Lessons from Latino Communities: Policy and Systems Change to Prevent Childhood Obesity

1. APHA Annual Meeting 2012 Lessons from Latino Communities: Policy and Systems Change to Prevent Childhood Obesity George R. Flores MD, MPH; Emma Sanchez-VaznaughDrPH; Lisa Goldman-Rosas PhD; Liz Schwarte MPH; Sandra Viera MPH; Robert Garcia JD; Seth Strongin; Amanda Navarro DrPH

2. Presenter Disclosures George R. Flores No Relationships to Disclose (1) The following personal financial relationships with commercial interests relevant to this presentation existed during the past 12 months:

3. Chapter One LATINO CHILDREN’S HEALTH AND THE ENVIRONMENT George R. Flores, Emma V. Sanchez-Vaznaugh, Lisa G.-Rosas, Liz U. Schwarte, Robert Garcia, Sandra R. Viera, Mariah S. Lafleur, Manal J. Aboelata, Seth H. Strongin and Amanda M. Navarro . . . If you grow up in a neighborhood with a good school, where it’s safe, where you can walk and play outside, where you have a regular doctor and where you have access to good food, you are more likely to live a long and healthy life. On the other hand, if you grow up in a neighborhood where you’re not safe, where your school is failing you and where you do not have a place to go when you are sick or need a basic grocery store, then you are far more likely to live a shorter life, to earn less money, to be party to or victim of violence and to be far less healthy emotionally and physically. If you are . . Latino, you are likely to face not just one of those challenges, but many or all of them at once. (Policy Link, 2010)

4. Introduction • Relative to non-Hispanic whites, Latino children that experience less favorable environments are at risk for poorer health outcomes. • The co-epidemics of type 2 diabetes and obesity are largely driven by adverse environmental conditions that are preventable. • It is reasonable to expect that improving environments to support healthy nutrition and physical activity can lead to better health outcomes

5. Purpose • Identify factors in the physical and social environments of children living in Latino communities that shape risks and opportunities for healthy nutrition and physical activity. • Identify practices and interventions in Latino communities that show promise for changing policies and conditions to improve opportunities for healthy nutrition and physical activity.

6. Methods • Scan of peer-reviewed publications, foundation-funded research, evaluations, community project reports, and key informant interviews to identify: • environmental conditions commonly experienced by Latino children that have bearing on their nutrition and physical activity; • promising practices in Latino communities working toward healthier environments.

7. Place Matters

8. Results: Unhealthy Food and Activity Environments • Latino children are more likely to live in poverty and poverty is associated with greater consumption of energy-dense foods and lower quality diets. • Poor Latino neighborhoods often have fewer structural resources to support healthy behavior such as grocery stores and parks, schools that are over-crowded and under-funded, and safety and violence problems. • Remote rural areas are at risk of economic and food insecurity with limited access to essential services and healthy food sources. • Children in Spanish-speaking households are more likely to be exposed to adult content and advertising of unhealthy foods like sugary drinks and fast food. • Sugary beverage companies target Hispanic kids, teens. • Lack of access to safe parks is a common barrier to physical activity for Latino children and youth.

9. Social and Place Inequities lead to… Health Inequities Segregation Income & Employment Education Housing Transportation Air Quality Food Access & Liquor Stores Physical Activity & Neighborhood Conditions Criminal Justice Access to Healthcare Social Relationships & Community Capacity

10. Health Happens in Latino Communities

11. Results Improved Food Environments • Mercado La Paloma (LA) – healthy menus • Healthy Bodegas (NYC)– healthy corner stores • CCROPP Farmers Markets (CA Central Valley) • Buen Provecho promoting fresh produce (Chicago) • Denver Urban Gardens

12. Results Improved Physical Activity Environments • Albuquerque Alliance for Active Living – bike trails • Alianza de los Pueblos del Rio (LA) – parks • PE and Civil Rights LAUSD • Active Living in Logan Square (Chicago) • Greenfield Walking Group (Bakersfield) • Reclaiming Lauderbach Park (Chula Vista)

14. COMMUNICATIONS POLICY POWER

15. CCROPP Farmers Markets and Produce Stands • Increases access to fresh produce in low-income communities • Creates opportunities for collaboration between community, schools, public health departments, farmers/vendors • Keeps locally grown produce local

16. Collaborative Efficacy • Santa Ana --60 Latino adults and 61 Latino youth involved in civic discourse on neighborhood improvement • Arvin / Lamont – 300 Latino residents push for closure of nuisance recycling plant ; 250 for school wellness policies • Greenfield – 75 Latinas secure approval and funds to improve parks • Boyle Heights – 500 youth organize for improved school food, access to health services, reduced community violence • Coachella – 150 Latino residents training to participate in public land use and transportation decision-making

17. Impact • Santa Ana – joint use at 2 schools; 2 new parks; community garden; walking and exercise groups • Arvin-Lamont– new parks and sidewalks, abate pollution, improved school nutrition, PE, and water access • Coachella– health and wellness element in general plan; farmers market; improved school food and access to drinking water; school clinic • West Fresno – walking / jogging trails; revitalization and smart growth; school discipline; • South Merced – community garden; farmers market; joint use; • East Salinas – violence reduction; “health in all places” policy in city -county planning; • South Sacramento, Coachella, South Kern, City Heights /San Diego --school wellness policies

18. Discussion • We found a growing body of scientific evidence and real-life examples of environmental conditions that shape the health and well-being of Latino children. • Descriptive and cross-sectional studies show that Latino children confront multiple inequitable conditions within the social and physical environments that surround them where they live, go to school, and play. • Foundation and government-funded programs that address social determinants, target environmental change, and employ community capacity-building, cross-sector collaboration, and policy advocacy, are found to improve opportunities and conditions for healthy nutrition and physical activity in Latino communities.

19. Conclusions • Critical examination of the impact that adverse environments can have on health outcomes suggests that the health and wellness of millions of Latino children is being compromised. • Projects demonstrating community-driven measures to create equitable and health-supportive nutrition and physical activity environments in Latino communities constitute a growing body of promising practices ripe for broad replication. • Policy and systems changes that inherently address root factors of social and environmental inequities have the potential to prevent obesity and its complications in Latino communities. • Co-benefits such as improved attendance and performance in school, community safety, and positive youth development have been reported, suggesting further investigation is merited. • Replication of and scaling-up these models require sustaining resources to assure institutionalization, lasting community change, and improvement in health status. • The Affordable Care Act’s Prevention and Public Health Fund supports this type of approach and is a potential resource for sustainability.

20. MONEY & POLITICS, HEALTH & WELFARE | DAILY REPORT Beverage lobbyist funds 'community' campaign against soda tax June 13, 2012 | William Harless, California Watch RICHMOND – A powerful Washington, D.C., trade organization that represents PepsiCo, Coca-Cola and other major beverage companies is helping fund a Richmond group that is fighting a November ballot measure to raise taxes on soda and other sweetened beverages, interviews and records show. A Richmond resident, Rosa Lara, is going door to door identifying herself as an organizer with the Community Coalition Against Beverage Taxes and collecting signatures on a petition. Although Lara doesn't mention it unless specifically asked, her group is supported by the American Beverage Association, the industry's main trade organization.

21. Housing Childcare Medical Care Jobs Healthy Food We each have a role Clean Air Parks and Activities Policy Makers Education Economic Justice Preschool Safe Neighbor-hoods Residents Transportation

22. Resources • www.calendow.org