Childhood Obesity Action Network

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Advocacy Strategies to Address Obesityin Your
Community- Childhood Obesity Action Network
-The Healthcare Campaign to Stop the Epidemic
Chicago, ILAugust 16, 2008

• Scott Gee, MD, FAAP
• Medical Director, Prevention Health Information
• Kaiser Permanente Northern California
• The speaker in this session has no relevant
  financial relationships with the manufacturer(s)
  of any commercial product(s) and/or provider of
  commercial services discussed in this CME
  activity. The speaker will not discuss or
  demonstrate pharmaceuticals and/or medical
  devices that are not approved by the FDA and/or
  medical or surgical procedures that involve an
  unapproved or "off-label" use of an approved
  device or pharmaceutical.

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By the end of the workshop attendees will be able
to

• Describe 3 evidence based environmental
  strategies to address obesity
• Construct a 3 minute advocacy talk
• Describe 3 roles of health professional advocacy

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Evidence Based Environmental Strategies to
Address Obesity
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Are overweight children a personal or community
issue?
1,068 random sample CA residents, telephone
survey 10-11/2003 http//calendow.org/caobesityatt
itudes/index.htm
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Pleasanton Pediatrics Bike Helmet Quality
Improvement Project 1990 -1993
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Community Health An Evidence-Informed Approach

• Collaborate with our communities to establish a
  specific, short-term health related goal
  (community data, needs assessment)
• Identify evidence-based best practice(s) for
  achieving shared goal (Medline, Community Guide)
• Collaborate with our communities to adapt this
  best practice to the communitys unique assets
  and constraints
• Evaluate the project by using appropriate
  expertise

Pediatrics April 20051151142-1147
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Which community physical activity interventions
have good evidence?

• Community-wide campaigns
• Point-of-decision prompts
• School-based physical education
• Social support in community settings
• Individually-adapted health behavior change
• Creation and/or enhanced access to places for
  physical activity combined with informational
  outreach activities
• Community-scale urban design/land-use policies
  practices
• Street-scale urban design/land-use policies and
  practices

http//www.thecommunityguide.org
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Which community physical activity interventions
have insufficient evidence?

• Classroom-based health education focused on
  information provision
• Mass media campaigns
• Health education w/ TV/video game turnoff
  component
• College-age physical education/health education
• Family-based social support

http//www.thecommunityguide.org
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School Strategies with Good Evidence

• Implementation of a comprehensive food policy
• Large food subsidies (gt 50 cost reductions)
• Multiple nutrition education activities with
  integrated curriculum including parent/family
  outreach
• Improved physical education
• Enhanced playgrounds
• After-school programming
• Multi-level comprehensive strategies

http//www.cnr.berkeley.edu/cwh
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A Community Intervention Reduces BMI z-score in
Children Shape Up Somerville First Year Results

• A non-randomized controlled trial was conducted
  in three culturally diverse urban cities in
  Massachusetts.
• Children (n 1178) in grades 1 to 3 attending
  public elementary schools participated in an
  intervention
• Focused on the before-, during-, afterschool,
  home, and community environments.

Obesity Vol. 15 No. 5 May 2007 Pages 1325 - 1336
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Shape Up Somerville First Year Results

• At baseline, 44 (n 385), 36 (n 561), and
  43 (n 232) of children were above the 85th
  percentile for BMI z-score in the intervention
  and the two control communities, respectively.
• In the intervention community BMI z-score
  decreased by -0.1005 (p 0.001) compared with
  children in the control communities after
  controlling for baseline covariates.
• A community-based environmental change
  intervention decreased BMI z-score in children at
  high risk for obesity.

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Shape Up Somerville First Year Results

• Before School
• Breakfast program
• Walk to school campaign
• During School
• Professional development for all school staff
• School food service improvements
• SUS classroom curriculum
• Enhanced recess
• School wellness policies

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Shape Up Somerville First Year Results

• After School
• SUS after-school curriculum
• Professional development for program staff
• Walk from school campaign
• Home
• Parent outreach and education
• Family events
• Parent nutrition forums
• Childs Health Report Card mailed each year

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Shape Up Somerville First Year Results

• Community
• SUS Community Advisory Council
• Ethnic-minority group collaborations
• Support from local community champions
• Walking/pedestrian training
• City employee wellness campaign
• Farmers Market initiative
• SUS approved restaurants
• City ordinances on walkability/bikeability
• Annual SUS 5 K Family Fitness Fair
• Regular local media placement
• Resource guides
• Local physician and clinic staff training

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Physical Activity, Obesity and Safety

• Access to safe parks helps increase physical
  activity among teenagers
• Neighborhood safety ratings were independently
  associated with a higher risk of obesity at the
  age of 7 years
• Public health efforts may benefit from policies
  directed toward improving both actual and
  perceived neighborhood safety

UCLA Health Policy Research Brief December 2005
(CHIS 2003) Arch Pediatr Adolesc Med. January
200616025-31
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Effective Speaking Techniques
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Physicians for Healthy Communities Toolkit

• Speaker Bureau Basics
• Key Messages
• Working with Schools
• Grassroots Advocacy and Obesity Prevention
• Research Articles
• Forms
• Resources

http//www.calmedfoundation.org/projects/phyChampi
on.aspx
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Effective Speaking Tips

• Adapt your presentation to meet the needs of your
  audience
• Practice especially the beginning and end of
  your talk
• Ask for audience participation What are your
  ideas on how to get kids to eat healthier or be
  more active?
• Relax, use a conversational tone and have fun
• Use powerful stories to convey your message
• Use humor carefully, it is safest to joke about
  yourself
• Expect tough questions and challenges
• Acknowledge controversies and concerns
• Redirect to other questions

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Health Professionals as Advocates

• Introduce yourself
• Name, credentials, specialty, years of experience
• Professional organizations if applicable
• Thank the audience and organizers
• Use examples from your practice to highlight your
  point of view
• Be an expert memorize key talking points
• Use data and research to improve your credibility
• Use the simplest (low-literacy) words possible,
  avoid jargon
• Be confident but not overconfident

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Organizing Your Talk

• Introduction
• Opening - Point of View
• Key Point 1 - The Problem
• Key Point 2 - The Solution
• Key Point 3 - The Benefits
• Closing - Reinforce Point of View

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Organizing Your Talk

• Opening
• Use storytelling to convey your point
• State what you are advocating for or state the
  conclusion
• Key Point 1 - The Problem
• Define the problem
• Tailor the message to match the audience using
  community or race/ethnicity data
• Key Point 2 - The Solution
• Ask audience for their ideas for solutions
• Give proposed solutions tailored to the
  audience/community

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Organizing Your Talk

• Key Point 3 - The Benefits
• Whats in it for me?
• Give proposed benefits tailored to the
  audience/community
• Closing
• Re-state what you are advocating for
• Use storytelling to reinforce your recommendation
  and improve self-efficacy

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Storytelling

• Is personal, emotional and memorable
• Can prove your point
• Complements the use of evidence and data
• Can be drawn from your personal or clinical
  experience
• Types of Stories
• Illustrating the problem
• Overcoming challenges and solutions
• Philosophy, mission or vision

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Visual Aids

• Visual aids can illustrate your point and create
  a more memorable presentation
• Photos
• Videos
• Props
• Examples of amount of sugar or fat content
• Portion sizes

Because of a lack of sidewalks and an adequate
bike lane, the residents have to put their own
signs out for the safety of their families and
their children walk in the street with the risk
of suffering an accident.
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Methods of Communication

• Legislators
• Letter or E Mail
• Phone Call
• Visit or Meeting
• Testify at a Legislative Hearing
• School Board
• Letters
• Presentation at School Board
• Using Media
• Newspaper Articles or Editorials
• Radio and TV
• Community Education and Health Promotion

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Key Messages

• Since the 1970s the number of obese children in
  the U.S. has tripled.
• I think were looking at a first generation of
  children who may live less long than their
  parents as a result of the consequences of
  overweight and type 2 diabetes.
• Once rare in children, Type 2 Diabetes is now 32
  of new cases, a 10 fold increase from 1982-1994.
• Health care for obese individuals costs an
  average of 37 more than for people of normal
  weight, adding an average of 732 to the annual
  medical bills of every American.

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Tailoring Key Messages - What is in it for me?

• Every audience has different knowledge,
  priorities and expectations
• Example School Principal
• There is a considerable amount of evidence that
  improving nutrition and fitness is associated
  with improved academic performance in children.
• Improving nutrition and fitness should increase
  school revenues. Severely overweight children
  miss four times as much school as normal-weight
  kids. If such health problems keep children out
  of school just one day per month, this could cost
  a large school district like Los Angeles about
  15 million each year.

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Finding Information and Research

• U.C. Berkeley Center for Weight and Health
  http//www.cnr.berkeley.edu/cwh
• Centers for Disease Control and Prevention
  http//www.cdc.gov/
• Institute of Medicine http//www.iom.edu
• Guide to Community Preventive Services
  http//www.thecommunityguide.org
• E. N. A. C. T. http//www.preventioninstitute.org
  /
• Childhood Obesity Action Network
  http//wwwNICHQ.org

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Finding Data Sources

• California Health Interview Survey (CHIS)
• Overweight Chronic Conditions
• Health Behaviors
• Adults and Children
• http//www.chis.ucla.edu
• Center for Public Health Advocacy
• Overweight Fitness
• Children in 5th, 7th 9th Grades
• http//www.publichealthadvocacy.org

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Childhood Obesity Action Network State Fact Sheets
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(No Transcript)
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Working with the Media

• Media Must Do...
• Your homework - know your key points and media
  format
• Practice delivering your introduction, message
  and presentation
• Dress professionally and maintain eye contact
  with the host
• Stay on message, insert your key points or story
  within the context of their questions
• Media Must Do Not
• Assume the reporter knows the subject
• Ever tell a lie, provide incorrect data or
  stretch the truth
• Try to cover too many subjects, ramble or use
  jargon
• Become defensive or argumentative with a reporter

Policy Link - www.policylink.org
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Working with Schools

• Identify a site champion
• Identify the academic goals
• Tailor your talk to meet the needs and cognitive
  ability of the children
• Make contact with the school principal
• Organize your presentation
• Visual aids fat, sugar , portion sizes
• Video Supersize Me
• School Presentation Toolkit

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Health Professional Advocacy
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The Role of Health Professionals in Community
Advocacy
JAMA January 7, 2004 - Vol. 291, No. 1 pp. 94-98

• Provide quality care to individual patients in
  regular practice.
• Improve the system of care delivered by
  group/organization.

• Environmental change in local schools and
  communities to address tobacco, injury
  prevention, and obesity.
• Public policy to address same issues.

• Provide quality care to uninsured patients.
• Improve insurance coverage, after-hours care and
  geographic distribution of services.

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Public Roles of US Physicians

• Mailed survey of 1,662 US physicians in 2003-2004
• Results
• Over 90 rated community participation and
  political involvement as important
• 54 had participated in a community event in the
  last 3 years
• Nutrition, immunization, substance abuse and road
  safety issues were rated as very important
• Older age, women, minorities and foreign medical
  graduates were more likely to rate advocacy as
  important

JAMA 20062962467-2475
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Doctors Make Particularly Good Advocates

• Polling information indicates that doctors are
  particularly effective messengers on obesity
  prevention issues.
• People trust doctors because of their expertise
  and because they believe doctors do not have
  ulterior motives.
• Doctors can use the unique respect they inspire
  to draw attention to the obesity epidemic.
• Doctors status in society makes them appealing
  to the media as authoritative spokespeople. The
  very presence of a doctor can attract reporters
  to an issue or event such as a press conference.

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The Role of Health Professionals in Community
Interventions and Advocacy

• Subject matter expertise and credibility
• Participation in community collaborative
  activities
• Consultation and advocacy on policy
  recommendations and legislation
• Presentations to government, school boards,
  teachers, parents and students
• Training community health professionals
• Media interventions

Pediatrics Vol. 112 No. 4 October 2003, pp.
e328-346 Pediatrics Vol. 115 No. 4 April 2005,
pp. 1142-1147
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Advocacy Overview

• Advocacy
• Identifying an issue
• Drawing attention to the issue
• Working towards a solution
• Lobbying
• Is a subset of advocacy which promotes or opposes
  specific legislation, political candidates, or
  ballot initiatives
• Often government or foundation funds will not
  support lobbying activities

Policy Link - www.policylink.org
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Steps to Advocacy

• Organizing and coalition building
• Finding information/research
• Policy and strategy development
• Mobilizing and communications

Policy Link - www.policylink.org
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Step 1 - Organization and Coalition Building
Effective Coalitions The 8-Step Process

• Analyze program objectives, determine whether to
  form a coalition
• Recruit the right people
• Devise preliminary objectives and activities
• Convene the coalition
• Anticipate necessary resources
• Develop a successful structure
• Maintain coalition vitality
• Improve through evaluation

Prevention Institute - www.preventioninstitute.org
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Step 2 - Finding Information and Research

• Why
• To help understand the issues
• To help identify priorities
• To help make your argument
• What
• Accessible, credible, clear
• Data and stories

Removing soda from school wont help me lose
weight. The only exercise I ever get is walking
upstairs to this vending machine.
Policy Link - www.policylink.org
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Step 3 - Policy and Strategy Development

• The Problem
• What issue will be your focus?
• Is it big enough? Is it small enough?
• The Solution
• How much can you ask for?
• The Process
• The Players
• Allies and opponents
• Power mapping - strength of opposition or support

• Identifying targets, opposition and tactics
• Primary targets the people who have the power to
  give you what you want
• Secondary targets the people who can influence
  the primary targets (media)
• Who has the power to organize an effective
  opposition?
• Pick an action you believe has some chance of
  success
• Know your priorities and the bottom line

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Step 4 - Mobilizing and Communications

• Outreach Directly to Policymakers
• Letters, phone calls, e-mails to decision-makers
• Meet with decision-makers and/or their staff
• Testify before a committee
• Reach People Who Can Influence Policymakers
• Outreach to other organizations for support
• Educate the public through strategic events and
  media coverage
• Produce fact sheets or reports
• Protests and grassroots activities

Policy Link - www.policylink.org
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Legislative Process

• The Legislature maintains a legislative calendar
  governing the introduction and processing of the
  legislative measures during its two-year regular
  session.

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State, County and Local Government Structure

• Policies and built environment can be addressed
  at the State, County and City level.
• Planning commissions can play a major role in
  land use and transportation issues.

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School System Structure

• Your first step as a school advocate is to send a
  letter to the school districts school board.
• Speaking to the School Board
• Call the districts board office and request to
  be placed on the agenda with an explanation of
  your subject matter.
• Request to be placed on the next board meeting
  agenda after speaking during the three minute
  public comment time at a public board meeting.

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Qualities of an Effective Health Professional
Advocate

• Has an important, relevant, personal or
  professional story to tell
• Knows the facts (data) and where to find them
• Leverages expertisetheirs and others
• Networkswith other advocates and with
  decision-makers
• Is consistent and persistent
• Is cooperative, courteous, and positive
• Is solutions-oriented
• Pays attentionto others, to the field, to policy
  developments, and to timing

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Steps to Effective Health Professional Advocacy

• Identify and understand the issue
• Get the data
• Partner and collaborate
• Frame your message
• Be descriptive
• Propose solutions
• Know your audience and tailor the messages for
  them
• Leverage your expertise as a doctor
• Choose your method(s) of communication

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Physicians for Healthy Communities Advocacy
Obesity Toolkit

• Sample Letter to Your Legislator
• Phone Script for Calling a Policymaker
• Tips for Planning Your Meeting with a Policymaker
• How to Testify at Legislative Hearings
• Sample Legislative/Committee Testimony
• Introductory Letter to School Board
• Guidelines for Full Presentation at a School
  Board Meeting
• Using the Three Minute Public Comment Period
• Sample Script Three Minute Public Comment

http//www.calmedfoundation.org/projects/phyChampi
on.aspx
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Advocacy Case Study
Case Study You are asked by a community based
organization to give a testimony to the county
transportation commission to support safe routes
to school.

• What would your introduction be?
• What would be your key messages?
• What might be the competing priorities for the
  transportation commission?
• What data or visual aids would you need?
• What story could you use to illustrate your point
  of view?

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Advocacy Case Study
Pick one of the following to practice

• Introduction
• Opening - Point of View
• Key Point 1 - The Problem
• Key Point 2 - The Solution
• Key Point 3 - The Benefits
• Closing - Reinforce Point of View

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Where can I start working on community advocacy?

• What is your passion and mission?
• What changes would you like to see happen in your
  schools or community?
• What community efforts could you join?
• Who is in your circle of influence?
• Your clinic or hospital
• Your childs school
• Your place of worship
• Your clubs or organizations

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Using a Proactive Focus to Improve Effectiveness

• Your circle of influence are the people who know
  you and respect you.
• Proactive people focus their efforts in the
  circle of influence, working on things they can
  do something about.
• The results of these activities are usually
  positive which leads to an expansion of the
  circle of influence into the circle of concern

The 7 Habits of Highly Effective People S.Covey
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Possible Health Care Policy and Organizational
Practices

• Policy Environmental Change at Healthcare
  Facilities
• Food policy - cafeteria, vending machines,
  patient meals, gift stores, food at professional
  meetings
• Pumping rooms for breast feeding mothers
• Infant formula - eliminate free samples and
  marketing
• Baby Friendly hospitals
• Organizational Practices
• Access to health care
• BMI as a vital sign
• Access to weight management and breastfeeding
  programs
• Breast feeding, communication advocacy training
• Health Plans reimbursement for obesity services

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Impact of Fast Food Restaurants in Childrens
Hospitals

• 59 of 200 hospitals with pediatric residencies
  had fast food restaurants
• Outpatient survey respondents from hospitals with
  a McDonalds restaurant were more likely to
• Have purchased McDonalds food that day
• Believe that McDonalds supported the hospital
  financially
• Rate McDonalds food as healthy

Pediatrics Vol 118, No 6 December 2006 pp.
2290-2297
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The normal physician treats the problem the
good physician treats the person the best
physician treats the community. Chinese proverb
The first US child safety seat law was passed in
1977 as the result of the hard work and
persistence of Robert S. Sanders, MD, a
pediatrician.