North Carolina’s Approach to Communicating with Policymakers

1. North Carolina’s Approach to Communicating with Policymakers Jimmy Newkirk Dave Gardner, D.A. Lexie Wolf, M.A.

2. Today’s talk • Introductions • Strategic Focus of PAN Branch • PAN’s role with statewide movement • Eat Smart Move More Overview • Including Policy Platform • Lessons learned for communicating with policy makers

3. Our mission • The mission of the Physical Activity and Nutrition Branch (PAN) Branch is to reverse the rising tide of obesity and chronic disease among North Carolinians by helping them to eat smart, move more and achieve a healthy weight.

4. Strategic Focus • Impact: Decrease obesity rates and related chronic diseases • Outcomes: • Increase Physical Activity • Increase consumption of fruits and vegetables • Decrease consumption of energy dense foods

5. Strategies (to achieve outcomes) • Enhanced land use and transportation policies • Creation of or enhanced access to places for PA, combined with informational outreach activities • Promote food policy councils • Increase access to healthy foods including corner stores, farmers markets, community gardens and at worksites

6. Our work is … • Across all levels of the socio-ecological model with an emphasis on policy and environmental change • In all “settings” with an emphasis on community environment, school aged children, and worksites • Always with partners!

7. Our work: • Enables us to be technical experts for issues in the General Assembly, educating policy makers (advocacy) • Supports local efforts of health departments, partners, and coalitions who may also be advocates

8. PAN’s role • Statewide movement: Eat Smart Move More North Carolina • Over 60 agencies formally signed on, many more informally involved • NC Division of Public Health is one partner • PAN provide staff support to the movement

9. Eat Smart Move More (ESMM) • Executive Committee • Leadership Team – reps from all member agencies • Ad Hoc Committees: • Policy / Advocacy • Key Measures • Surveillance

10. Eat Smart Move More NC • Eat Smart Move More: North Carolina’s Plan to Prevent Overweight, Obesity and Related Chronic Diseases 2007 – 2012 • ESMM Policy Strategy Platform * • Many policy tools and curricula • Website: • www.EatSmartMoveMoreNC.com • www.MyEatSmartMoveMore.com

11. Policy Strategy Platform • Focal Point for Policy Action • Platform: focused but at a strategic level • Tactical level (e.g., specific language and sub-components of policy issue) is supported by partners such as the NC Alliance for Health • Includes 20 policy strategies • organized with frame from CDC’s Community Strategies and Measurements Guide • state and local; legislative and organizational

12. Platform includes strategies to: • Promote the Availability of Affordable Health Food and Beverages • Support Healthy Food and Beverage Choices • Encourage Breastfeeding

13. Platform includes strategies to: • Encourage Physical Activity or Limit Sedentary Activity Among Children and Youth • Create Safe Communities that Support Physical Activity • Develop Capacity and Support for Obesity Prevention

14. Each Policy Strategy: • General Action – organizational actions that can advance the strategy • Legislative Action – legislative actions that can advance the strategy • Cost - summary of any costs identified • Sources – list of where strategy has been recommended by Task Forces, Organizations, etc. • Evidence - references to key evidence • Current Status - (dynamic document)

15. Partners use of Platform: • Common focal point for NC policy action • Incorporated into organizational platform (e.g., one agency can “own” specific issues) • Educate decision makers (i.e., advocate) • Some partners able to communicate directly with policy makers with specific policy “asks” (i.e., lobby)

16. Next Steps for Platform • One pagers to support each policy strategy • Include success stories • Enhance “alignment” with behavioral messages • Public tracking system (for “current status”) • Increase distribution and partners use

17. Childhood Obesity Prevention Lawmaker Information Gathering Project Dr. Jodie Abbatangelo-Gray, Sc.D., M.S., M.A. Dr. Jill Fromewick, Sc.D., M.S. Lexie Wolf, M.A. A project of The North Carolina Center for Health and Wellness (NCCHW) at University of North Carolina Asheville Funded by the Blue Cross and Blue Shield of North Carolina Foundation

18. Project goal: To learn more about North Carolina policymakers’ attitudes about childhood obesity including: • knowledge & gaps in knowledge • what they believe are the causes of childhood obesity • opinions about policy areas that could prevent childhood obesity • how they research and make policy decisions

19. Project design: • Survey distributed through Survey Monkey to members of the North Carolina General Assembly • In-depth interviews with 14 North Carolina policymakers (3 municipal lawmakers, 6 county commissioners, and 5 state representatives)

20. Identification & recruitment of interview subjects: municipal and county lawmakers Used websites to obtain biographical information when available; selected a pool of prospective interviewees that was diverse with respect to geographic locale, age, gender, ethnicity, party affiliation, and exposure to issues related to childhood obesity

21. Identification & recruitment of interview subjects: state legislators • Spoke to representatives who did not have a history of involvement in childhood obesity or related issues • Sought variation with respect to party affiliation, gender and location of district

22. Subject areas: • Magnitude of problem: how serious? • Causes of problem • Role of lawmakers and policy in childhood obesity prevention • How they make policy decisions: where they get information, how they do research, etc.

23. Magnitude of problem • 10 out of 15 lawmakers termed childhood obesity “serious” or “very serious” • 2 lawmakers: “extremely serious” and “crisis making” • 2 lawmakers: “not earth-shaking” (mayor) and “not a huge problem” (state legislator)

24. How have they come to believe that childhood obesity is a problem? “You can tell just from looking at them on the street” “Because I look at all the young people around me, and all of them are bigger than I am” “I see many young people – in our church for example”

25. What are the causes of the problem? Modern family life: less unstructured play, lack of home cooking and family meals, more screen time “I suspect few children are getting training and discipline in terms of food in their families these days” -County commissioner • Most framed this as parental choice, just a few noted contextual/structural factors influencing family lifestyles “ I think that parents have got to take some kind of responsibility. I know of families who just let their kids eat out of boxes every night.” - County commissioner

26. What is the role of the lawmaker in this issue? • Much variation in how lawmakers viewed their own roles and responsibility with respect to this issue • Many county and municipal lawmakers did not immediately think that this was an issue that fell within their jurisdiction

27. Framing the issue “We’re putting in walking tracks and bike trails through the town. So I think we’re certainly doing our part, but we don’t want to cram it down anybody’s throat, you know?” -Mayor of small central NCtown • Lawmakers at all levels did not want to be perceived as “intervening” and “legislating” health • Local lawmakers seemed more comfortable with the idea of “promoting health and fitness” rather than “obesity prevention.”

28. Jurisdiction & policy settings • State legislators more likely to discuss school policy interventions than county or municipal lawmakers • Local lawmakers articulated built environment policy solutions such as trails and sidewalks more often than did state lawmakers

29. Policy interventions for healthy eating? “Certainly I’m not going to blame the fast food industry. Thank goodness for Burger King and McDonald’s. They feed an awful lot of people. And doing away with them is only going to bring up something. You know, we’re not going to live on tofu and yogurt. So what we have to do is personally come to an understanding that we have some control over our own lives.” -Mayor of small municipality in central NC

30. Making policy decisions • All five state lawmakers and all six county commissioners reported that they viewed evidence and research before making decisions as very important • However, nearly every interviewee referenced personal anecdotes and observations during the course of the conversation

31. Key findings & implications for advocacy • While many lawmakers may feel that childhood obesity is a major problem, they may have a limited understanding of the depth, severity, and macro-level impacts of the disease. • Understanding of causes, impacts and possible solutions may be based on personal experiences and observations

32. Therefore….. • Lawmakers may not always see the connection between policy and behavior or see their role in childhood obesity prevention. • Policies that create opportunities or incentives will likely be received more positively than those that are more regulatory in nature.

33. PAN: Communicating with Policymakers • The Healthy Environments Initiative: goal is to implement state level policies that promote healthy environments and active lifestyles in North Carolina communities.

34. Communicating with policymakers about healthy environments: “bottom-up” approach • Communications campaign will begin by educating communities and citizens about how they can shape their built environments for active living • Education about the relationship between the built environment and physical activity will provide context for future policy action

35. Making the connection through personal stories • NC youth to participate in a video contest exploring features in their community that help or hinder active living; videos showcased in community • Communications campaign will utilize personal stories and anecdotes to raise awareness about the relationship between physical activity, policies and environments, and health

36. Conclusions • When communicating with decision makers at all levels: • Bridge the gap between personal choice and opportunity • Don’t assume an understanding of the issue • Provide the facts, e.g., research, but use personal stories and case studies • Collaboration is, quite simply, the way to move policy forward

37. Contact: Jimmy Newkirk Jimmy.newkirk@dhhs.nc.gov Dave Gardner dgardner@unca.edu Lexie Wolf Lexie.wolf@dhhs.nc.gov