Moving the Needle to Healthy Eating and Active Living for All: Strategies for Policy, (Systems) and Environmental Change Susan B. Foerster, Chief Cancer Prevention and Nutrition Section California Department of Health Services Oregon Division of Health Portland, OR February 11, 2003

Objectives Share “what’s working” in current environment south of the (Oregon) border. Provide disciplined way of thinking about, gaining synergy from diverse activity. Reflect strategically on where we are with social change.

What’s Working?

Social Marketing, as Defined, Works! California Nutrition Network Definition of Social Marketing “…The use of commercial marketing approaches to achieve a social goal… includes the traditional mix of advertising, public relations, promotion, and personal sales, and adds consumer empowerment, community development, partnership, media advocacy, and policy-systems-and-environmental change…”

A Multi-Level Campaign Works National (5 A Day, Food Stamp Outreach, Team Nutrition, Changing the Scene, Verb Campaign, etc.) State (5 a Day, Nutrition Network, CPL, state agencies and organizations) Regions (Media Markets) Counties, Cities, School Districts (Local Governments) Communities

The Social-Ecological Model Works! F

Using a Disciplined Eye

Focus on the “Outer Spheres of Influence” Institutions = “Channels” that influence consumer behavior Community = Multiple channels collectively influencing behavior Society = Norms and values, the broadest level of influence

Use the Right Strategies, a la Carrots, Sticks and Promises* Education is enough for: The “prone” individual/segments Marketing encourages: The “unable” individual/segments Law is needed for: The “resistant” individual/segments * Rothschild, Journal of Marketing, 1999

Aim for Endpoints that Affect Lots of People Policies = Written statements of values, behavior, resource allocation by public, non-profit or private sectors System Changes = Interventions in channels/organizations with “reach” and influence that promote and enable new behaviors efficiently Environments = Physical (food, transportation), media, or economic factors that incent or enable behavior

So, Where Are We?

Institutional Changes that Local Partners Are Making Media—coverage, editorials, sustained issues programming School districts—farmers’ market salad bars, farm-to-school programs, Power Play! participation, school food and PE policies, participation in federal food assistance programs Worksites—Fuel Up, Lift Up LA!, San Diego Nutrition Network partnership agreements African American Faith Organizations— pastoral leadership, change food and physical activity practices, outreach to community

Institutional Changes that State Partners Are Making Media—Media relations w/interested reporters/outlets Supermarkets, restaurants—5 a Day initiatives School districts—Superintendent’s Garden in Every School initiative, First Lady’s Nutrition Task Force, CEWAER’s Healthy School Alternatives Worksites—Be Active—5 a Day! Campaign (new) Food Security—Food Stamp WIC/DSS “summits”, EBT in farmers’ markets, Special Projects Local Incentive Award program—require, fund policy, systems, environmental change Interagency Agreements with sister state agencies

Community Changes that Local Partners Are Making Cities—Healthy Cities’ Fresh Ideas, proclamations, food policy councils, Berkeley bond measure Multiple sites—advocacy for environmental and policy change a la CFSC’s Weaving the Food Web (Farm Fresh Choice, farm tours, transportation) Legislative Districts—Grassroots Child & Youth Nutrition and Fitness Campaign starting move to SB 19, SB 1520 (soda tax attempt) Commercial food outlets—South Central LA, Alameda County—“Show me the money!”

Community Changes that State Partners Are Making CDE/CEWAER’S 2000 Healthy School Environment Summit, subsequent activities NetCom—started as PR training, became regional collaboratives, emerging as ongoing and more vertically integrated PR “counsel” Convenings—2001, 2003 Childhood Obesity Conferences; 2003 Working Families Policy Summits; Network’s Policy Action Teams

Societal Changes that Local Partners Are Making NetCom—Some collaboratives have set aggressive policy goals Center for Food and Justice’ investigation of fast food in children’s hospitals, multiple agriculture initiatives, examination of food industry influence (Fat Land) County-wide campaigns—Alameda, San Diego California Food Security Network—drafting a policy platform

Societal Changes that State Partners Are Making Get smart with practical research—barriers to Food Stamp use, cost of obesity and physical inactivity, economic benefits of increased f/v intake National 5 A Day Program—state strategic planning w/expanded national partnership leading to policy proposals—preschoolers, worksites, African American Campaign California State Library—Overweight Kids, Why Should We Care?, policy seminars and field trips, ongoing counsel, men’s nutrition study

Societal Changes that State Partners Are Making (cont’d.) Working Families Summits—“deep” policy development, alliances, caucus support leading to legislative proposals Secondary data analysis by geopolitical unit— CPHA’s Fitnessgram by Assembly district, CFPA’s food insecurity rates by county Federal policy—state’s weighing in on 2002 Farm Bill, 2003 Child Nutrition Act, transportation act?

Emerging Themes “Convenings” work! For now, no-cost, low-cost, revenue- generating ideas are it Use no-money time to plan, streamline, ask “why not”? Tailor to legislators’ interests “Silos” breaking down, “networks” and collaboratives forming Stay tuned!

Musings on Social Transformation, as per Tufts Crisis Science Mass media coverage Economic feasibility, plus education to drive demand Champions and leaders Coalitions, advocacy Government involvement An integrated plan!

With thanks to our funders! California public agency partners, for in-kind contributions USDA Food Stamp Program The California Endowment CDC Prevention Block Grant California Department of Social Services California Department of Food and Agriculture