Power of Maps - CDC Foundation€¦ · ischemic heart disease, stroke, chronic rheumatic heart...

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UNDERLYING CAUSES OF DEATH IN THE UNITED STATES, 2000

Source: Centers for Disease Control and Prevention, 2010 Census Data

Preventable (avoidable) deaths are defined as those from ischemic heart disease, stroke, chronic rheumatic heart disease, and hypertensive disease in people under age 75

Source: National Vital Surveillance System,US Census Bureau

Age-Adjusted Preventable Death Rates per 100,000 People

Diabetes by County

Obesity by County

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UNDERLYING CAUSES OF DEATH IN THE UNITED STATES, 2000

Source: Mokdad et al JAMA 2004

Sexual Behavior

Alcohol Motor Vehicle

Guns DrugInduced

Obesity & Inactivity

Smoking

500

400

300

200

100

0

20

85

4329 17

365

435

No.

of D

eath

s (t

hous

ands

)

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FOR BABIES BORN WITHIN FIVE MILES OF DOWNTOWN RICHMOND, VIRGINIA, OPPORTUNITIES TO LEAD A LONG AND HEALTHY LIFE CAN VARY DRAMATICALLY.Why the gap? Good health outcomes are related to such things as access to nutritious food, safe and walkable streets, active playgrounds and public spaces, good jobs, educational opportunities and stable housing.

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AS OF 2014, MORE THAN 1 IN EVERY 3 AMERICAN ADULTS HAD OBESITY (BMI GREATER THAN OR EQUAL TO 30). BUT THE PREVALENCE OF OBESITY DIFFERS BY OTHER FACTORS, INCLUDING RACE AND ETHNICITY.

Non-Hispanic Whites Non-Hispanic Blacks

Hispanics

Prevalence of Self–Reported Obesity Among U.S. Adults by Race/Ethnicity, State and Territory, BRFSS, 2012-2014

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WHAT DO YOU NOTICE ABOUT THESE MAPS OF KING COUNTY, WASHINGTON?

More information on reverse side

Power of MapsMore information on reverse side

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THE COMMUNITY DEVELOPMENT* SECTOR AND THE HEALTH SECTOR ARE TRYING TO HELP THE SAME PEOPLE, BUT OFTEN WITHOUT COORDINATION OR EVEN COMMUNICATION.

* “Community Development” was defined by the United Nations in 1948 as “a process designed to create conditions of economic and social progress for the whole community with its active participation and fullest possible reliance upon the community’s initiative.”

Prevalence of Childhood Obesity by City/Community Los Angeles County, 2005

Pow

er o

f Map

s

YOU

CA

N L

IVE

IN A

DES

ERT,

B

UT

STIL

L D

ROW

N IN

A S

WA

MP.

ROLE PROFILE AGENDA/HOPE TO ACHIEVE

Tiffany Duncan

Clinic Receptionist

• 30-year-old black woman• Lives in the community with her husband and two children• Struggled with obesity since adolescence• Participates in and has become a champion for the clinic’s Walk with a

Doc program and other community health initiatives

• Attain a healthy weight for the first time in her life• Help the clinic’s patients achieve their weight-loss goals by

encouraging them, for example, to walk more often• Become involved in real community-level change, like

improving the city’s sidewalks

Tim Jacobs

Public Health Representative

• White man in his mid-twenties• MPH, recently hired by the County Health Department

• Intervene in the community to break the cycle of unhealthy lifestyle choices and preventable disease, especially involving schoolchildren

Wade Billups

City Manager

• White man, has been the city manager for 25 years• Monitors, reports on and makes recommendations regarding the city

budget

• Demonstrate leadership to new boss, develop job security• Interact/get involved with the community to understand

pressing needs

Victoria Nuñez

Parks and Recreation Director

• Young Latina who grew up in the neighborhood• Spent three years in the military• Has an undergraduate degree in sports management and is passionate

about fitness

• Initiate new, culturally appropriate fitness programs in the city• Prevent the pending sale of a land tract as commercial real

estate and instead have it earmarked for a new park

Tien Jiang (T.J.) Xiāo

Business Owner• 70-year-old Asian owner of Pop’s Market, a family business started in

the 1930s • Maintain a successful neighborhood convenience store

Dr. Julie Carson

Clinic Director• Black woman, physician director of the clinic where Dr. Sylvia

Peterson works• Make evidence-based decisions that will benefit the

clinic’s patients and its financial bottom line

Reverend Isaiah Bishop

Clinic Director• Black man, pastor of a large black congregation in the community• Influential leader with a straightforward, no-nonsense attitude

• Feels he could help make a difference with the right (effective) approach

Others Who Care SummaryOBESITY

ROLE OBSTACLES FACED RESOURCES TO OFFER

Tiffany Duncan

Clinic Receptionist• Lack of education/possible perceived lack of professional

credibility

• Community resident/seen as a credible community representative

• Affable personality has made her a community “connector”

Tim Jacobs

Public Health Representative

• Lack of real-world experience with at-risk communities

• Awareness of funding opportunities and experience writing grants• Network of allies in the school district and the county health

department• Youthful exuberance

Wade Billups

City Manager• A city budget deficit resulting from lower property tax values

and higher expenditures for public safety workers• Far-reaching professional network• Extensive institutional knowledge of how the city operates

Victoria Nuñez

Parks and Recreation Director

• Must convince city officials of the merits of building a park instead of leasing land for lucrative fast food outlets

• Knowledge of the Hispanic community• Personal experience with poor diet and a sedentary lifestyle• Data about the financial advantages of creating a park, such as

government subsidies and tax credits

Tien Jiang (T.J.) Xiāo

Business Owner

• Has lost revenue in the past when attempting to sell fresh fruits and vegetables

• Not interested in change

• Owns a popular and convenient venue, often used by the community for buying groceries

Dr. Julie Carson

Clinic Director

• Does not understand why patients with obesity can’t just change their eating habits

• Lack of resources to hire extra staff requested for an official obesity program at the clinic

• Can offer some assistance that is mutually beneficial (such as adding intake questions for patients’ electronic health records), as long as cost is minimal

Reverend Isaiah Bishop

Clinic Director• Prior experience with community-based projects have not

always been positive• Well-respected by the community• Has influence with many people

Others Who Care SummaryOBESITY

Know What Affects Health

Source: www.cdc.gov/chinav

Know What Affects Health

Match these factors to their impact level:

• Physical environment

• Clinical care

• Socioeconomic factors

• Health behaviors

40%

10%

30%

20%

More information on reverse side

NA

ME:

Tiffa

ny D

unca

n

YOU

R ST

ORY

:

Tiffa

ny is

a fu

ll-tim

e em

ploy

ee a

t the

clin

ic w

here

Dr.

Pete

rson

w

orks

two

days

a w

eek.

She

is a

30-

year

-old

bla

ck w

oman

who

live

s in

the

com

mun

ity w

ith h

er h

usba

nd a

nd tw

o ch

ildre

n. T

iffan

y ha

s st

rugg

led

with

her

wei

ght a

ll he

r life

. As

a te

enag

er, h

er s

tepf

athe

r w

as v

erba

lly a

busi

ve a

bout

her

app

eara

nce,

whi

ch o

nly

mad

e th

ings

wor

se. A

dditi

onal

ly, s

he w

as th

e pr

imar

y ca

regi

ver f

or h

er

brot

hers

and

sis

ters

, and

was

oft

en re

quire

d to

mak

e su

re th

ey h

ad

food

to e

at –

not

an

easy

task

with

a v

ery

limite

d fa

mily

bud

get.

One

day

a fe

w m

onth

s ag

o, D

r. Pe

ters

on a

nnou

nced

that

she

was

st

artin

g a

Wal

k w

ith a

Doc

pro

gram

dur

ing

the

lunc

h ho

ur, a

nd

wel

com

ed s

taff

to jo

in a

long

with

clin

ic p

atie

nts.

Tiffa

ny th

ough

t th

is w

as a

gre

at id

ea b

ecau

se s

he fe

lt sa

fer w

alki

ng a

roun

d th

e ne

ighb

orho

od d

urin

g th

e da

ytim

e an

d w

ith a

gro

up o

f peo

ple.

Als

o,

the

timin

g w

as p

erfe

ct b

ecau

se h

er k

ids

wer

e in

sch

ool a

nd s

he

was

n’t b

usy

with

cho

res,

as sh

e is

on

the

wee

kend

s. Sh

e w

as th

e fir

st

pers

on to

sig

n up

and

bec

ame

the

clin

ic’s

cham

pion

for t

he W

alk

with

a D

oc p

rogr

am, r

ecru

iting

ove

r 50

peop

le to

bec

ome

regu

lar

wal

kers

. Tiff

any

is h

elpi

ng D

r. Pe

ters

on d

raft

a le

tter

to th

e co

unty

co

mm

issi

oner

abo

ut th

e ne

ed fo

r mor

e si

dew

alks

to a

id th

e gr

oup’

s ro

utes

aro

und

tow

n; c

urre

ntly

it is

a p

atch

wor

k of

side

wal

ks, a

nd n

ew

ordi

nanc

es c

ould

ben

efit w

alke

rs a

s wel

l as p

eopl

e w

ith w

heel

chai

rs.

Oth

ers W

ho C

are

CLIN

IC R

ECEP

TIO

NIS

T

NA

ME:

Tim

Jaco

bs

YOU

R ST

ORY

:Ti

m, a

whi

te m

an in

his

mid

-tw

entie

s, go

t his

MPH

at a

top-

rank

ed c

olle

ge a

fter

at

tend

ing

excl

usiv

e pr

ivat

e sc

hool

s hi

s w

hole

life

. He’

s re

lativ

ely

new

to h

is jo

b at

th

e co

unty

hea

lth d

epar

tmen

t and

is k

een

on m

akin

g a

real

diff

eren

ce fo

r at-

risk

com

mun

ities

. He

is a

rmed

with

all

the

late

st p

eer-

revi

ewed

lite

ratu

re a

bout

the

rela

tions

hip

betw

een

lifes

tyle

fact

ors

and

prev

enta

ble

dise

ase.

Ti

m w

as a

sked

to s

peak

to a

n ei

ghth

-gra

de h

ealth

cla

ss a

t a n

earb

y m

iddl

e sc

hool

. Ex

cite

dly,

he

prep

ared

a le

ctur

e on

nut

ritio

n an

d sp

orts

per

form

ance

. Unf

ortu

nate

ly,

the

talk

bom

bed

… to

his

sur

pris

e:•

Mos

t of t

he k

ids

had

neve

r pla

yed

an o

rgan

ized

spo

rt•

Rece

ss h

ad b

een

redu

ced

from

50

min

utes

a d

ay to

10

min

utes

a d

ay o

nly

thre

e da

ys a

wee

k•

The

scho

ol d

idn’

t hav

e an

y de

dica

ted

phys

ical

edu

catio

n te

ache

rs•

Man

y of

the

kids

told

him

that

they

did

n’t p

lay

outs

ide

afte

r sch

ool e

ither

, pr

efer

ring

to p

lay

vide

o ga

mes

or w

atch

TV

But t

he lo

w p

oint

cam

e w

hen

he w

as in

vite

d to

join

the

kids

for l

unch

… m

ost o

f the

fr

esh

frui

t on

thei

r tra

ys w

as e

ndin

g up

in th

e br

ight

yel

low

gar

bage

can

s. W

hen

Tim

ex

pres

sed

his s

urpr

ise th

at so

muc

h fo

od w

as b

eing

was

ted

and

aske

d th

e te

ache

rs w

hy

the

kids

did

n’t e

at th

e fru

it off

ered

that

day

, the

y sa

id it

was

bec

ause

of t

he sh

ort l

unch

pe

riod,

and

that

mos

t kid

s con

side

red

it “u

nfam

iliar

food

” tha

t the

y di

dn’t

see

at h

ome.

Sinc

e th

at ti

me,

Tim

, a s

choo

l nur

se, t

he P

TA a

nd a

die

ticia

n at

the

loca

l hos

pita

l w

rote

a g

rant

to w

ork

tow

ard

impr

ovem

ents

to m

eet t

he s

choo

l dis

tric

t wel

lnes

s po

licy.

Thi

s in

clud

ed:

• H

iring

an

out-

of-s

choo

l-tim

e ac

tivity

coo

rdin

ator

who

has

ope

n gy

m ti

me

each

m

orni

ng a

nd a

fter

sch

ool f

or c

hild

ren

• Re

plac

ing

unhe

alth

y fu

ndra

iser

s (t

hose

that

sel

l cho

cola

te b

ars

and

cand

y) w

ith a

bo

xed

frui

t sal

e•

Crea

ting

two

serv

ing

lines

in th

e ca

fete

ria to

reso

lve

of fi

x th

e sh

ort l

unch

per

iod

• St

artin

g a

heat

h-in

itiat

ive

at th

e sc

hool

that

incl

uded

tast

e-te

stin

g fru

its a

nd v

eget

able

s

Oth

ers W

ho C

are

PUB

LIC

HEA

LTH

REP

RESE

NTA

TIV

E

NA

ME:

Wad

e Bi

llups

YOU

R ST

ORY

:

Wad

e Bi

llups

, a 5

8-ye

ar-o

ld w

hite

man

, has

bee

n th

e ci

ty m

anag

er

for 2

5 ye

ars.

He

has

seen

sev

eral

may

ors

and

city

cou

ncil

mem

bers

co

me

and

go, b

ut h

is w

ides

prea

d ne

twor

k of

con

tact

s an

d ex

tens

ive

expe

rienc

e ha

s al

low

ed h

im to

sta

y in

his

pos

ition

– s

o fa

r. Bu

t now

, th

e ne

wly

ele

cted

may

or a

nd s

ever

al n

ew c

ity c

ounc

il m

embe

rs h

ave

give

n hi

m a

bad

per

form

ance

revi

ew, m

ainl

y fo

r sta

gnan

t eco

nom

ic

deve

lopm

ent a

nd la

ck o

f lea

ders

hip.

One

par

t of h

is jo

b is

to m

onito

r, re

port

on

and

mak

e re

com

men

datio

ns

rega

rdin

g th

e ci

ty b

udge

t, w

hich

– a

dmitt

edly

– is

in th

e re

d. P

rope

rty

valu

es k

eep

drop

ping

, whi

ch m

eans

less

reve

nue

from

pro

pert

y ta

xes.

Mea

nwhi

le, e

xpen

ditu

res h

ave

incr

ease

d du

e to

hiri

ng e

xtra

pub

lic sa

fety

w

orke

rs. A

nd m

any

traffi

c offi

cers

– th

e so

urce

of a

lmos

t $1

mill

ion

in

reve

nue

from

fine

s in

pas

t yea

rs –

hav

e be

en re

allo

cate

d aw

ay fr

om

traffi

c du

ty to

han

dle

viol

ent c

rimes

and

dom

estic

dis

pute

s. An

othe

r pa

rt o

f Wad

e’s jo

b is

to in

terf

ace

with

the

com

mun

ity to

dev

elop

new

pr

ogra

ms,

but h

is p

erfo

rman

ce re

view

mad

e hi

m a

war

e th

at h

e ha

s no

t bee

n m

eani

ngfu

lly e

ngag

ed w

ith th

e co

mm

unity

for q

uite

som

e tim

e. S

o, w

hen

Dr.

Sylv

ia P

eter

son

requ

este

d a

mee

ting

with

him

to

disc

uss

poss

ible

str

ateg

ies

to re

duce

obe

sity

rate

s in

the

com

mun

ity,

he th

ough

t it w

ould

be

an e

asy

way

to g

et in

volv

ed, o

r at l

east

gar

ner

som

e go

odw

ill fr

om h

is b

oss.

She

brou

ght a

list

of p

oten

tial s

trat

egie

s, de

velo

ped

by th

e Ce

nter

s fo

r Dis

ease

Con

trol

and

Pre

vent

ion

and

linke

d to

thei

r Sta

te C

hron

ic D

isea

se P

lan,

and

won

dere

d if

he w

ould

be

will

ing

to m

eet w

ith o

ther

com

mun

ity s

take

hold

ers

to d

iscu

ss th

em.

She

also

invi

ted

him

to p

artic

ipat

e in

her

Wal

k w

ith a

Doc

pro

gram

.

Oth

ers W

ho C

are

CITY

MA

NA

GER

NA

ME:

Vict

oria

Nuñ

ez

YOU

R ST

ORY

:

Vict

oria

was

just

hire

d by

City

Man

ager

Wad

e Bi

llups

to b

e th

e pa

rks

and

recr

eatio

n di

rect

or, a

pos

ition

that

has

bee

n va

cant

for t

hree

ye

ars.

Vict

oria

is th

rille

d w

ith th

e jo

b, b

ecau

se it

brin

gs h

er b

ack

to h

er

hom

etow

n an

d th

e ba

rrio

whe

re h

er p

aren

ts s

till l

ive.

Aft

er fi

nish

ing

high

sch

ool o

verw

eigh

t and

out

of s

hape

, she

ser

ved

thre

e ye

ars o

n ac

tive

duty

with

the

U.S

. mili

tary

. Usi

ng th

e G

I Bill

, Vic

toria

go

t a d

egre

e in

spor

ts m

anag

emen

t and

then

stay

ed o

n at

the

univ

ersi

ty

wor

king

as

an a

ssis

tant

dire

ctor

in th

e at

hlet

ics

depa

rtm

ent f

or s

ever

al

year

s. Sh

e is

pas

sion

ate

abou

t fitn

ess

and

exci

ted

abou

t sta

rtin

g so

me

new

pro

gram

s in

the

city

. She

is a

lread

y pl

anni

ng s

ome

cultu

rally

ap

prop

riate

mar

ketin

g fo

r the

com

mun

ity, b

ased

on

her o

wn

pers

onal

ex

perie

nce

as a

n ad

oles

cent

with

a p

oor d

iet a

nd s

eden

tary

life

styl

e.

Dur

ing

her fi

rst m

eetin

g w

ith th

e ci

ty m

anag

er a

nd th

e ot

her

depa

rtm

ent h

eads

, she

lear

ned

of p

lans

to d

emol

ish

a co

ndem

ned

build

ing

next

to a

low

-inco

me

hous

ing

unit.

Mr.

Billu

ps is

reco

mm

endi

ng

that

the

land

be

sold

as c

omm

erci

al re

al e

stat

e be

caus

e se

vera

l fas

t foo

d ch

ains

hav

e ex

pres

sed

inte

rest

. But

Vic

toria

has

a d

iffer

ent v

isio

n fo

r the

pr

oper

ty …

she

see

s a

smal

l par

k w

ith a

pla

ygro

und,

bas

ketb

all c

ourt

an

d m

aybe

eve

n a

publ

ic sw

imm

ing

pool

. The

fact

that

it is

nex

t doo

r to

a ne

w c

omm

unity

gar

den

mak

es h

er p

lan

even

mor

e id

eal.

She

aim

s to

brin

g so

lid e

vide

nce

to th

e ne

xt m

eetin

g, a

long

with

info

rmat

ion

abou

t go

vern

men

t sub

sidi

es a

nd ta

x cr

edits

, to

conv

ince

the

team

and

the

city

co

unci

l tha

t the

city

resi

dent

s de

serv

e an

d ne

ed th

is n

ew p

ark.

Oth

ers W

ho C

are

PARK

S A

ND

REC

REAT

ION

NA

ME:

Tien

Jian

g (T

.J.)

Xiāo

YOU

R ST

ORY

:

T.J.

Xiāo

is th

e 70

-yea

r-ol

d ow

ner o

f Pop

’s M

arke

t. H

is fa

ther

, a

Chin

ese

mer

chan

t who

imm

igra

ted

to th

e ci

ty in

the

1950

s, pu

rcha

sed

the

stor

e fr

om it

s or

igin

al o

wne

r, Po

p D

unca

n. B

ecau

se

cust

omer

s w

eren

’t su

re h

ow to

pro

noun

ce h

is n

ame,

they

just

cal

led

the

new

ow

ner “

Pops

.”

The

stor

e lo

oks

pret

ty m

uch

the

sam

e as

it d

id w

hen

Pop

Dun

can

star

ted

it du

ring

the

Dep

ress

ion,

and

T.J

. stil

l use

s so

me

of th

e sa

me

vend

ors f

or sn

ack

food

s, bo

xed

mea

ls, li

quor

, cig

aret

tes a

nd to

iletr

ies.

A la

dy s

topp

ed b

y th

e ot

her d

ay, s

ayin

g sh

e w

as a

doc

tor a

t a lo

cal

clin

ic. S

he w

as c

heck

ing

the

plac

e ou

t, se

eing

if th

ere

was

any

he

alth

y fo

od fo

r sal

e. T

.J. t

old

her t

hey

had

trie

d to

sel

l pro

duce

–

actu

ally

trie

d th

is s

ever

al d

iffer

ent t

imes

– a

nd it

just

nev

er c

augh

t on

. Tho

se b

ins

of le

ttuc

e, g

reen

bea

ns, b

anan

as a

nd o

rang

es ju

st s

at

in th

e ba

ck o

f the

sto

re a

nd a

ttra

cted

flie

s. H

e lo

st m

oney

eac

h tim

e he

trie

d it.

Not

too

long

ago

, a s

ales

man

ask

ed h

im if

he

wan

ted

to

put i

n a

new

refr

iger

atio

n un

it so

he

coul

d ke

ep th

e pr

oduc

e lo

nger

. “H

ow m

uch

do th

ey c

ost?

” T.J

. had

ask

ed h

im.

“I co

uld

get y

ou o

ne fo

r abo

ut $

2,00

0,” h

e sa

id. “

And

the

stat

e ha

s ta

x cr

edits

for t

hese

type

s of

ene

rgy-

effici

ent a

pplia

nces

.”

“Wel

l, I m

ight

be

inte

rest

ed, b

ut fo

r tha

t muc

h m

oney

I’d fi

ll it

with

be

er in

stea

d an

d se

ll it

all d

ay lo

ng.”

T.J.

just

doe

sn’t

unde

rsta

nd w

hy p

eopl

e ar

e al

way

s w

antin

g to

ch

ange

eve

ryth

ing.

Are

n’t t

hing

s fin

e ju

st th

e w

ay th

ey a

re?

Oth

ers W

ho C

are

BU

SIN

ESS

OW

NER

NA

ME:

Dr.

Julie

Car

son

YOU

R ST

ORY

:

Julie

Car

son,

MD

, is a

bla

ck w

oman

and

the

dire

ctor

of t

he B

enni

ngto

n Co

mm

unity

Hea

lth C

ente

r. Sh

e ha

s trie

d to

be

supp

ortiv

e of

the

wor

k D

r. Pe

ters

on h

as b

een

doin

g, b

ecau

se it

seem

s to

have

gai

ned

trac

tion

with

pat

ient

s in

the

Wom

en a

nd C

hild

ren’

s Pr

ogra

m. E

ven

som

e of

th

e di

abet

es w

elln

ess

prog

ram

pat

ient

s ha

ve jo

ined

her

for a

Wal

k w

ith D

oc o

n oc

casi

on, w

hich

is a

goo

d th

ing,

bec

ause

thos

e fo

lks

need

to b

e ac

tive.

But

for p

atie

nts

with

obe

sity

, it s

eem

s to

Julie

that

th

ere

shou

ld b

e m

ore

of a

focu

s on

eat

ing

beha

vior

s, si

mpl

y he

lpin

g pa

tient

s fig

ure

out h

ow to

mak

e he

alth

ier c

hoic

es.

Dr.

Pete

rson

is c

ampa

igni

ng fo

r ext

ra s

taff

to e

xpan

d he

r wor

k an

d cr

eate

an

offici

al o

besi

ty p

rogr

am c

alle

d “D

on’t

Wei

ght –

Act

ivat

e!”

Alth

ough

Julie

hat

es th

is p

ropo

sed

nam

e, s

he’s

been

ope

n to

D

r. Pe

ters

on’s

idea

s …

she

eve

n ag

reed

to a

dd a

list

of s

cree

ning

qu

estio

ns fo

r all

patie

nts,

the

answ

ers

to w

hich

wou

ld b

e st

ored

in

thei

r ele

ctro

nic

heal

th re

cord

s. Th

ese

ques

tions

invo

lve

thin

gs

that

don

’t se

em d

irect

ly re

late

d to

obe

sity

in Ju

lie’s

view

– fi

nanc

ial

reso

urce

str

ain,

intim

ate

part

ner v

iole

nce,

adv

erse

chi

ldho

od

expe

rienc

es, s

ocia

l con

nect

ions

and

soc

ial i

sola

tion.

Her

dec

isio

n to

add

them

was

a p

ract

ical

one

: hav

ing

acce

ss to

that

info

rmat

ion

will

be

bene

ficia

l for

the

com

mun

ity n

eeds

ass

essm

ent t

he c

linic

is

requ

ired

to s

ubm

it as

a fe

dera

l gov

ernm

ent g

rant

ee. B

ut a

s fa

r as

hirin

g ne

w s

taff?

The

re’s

just

no

mon

ey in

the

clin

ic b

udge

t for

that

rig

ht n

ow, a

nd th

e ex

istin

g st

aff is

alre

ady

stre

tche

d to

o th

in a

s it

is.

Oth

ers W

ho C

are

CLIN

IC D

IREC

TOR

NA

ME:

Reve

rend

Isai

ah B

isho

p

YOU

R ST

ORY

:Re

v. B

isho

p is

the

past

or o

f a la

rge

blac

k co

ngre

gatio

n in

the

com

mun

ity. H

e is

a v

ery

influ

entia

l lea

der,

so m

any

peop

le s

eek

his

supp

ort a

nd e

ndor

sem

ents

for t

heir

vent

ures

. The

y ar

en’t

alw

ays

happ

y w

ith h

is re

spon

se, h

owev

er. R

ev. B

isho

p is

kno

wn

for h

is st

raig

htfo

rwar

d,

no-n

onse

nse

appr

oach

to li

fe. T

ake,

for e

xam

ple,

his

late

st m

eetin

g w

ith

Tim

Jaco

bs fr

om th

e he

alth

dep

artm

ent.

Tim

wan

ted

him

to h

elp

prom

ote

a co

mm

unity

gar

den

he h

ad ju

st st

arte

d ne

arby

. He

had

char

ts a

nd g

raph

s ab

out h

ow m

any

peop

le in

the

cong

rega

tion

need

ed to

lose

wei

ght a

nd e

at

heal

thie

r. Al

l fine

and

goo

d. R

ev. B

ishop

coul

d te

ll the

m to

get

off

thei

r but

ts

and

out o

f the

hou

se. H

e co

uld

tell

them

to st

op e

atin

g so

muc

h ju

nk. B

ut

unlik

e Ti

m Ja

cobs

, Rev

. Bis

hop

had

expe

rienc

e w

ith a

com

mun

ity g

arde

n,

seve

ral y

ears

ago

whe

n he

was

the

asso

ciat

e pa

stor

of a

noth

er c

hurc

h.

He

gave

Tim

an

earf

ul a

bout

the

thie

very

that

wen

t on

– ye

s, Ira

Tur

ner

stol

e G

lady

s Jon

es’ z

ucch

inis,

eve

ryon

e kn

ew it

– a

nd h

e ta

lked

abo

ut th

e tim

e M

yron

Daw

son

thre

aten

ed to

cho

ke li

ttle

Tim

my

Lee

for t

ram

plin

g hi

s tom

atoe

s, an

d ho

w th

e sh

ade

crea

ted

by th

e Jo

hnso

n’s b

ean

teep

ees

caus

ed th

e Cr

ensh

aw’s

pepp

ers t

o ge

t pow

dery

mild

ew. H

e ex

plai

ned

how

th

ey fi

nally

had

to c

lose

the

plac

e, b

ecau

se th

ere

wer

e so

man

y ho

mel

ess

peop

le w

ho c

limbe

d th

e fe

nce

look

ing

for s

helte

red

area

s to

sle

ep.

No,

he

wou

ld n

ot p

rom

ote

a co

mm

unity

gar

den.

But

Rev

. Bis

hop

wan

ts

to d

o so

met

hing

. He

know

s bl

ack

peop

le h

ave

high

er ra

tes

of o

besi

ty

and

diab

etes

than

oth

er s

egm

ents

of t

he c

omm

unity

. He

feel

s he

cou

ld

help

mak

e a

diffe

renc

e; h

e ju

st w

ants

to m

ake

sure

it’s

the

right

thin

g.

He’

s de

cide

d to

sta

rt w

ith a

hea

lthy

potlu

ck c

halle

nge

at th

e ne

xt

chur

ch g

athe

ring.

Oth

ers W

ho C

are

RELI

GIO

US

LEA

DER

STRATEGIES TO PROMOTE THE AVAILABILITY OF AFFORDABLE HEALTHY FOOD AND BEVERAGESStrategy 1 Communities should increase availability of healthier food and beverage choices in public service venues.

Suggested Measurement

A policy exists to apply nutrition standards consistent with the dietary guidelines for Americans (U.S. Department of Health and Human Services, U.S. Department of Agriculture. Dietary guidelines for Americans. 6th ed. Washington, DC: U.S. Government Printing Office; 2005.) to all food sold (e.g., meal menus and vending machines) within local government facilities in a local jurisdiction or on public school campuses during the school day within the largest school district in a local jurisdiction.

Strategy 2 Communities should improve availability of affordable, healthier food and beverage choices in public service venues.


A policy exists to affect the cost of healthier foods and beverages (as defined by the Institute of Medicine [IOM] [Institute of Medicine. Preventing childhood obesity: health in the balance. Washington, DC: The National Academies Press; 2005]) relative to the cost of less healthy foods and beverages sold within local government facilities in a local jurisdiction or on public school campuses during the school day within the largest school district in a local jurisdiction.

Strategy 3 Communities should improve geographic availability of supermarkets in underserved areas.


The number of full-service grocery stores and supermarkets per 10,000 residents within the three largest underserved census tracts within a local jurisdiction.

Strategy 4 Communities should provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas.


Local government offers at least one incentive to new and/or existing food retailers to offer healthier food and beverage choices in underserved areas.

Strategy 5 Communities should improve availability of mechanisms for purchasing foods from farms.

Suggested Measurement The total annual number of farmer-days at farmers’ markets per 10,000 residents within a local jurisdiction.

Strategy 6 Communities should provide incentives for the production, distribution and procurement of foods from local farms.

Suggested Measurement Local government has a policy that encourages the production, distribution and procurement of food from local farms in the local jurisdiction.

CDC’s Summary of Recommended Community StrategiesSTRATEGIES AND MEASUREMENTS TO PREVENT OBESITY IN THE U.S.

Source: MMWR, Recommendations and Reports, July 24, 2009 / 58(RR07);1-26

STRATEGIES TO SUPPORT HEALTHY FOOD AND BEVERAGE CHOICESStrategy 7 Communities should restrict availability of less healthy foods and beverages in public service venues.


A policy exists that prohibits the sale of less healthy foods and beverages (as defined by IOM [Institute of Medicine. Preventing childhood obesity: health in the balance. Washington, DC: The National Academies Press; 2005]) within local government facilities in a local jurisdiction or on public school campuses during the school day within the largest school district in a local jurisdiction.

Strategy 8 Communities should institute smaller portion-size options in public service venues.


Local government has a policy to limit the portion size of any entree (including sandwiches and entrée salads) by either reducing the standard portion size of entrees or offering smaller portion sizes in addition to standard portion sizes within local government facilities in a local jurisdiction.

Strategy 9 Communities should limit advertisements of less healthy foods and beverages.


A policy exists that limits advertising and promotion of less healthy foods and beverages within local government facilities in a local jurisdiction or on public school campuses during the school day within the largest school district in a local jurisdiction.

Strategy 10 Communities should discourage consumption of sugar-sweetened beverages.


Licensed child care facilities within the local jurisdiction are required to ban sugar-sweetened beverages, including flavored/sweetened milk, and limit the portion size of 100% juice.





Local government has a policy that encourages the production, distribution and procurement of food from local farms in the local jurisdiction.



STRATEGIES TO ENCOURAGE PHYSICAL ACTIVITY OR LIMIT SEDENTARY ACTIVITY AMONG CHILDREN AND YOUTHStrategy 12 Communities should require physical education in schools.


The largest school district located within the local jurisdiction has a policy that requires a minimum of 150 minutes per week of PE in public elementary schools and a minimum of 225 minutes per week of PE in public middle schools and high schools throughout the school year (as recommended by the National Association of Sports and Physical Education).

Strategy 13 Communities should increase the amount of physical activity in PE programs in schools.


The largest school district located within the local jurisdiction has a policy that requires K-–12 students to be physically active for at least 50% of time spent in PE classes in public schools.

Strategy 14 Communities should increase opportunities for extracurricular physical activity.


The percentage of public schools within the largest school district in a local jurisdiction that allow the use of their athletic facilities by the public during non-school hours on a regular basis.

Strategy 15 Communities should reduce screen time in public service venues.


Licensed child care facilities within the local jurisdiction are required to limit screen viewing time to no more than two hours per day for children aged ≥2 years.





Local government has a policy that encourages the production, distribution and procurement of food from local farms in the local jurisdiction.



STRATEGIES TO CREATE SAFE COMMUNITIES THAT SUPPORT PHYSICAL ACTIVITYStrategy 16 Communities should improve access to outdoor recreational facilities.


The percentage of residential parcels in a local jurisdiction within a half-mile network distance of at least one outdoor public recreational facility.

Strategy 17 Communities should enhance infrastructure supporting bicycling.


Total miles of designated shared-use paths and bike lanes relative to the total street miles (excluding limited access highways) that are maintained by a local jurisdiction.

Strategy 18 Communities should enhance infrastructure supporting walking.

Suggested Measurement Total miles of paved sidewalks relative to the total street miles (excluding limited access highways) that are maintained by a local jurisdiction.

Strategy 19 Communities should support locating schools within easy walking distance of residential areas.


The largest school district in the local jurisdiction has a policy that supports locating new schools, and/or repairing or expanding existing schools within easy walking or biking distance of residential areas.

Strategy 20 Communities should improve access to public transportation.


The percentage of residential and commercial parcels in a local jurisdiction located either within a quarter-mile network distance of at least one bus stop or within a half-mile network distance of at least one train stop (including commuter and passenger trains, light rail, subways and street cars).

Strategy 21 Communities should zone for mixed-use development.


Percentage of zoned land area (in acres) within a local jurisdiction zoned for mixed use that specifically combines residential land use with one or more commercial, institutional or other public land uses.

Strategy 22 Communities should enhance personal safety in areas where persons are or could be physically active.

Suggested Measurement The number of vacant or abandoned buildings (residential and commercial) relative to the total number of buildings within a local jurisdiction.

Strategy 23 Communities should enhance traffic safety in areas where persons are or could be physically active.


Local government has a policy for designing and operating streets with safe access for all users, which includes at least one element suggested by the National Complete Streets Coalition (http://www.completestreets.org).



Mod

el fo

r Im

prov

emen

tSource: Langley GL, Moen R, Nolan KM, Nolan TW, Norman CL, Provost LP. The Improvement Guide: A Practical Approach to Enhancing Organizational Performance (2nd edition). San Francisco: Jossey-Bass Publishers; 2009.

Wha

t are

we

tryi

ng

to a

ccom

plis

h?

How

will

we

know

th

at a

cha

nge

is a

n im

prov

emen

t?

Wha

t cha

nges

can

we

mak

e th

at w

ill re

sult

in

impr

ovem

ent?

Act

Stud

y

Plan Do

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