

How have they come to How have they come to believe that childhood believe that childhood obesity is a problem?obesity is a problem?

““You can tell just You can tell just from looking at from looking at

them on the street”them on the street”

““Because I look at all Because I look at all the young people the young people

around me, and all around me, and all of them are bigger of them are bigger

than I am”than I am”

““I see many young I see many young people – in our people – in our

church for example”church for example”

What are the causes of the What are the causes of the problem? problem?

Modern family life: less Modern family life: less unstructured play, lack unstructured play, lack of home cooking and of home cooking and family meals, more family meals, more screen timescreen time

“ I think that parents have got to take some kind of responsibility. I know of families who just let their

kids eat out of boxes every night.”

- County commissioner

“I suspect few children are getting training and

discipline in terms of food in their families

these days”-County commissioner

Most framed this as parental choice, just a few noted contextual/structural factors influencing family lifestyles

What is the role of the What is the role of the lawmaker in this issue?lawmaker in this issue?

Much variation in how Much variation in how lawmakers viewed lawmakers viewed their own roles and their own roles and responsibility with responsibility with respect to this issuerespect to this issue

Many county and Many county and municipal lawmakers municipal lawmakers did not immediately did not immediately think that this was an think that this was an issue that fell within issue that fell within their jurisdictiontheir jurisdiction

Framing the issueFraming the issue Lawmakers at all levels Lawmakers at all levels

did not want to be did not want to be perceived as perceived as “intervening” and “intervening” and “legislating” health“legislating” health

Local lawmakers seemed Local lawmakers seemed more comfortable with more comfortable with the idea of “promoting the idea of “promoting health and fitness” health and fitness” rather than “obesity rather than “obesity prevention.”prevention.”

““We’re putting We’re putting in walking tracks in walking tracks and bike trails and bike trails through the through the town. So I think town. So I think we’re certainly we’re certainly doing our part, doing our part, but we don’t but we don’t want to cram it want to cram it down anybody’s down anybody’s throat, you throat, you know?”know?”--Mayor of small central NCMayor of small central NC towntown

Jurisdiction & policy Jurisdiction & policy settingssettings

State legislators more likely to State legislators more likely to discuss school policy interventions discuss school policy interventions than county or municipal lawmakersthan county or municipal lawmakers

Local lawmakers articulated built Local lawmakers articulated built environment policy solutions such as environment policy solutions such as trails and sidewalks more often than trails and sidewalks more often than did state lawmakersdid state lawmakers

Policy interventions for Policy interventions for healthy eating? healthy eating?

““Certainly I’m not going to blame the Certainly I’m not going to blame the fast food industry. Thank goodness for fast food industry. Thank goodness for

Burger King and McDonald’s. They Burger King and McDonald’s. They feed an awful lot of people. And doing feed an awful lot of people. And doing away with them is only going to bring away with them is only going to bring

up something. You know, we’re not up something. You know, we’re not going to live on tofu and yogurt. So going to live on tofu and yogurt. So

what we have to do is personally come what we have to do is personally come to an understanding that we have some to an understanding that we have some

control over our own lives.”control over our own lives.” -Mayor of small municipality in central NC-Mayor of small municipality in central NC

Making policy decisionsMaking policy decisions

All five state lawmakers and all six All five state lawmakers and all six county commissioners reported that they county commissioners reported that they viewed evidence and research before viewed evidence and research before making decisions as very importantmaking decisions as very important

However, nearly every interviewee However, nearly every interviewee referenced personal anecdotes and referenced personal anecdotes and observations during the course of the observations during the course of the conversation conversation

Key findings & implications Key findings & implications for advocacyfor advocacy

While many lawmakers may feel that While many lawmakers may feel that childhood obesity is a major problem, childhood obesity is a major problem, they may have a limited understanding they may have a limited understanding of the depth, severity, and macro-level of the depth, severity, and macro-level impacts of the disease. impacts of the disease.

Understanding of causes, impacts and Understanding of causes, impacts and possible solutions may be based on possible solutions may be based on personal experiences and observationspersonal experiences and observations

Therefore…..Therefore…..

Lawmakers may not always see the Lawmakers may not always see the connection between policy and connection between policy and behavior or behavior or see their role in see their role in childhood obesity prevention. childhood obesity prevention.

Policies that create opportunities or Policies that create opportunities or incentives will likely be received more incentives will likely be received more positively than those that are more positively than those that are more regulatory in nature. regulatory in nature.

PAN: Communicating with Policymakers

• The Healthy Environments Initiative: goal is to implement state level policies that promote healthy environments and active lifestyles in North Carolina communities.

Communicating with policymakers about healthy environments: “bottom-up” approach

• Communications campaign will begin by educating communities and citizens about how they can shape their built environments for active living

• Education about the relationship between the built environment and physical activity will provide context for future policy action

Making the connection through personal stories

• NC youth to participate in a video contest exploring features in their community that help or hinder active living; videos showcased in community

• Communications campaign will utilize personal stories and anecdotes to raise awareness about the relationship between physical activity, policies and environments, and health

Conclusions

• When communicating with decision makers at all levels:– Bridge the gap between personal choice and

opportunity– Don’t assume an understanding of the issue– Provide the facts, e.g., research, but use

personal stories and case studies– Collaboration is, quite simply, the way to move

policy forward

Contact:

Jimmy Newkirk

Jimmy.newkirk@dhhs.nc.gov

Dave Gardner

dgardner@unca.edu

Lexie Wolf

Lexie.wolf@dhhs.nc.gov