Background:
The San Diego County Childhood Obesity Initiative (COI) is a public/private partnership whose mission is to reduce and prevent childhood obesity in San Diego County by creating healthy environments through advocacy, policy development, and environmental change. Based on a social-ecological model, COI mobilizes partners across seven domains: Government, Healthcare, School-After School, Early Childhood, Community, Media and Business.
Objectives:
A case study was designed to:
• document the unique efforts of COI’s Government Domain to support and enact policy change at multiple levels of government;
• study multidisciplinary partnerships that have developed;
• investigate factors influencing partnership success.
Methods:
Case study methodology included interviews of multidisciplinary domain partners representing public health, parks and recreation, transportation planning, architecture, city planning, and citizen advocacy. Documentation analyzed included 1) public records of laws/regulations, 2) advocacy correspondence and documents evidencing integration of advocated changes into policy, 3) domain reports and symposia participant lists, and 4) domain partner websites.
Results:
COI’s Government Domain is led by the County of San Diego’s Public Health Services and Department of Parks and Recreation. At the County level, policy changes included 1) changes to the County’s General Plan to incorporate systematic review and comment on land use proposals by public health personnel, 2) enactment of Healthy Choice Options in Vending Machines on County Property, 3) enactment of a Parkland Dedication Ordinance providing land development fees to support park development, 4) adoption of a Health and Human Services Agency breastfeeding accommodation policy and 5) development of a County parks master plan (in process).
In collaboration with partners, the Government Domain 1) convened public health and land use / transportation planning professionals to integrate public health into community design, 2) provided trainings for municipalities to incorporate health into land use policy, 3) assisted in developing forums highlighting opportunities for elected officials to support community gardens and healthy food retail; and 4) participated in integrating health considerations into the County’s regional transportation update.
Lessons learned:
1) Finding a common agenda and shared solutions effectively engages partners from different sectors. Climate change and California’s AB 32 /SB 375 requirements have provided a powerful incentive to seek common solutions that are aligned with public health goals of creating environments supporting active living and healthy eating. Public health was invited to participate on an internal working group of SANDAG, the regional transportation planning authority guiding the update of the regional transportation plan. Health data about the importance of built environments for physical activity has proven synergistic and possibly softened resistance to climate change regulation. Business is engaged through the local Urban Land Institute, including developers, architects, planners, and elected officials. The increased market for walkable communities represents another common agenda focus.
2) Offering value to non-traditional health partners is essential. Providing educational symposia on topics of mutual interest effectively engaged urban planners, transportation planners, policymakers, and developers as well as traditional public health partners. It provided vision, concrete tools for creating policy change, and opportunities to build “bridges” across disciplines. Networking has led to collaborative advocacy efforts among unlikely partners, including a successful submission of proposed revisions to the City of San Diego’s General Plan.
3) Leadership and political will on multiple levels is critical. COI was initially supported by two members of the County Board of Supervisors, and the County’s Public Health Officer serves as Co-Chair. The COI’s ability to provide staff to coordinate and support partners, such as providing health data at municipal general plan update workshops, provides a unifying resource. The County’s Health and Human Services Agency secured a major stimulus grant leveraging the work of COI and augmenting existing efforts, including development of a health impact and forecasting assessment tool, integrating health into regional comprehensive transportation and land use policies, and creating a healthy communities campaign to include grants for local communities to support planning for changes to support active living and access to healthy foods.
Conclusions:
As research continues to reveal the aspects of the built environment that influence physical activity and access to healthy foods, the translation of this information into policy change requires creative partnerships. While chronic disease has traditionally been the exclusive province of health departments, rich partnerships across sectors are essential to implement policy change. COI’s Government Domain has successfully embraced the ecological model at multiple levels, created vibrant new partnerships, enjoyed significant early policy change successes, and laid the groundwork for future impact through solid, synergistic partnerships. The Initiative’s model is successfully marshalling the “unique ability of humans to plan creatively for healthy communities” envisioned by Dr. Richard Jackson.
Support:
This study was supported by a subcontract from San Diego County Childhood Obesity Initiative to Health Policy Consulting Group with evaluation funds from the County of San Diego HHSA.
