1. Systems and Environmental Change Web-based Toolkit
Suzanne: I will now provide a short introduction and Jenny Wong who just completed her MPH internship with me will present on her project- the Systems and Environmental Change toolkit that is tailored for those working with MCAH programs.
Suzanne Haydu, MPH, RD
Jenny Wong, MPH

2. Project Overview
Jenny’s MPH project was to develop a web-based toolkit for local MCAH programs to use when working on environmental change projects related to 1) optimal nutrition, 2) physical activity and 3) breastfeeding. It is not intended to be a comprehensive site but was to cull existing materials for what might be most useful to you.
To develop the toolkit, Jenny was asked to click click 1) review the LHJ MCAH annual reports for systems and environmental change activities that they are involved in, click 2) interview MCAH Directors and key state and local experts, click 3) review existing related web sites, and click 4) complete a literature review

3. Systems and Environmental Changes
Reviewing the MCAH annual reports and talking to MCAH Directors, we realized that some MCAH Directors did not think MCAH was involved in environmental change—this included some MCH programs that actually were working in this area. So as I mentioned earlier, we consider systems and environmental changes to be altering the built environment to influence health across a population. Advice to click breastfeed our babies or to click eat well and exercise often does not take into account that the environment may not be conducive to these healthy activities.
Systems and environmental changes can involve a variety of activities: for example, having lactation accommodations can help promote and support breastfeeding in the workplace. This photo is one of our lactation rooms at CDPH. And supporting a farmers’ market can increase access to fruits and vegetables. This photo is of one of two local farmers’ markets that has inspired my coworkers and myself to buy and eat more fruit and vegetables.

4. Systems and Environmental Changes
Suzanne: We were happy to find that 33 out of the 61 LHJ MCAH programs were working on Systems and Environmental Changes! Each local health jurisdiction reported working on different projects with different resources to share. Jenny will update you on this and explain the toolkit.
Jenny:
Systems and Environmental Changes
Going off of what Suzanne said, over half of the local health jurisdiction (or LHJ) MCAH programs were working on systems and environmental changes. This bar graph stratifies the different breastfeeding, nutrition, and physical activity-related activities done in these 33 counties. As you can see, there were many interventions focused on improving the breastfeeding built environment, followed by the nutrition and physical activity environments.
Side note:
Planned Implemented
Breastfeeding 4 23
Nutrition 8 16
Physical Activity 7 11
Other 3 3
Other:
planning includes empowerment and/or training
implementation includes community safety
Toolkit demonstration
We used these three categories of breastfeeding, nutrition, and physical activity as the main focus areas of our toolkit.
(Share view of toolkit on Internet Explorer)
We developed a Tree Diagram to highlight Resources – Users are able to use the tree to navigate to various built environment resources. The branches of the trees represent the main focus areas of the toolkit and clicking on them will take you to general resources about that topic area. For example, under “Nutrition” (click “Nutrition” branch) you can find general resources about the nutrition environment and health (click ‘Go to top”). The leaves represent chosen interventions or activities, and clicking on those will take you to resources pertaining to that specific intervention. If you click on one of the leaves, like “Farm to School,” (click “Farm to School”) it will take you to Farm to School resources (click “Go to top”). The apples represent “low-hanging fruit” which are a course of action that can be undertaken relatively quick and easy as part of a wider range of changes or solutions to a problem. These projects are similar to those already implemented by Directors or other key informants thus designated as “low-hanging fruit.” They are optimal projects to begin with as other MCAH programs have been successful already doing them. For the “Nutrition” section, we have designated Farmers’ Markets as the low-hanging fruit (click “Farmer’s markets”) and included various resources on how to establish a farmers’ market in your own community. When reviewing the MCAH annual reports, we found that half of the counties who reported working on systems and environmental changes in the nutrition environment were actually involved in a farmers’ market.
(stay in this part of webpage)
Success stories – Under each topic area, we have a short section titled “Success story” to highlight best practices for local health jurisdictions to replicate. For the nutrition topic area, we highlight Alameda County who received a Kresge Foundation Grant to improve the nutrition environment in local corner stores of their community.
(click “Go to top”)
Backgrounder – At the top of the toolkit under the banner, there is a background statement that provides selected evidence on the chosen interventions (click “Systems and Environmental Interventions Backgrounder (PDF)” and scroll). This is not meant to be a comprehensive literature review, but will be helpful if you are not familiar or comfortable talking about systems and environmental change. The backgrounder also provides references for the main interventions included in the toolkit.
PowerPoint Template – Under the “General” section, we have “Funding Opportunities” and “Presentations.” If we click on “Presentations” (click on “Presentations”) we will see two PowerPoint Presentations with general information on the built environment and a PowerPoint Presentation template to refer to when preparing a presentation on systems and environmental change (click on ‘Built Environment PowerPoint Presentation Template”). Users are able to customize the existing slides with data and images from their own local health jurisdictions.
Selected slides:
1 – Template cover
3 – We provide suggestions for you to customize the slides, such as how to begin the presentation.
5 – We also provide links to find health-related data that is specific to your local health jurisdictions so you can highlight issues in your own communities.
9 – This is a slide that helps to highlight the unique role that MCAH has in addressing the built environment. The notes on this slide in the template include a more detailed explanation. The photos on this slide came from the online Microsoft Office Clip Art and Images gallery. For each slide with a photo, the notes section will tell where it is from and provide links where you can find images that you can use for your own presentation. It is also a good idea to replace these images with images from your local health jurisdiction.
15 – We provide opportunities for you to illustrate the built environment in your own local health jurisdictions as well. This includes showing parts of your communities that may not be conducive to healthy living…
16–..and then a potential solution to that problem.
23 – Finally, we provide sample interventions to promote.
Closing remarks
Those were just a few resources on our toolkit. Again, our toolkit is not meant to be comprehensive; instead, we chose to focus on specific interventions that MCAH programs can easily be involved in. We will continue to update these resources, so if you have a particular resource you found useful, please share with us and we can add it to the toolkit.

5. Questions
Today you have heard an overview of systems and environmental change to promote optimum nutrition, physical activity and breastfeeding AND the role local MCAH programs have and can play. Many of you on the call belong to a local MCAH program or collaborate with one. Hopefully this has inspired you to consider a future collaborative project.
We now will address questions and comments.
END
I would like to thank our speakers, Dr. Jackson, Dr. Gilchick, Sandra Pearce, and Jenny Wong for their participation.
We hope that this webinar will inspire you to do similar work in your communities. Please check out the Toolkit if you haven’t done so already. Also, fill out the Survey Monkey evaluation that will be sent to you.