MOVING TOWARDS A HEALTHIER HARFORD KATHERINE RICHARDSON, MD An Analysis of Obesity Prevention Interventions for Harford County, Maryland

Acknowledgements  Capstone project for Master of Public Health, Johns Hopkins Bloomberg School of Public Health (JHSPH)  Harford County  Susan Kelly, Russ Moy, Kathy Kraft, and Bari Klein  JHSPH  Beth Resnick and Sara Bleich

My Background and Interests  Family physician in Baltimore  Interested in the role of the environment in an individual’s lifestyle decisions around food and physical activity  Believe states and counties are incubators for innovation in obesity prevention

Project Background  Harford County has a 20+ year history of public health efforts around nutrition and physical activity  Still, dramatic rise in obesity rates and the health consequences of obesity

Project Background  A wealth of information on goals, objectives, and evidence-based recommendations is available  Healthy People 2020 (HHS)  2010 White House Task Force on Childhood Obesity report  The Guide to Community Preventive Services (CDC)  Putting Business to Work: Incentive Policies for the Private Sector (Public Health Law & Policy)

Project Goal  To analyze community-based obesity prevention interventions in counties with similar demographics to Harford

Methods  56 peer counties from Community Health Status Indicators (HHS)  Peer counties stratified on the basis of population size and density, poverty level, income, age and race/ethnicity mix  56  14 counties by matching more closely on criteria above and proximity to Harford  14  8 counties based on online search for interventions

Methods  Included interventions in the matrix for each county if they were recent and local health department was involved  Spoke to staff at each local health department to refine matrix with the who, what, when, where, and how of each intervention  Received information on which were evidence- based, involved other stakeholders or policy changes, or were evaluated in any way

Key Conclusions  Interventions usually evidence-based, but typically lack evaluation and plan for sustainability  Community engagement, by building relationships over time and keeping key stakeholders motivated and active, is essential  Access to healthy foods includes lowering both physical and financial barriers  Incentive policies and programs often most acceptable to increase access

Key Conclusions  Promote health in policy decisions by planning and transportation departments via relationships across local governmental agencies  Address access to locales for physical activity as well as safety for built environment interventions

Policy Implications for the short-term  Conduct a Health Needs Assessment  Use best practices when forming action plans  Leverage resources and build consensus via collaborations

Policy Implications for the long-term  Adopt a “Health in All Policies” philosophy  Address policies, regulations, systems, and the built environment to promote sustainability  Employ a comprehensive approach, including schools, workplaces, restaurants, food stores, child care centers, and the built environment  Consider equity in decision-making by combining a population approach with a targeted approach aimed at high-risk populations

Wrap-up  Harford County is a leader for nutrition and physical activity interventions  History of addressing these issues  Timely local data gathered on important health indicators  Wide range of stakeholders involved over time  More comprehensive approach needed to make “the healthier choice the easier choice” with changes to  Policies  Regulations  Systems  Built environment

Wrap-up  With an emphasis on sustainability and evaluation, Harford County can learn from others, adapt best practices to the local community, and continue to insist that data inform priorities and define progress