The Value of Policy and Environmental Changes Texas Department of State Health Services Nutrition, Physical Activity & Obesity Prevention Program The Value of Policy and Environmental Changes to Support Physical Activity Natalie Clifton, M.Ed., CHES 2010 State Agency Wellness Conference September 22, 2010 1

Evidence Available, Affordable, & Easy “Policy and environmental change initiatives that make healthy choices in nutrition and physical activity Available, Affordable, & Easy Will likely prove most effective in combating obesity.” 2

Obesity Target Areas Physical Activity Fruits & Vegetables TV Viewing Sugar-Sweetened Beverages Physical Activity Fruits & Vegetables High- Energy- Dense Foods TV Viewing Breastfeeding 3

Basic Public Health Question Will the public’s health improve primarily as a result of: Individuals getting more and better knowledge about personal risk factors that increase the likelihood of obesity OR Individuals and groups getting more skills and opportunities to participate in changing public policy and environments?

Socio-ecological Model

Policy & Environmental Change: More than telling people what to eat and how to exercise Shift the focus from individual behavioral level Advance solutions that improve health on a population level

So What is P&E Change? Policy – laws, regulations, formal and informal rules and understandings that are adopted on a collective basis to guide individual and collective behavior Environmental change – things that alter or control the legal, social, economic, and physical environment affecting health

What P&E Change is Not Health fairs Education Events Brochures Classes Other

Social Accountability Personal Responsibility Balancing Values Social Accountability Personal Responsibility

Growing Community Video Series www.dshs.state.tx.us/obesity/GrowingCommunity.shtm 11

Texas! Bringing Healthy Back: The DVD Six short videos (5-8 minutes each) featuring inspiring community programs CDC Evidence Based Strategies 12

Texas! Bringing Healthy Back Initiative with a pioneering approach: Community vs. Individual Examples of changing our environment to make healthy living the easy choice in Texas. Goal: To Make Healthy Eating and Active Living the Easy Choice for All Texans.

Your Role: Catalyst for Change Help Bring Healthy Back to Texas by: Watching the six videos Sharing the videos with others: Encouraging a discussion Logging your Screenings at the Bringing Healthy Back Web site: www.texasbringinghealthyback.org 14

1. Watch the Six Videos on the DVD

2. Share the videos with others by:

3. Share the Message Encourage a discussion

4. Share the results with DSHS

CDC Community Guide: Environmental and Policy Approaches to Increase Physical Activity Community-Scale Urban Design Land Use Policies Creation of or Enhanced Access to Places for Physical Activity Combined with Informational Outreach Activities Street-Scale Urban Design Land Use Policies Point-of-Decision Prompts to Encourage Use of Stairs

Create or enhance access to places to be physically active… Building walking trails Providing public access to school gymnasiums, playgrounds, or community centers. Worksite activity programs that provide access to onsite or offsite fitness rooms, walking breaks, or other opportunities to engage in physical activity. Interventions to improve access should also include outreach that increases awareness of the opportunity to be active

Worksite Physical Activity Strategies 1. Allow maximum access to recreation facilities. 2. Provide cash incentives or reduced insurance costs for participation in physical activity and/or weight management or maintenance activities 3. Institute environmental changes to increase activity.

Worksite Physical Activity Strategies 4. Set up programs that have strong social support systems and incentives. 5. Encourage scheduling that allows for more activity. 6. Promote opportunities. 7. Provide on-site child care facilities to facilitate physical activity

Improving Worksite Stairwells Stairwell Basics • The stairwells need to be safe, with controlled access from the outside. • Stairwells should be well-lit with good visibility (including mirrors and video cameras if needed). • Stairwells should be well constructed and maintained, equipped with non-slip or non-skid treads, and cleaned regularly. Creating Attractive and Inviting Stairwells • Post motivational signs and prompts at elevators that encourage employees to take the stairs.

Alternative Transportation "Alternative transportation" modes are telecommuting, carpools, vanpools, public transportation, bicycling, walking, and running. These commute methods are relevant to employee health in two ways: A reduction in the use of single-occupancy vehicles helps reduce environmental fuel emissions. Employees who use "active transport" (public transportation, bicycling, and walking) to commute to work may increase their daily physical activity.

Federal Agency Policy Examples 5 U.S.C. § 7901 Federal agency heads may establish health service programs to promote and maintain the physical and mental fitness of their employees. Authorizes agencies to establish and operate physical fitness programs and facilities designed to promote and maintain employee health, such as occupational safety and health. 41 CFR 102-79.30 States that federal agencies can allot space in federal buildings for fitness programs. 5 U.S.C. § 7905 States that federal agency heads may develop programs to encourage commuting by means other than single-occupancy motor vehicles. Includes transit passes and furnishing space, facilities, and services to bicyclists. 5 U.S.C. § 5946 Sets limits on paying membership fees or dues of federal employees in societies or associations. However, Comptroller General Decision B-240371 (Jan 18, 1991) allows agencies to pay for access to private fitness facilities for its employees as part of its health service program.

Resources 2008 Physical Activity Guidelines for Americans: http://www.health.gov/paguidelines/ Guide to Community Preventive Services: Worksite Health Promotion http://www.thecommunityguide.org/worksite/index.html Recommended Community Strategies and Measurements to Prevent Obesity in the United States: http://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf Healthier Worksite Initiative, CDC http://www.cdc.gov/nccdphp/dnpa/hwi/index.htm Indicators of Activity-Friendly Communities http://www.nspapph.org/index.php?option=com_docman&task=doc_download&gid=26&Itemid=83 Visit www.cdc.gov/nccdphp/dnpa/stairwell/motivational_signs.htm to obtain sample stairwell signs that have been tested and found to be effective.

For further information & resources: www.texasbringinghealthyback.org 27

Natalie Clifton Texas Department of State Health Services Nutrition, Physical Activity & Obesity Prevention Program Natalie Clifton Texas Department of State Health Services Nutrition, Physical Activity & Obesity Prevention  Tower Building 406 / Mail Code 1944 PO Box 149347  Austin, Texas 78714 P 512-458-7111 ext. 3447 F 512-458-7618 E-Mail: Natalie.Clifton@dshs.state.tx.us 28