Reshaping Our Communities, Reclaiming Our Health by Global Policy Solutions

Reshaping Our Communities, Reclaiming Our Health African Americans Define Strategies for Healthy Kids and Healthy Neighborhoods

Leadership for Healthy Communities Advancing Policies to Support Healthy Eating and Active Living

This document is the result of a one-day strategy session co-hosted by the Congressional Black Caucus Foundation, Inc. (CBCF) and Leadership for Healthy Communities. CBCF was instrumental in bringing African-American leaders from all over the nation to participate in the event. The content of this document is derived from the event's proceedings. Leadership for Healthy Communities authored the report, which was made possible with support from the Robert Wood Johnson Foundation.

African Americans for Healthy Communities On June 5â&#x20AC;&#x201C;6, 2008, 47 researchers, policy-makers and leaders from communitybased organizations, professional associations and businesses gathered in Washington, D.C. to discuss the childhood obesity epidemic and strategies for reversing the trend in the African-American community.

Co-hosted by the Congressional Black Caucus Foundation and Leadership for Healthy Communities, a national program of the Robert Wood Johnson Foundation, meeting participants engaged in a day-long strategy session where they identified and discussed potential options for supporting healthy children and healthy communities. Participants were drawn together with the common purpose of brainstorming solutions to reduce obesity in the African-American community. This document outlines some of the priorities, recommendations and areas of consensus raised by participants. It is intended to inform policy-makers, community-based organization leaders, foundations, the media and other relevant audiences about the overweight and obesity epidemic in the African-American community and the need for sustainable strategies to reverse the crisis. A full list of the participants and their organizational affiliations are below.

Participants

Wesley L. Boykin Ph.D., MPH Director Research and Development Institute National Alliance of Black School Educators Diane Brown, Ph.D. Executive Director UMDNJ School of Public Health Institute for the Elimination of Health Disparities Shirley Brown-Ornish, M.D. Senior Planner Prince George's County Health Department Robert D. Bullard, Ph.D. Director Environmental Justice Resource Center Clark Atlanta University Judith Burrell Principal Burrell Project Consult, LLC

The following individuals participated in the June 5â&#x20AC;&#x201C;6 meeting in Washington, D.C. It is their collective recommendations that comprise the body of this report.

Sandy Carpenter-Stevenson, Ed.D. Regional Coordinator California Gear Up Oakland National Alliance of Black School Educators

Leon Andrews Program Director National League of Cities Institute for Youth, Education, and Families

Patricia Carter Senior Advisor United States Conference of Mayors

Kathryn Bertram Communications Director Leadership for Healthy Communities

Candice Cason, M.Ed. Director of Addiction and Mental Health Prince George's County Health Department

Reshaping Our Communities, Reclaiming Our Health

The Honorable Donna Christensen Delegate (VI) U.S. House of Representatives

Michelle Klink, Ph.D. Senior Advisor Leadership for Healthy Communities

The Honorable Brenda Clack 1st Vice Chair (MI) Michigan House of Representatives National Black Caucus of State Legislators

Vikki C. Lassiter, M.S. Director African American Collaborative Obesity Research Network School of Medicine, University of Pennsylvania

The Honorable Michael Davis Plan Commissioner Dallas City Plan Commission

Atiba Madyun Division Director National Black Caucus of State Legislators

Mary Grant, Ed.D. Principal DCPS Takoma Educational Center National Alliance of Black School Educators

Laura Ojeda, M.P.H. Deputy Program Director Leadership for Healthy Communities

LaRuth Gray, Ph.D. Deputy Director Metropolitan Center for Urban Education New York University National Alliance of Black School Educators The Honorable Melony Griffith Delegate Prince George's County Maryland Riley Harris, M.B.A. Managing Partner Blackstone Promotions and Advertising Group, LLC Barbara J. Hatcher, Ph.D., M.P.H., R.N. Director Center for Learning & Global Public Health The American Public Health Association Liz Humphrey Projects Manager National Organization of Black County Officials Marjorie Innocent, Ph.D. Director of Research and Programs Congressional Black Caucus Foundation Nicole Jarrett, Ph.D. Director of Health Policy Research W. Montague Cobb/NMA Health Institute National Medical Association The Honorable Lewis Johnson City Councilmember National Black Caucus of Local Elected Officials

Ruth Perot, M.A.T. Co-founder and Executive Director Summit Health Institute for Research and Education, Inc. Dwayne Proctor, Ph.D. Senior Program Officer Childhood Obesity Team Leader Robert Wood Johnson Foundation Bianca Pullen Bill Emerson National Hunger Fellow Joint Center for Political and Economic Studies The Honorable Usie Richards 2nd Vice Chair (VI) Legislature of the Virgin Islands Maya Rockeymoore, Ph.D. Program Director Leadership for Healthy Communities President and CEO Global Policy Solutions Victor Rubin, Ph.D. Vice President for Research PolicyLink Lloyd Sain, Jr., Ed.D. Director Leadership and Secondary Teacher Development National Alliance of Black School Educators Elsie Scott, Ph.D. President and CEO Congressional Black Caucus Foundation Barb Seckler Director The Institute for Active Living Columbus Public Health

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Amy Slonim, Ph.D. RWJF Health Group Consultant Robert Wood Johnson Foundation Byron Sogie-Thomas Director of Health Policy National Medical Association Crystal Swann Assistant Executive Director United States Conference of Mayors The Honorable Barbara Swearengen-Ware Councilmember City of Memphis National Black Caucus of Local Elected Officials Makani Themba-Nixon Executive Director The Praxis Project/PATH Gina Villani, M.D., M.P.H. Vice President of Health and Quality of Life National Urban League The Honorable James Walls Mayor District Heights Maryland The Honorable J.C. Watts Former Member of Congress U.S. House of Representatives Founder and Chairman J.C. Watts Companies Jerome D. Williams, Ph.D. F. J. Heyne Centennial Professor University of Texas at Austin The Honorable Levoyd L. Williams Councilmember City of Lauderdale Lakes National Black Caucus of Local Elected Officials Nsedu Obot Witherspoon Executive Director Childrenâ&#x20AC;&#x2122;s Environmental Health Network Beverly Wright, Ph.D. Founder and Executive Director Deep South Center for Environmental Justice at Dillard University

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Executive Summary Where you live is vital to how well you live. That is why it is essential to address barriers in the community setting that undermine health and wellness. A growing body of research has documented that African Americans live in communities that are less likely to have parks, green spaces, walking/biking trails, swimming pools, or beaches (Powell et al. 2004). African-American neighborhoods also have less access to commercial physical activity outlets such as physical fitness facilities, sports clubs, dance facilities, and golf courses (Powell et al. 2006). These disparities suggest that environments without a supportive infrastructure contribute to poor health. African-American and low-income neighborhoods also have less access to full-service supermarkets with fresh fruits and vegetables (Morland 2002). The poor food environment is exacerbated by an abundance of fast-food restaurants serving high-calorie meals of low nutritional value (Lewis et al. 2005). The food and physical activity environment among other factors have contributed to the burgeoning overweight and obesity epidemic among African Americans. Between 1986 and 1998, the prevalence of overweight increased by more than 120 percent among AfricanAmerican children, compared with more than 50 percent among white children (Strauss and Pollack 2001). African-American adults are also affected. Sixty-seven percent of African-American men are overweight or obese—a figure on par with the national rate—and 79.5 percent of African-American women—about four out of every five black women—are categorized as either overweight or obese. With obesity-related illnesses like type 2 diabetes, heart disease and hypertension disproportionately hitting the African-American community, the health consequences of overweight and obesity are steep. In recognition of this growing crisis, researchers, policymakers, and leaders from community-based organizations, professional associations and businesses across the

country gathered in Washington, D.C. to discuss the childhood, adolescent and adult obesity epidemic and strategies for reversing the trend in the African-American community. Meeting participants offered a variety of recommendations about what schools, communities, families, the media, and businesses can do to help prevent obesity. A sample of the proposed strategies included: • Making physical activity in schools mandatory and providing tools to help schools integrate physical activity throughout the school day. • Creating tax and other incentives to improve residents’ access to amenities (e.g., supermarkets, complete sidewalks) that support health and wellness. • Engaging faith- and community-based organizations as well as public and private entities and volunteers in community wellness initiatives. • Creating a media and marketing campaign that leverages youth social networking to advance health and wellness. • Creating a scorecard that evaluates corporate efforts to support health and wellness in African-American communities. The recommendations in this report provide essential action strategies for African-American communities seeking to close health disparities and improve the quality of life for their residents.

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Introduction Prevalence The obesity epidemic cuts across all categories of race, ethnicity, family income and locale, but some populations are at higher risk than others. Low-income individuals, African Americans, Latinos and those living in the Southern part of the United States are among those affected more than their peers. Results from the 2003-2004 National Health and Nutrition and Examination Survey show that 66 percent of all American adults are either overweight or obese. The survey reports that 67 percent of African-American men are overweight or obese—a figure on par with the national rate—and 79.5 percent of African-American women—about four out of every five black women—are categorized as either overweight or obese. Compared to men and women of other racial and ethnic groups, African-American women have the highest rates of overweight and obesity in the nation. During the past four decades, overweight and obesity rates have also soared among all young people and especially among children and adolescents of color (Crawford et al. 2001). Between 1986 and 1998, the prevalence of overweight increased by more than 120 percent among AfricanAmerican and Hispanic children, compared with more than 50 percent among white children (Strauss and Pollack 2001). Currently, 34.9 percent of African-American children ages 2-19 are obese or overweight, compared with 31.9 percent of all children in this age category (Ogden et al. 2008). As suggested by the rates of adult black women, adolescent African-American girls are particularly susceptible to weight gain (Ogden et al. 2008). National statistics confirm what many families observe on a daily basis: African-American children, adolescents and adults suffer disproportionately from obesity. Unfortunately, many do not understand why some communities are at greater risk for obesity than others. Until recently, the national dialogue has placed personal responsibility at the center of the discourse on America’s weight problem.

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However, emerging evidence suggests that there are a variety of policy and environmental factors that contribute to the skyrocketing epidemic in the AfricanAmerican community.

Consequences Alarmingly high rates of overweight and obesity among African Americans come at a steep human price— increased risk for type 2 diabetes, hypertension, osteoarthritis, stroke, certain kinds of cancer and many other debilitating diseases. In addition, childhood obesity statistics suggest that illness, disability and early death will increase in the future if nothing is done to reverse the trend. African-American children already are being diagnosed with health problems that were considered to be adult illnesses. One in two African-American children are expected to develop type 2 diabetes in their lifetimes (Bindler and Bruya 2006). As a result, many experts are predicting that we are raising the first generation of children to live sicker and die younger than their parents.

Causes As a society, we’ve dramatically altered the way we live, eat work and play—creating an environment that fuels the obesity epidemic. Too many of us do not have a healthy “energy balance.” In other words, we’re taking in far more calories than we burn, which leads to unhealthy weight gain.

A growing body of evidence is pointing to factors in the physical activity, food and social environments that show that African-American adults and children are also at risk for obesity because of where they live. Like many Americans, African-American children, adolescents and adults do not engage in enough physical activity to burn off the excess amount of calories they consume. A growing body of research has documented that residents living in predominantly African-American and low-income communities also have structurally fewer opportunities for physical activity. African Americans live in communities that are less likely to have parks, green spaces, walking/biking trails, swimming pools, or beaches (Powell et al. 2004). African-American neighborhoods also have less access to commercial physical activity outlets such as physical fitness facilities, sports clubs, dance facilities, and golf courses (Powell et al. 2006). These disparities suggest that environments without a supportive infrastructure limit African Americansâ&#x20AC;&#x2122; ability to engage in physical activity and negatively impact their health (Estabrooks et al. 2003).

African Americansâ&#x20AC;&#x2122; perceptions of their physical environments also influence their activity levels. Thirty-one percent of African-American parents cite a lack of available opportunities as a barrier to physical activity compared with only 13 percent of white parents (Duke et al. 2003). Additionally, research shows that African Americans are more likely to perceive of their neighborhoods as less safe and less pleasant for physical activity than whites (Boslaugh et al. 2006). The food environment is another factor influencing overweight and obesity among African-American children and adults. In some communities, parents have limited food choices because they donâ&#x20AC;&#x2122;t have a local supermarket. A study of close to 700 neighborhoods found that minority and racially-mixed communities have access to half as many supermarkets as white neighborhoods and twice as many small grocery stores. Low-income areas have access to half as many supermarkets as wealthy areas and four times as many small grocery stores (Moore and Roux 2006). For African Americans, research has shown that access to supermarkets can be particularly beneficial and has a

Reshaping Our Communities, Reclaiming Our Health

significant association with lower obesity rates and body mass indices for nearby residents (Powell et al. 2007a). The poor food environment in predominantly AfricanAmerican and low-income neighborhoods is exacerbated by the abundance of fast-food restaurants serving highcalorie meals of low nutritional value. One study of the availability of healthy food choices in south Los Angeles found that lower-income neighborhoods with higher concentrations of African Americans had greater number of restaurants with unhealthy food options (Lewis et al. 2005). The social environment is another factor contributing to disproportionate rates of overweight and obesity among African Americans. Like the general population, physical activity among African-American children and adolescents has declined with the increased use of television, video games and computers (Roberts et al. 2005). In addition, research has found that African-American households watch more television—75 hours of television per week compared to 52 hours for white households—and may be more susceptible to the influence of unhealthy food marketing (Tirodkar and Jain 2003).

Reshaping Our Communities, Reclaiming Our Health

In fact, new research shows that targeted marketing of high-calorie foods and beverages may overexpose AfricanAmerican consumers to unhealthy messages around eating and provide them with limited access to healthy food relative to whites or the general population. The study also indicated that the overall effect of current marketing strategies may contribute to the significantly higher rates of obesity among African Americans than in whites (Grier and Kumanyika 2008). It has long been established that adolescents who watch more television have a higher prevalence of obesity and “superobesity” (Dietz 1985). But what many may not realize is that African-American children are exposed to 14 percent more food advertisements than their comparable peers (Powell 2007b). Another study found that the television stations most watched by African-American youth had significantly more unhealthy food and beverage advertisements but received few messages with content related to health or physical activity (Outley and Tadesse 2006).

Policy and Program Recommendations Policy-makers at the local, state and national levels have significant influence in shaping the environments where children live, learn and play. The strategies identified by meeting participants leaned heavily towards the policy changes needed to promote healthy eating and physical activity in schools, communities, businesses, families and the media. Participants also highlighted promising obesity prevention programs, research and advocacy strategies for African Americans. Schools Children and teens spend about seven hours of every weekday in educational settings during the school year, and they consume an estimated 35 percent to 50 percent of their daily calories during the average school day (Neumark-Sztainer et al 2005). Considering the impact that the school environment can have on a student’s health and development, it offers an ideal opportunity to improve students’ access and exposure to healthy eating and active living. Policy and program recommendations supporting this approach included: • D eveloping an age-appropriate, health education curriculum that focuses on wellness and nutrition. • Limiting access to unhealthy competitive foods and increasing access to nutritious foods and drinks in the cafeteria and in vending machines. • Offering physical education classes based on high common standards. • Making physical activity in schools mandatory and provide tools to help schools integrate physical activity throughout the school day. • Benchmarking student body mass index (BMI). • Implementing and enforcing school and local wellness policies that support healthy eating and physical activity in schools and surrounding areas. • Creating connections with community organizations and businesses that can support student wellness (e.g., farmto-school programs). • Developing a BMI awards program that recognizes schools that demonstrate significant improvement in the body weight of their students.

• C oordinating education and health policy in a manner that supports the development of children’s minds and bodies.

Communities Where you live is vital to how well you live. The quality and accessibility of the roads, sidewalks, stores, houses, parks and other resources can become important factors in strengthening community health and wellness. Can children and adults walk or bike to desirable destinations? Is the community’s physical infrastructure supportive of healthy eating and active living? Are the necessary amenities in place to advance wellness? Suggestions on how to create healthier communities included:

Policies • Supporting federal, state and local laws that generate funding for community redevelopment and enhancements to community infrastructure. • Creating tax and other incentives to improve access to necessities such as supermarkets and complete streets. • Increasing the amount of green space available in underserved communities that can be used for physical activity and play. • Enforcing non-discrimination laws in housing, transit and equal access to green space and other community amenities. • Working with state and local authorities to establish zoning laws and model ordinances that enhance access to healthy eating and active living opportunities.

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• I mproving safety by increasing police support in underserved areas and providing more funds to support community policing. • Ensuring community involvement in the development of public policies. • Reinforcing the message that African Americans have a right to have access to neighborhood amenities that support health and wellness.

Programs • E stablishing community gardens to support access to affordable healthy foods. • Connecting with faith- and community-based organizations to leverage their facilities and related resources. • Developing public-private partnerships that support efforts such as the creation of child-focused fitness centers and nutrition and fitness programs connected to schools and universities. • Adopting a sustainable community model (e.g., Harlem Children’s Zone, Holy Cross neighborhood in New Orleans) that supports community wellness.

Research • C reating a “follow the dollars” community mapping project that tracks public investments in schools, parks, hospitals and other neighborhood amenities for the purpose of identifying disparities in the allocation of infrastructure support. • Establishing a study that develops benchmarks and • Encouraging flexible program options that take the needs other indicators to measure the quality and quantity of of single parents into account. changes in the built environment. • Engaging faith- and community-based organizations as • F unding healthy eating and active living research at well as public and private entities and volunteers. historically black colleges and universities. • Developing community needs assessments that evaluate • Investigating the root causes of racial and ethnic disparities. the needs of children and adolescents and providing a roadmap for public investments needed to support youth. The Family & Cultural Environment • Supporting funding for family and community-based wellness programs. Families and the culture that surrounds them are essential • R esearching the socio-cultural determinants of health as to supporting healthy children, adolescents and adults. The they pertain to the obesity epidemic in African-American habits, practices and attitudes of immediate and extended communities. families often shape the habits and practices of children and adolescents. These influences have direct implications • Establishing evaluation plans that benchmark and evaluate the effectiveness of wellness initiatives. for healthy eating and active living. Recommendations in this area included:

Media

• Establishing community-based wellness initiatives that: Considering the ubiquity of media in our daily • provide education and activity options; lives, strategies to encourage large-scale policy and • consider the interests, likes and dislikes of various environmental changes must leverage appropriate ages, races/ethnicities and classes; media outlets to promote positive messages about the • i ncorporate community and built environment options, importance of nutrition and physical activity. Participants including community gardens, farmers markets, food recommended the following approaches. co-ops, and accessible exercise/play facilities; and, • address food choices, access, affordability and • Creating a media and marketing campaign that leverages preparation methods. youth social networking to advance health and wellness.

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• Designing a campaign message that reframes the obesity epidemic in a manner that attracts African-American youth and encourages them to make healthier choices when they are available. • Creating a media message that establishes access to healthy foods as a human right and reframes obesity as a consequence of environmental inequities—not just a personal choice. • Developing scorecards evaluating how television and radio broadcasters and other media outlets market food, beverages and physical activity (or the lack thereof) to children and adolescents. • Encouraging the development of culturally-relevant healthy gaming software. • Requesting that media outlets employ feature documentaries or movies to illustrate the nature of the obesity problem and solutions.

Business Businesses play a vital role in the health and well-being of entire communities. Through the marketing of their services and products, businesses influence food choices, work and leisure activities and even community and individual self-perceptions. Because businesses are located

at the center of communities and often engage in activities beneficial to the communities they serve, they can also be important partners in promoting health and wellness. Suggestions for engaging businesses included: • Developing corporate wellness programs that educate and support adults in their efforts to achieve a healthy BMI for themselves and their children. • Working with companies to establish healthy marketing campaigns in the African-American community. • Encouraging companies to develop convenient meals that are healthy. • Creating a scorecard that evaluates corporate efforts to support health and wellness in African-American communities. • Engaging minority-owned businesses and black chambers of commerce in the effort to create and support healthy communities. • Involving sports teams, sports media outlets, corporate sponsors and the non-profit and public sectors in a common effort to combat obesity. • Working with healthcare providers to ensure that they provide educational opportunities and institutional environments that support healthy eating and active living.

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What’s Next? Action Strategies Policy Advocacy Public policy is a lever that has the power to create and support changes on a large scale. That is why it is essential for African-American leaders, advocates and citizens to engage and inform the public policy process. By sharing their concerns, providing information and discussing desired outcomes, these actors can help direct vital resources to support healthy African-American children and communities. Advocacy recommendations included:

• Engaging African-American media outlets (e.g. National Newspaper Publishers Association, Black Entertainment • Developing a targeted advocacy campaign that advances Television, Black America Web) in the effort to promote policies to support healthy children and healthy healthy communities and kids. communities. The concept that health is a human right • Developing common talking points for group participants should be central to the campaign message. and others to use when discussing this issue. • Training and educating advocates about the legislative • Creating a blog forum to promote childhood obesity process and how to develop working relationships with prevention. policy-makers. • Getting young people involved in the effort to reshape • Collaborating with businesses, chambers of commerce, their communities. community-based, faith-based and civil rights • Encouraging the creation of obesity prevention organizations to expand and improve options for healthy conferences and summits in African-American eating, active living and preventative healthcare services. communities across the country. • Working with policy-makers at each level of government • A sking civil rights organizations, community-based to develop legislation and regulations to advance healthy organizations, faith-based organizations, sororities and eating and active living opportunities (e.g., tax incentives, fraternities to create links to this document on their zoning laws, Community Reinvestment Act). web sites. • Creating a policy-maker honor roll that recognizes policy • Cultivating an army of messengers including youth leaders who do exceptional work on behalf of children spokespersons, researchers, organizational leaders and and communities. celebrity champions from the music/Hip Hop, movie • Identifying and disseminating model policies and practices and television worlds and feature these messengers at that can advance healthy eating and active living. community summits and in media campaigns. • Establishing a strong African-American presence in the Community Advocacy growing anti-obesity movement. • Distributing this strategies document to policy-makers, Beyond public policy, there are things that communities local and national organizations, funders, food and themselves can do to help advance the strategies and beverage companies, national associations, Africanrecommendations outlined in this document. American professional organizations, youth councils and the media. Recommendations in this area included: • Writing articles and op-eds promoting the need to • Developing a story bank that illustrates the experiences implement strategies that encourage healthy eating and and perspectives of African- American children and active living. communities.

Reshaping Our Communities, Reclaiming Our Health

Conclusion Every person, organization and level of government has a role to play in reversing the obesity epidemic and supporting community health and wellness. The latest statistics demonstrate that the obesity epidemic has spiraled out of control in the African-American community. Given the stark health disparities that many African Americans face, it is crucial that community leaders, policymakers and others recognize this problem as a national health crisis and prioritize the implementation of solutions for preventing obesity. The good news is that we are constantly learning more about how to address disparities in the built environment that undermine our health and we are learning more about what laws and programs need to be established or enforced to support African-American health and wellness. The recommendations in this report provide a roadmap for African Americans who want to improve the quality of life in their communities. While it will take collaboration, innovation and sustained effort to implement many of the recommendations suggested, the effort will be worthwhile because the health of our children and the well-being of our communities are at stake.

Leadership for Healthy Communities is a nonpartisan organization that supports local and state government leaders nationwide in their efforts to reduce childhood obesity through public policies that promote active living, healthy eating and access to healthy foods. We focus, in particular, on policy efforts that can increase physical activity and improve nutrition among children at the highest risk for obesityâ&#x20AC;&#x201D;African-American, Latino, Native American, Asian American and Pacific Islander children living in low-income communities. Leadership for Healthy Communities is a $10 million national program of the Robert Wood Johnson Foundation, and the efforts we fund are expected to help the Foundation achieve its goal of reversing the childhood obesity epidemic by 2015. The Congressional Black Caucus Foundation was established in 1976 as a nonpartisan, non-profit, public policy, research and educational institute intended to broaden and elevate the influence of African Americans in the political, legislative and public policy arenas. Toward that end, CBCF seeks to educate future leaders and promote collaboration among legislators, business leaders, minority-focused organizational leaders and others to achieve positive and sustainable change in the African-American community.

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