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Policy, Systems, and Environmental Approaches for Obesity
Prevention: A Framework to Inform Local and State Action
Dr. Rodney Lyn, PhD, MS, Dr. Semra Aytur, PhD, MPH, Tobey A. Davis, JD, MPP, Dr. Amy A.
Eyler, PhD, CHES, Dr. Kelly R. Evenson, PhD, MS, Dr. Jamie F. Chriqui, PhD, MHS, Dr. Angie
L. Cradock, ScD, MPE, Karin Valentine Goins, MPH, Dr. Jill Litt, PhD, and Dr. Ross C.
Brownson, PhD
Division of Health Management and Policy, Institute of Public Health, Georgia State University,
Atlanta, Georgia (Dr Lyn); Department of Health Management and Policy, University of New
Hampshire, Durham, New Hampshire (Dr Aytur); Institute of Public Health at Georgia State
University, Atlanta, Georgia (Ms Davis); George Warren Brown School of Social Work, Program
for Public Health, Washington University, St Louis, Missouri (Dr Eyler); Department of
Epidemiology and Center for Health Promotion and Disease Prevention, University of North
Carolina, Chapel Hill, North Carolina (Dr Evenson); Institute for Health Research and Policy,
University of Illinois, Chicago, Illinois (Dr Chriqui); Department of Social and Behavioral Sciences,
Harvard School of Public Health; and Harvard Prevention Research Center, Boston,
Massachusetts (Dr Cradock); Division of Preventive and Behavioral Medicine, University of
Massachusetts Medical School, Worcester, Massachusetts (Ms Goins); Department of
Environmental Health, Colorado School of Public Health and the Environmental Studies Program,
University of Colorado, Boulder, Colorado (Dr Litt); Prevention Research Center in St Louis,
Brown School, and the Division of Public Health Sciences, School of Medicine, Washington
University, St Louis, Missouri (Dr Brownson)
Background
Obesity is a major threat to the health of the nation. The prevalence of obesity1,2 and its
associated health risks are well documented.3,4 Known determinants of obesity include
physical activity and dietary behaviors. Public health efforts to increase physical activity and
improve nutrition among the general population have traditionally been aimed at individual-
level health changes. Such approaches have been found to be minimally effective, costly, and
difficult to sustain.5 In 2002, the Institute of Medicine (IOM) endorsed a broad approach to
public health problems recommending the adoption of an ecologic model, where individuals
and their behavioral choices are situated within and influenced by their broader social and
environmental context.6,7 Physical activity and nutrition researchers and practitioners have
applied the ecologic model.8 Researchers currently recommend a systems-oriented
multilevel framework, which acknowledges the interrelated, dynamic, and adaptive factors
that can influence obesity.3,9–11 A national focus on “policy, systems, and environmental
Correspondence: Rodney Lyn, PhD, MS, Division of Health Management and Policy, Institute of Public Health, Georgia State
University, PO Box 3995, Atlanta, GA 30302 (rlyn1@gsu.edu).
There are no conflicts of interest on the part of any of the authors.
HHS Public Access
Author manuscript
J Public Health Manag Pract
. Author manuscript; available in PMC 2016 July 13.
Published in final edited form as:
J Public Health Manag Pract
. 2013 ; 19(3 Suppl 1): S23–S33. doi:10.1097/PHH.0b013e3182841709.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
change strategies” has emerged in public health, supported by evidence showing that policy
has the potential to impact population health.12–15
Leading US public health organizations have led efforts to promote policy, systems, and
environmental change (PSE) strategies nationwide and have encouraged practitioners and
researchers to implement nutrition and physical activity policies. These public health
organizations have provided a rapid infusion of resources to support such attempts.16–18
Collaborative endeavors among philanthropic organizations and government agencies have
emerged to focus on accelerating progress on policy changes.19,20 Recent investments by
these sectors have supported an increased focus on obesity prevention by public health
practitioners and led to the establishment of collaborative groups (e.g. coalitions, networks,
partnerships). These groups are actively working to promote PSE strategies at state and local
levels.21 Their ability to lead the development of PSE is likely to impact the nation’s
progress on obesity prevention. There is a pressing need to increase the familiarity and
expertise of those working to promote obesity prevention with the processes and activities
that facilitate PSE approaches.13,22,23 The IOM has urged practitioners to familiarize
themselves with legal and policy interventions to improve public health.13 A recent
assessment of the competencies necessary for obesity prevention and control identified the
ability of public health practitioners to understand the process by which laws are developed
as a key area in which to build competence.23 Other researchers have noted the importance
of studying policy development,24 which is considered a core public health function.25 Yet,
public health policymaking processes generally have been understudied and poorly
understood.5 There is an urgent need to bring knowledge and skills on advancing PSE to the
local and state levels, where practitioners have the greatest potential to exert influence on the
decision making of public officials.
The purpose of this article was to provide guidance for practitioners and collaborative
groups on the activities that hold promise for facilitating policy change for obesity
prevention. The article first provides an overview of the policy process by describing three
domains that influence policymakers in their decisions to adopt one policy instead of
another. The
problem
,
policy
, and
politics
domains each, respectively, plays a vital role in
determining the fate of most policy proposals. Together, they provide a frame through which
the policy-making process can be understood. Next, the article focuses on ways to promote
conditions favorable to obesity prevention policies. Collectively, the three domains and six
activities presented here represent a framework (Figure 1) to guide advocacy for PSE around
obesity prevention. Other aspects of the policy process, such as implementation and
evaluation, are beyond the scope of this article and are discussed elsewhere.26,27
The development of this article was informed by a literature search for published works that
describe or explain the policymaking process. We conducted an assessment of articles on the
basis of accepted rules of qualitative inquiry, with the goal of distilling activities identified
as having utility in influencing the policy process. The key activities included in this article
represent themes that emerged from our review and analysis. Findings are not meant to
represent a systematic review. There is much to be studied and learned on the art and science
of advocacy for obesity prevention policy. This article seeks to communicate what is
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currently known about strategies for influencing the policy process. It aims to contribute to
public health practice and the building of a knowledge base in this area.
Overview of the Policy Process
The current focus on PSE as an effective approach for obesity prevention prompts a review
of the process through which policy is made. The policymaking process has been described
as consisting of three domains:
problems
,
policy
, and
politics
.28 In the
problem
domain,
practitioners and collaborative groups must have their issue of interest acknowledged by
policymakers as a problem worthy of attention. The issue must be placed on the policy
agenda by decision makers. While obesity is a serious public health problem, it is but one
problem among many competing for the finite attention of policymakers. The practitioner’s
goal in the problems domain is simply to have their issue recognized as a problem and
placed on the policy agenda for action. Failure to achieve this goal reduces the odds that
desired policies will be considered or implemented.
The second area of focus in the policy process is the
policy
domain. It is focused on
identification of policy solutions that address the problem of focus (i.e. typically a specific
determinant of obesity). Many proposals may be put forth. Some are taken seriously by
policymakers and others quickly discarded. The policy proposals that survive to ultimately
receive serious consideration generally meet several selection criteria, including technical
feasibility, congruence with values, and anticipation of future restrains, including fiscal
limitations, public acceptability, and politicians’ receptivity. The third point of focus is the
politics
domain. It represents the prevailing political context. It determines whether or not a
policy proposal will be legitimized and adopted. The
politics
domain is affected by factors,
such as national mood, public opinion, changes in administration, shifts in partisan or
ideological distributions among politicians, and interest group pressure campaigns. In this
domain, practitioners and collaborative groups must work to establish a favorable
environment for policies that promote obesity prevention. The adoption of policy proposals
is most likely to occur when the three domains become coupled. As the process goes, a
problem is recognized, policy proposals are generated, the political climate makes the time
right for change, and the constraints do not prohibit action.28 Efforts to implement PSE for
obesity prevention are likely to benefit from a clearer presentation of the activities that
promote success within each of the three domains. Next, we summarize activities that hold
promise for promoting policy change by facilitating the convergence of the three domains.
Key Activities for Policy Change
Our review of the literature suggests that desirable policy change outcomes involve six key
activities: (
a
) assess the social and political environment; (
b
) engage, educate, and
collaborate with key stakeholders; (
c
) identify and frame the problem; (
d
) utilize available
evidence; (
e
) identify policy solutions; and (
f
) build support and political will. The activities
focus on addressing issues of interest, facilitating effective policy development and
evaluating the existing political and social environment. These activities do not necessarily
occur sequentially, and each may take place in the
problem
,
policy
, and
politics
domains of
the policy process. We highlight these activities for their potential to facilitate the
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development and implementation of policy solutions that reshape environments to promote
healthy behaviors related to nutrition and physical activity. Supplemental examples and
resources for each activity are provided in Table 1.
Assess the social and political environment
Successful policy change often hinges on understanding how and when the processes of
problem recognition, policy development, and political decision making converge. The
coupling of these domains is a phenomenon commonly referred to as the opening of a policy
window, representing an advantageous context for policy change. The window opens when
the problem has been highlighted, decision makers begin seeking solutions, and the political
climate is favorable for policy adoption.28 Practitioners and collaborative groups can help
create the conditions that promote the coupling of the problem, policy, and political domains
by surveying the social and political environment. These actions may include acquiring
knowledge about the government structures, processes, and rules that affect policy proposals
and identifying powerful political actors and their agenda priorities.31 For example, it is
important to understand which unit of the legislative or executive branches has oversight of
the issue(s) of concern, which policymakers hold key positions, and what can be learned
about their political beliefs and ideologies.32 Elected and appointed officials are often
situated within influential networks of political support.33 Developing knowledge of these
networks can inform decisions on which policymakers to engage and which policy issue(s)
to pursue. Strategies for better understanding these networks might include identifying key
decision makers’ colleagues, community and business affiliations; and donors and political
supporters.
Public opinion is another factor that should be considered when working to advance policy
issues. It reflects the mood, values, and policy preferences of voters. Public opinion has been
found to influence political agendas and political decision making.34 It can be a powerful
force in persuading policymakers to support, or even champion, obesity prevention policy.
Data on public opinion can be acquired through surveys of the public at-large; interviews
with key opinion leaders in relevant sectors; or even by reviewing the public’s voting records
on related ballot measures. By assessing and understanding the environment, advocates can
identify policy opportunities, tailor policy options to the existing political environment, and
gauge the likelihood of successful PSE.34
Engage, educate, and collaborate
Successfully promoting obesity prevention policies requires support from a broad coalition
of stakeholders that often include politicians, public officials, interest groups, and other
parties. Engaging and educating these groups and initiating formal collaboration early in the
process can pay dividends when efforts are made to have the problem placed on the agenda,
to identify solutions, and to advocate for adoption of desired policies. Politicians and public
officials have significant power and influence in shaping governmental policy agendas. To
attain agenda status, an issue will need to garner the support of key decision makers, who
develop and guard the formal policy agenda.35 It is vital to engage and educate these
individuals about obesity and the specific policy strategies that are being pursued to address
the problem.
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Interest groups also have significant potential to impact policy outcomes.32 Interests groups
are organizations that seek to influence public opinion and policy on a particular cause. They
can represent stakeholders affected by policy decisions. For example, an effort aimed at
physical education policy in schools would benefit from engaging stakeholders, such as
physical education teachers, parents, school administrators, and the professional associations
representing these constituencies. policymakers often seek information and opinions from
these groups in determining whether a problem exists (
problems
domain) and whether the
policy proposal being considered is feasible and acceptable (
policy
and
politics
domains).
Advocacy efforts that include groups with access to key points of government and decision
making are more likely to have their issues placed on an agenda and addressed.35 In a recent
study, researchers conducted interviews with legislators across 11 states to examine factors
enabling state-level childhood obesity prevention legislation.36 Consistent with previous
research,37 legislators identified “support or involvement of stakeholders” and “involvement
of senior legislators” as enablers of policy adoption. Establishing broad engagement across a
mix of policymakers, stakeholders, and interest groups contributes to the building of a strong
coalition, which can exert tremendous influence on future policy decisions.38 Such
collaborative groups focused on promoting active living and healthy eating achieve policy
change successes in part by soliciting endorsements from community leaders and offering
testimony in policy, legal, or judicial hearings.21 A case study illustrating the results of
effective engagement and education of key stakeholders is presented in Table 2.
Identify and frame the problem
Recognizing obesity as a problem that merits immediate attention and a place on the public
policy agenda is a critical step in promoting the adoption of desired policies. Approaches in
this area directly impact the
problems
domain of the policy process, helping decision makers
to recognize the need for policy intervention. Practitioners and collaborative groups who
coordinate their efforts to advocate in the public’s interest can “trigger” attention for a
problem such as obesity and ultimately get it prominently placed on the policy agenda.35
Available data can serve as a problem indicator (e.g. low student fitness reports) or may
highlight a condition demanding action (e.g. obesity prevalence, lack of access to healthy
foods). Research indicates that simply providing information about a problem to
policymakers is insufficient to change policy.29 Information must be packaged in a
persuasive manner.41 Narratives or stories generating empathy and calling attention to
external causes of obesity promote support for obesity-related policy change.42 For example,
stories about barriers in the built environment that make it difficult or unsafe for children to
walk to school have prompted action to create safe routes for walking.29 Participatory action
research methods such as Photovoice, which engages residents in documenting their
concerns using photography, can further focus the lenses on a problem by illustrating the
barriers and enablers of physical activity.43,44
Efforts to identify and frame an obesity-related problem should also utilize media. Media
exposure of childhood obesity policy has been identified as an enabler of policy adoption.36
Research shows that community coalitions that frequently use media advocacy are more
likely to achieve environmental changes in support of active living.21 Effective media
communication can reduce barriers to policy change by addressing any misconceptions and
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fears associated with proposed legislation.36 Overall, advocates for obesity prevention
policies can advance their work by leveraging media, using powerful narratives, and
packaging communication tools persuasively.
Utilize available evidence
Efforts to identify and frame obesity occur in the
problems
domain of the policy process.
But there is also a need to carry out work that aims to identify policies that hold promise in
addressing obesity (the
policy
domain). In doing so, existing evidence should be used as a
guide to determine the most effective policies. Next, we highlight three key factors that can
be used to determine the most policy-relevant evidence.45,46
First, it is important to have
evidence on the content of the policy.
The Guide to Community Preventive Services12
outlines specific intervention topics that, after systematic review, were recommended for
obesity prevention. These topics span settings, sectors, and policy levels. While it is
important to seek out the best available evidence for content, it may be necessary to include
untested yet promising strategies.47 The Center of Excellence for Training and Research
Translation48 provides systematic evaluation of evidence-based and emerging interventions
and policies in obesity prevention. The Center TRT recognizes the importance of practice-
tested initiatives in building the evidence for these strategies and has provided an evaluation
framework for policy interventions.49 Credible information can also be found in reports,
briefs, or analyses produced by leading philanthropies, not-for-profits, and nongovernmental
organizations. Using aggregate policy data sources can also help assess content
effectiveness. One such source is Bridging the Gap,50 an annual compilation of school
policies related to wellness and obesity prevention; other sources may be topic-specific.
Web-based resources for Complete Streets,51 Joint Use Agreements,52 or Farm to School,53
all keep current lists of federal, state, and local policies, including model policy language
based on the evidence (when available) or practice-tested content.
The second key factor in determining policy-relevant evidence is to examine
evidence
related to the likelihood of policy adoption
.45,46 Many approaches to obesity prevention
have potential in various settings, such as cities, counties, local communities, and states.9 It
is important to consider which approaches are more or less likely to be adopted given
contextual factors. Kindgon’s policy stream model suggests that factors, such as national
mood, public opinion, and interest group pressure, can affect policy adoption.28 For
example, in a recent study, Eyler et al54 found that bills containing content about menu
labeling or increased tax were more than two times less likely to be enacted than other
obesity prevention topics. Conversely, bills containing content about curriculum changes or
Safe Routes to School were more likely to be enacted than other topics. Determining the
degree of receptiveness among key stakeholders is critical to adoption.
The third key factor in determining policy-relevant evidence is
documenting the potential
impact of a proposed policy.
One approach that is receiving increasing attention in the
United States is Health Impact Assessment. Health Impact Assessment is a public
engagement and decision-support methodology that can be used to prospectively assess the
health impacts of policy proposals and to make recommendations to inform decision making
and ultimately improve public health outcomes.55 Several states and cities now offer Health
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Impact Assessment training, as does the Centers for Disease Control and Prevention and the
National Association of County and City Health Officials.56
Existing data and surveillance systems also can be used to assess changes in health
outcomes over time.57 These include, the Behavioral Risk Factor Surveillance System, the
Youth Risk Behavior Surveillance Survey;58 the National Survey of Children’s Health;59
National Immunization Survey;60 state-specific vital statistics; and census data. The
National Collaborative on Childhood Obesity Research developed a catalog of surveillance
systems, which provide a unique window on obesity-related policies and environmental
factors as well as trends in relevant health behaviors, outcomes, and determinants.20 Using
data to inform policies can assist in revealing the extent of the problem, setting targets, and
demonstrating improvement.
Identify policy solutions
Identifying the appropriate policy solutions (
policy
domain) to address obesity requires
careful consideration of the wide range of available policy options to influence food systems
(Table 3) and physical activity environments (Table 4). Of utmost importance,
policy
solutions should be practical and suitable
. Kingdon28 suggests that a range of factors should
be considered in developing policy solutions. Proposed solutions should be technically
feasible. Solutions should specify actual mechanisms by which an idea would be brought
into practical use. The idea should be compatible with expert opinions and key stakeholders
(i.e. reflect shared values). It should be cost-sensitive. Solutions should include information
on efficiency and should address whether benefits could be achieved through less costly
policy interventions. Cost considerations should also include anticipation of future financial
constraints and how they can be addressed. The idea should be compatible with public mood
and political climate (i.e. publically acceptable). Information on the number, proportion, and
representativeness of individuals that are likely to be affected should be provided (i.e.
population reach). Policy solutions should be aimed at a wide audience. The proposed policy
should hold promise for altering the environment in a manner that positively influences
population-level physical activity or dietary behaviors (i.e. effectiveness). Identification of
appropriate policies can be informed by established models that aim to inform the selection
of policy solutions by examining many of the factors listed previously.62,63
It is also important to identify the governing body responsible for passing or adopting the
policy of interest (e.g. the town zoning board or the state legislature).62 The recognition of
receptive venues for policy increases the likelihood of adoption of desirable policies. While
receptive legislatures may adopt policies designed to address obesity,39,40 the executive
branch can issue orders by proclamation or through its regulatory agencies or offices.64 By
understanding these dynamics, advocates can identify and develop a policy appropriate for
the governing body of interest.
Consideration should also be given to the likelihood of sustainability, effects on health
equity, and any potential for unintended consequences (e.g. traffic congestion, economic
impact, stigmatization).47 It is best to have more than one policy solution available, as
devising a short list of ideas will allow for flexibility. Kingdon28 recommends having these
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solutions “in hand” so that the solution is already developed when a window of opportunity
opens.
Build support and political will
Building community and political support has a direct impact on the
politics
domain, and it
is vital to achieving policy change. Public opinion influences the “political will” of
policymakers to enact desired policies.34 Garnering support for obesity-related policy among
the general public and encouraging the public to voice concerns about obesity to
policymakers improves the likelihood that policy change will occur. Advocates can increase
awareness, support, and political will to develop obesity-related policy by encouraging
participation from local officials, individuals and community groups, and public and private
entities.37 Community members, leaders, advocates, and organized groups within
communities have a perspective of the local context that helps them recognize unique policy
opportunities, build support, and encourage collaboration among interested parties and
policymakers.37 Building support ensures that policies will reflect the needs and concerns of
community members.65 Coordinating efforts across all levels of government66 and including
potential opponents in the discussion67 promotes successful policy initiatives.
Efforts associated with building support and political will should leverage relationships that
have been established in the
problems
domain, where the
engage, educate, and collaborate
activity (previously presented) is carried out with an eye toward building a broad base of
support for the issue of interest. There is an ongoing need to build such support from key
stakeholders across the entire policy process. However, as public officials bring the policy
proposal of interest under consideration (the
politics
domain), the collective will of engaged
policymakers, interest groups, coalitions, and the public must be galvanized and brought to
bear on decision makers. The policy process is not fully sequential. It will usually be
necessary to work concurrently on many of the activities recommended here. A relevant case
study is highlighted in Table 5.
Conclusion
Public health efforts to accelerate obesity prevention are increasingly focused on policy,
systems, and environmental approaches. Practitioners and collaborative groups at the state
and local levels, such as coalitions and other networks, are well positioned to initiate and
advance this work. This article has sought to describe the policy process and identify the
specific activities that have promise for promoting the adoption of active living and healthy
eating policies. A key takeaway is that the policy-making process is multifaceted. It consists
of three domains:
problems
,
policy
, and
politics
, which focus on problem identification,
developing of policy solutions, and promoting a political context that supports policy
change, respectively. Recommended activities in this article to advance obesity prevention
policies include the following:
•
Assess the social and political environment
. The social and political
environments are powerful forces in constraining policy options.
Understanding the environment can inform planning and build an
awareness of the types of PSE strategies that may be possible.
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•
Engage, educate, and collaborate
. Stakeholders representing diverse
constituencies should be engaged to articulate the urgency of the problem,
to provide input on appropriate solutions, and to advocate for the adoption
of proposed policies. Building broad engagement and support early will be
beneficial in advancing other key activities.
•
Identify and frame the problem
. Efforts aimed at PSE should frame the
issue of interest in a manner that leads it to be recognized by decision
makers and placed on the agenda.
•
Use available evidence
and
identify policy solutions
. The identification of
plausible policy solutions requires consideration of current evidence,
feasibility, acceptability, reach, and impact.
•
Build political will
. Policymakers respond positively to policy proposals
that carry the support of their constituencies and colleagues, including
public officials, community leaders, organized collaborative groups, and
the general public (i.e. voters). It is vital to assess the local context and
work cooperatively to build support across all stakeholders.
This article has suggested that engaging in these policy activities promotes increased
efficiency and effectiveness in advancing policies for obesity prevention. It has also provided
various policy and environmental change strategies for nutrition and physical activity (see
Tables 3 and 4), although not exhaustive of possible options. Practitioners and collaborative
groups should consider the approaches presented here in their planning and stakeholder
convening process.
While the development and adoption of policy is important, emerging evidence suggests that
policy and environmental change strategies in the absence of intentional efforts to connect
people to new opportunities for physical activity and healthy eating may not have the desired
impact on behavior. Policies and/or environmental changes undertaken individually are often
insufficient to produce desired behavioral and health outcomes.69
Although we have focused on the portion of the policy process leading up to adoption, the
process of implementation (i.e. applying and enforcing a policy change) is crucial if the
policy is to achieve its intended public health impact. The governing bodies that implement
policy usually differ from those that adopt policy.62 A detailed discussion of policy
implementation pertaining to obesity prevention is beyond the scope of this article but
should be considered in future research. The framework presented here has been guided by
the literature. We believe that applications of the framework by practitioners and
collaborative groups holds promise for accelerating progress on PSE strategies for obesity
prevention.
Acknowledgments
This work was supported through research grants from the US Centers for Disease Control and Prevention (CDC)
to the Physical Activity Policy Research Network (#U48/DP001903; 5U48DP001938-02; U48/DP001946; U48-
DP000059). The content is solely the responsibility of the authors and does not necessarily represent the official
views of CDC.
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FIGURE 1.
Framework for Advancing Policy, System, and Environmental Change Approaches for
Obesity Prevention
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Table 1
Key Activities to Facilitate Success in Policy and Environmental Approaches
Activity and definition Examples of action Tools/Resources
Identify and frame the problem.
Presenting the issue as a problem
worthy of action and caused by factors
amenable to policy intervention.
Using media to highlight a
problem. •Communicate prevention messages to
policy makers
a
•CDC Media Access Guide: A Resource
for Community
b
•CDC Social media tools
c
•CDC Social Marketing for Nutrition
and Physical Activity web course
d
•Press releases
e
Developing policy briefs that
help policymakers understand
the problem and possible
solutions.
Using participatory action
research methods, such as
Photovoice.
•Sample policy brief
f
•Active Living Research: Policy &
Practice Impact Stories
g
•Participatory Photography Project
Guide: From Community Assessment
to Political Action
h
•Framing Public Issues, the Frameworks
Institute
i
Engage and educate key people.
Intentional interaction with politicians,
public officials, and stakeholders to
raise awareness of the problem and
initiate public and political engagement.
Developing a coalition; working
collaboratively with
stakeholders to develop an
action agenda;
•Understanding Your Community: The
Key to Building an Impactful,
Sustainable Coalition
j
•A toolkit to guide community partners
in forming successful agreements
k
Educating policymakers;
building public awareness and
engagement.
•YMCA Healthier Communities
Initiatives
l
•The CDC Guide to Strategies to
Increase Physical Activity in the
Community
m
Identify policy solutions.
Defining policy opportunities and
specific levers to influence food
systems or physical activity
environments
Review evidence-based
recommendations; consider
feasibility, acceptability, cost,
and reach;
•Non-communicable disease prevention:
Investments that Work for Physical
Activity
n
•CSG childhood obesity tool kit
o
Utilize available evidence.
Using credible sources of evidence to
inform policy formulation.
Review evidence-based
recommendations to inform
content of policies (CDC, IOM,
the Community Guide);
consider likelihood of policy
adoption, anticipated outcomes.
•The Community Guide
p
•Recommended Community Strategies
and Measurements to Prevent Obesity
in the United States
q
•Interventions on Diet and Physical
Activity: What Works: Implementation
of the Global Strategy on Diet, Physical
Activity and Health
r
•Obesity prevention: a proposed
framework for translating evidence into
action
s
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Activity and definition Examples of action Tools/Resources
Assess social and political environment.
Working to understand the prevailing
context in which policy proposals are
considered for adoption.
Conduct a public opinion
survey; test reactions to various
policy proposals; identify hot
issues and how they might
connect with obesity
prevention; consider how to use
elections cycles to promote
policy solutions.
•The National Council of State
Legislatures annual reports
t
•Example of public opinion survey
u
•CDC, Chronic Disease State Policy
Tracking System
v
•State Actions to Promote Healthy
Communities and Prevent Childhood
Obesity: Summary and Analysis of
Trends in Legislation
w
Build support and political will.
Encouraging advocates, policymakers,
and the general public to support
proposed policies
Educate stakeholders about the
problems and possible
solutions; support
•Leadership for Healthy Communities
x
•Advocacy in Action: a toolkit for Public
Health Professionals
y
•Childhood obesity: The new tobacco
z
a
Stamatakis KA, McBride TD, Brownson RC. Communicating prevention messages to policy makers: the role of stories in promoting physical
activity.
J Phys Act Health.
2010; Suppl 1:S99–107.
b
http://www.cdc.gov/healthycommunitiesprogram/tools/index.htm#rp.
c
http://www.cdc.gov/obesity/resources/multimedia.html.
d
http://www.cdc.gov/nccdphp/dnpa/socialmarketing/training/index.
e
http://www.hsph.harvard.edu/news/press-releases/2011-releases/children-worldwide-obesity-epidemic.htmldhtm.
f
http://www.chipolicy.org/pdf/Issue_Briefs/CHIObesityBriefFinal.pdf.
g
http://www.activelivingresearch.org/toolsandresources/policypracticeimpact.
h
http://www.orphi.org/images/stories/PDF/healthy_planning_pdfs/ophi%20photovoice%20guide_0916.pdf.
i
http://www.frameworksinstitute.org/assets/files/PDF/FramingPublicIssuesfinal.pdf.
j
http://www.ucdenver.edu/academics/colleges/ArchitecturePlanning/discover/centers/CCCD/LearningLandscapes/About/Documents/lwc-coalition-
white-paper-1109.pdf.
k
http://copcwa.org/wp-admin/images/toolkit/COPC_Toolkit_1.5_TOC_all.pdf.
l
http://ymca.net/healthier-communities-guide/.
m
http://www.cdc.gov/obesity/downloads/PA_2011_WEB.pdf.
n
http://www.globalpa.org.uk/pdf/investments-work.pdf.
o
http://www.healthystates.csg.org/NR/rdonlyres/36F21685-38E8-44BC-9C06-1458515BE93E/0/RWJtoolkitwhole.pdf.
p
Community Preventive Services Task Force: http://www.thecommunityguide.org/uses/research.html.
q
Centers for Disease Control and Prevention. MMWR 2009;58: http://www.cdc.gov/mmwr/pdf/rr/rr5807.pdf.
r
http://www.who.int/dietphysicalactivity/whatworks/en/.
s
Swinburn, B; Gill, T; Kumanyika, S (2004). Obesity prevention: a proposed framework for translating evidence into action. Obesity Reviews,
6:23–33.
t
http://www.ncsl.org/about-us.aspx?tabs=1027,82,574.
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u
http://www.yaleruddcenter.org/resources/upload/docs/what/policy/SSBtaxes/CA_Field_Poll_4.12.pdf.
v
http://apps.nccd.cdc.gov/CDPHPPolicySearch/Default.aspx
w
http://www.rwjf.org/childhoodobesity/product.jsp?id=74501
x
http://www.iom.edu/~/media/Files/Activity%20Files/Nutrition/ObesityPrevProgress/Measurement%20Workshop/Maya-Rockeymoore.pdf
y
http://www.phaa.net.au/documents/100114PHAIAdvocacyToolkit%202ndedition.pdf.
z
Klein JD, Dietz W. Childhood obesity: The new tobacco.
Health Aff
. 2010;29:3,388–392.
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Table 2
Engage and Educate People: Arkansas Act 1220
The Arkansas case study on obesity prevention policy efforts illustrates the value of engaging and educating key decision-makers. Prior to the
passage of Arkansas’s Act 1220 of 2003 a series of events occurred placing a spotlight on the problem of childhood obesity, ultimately
catapulting obesity prevention onto the policy agenda.
a
,
b
Arkansas policy leaders focused on engaging and educating key decision-makers and
stakeholders through various activities. These included:
•Health advocates reporting concerns about the nutritional quality of foods in school vending machines.
•Public health professionals from educational institutions and the Arkansas Department of Health annually informed
Arkansas legislators on obesity-related issues including evidence on the health burdens and the severity of the childhood
obesity epidemic.
•In 1999, Arkansas authorized the creation of an Obesity Task Force to address the obesity epidemic. The Task Force
reported its findings and made policy-related recommendations to the public and legislature in 2000.
•In 2001, Arkansas legislators attending the National Foundation for Women Legislators Conference were introduced to
state-specific obesity indicators.
•In 2002, Arkansas legislators, policymakers and public health professionals attended a conference sponsored by the
National Conference of State Legislators, National Governors Association, and Association of State and Territorial
Health Officials focusing on approaches and interventions related to childhood obesity prevention.
•In 2002, public health professionals convened a Physical Activity Summit addressing issues involving physical activity
in Arkansas schools.
•Prior to the 2003 legislative session, two prominent Arkansas politicians experienced serious obesity-related health
issues, further publicizing the implications of an increasingly obese population.
Collectively, these events and actions focused influential policymakers on the problem of childhood obesity and on possible policy solutions.
The initiative promoted by health advocates culminated in the implementation of a comprehensive school-based obesity prevention program.
a
Ryan K, Card-Higginson P, McCarthy S, Justus M, Thompson J. Arkansas fights fat: translating research into policy to combat childhood and
adolescent obesity.
Health Aff
. 2006;25(4).
b
Craig R, Felix H, Walker J, Phillips M. Public health professionals as policy entrepreneurs: Arkansas’s childhood obesity policy experience.
Am J
Public Health
. 2010;100(11):2047–52.
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Table 3
Policy Areas that Influence the Food System
a
Sector Level of Governance
Food Production
Local
Land-use management, zoning
Community Gardens
State
Production subsidies, taxes
Food Processing Food safety
Distribution Food transport
Marketing Laws, regulations regarding marketing unhealthy
foods
Laws, regulations regarding marketing healthy foods
Laws, regulations restricting marketing unhealthy
foods
Laws promoting marketing of healthy foods
Retail
Land-use management, zoning
Density, location of fresh food retailers
Density, location of fast food outlets
Food deserts
Products sold in schools
Restaurants and Food
Service Nutrition information in restaurants
Food safety
a
Adapted from:
Sacks G, Swinburn BA, Lawrence MA. A systematic policy approach to changing the food system and physical activity environments to prevent
obesity.
Aust New Zealand Health Policy
. 2008;5:13
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Table 4
Policy Areas that Influence Physical Activity Environments
a
Sector Level of Governance
Local State
Infrastructure and Planning Land-use management, zoning Urban planning
Walking environment Roads Public, alternative transportation
Cycling environment
Play environment
Education Physical education in schools Facilities, equipment for
physical activity in schools
Employment Building design standards
Transportation Public transportation Public transportation
Parking restrictions Alternative transportation
Traffic control Traffic control
Sports and Recreation Facilities for physical activities - built structures Public liability
Facilities for physical activities - parks and open
spaces Access of general community to school physical
activity/sports facilities
Public liability
a
Adapted from:
Sacks G, Swinburn BA, Lawrence MA. A systematic policy approach to changing the food system and physical activity environments to prevent
obesity.
Aust New Zealand Health Policy.
2008;5:13
J Public Health Manag Pract
. Author manuscript; available in PMC 2016 July 13.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Lyn et al. Page 21
Table 5
Build Support and Political Will: Grocery Gap II
In 2001, the Food Trust, a non-profit organization dedicated to increasing access to healthy food focused its policy change efforts on closing the
“grocery gap” and expanding access to healthy, nutritious food in underserved communities. The Food Trust spearheaded a campaign to
increase the number of fresh food outlets in underserved communities and worked to unite community and political leaders and other key
stakeholders from diverse sectors around its policy goal.
Recognizing that building support in the community and among local political leaders was critical to its success, the Food Trust focused its
efforts on outreach and education. Its members established a telephone campaign targeting supermarket representatives, children’s health-related
non-profit organizations, academic institutions, and public health departments and other governmental organizations. They also organized
meetings to gauge the existing understanding of the connection between supermarkets, health, underserved communities and measures that
could be implemented to increase access to healthy food. Policy advocates convened local task-force comprised of local organizations and key
stakeholders and engaged and educated local decision makers. Building support across a broad, diverse group of stakeholders ultimately led to a
successful policy change effort.
a
Karpyn A, Manon M, Treuhaft S, Giang T, Harries C, McCoubrey K. Policy solutions to the ‘grocery gap’.
Health Aff.
2010 Mar–Apr;29(3):473–
80.
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