Creating healthy communities where we live, learn, work and play

1. New Hampshire Creating healthy communities where we live, learn, work and play

2. Objectives Target areas for obesity prevention How environment and policy influence behavior Key policy changes to promote healthy behaviors What can be done in the community to promote healthy behaviors

3. Vision All New Hampshire residents enjoy health and quality of life through healthy eating and active living. Mission To inspire, advance and support policies and practices that promote healthy places and healthy people in New Hampshire.

4. HNHfoundation Anthem Blue Cross and Blue Shield Foundation Endowment for Health Harvard Pilgrim Health Care Foundation NH Charitable Foundation NH Department of Health and Human Services Funding Partners

5. Obesity Trends in NH - adults 17.4% increase in combined prevalence of overweight and obesity from 1990 to 2008

6. Children in NH:Third Grade Healthy Smiles and Healthy Growth Survey 33.4% of third graders have a BMI in the overweight or obese ranges.

7. Health Consequences of Being Overweight or Obese • Hypertension • High total cholesterol • Type 2 diabetes • Coronary heart disease • Stroke • Gallbladder disease • Arthritis • Sleep apnea and respiratory problems • Some cancers Centers for Disease Control and Prevention, Division of Nutrition, Physical Activity and Obesity Implications: “The steady rise in life expectancy during the past two centuries may soon come to an end.” New England Journal of Medicine 2005; 352:1138-1145

8. Annual Health Care Costs of Obesity Economic Consequences US – $147 billion – 2009 Finkelstein, Trogdon, Cohen and Dietz, 2009 *Doubled in less than a decade NH – $302 million – 2004 Finkelstein, Fiebelkorn, and Wang, 2004

9. What’s causing these trends?Place Matters… (For example: healthy places support healthy people through providing opportunities for active transportation) Vs.

10. Factors that Affect Health Smallest Impact Largest Impact Examples Counseling & Education Eat healthy, be physically active Counseling & Education Rx for high blood pressure, high cholesterol, diabetes Clinical Interventions Immunizations, brief intervention, cessation treatment, colonoscopy Long-lasting Protective Interventions Long-lasting Protective Interventions Fluoridation, 0g trans fat, iodization, smoke-free laws, tobacco tax Changing the Context to make individuals’ default decisions healthy Changing the Context to make individuals’ default decisions healthy Poverty, education, housing, inequality Socioeconomic Factors a Socioeconomic Factors

11. How do we change behaviors? Healthy Policies Healthy Environment Healthy Behaviors Healthy People • Adopt policies and laws to create environments that support health

12. Change policies and environments where people live, learn, work and play…

13. Healthy environments… …give people an opportunity to be healthy and thrive

14. Change is not easy…

15. Schools Food Outlets Health Care Individuals & Families Worksites Cities/Towns Strategies to Effect Change in NH • Promote environmental and policy changes at state and local levels • Engage partners from many sectors • Support local coalitions to implement environmental and policy change interventions

16. Goals • Provide access to healthy food and opportunities for physical activity • Engage and empower partners to effect change in New Hampshire • Build and support community coalitions

17. Target Areas Increase breastfeeding initiation, duration, and exclusivity Increase fruit and vegetable consumption Increase physical activity

18. Target Areas • Decrease TV viewing • Decrease consumption of energy dense foods • Decrease consumption of sugar sweetened beverages

19. Pricing and Promtion • Healthy foods • Soft drink taxes • Restrict soft drink advertising • Restrict marketing of unhealthy foods • Availability of safe potable water • Availabiltiy of low cost fruits and vegetable • Menu labeling

21. Land Use Policies • Complete Streets • Sidewalks • Bicycle lanes • School siting • Joint Use Agreements

25. Physical Activity • Written policies regarding TV viewing • Increase amount of PE in schools • Increase amount of activity in PE • Increase activity time in chid care (IMIL, NAP-SACC)

26. Breastfeeding • Baby Friendly Hospital Initiative • Worksite breastfeeding support • Child care breastfeeding policy • WIC breastfeeding peer support

27. Community Change Resources • Recommended Community Strategies and Measures to Prevent Obesity in the United States www.cdc.gov/NCCDPHP/DNPAO/Publications/index.html • Leadership for Health Communities Action Strategies Toolkit http://www.leadershipforhealthycommunities.org/index.php?option=content&task=view&id=355 • Convergence Partnership Promising Strategies for Creating Healthy Eating and Active Living Environments http://www.convergencepartnership.org/atf/cf/%7B245A9B44-6DED-4ABD-A392-AE583809E350%7D/CP_Promising%20Strategies_printed.pdf

28. Funded Local HEAL Coalitions • Franklin/Three Rivers Region • Cheshire County • Manchester • Lakes Region • Upper Valley Over $600,000 awarded to coalitions serving 47 NH cities and towns to create healthy eating/active living environments

29. Strategies forCities and Towns • Improve access to locally grown fruits, vegetables and healthy foods through farmer’s markets, community gardens, and other food outlets • Improve availability and access to sidewalks, bike paths, trails, parks, and recreation facilities

30. Strategies forSchools, After Schools and Child Care Programs • Offer healthy foods and beverages during meals, and in vending machines, school stores and concession stands • Provide opportunities for physical activity throughout the day

31. Strategies forHealth Care Organizations • Adopt procedures for routine screening of BMI (Body Mass Index) for children and adults • Provide patients with counseling and resources to improve healthy eating and active living behaviors

32. Strategies forWorksites • Offer healthy foods and beverages in cafeterias, vending machines and meetings • Promote physical activity through flexible work schedules, and providing such facilities as showers and bicycle racks

33. Strategies forFood Outlets (restaurants, grocers, corner stores) • Include healthy food and beverage options on menus • Prominently display healthy food and beverage items on store shelves

34. Tools & Resources • Tools and resources • Convening and networking • Technical assistance • HEAL Home HEAL helps coalitions and organizations create healthy places by providing: • HEAL Website • www.HEALNH.org

35. For more information… or contact: Terry Johnson, HEAL Director www.HEALNH.org (603) 225-0900 tjohnson@healthynh.com

36. Tools & Resources • Technical Assistance • Evidence Based Strategies • Best Practices • Provide linkages to relevant initiatives (SRTS, NAP SACC) • Focus on CDC Target Areas for Obesity Prevention OPP helps coalitions and organizations create healthy environments by providing: • http://www.dhhs.nh.gov/dphs/nhp/obesity.htm

37. For more information about OPP contact Regina Flynn rflynn@dhhs.state.nh.us (603) 271-4623