Addressing Obesity through the Built Environment: An Event Recap

DASHNY Active Communities, Advocacy & Policy, Economic and Community Development, Environment, Prevent Chronic Disease, Tools & Resources 0 Comments

By Ellie DeGarmo, B.A., Junior Policy Associate and Diane Kolack, B.A., Policy Associate

We tuned into a daylong Roundtable on Obesity Solutions Workshop

In an effort to address obesity by exploring potential mechanisms for changing the built environment, the National Academies of Sciences, Engineering, and Medicine (the National Academies) hosted Advancing Obesity Solutions through Investments in the Built Environment: A Workshop on September 12, 2017. The daylong event was a part of the National Academies’ Roundtable on Obesity Solutions, which began in 2014 with the mission of coordinating efforts across sectors to address the obesity epidemic.

The event was broken up into the following three topical sections:

  1. Built Environments, Obesity and Health Overview
    • Rodrigo Reis from Washington University in St. Louis spoke about the importance of cross-sector collaboration in creating policies for healthier built environments. Through computer modeling, his multi-disciplinary team identified eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transit use, while reducing private motor vehicle use. Reis also suggested that in order to maximize cross-sector engagement, messaging should be crafted effectively. Research shows that this means shifting the conversation from a focus on health to a focus on the sector specific co-benefits (e.g. environmental sustainability and improved safety) that result from changes to the built environment.
    • Karen Glanz of the University of Pennsylvania began by telling the well-known parable of the Blind Men and the Elephant in which each man feels a different part of the elephant, and confidently arrives at a completely different conclusion about the definition of an elephant. Glanz used this analogy to illustrate the limitations of some recent research on obesity and food environments. She cautions that when interventions that focus on just one piece of the puzzle (or the elephant) fail, we need to ask why and consider the bigger picture.
    • Daniel Rodríguez from the University of California, Berkeley emphasized the ways that city planners can improve the built environment through transportation elements and land use policies that benefit the 53 percent of our country’s population living in suburban environments.
  1. Progress in Improving Built Environments – Examples from Communities and Cities
    • Michelle Nance of the Centralina Council of Governments had the goal of making places more walkable. She conducted “walkability audits,” and discovered that a crucial element was increasing safety through simple and understandable measures like expanding sidewalk lighting.
    • Leslie Meehan from the Tennessee Department of Health cited the example of the Middle Tennessee Transportation and Health Study to demonstrate that data collection is an effective way for the transportation and health sectors to work together. In this case, each sector took responsibility for a distinct part of the process: the transportation department funded the study, while public health professionals executed it.
    • Cathy Costakis of Montana State University explained how community reluctance can be a barrier to implementing changes in the built environment. She offered an effective way of mitigating this through temporary modifications (referred to as “pop-up interventions”), allowing residents to “test” measures before permanent changes are made, including temporary road signs and crosswalks, a roundabout made with hay bales, and mini recreational spaces called parklets.
  1. Challenging and Promising Strategies for Achieving Equitably Healthy Environments
    • KaBOOM! CEO James Siegal discussed how his organization builds playgrounds to increase an area’s “playability,” an idea that can be thought of as “the extent to which a city makes it easy for all kids to get balance and active play.” KaBOOM! focuses on health equity by prioritizing their work in the neighborhoods that need it most.
    • Kimi Watkins-Tartt from the Alameda County Public Health Department shared three health-related projects that her department carried out. She attributed the success of each initiative to the county’s broad approach that included policy and systems change, institutional change, and partnerships and community collaboration. The projects included writing a community health and wellness plan, creating healthy and equitable development guidelines, and implementing tobacco and food-related changes in retail environments.
    • Sara Hammerschmidt from the Urban Land Institute (ULI) talked about the work her organization does through providing real estate developers with expertise on using land responsibly and sustainably. For example, ULI lent support to construct Arbor House in the Bronx, New York, a building with 124 units of affordable housing. Arbor House is located in a neighborhood where residents suffer from disproportionately high rates of chronic disease. The development includes a hydroponic rooftop farm for residents with 40 percent of the produce designated for school, hospital, and food market programs. Arbor House’s design also promotes physical activity, from fitness areas located inside and outside the building to prominently placed stairwells.
    • Finally, Shai Lauros, a developer from Local Initiatives Support Coalition (LISC) National discussed the ways in which her organization supports local initiatives by involving local leaders and residents, facilitating cross-sector partnerships, and addressing the physical, social, and economic needs in a community.

The rate of obesity in New York State (NYS) is 25.5 percent. Even though this is more than 10 percent below the national average, addressing obesity is a top priority, and we strongly encourage communities across the state to consider the importance of the built environment in their work to reduce obesity and chronic diseases.

In the second and final part of our series on health and the built environment, we will highlight innovative approaches from communities throughout NYS.

Universal Free Lunch—Feeding Even More Kids

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Image Credit: Wikimedia Commons

By Holly Woodbury, B.A., Center for Health Policy & Programs Intern

The push toward improved healthy food access for children scored another victory earlier this summer. New York City’s new budget allows for universal free lunches for public school children. The City has already made strides for healthy food access for children, like NYC’s Free Summer Meals and Free Breakfast Program at schools, but this recent change in spending will be a gamechanger for lunchtime. Currently, New York’s free and reduced-price lunch program is structured as follows:

  • Free lunch for students who come from families with incomes at or below 130 percent of the poverty level
  • Reduced price lunch for students who come from families with incomes at or below 185 percent of the poverty level
  • Full price lunch for students who come from families with incomes above 185 percent of the poverty level

Children having access to nutritious food throughout the school day is crucial to their overall health and development, but it is even more imperative for their learning. It’s been proven that when children have healthy meals at school, they are more attentive, more energetic, and retain their lessons better.

While free and reduced-price food is vital for many kids, there is the fear of being teased for paying a reduced price. Sometimes, kids face ostracization if their family cannot pay the full price, which may lead to their food being thrown out or kids not eating at all. In addition, some schools shame their students and throw their food away if the fee is not paid on time. Not only does teasing lead to a negative school environment, but throwing uneaten food away contributes to food waste. The way to quell this problem is to implement a universal free school lunch program, which would make lunch available for over one million school children in New York City. Before, it was just a popular idea.

Now it’s been made possible.

President and CEO of the New York State Health Foundation, David Sandman, PhD, announced on Wednesday, June 7th that, thanks to the Foundation, New York City’s budget for 2017-18 has expanded to give all 1.1 million public school children have access to free lunches, along with the already established free breakfast. Sandman said that the expanded budget means “students will have the food they need to be healthy, to learn, and to play.” Numerically, this new budget means that 90 percent of public schools will offer free lunches. In addition to the expanded lunch program, the budget will also help in improving food quality in schools, and aid in program promotion.

Universal free school lunch means that no child will have to face teasing or alienation over the need to have a free lunch. Moreover, this will ensure that no child will be teased. In addition, this new budget expansion will especially help children from low-income communities, which are often disproportionally affected by lack of healthy food access. The implementation of universal free lunch will not only be beneficial for children and help them succeed in class, but will also be a great step for food justice.

New York State’s budget expansion for New York City aligns with the Academy’s work to prevent chronic diseases and promote health equity. The Academy and Designing a Strong and Healthy New York (DASH-NY) applaud New York State’s efforts in building a healthier and more equitable New York City.

Spike in Opioid Overdose Deaths Due to Increase in Illicitly Manufactured Fentanyl: New Report

DASHNY Advocacy & Policy, Clinical and Community Linkages, Emerging Evidence, Prevent Substance Abuse 0 Comments

Image credit: PBSS issue brief, page 2

By Ellie DeGarmo, B.A., Junior Policy Associate

Opioid overdose deaths are on the rise in the United States, with over 52,400 in 2015 and recent estimates indicating that 2016 saw the steepest annual increase to date, and reaching a record annual death count of over 59,000. There are many different kinds of opioid drugs and new research reveals that there are certain types that have led to sharp increases in overdose deaths. A recently released Prescription Behavior Surveillance System (PBSS) issue brief reports that overdose deaths specifically involving a narcotic called fentanyl have increased significantly. The infographic accompanying this post is an image from this issue brief and can be found on page two.

Fentanyl can be manufactured and prescribed legally, but can also be produced illicitly and sold illegally as heroin or combined with heroin. The PBSS brief analyzes data from five states (Maine, Ohio, Virginia, Washington, and West Virginia) and explores how trends in fentanyl related deaths compare to trends in legally prescribed fentanyl. Four out of the five states demonstrated their greatest number of fentanyl overdoses in 2015 (the final year in the study’s 2010 to 2015 timeframe), yet prescribed fentanyl rates remained stable or had fallen during this time.

This means that the increase in fentanyl overdoses can be attributed to an increase in illicitly manufactured fentanyl (IMF). The PBSS issue brief insists that this reality “highlights the need for close collaboration between public health and public safety in order to optimize the response to the ongoing opioid overdose epidemic.”

To this end, the PBSS brief concludes with two main recommendations. One concerns improving surveillance of fentanyl outbreaks, while the other calls for expanding access to naloxone, an antidote that counteracts the effects of opioids, and ultimately prevents overdose deaths. The recommendations offer guidelines for health care providers and harm reduction organizations that are specific to their capacity and expertise. For example, they suggest that health care providers supply more naloxone to first responders like EMS personnel, while they encourage harm reduction organizations to make available take-home naloxone kits.

The New York State (NYS) Prevention Agenda (NYSPA), on the other hand, did not mention naloxone in its original version that was published in 2013. Since then, however, naloxone has found its way into the language of updated NYSPA publications. Most notably, in December of 2015, the NYS Department of Health released an Action Plan Re-Fresh Chart, incorporating recent information generated from their Update Survey. On page 22 of this document, “harm reduction including Naloxone training” is listed as one of the eight recommended interventions for overdose prevention.

The Academy commends the NYSPA’s addition of naloxone and encourages stakeholders to consult the PBSS brief’s recommendations for more detailed guidelines about how to implement this crucial safeguard against overdose deaths.

Perhaps the most promising solution for combatting the opioid epidemic, however, is through the implementation of supervised injection facilities (SIFs), legally safe spaces in which users can inject drugs with medical supervision. A previous Promoting Prevention blog post discusses, in detail, the controversial measure that exists in over 60 cities in ten countries, curbing the epidemic and preventing overdose deaths. In fact, over the course of 30 years and millions of injections in SIFs around the world, not a single overdose death has occurred in a SIF.

Despite this proven success, mention of SIFs is completely absent from both the original and recent updates to the NYSPA. This is probably because there are no SIFs in NYS. New York City, along with Seattle, San Francisco, Baltimore, Ithaca, NY and other municipalities are examining the issues surrounding implementation of this strategy. In New York City, the Academy is currently engaged in research aimed at advancing SIF implementation in New York. The ongoing SIF Feasibility Study is gathering opinions from local stakeholders – people who use drugs, health care providers, the faith and business communities, law enforcement – on the topics of drug use and SIFs, in order to better understand and maximize the benefits of establishing SIFs in NYS.

In addition to this, the Academy joins over 30 organizations and over 100 health care professionals in support of the SIF NYC coalition, a coordinated effort to advocate for SIF implementation. Spurred into action by a letter of support signed by the 100 health care professionals, bill A. 8534, which would authorize the implementation of SIFs in NYS, was introduced to the New York State Senate by Assemblymember Linda B. Rosenthal (D – Manhattan).

Continued strong support for SIFs is needed to ensure that this crucial bill becomes law. New York has an incredible opportunity to become the first state in the country to authorize SIFs. Hopefully, this would encourage other states to follow, so that overdoses can be prevented and lives can be saved nationwide.

Breastfeeding Awareness Every Month – Not Just August

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By Ellie DeGarmo, B.A., Junior Policy Associate

August is National Breastfeeding Month, and New York State (NYS) is dedicated to promoting breastfeeding as a part of the NYS Prevention Agenda (NYSPA). Specifically, the NYSPA identifies the goal of “increas[ing] the proportion of NYS babies who are breastfed” as one of the ways to accomplish the Promoting Healthy Women, Infants and Children Action Plan.

Breastfeeding is important because there are many proven benefits to both mothers who breastfeed and to their babies. For example, breastfed babies are more likely to have stronger immune systems and are less likely to develop childhood obesity, while mothers who nurse are also likely to have positive effects on their immune systems and will have a reduced risk of developing breast cancer.

When in the hospital, after giving birth and before discharging, mothers typically make the crucial decision of whether to breastfeed or to use formula. This is why the position that hospitals take plays a crucial role in informing this decision.

The NYSPA recognizes this influence. To this end, as a part of its suggested interventions, the NYSPA emphasizes the expansion of Baby Friendly Hospitals, calling on various stakeholders to support this effort. To acquire the designation of being a Baby Friendly Hospital, birthing facilities must implement the Ten Steps to Successful Breastfeeding and abide by the International Code of Marketing Breast-milk Substitutes.

In addition to breastfeeding being a part of the NYSPA, there is relevant information that, if equipped with, New Yorkers can become aware about breastfeeding in NYS. Two examples of this are by understanding (1) the relevant legal framework in NYS; and (2) the resources available to breastfeeding mothers.

The most important piece of NYS legislation to know is the “right to breast feed,” found in Section 79-E within the 1994 New York Civil Rights Law. This law provides the most explicit and comprehensive protection to nursing women, allowing mothers to nurse wherever they want, regardless of whether they are in a public or private space. The New York Civil Liberties Union expands upon this by highlighting the fact that and the ways in which the right to breast feed protects women in specific settings like at hospitals and in the workplace.

Despite these protections, prevailing stigma towards breastfeeding in public can deter women from exercising their right to do so. To address this, baby cafés, which are places that “offer support on all aspects of breastfeeding,” have sprung up across the country. There are currently 17 baby cafés operating in NYS alone, six of which recently opened.

Nursing mothers in New York City (NYC) also have the option of using public “lactation pods” to pump milk or breastfeed their babies. These 4 foot by 8 foot pods are enclosed spaces that can be locked and are equipped with an electrical outlet for breast pumps. There are dozens of these units located throughout NYC, five of which were unveiled at the beginning of this month.

Although the official National Breastfeeding Month is coming to a close, our dedication to this issue is far from over. It’s important to ensure that awareness and advocacy extends beyond August, and continues throughout the year.

Accomplishing this requires sustained attention to both the institutional level and the individual level. Specifically, relevant professionals and hospitals must adopt the guidelines delineated in the NYSPA to become baby friendly, while mothers must be provided with necessary information about the protections and services that are available to them. For more material and resources to help guide this process, please refer to the breastfeeding factsheet that was assembled by the Academy’s Designing a Strong and Healthy New York (DASH-NY) project team.

Children’s Menus Offer Fewer Sugary Drink Options but There is Still Room for Improvement: New Report

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By Ellie DeGarmo, B.A., Junior Policy Associate

Research reveals that children’s chain restaurant meals have gotten healthier. More specifically, children’s menu items are less likely to offer sugary drinks and more likely to offer low-fat milk now than they did four years ago. The Center for Science in the Public Interest (CSPI) recently released a report examining 38 of the country’s largest restaurant chains like McDonald’s, Chipotle Mexican Grill, and Panda Express. The image accompanying this post is a figure from this report and can be found on page two.

Researchers explored beverage options found on the children’s menus at these restaurants and grouped each drink into five categories: sugary drinks, high-fat milk, low-fat milk, juice, and bottled water/seltzer. Findings related to two of these groups were significant. First, sugary drinks, like soda and sports drinks, were offered by 74 percent of restaurant’s children’s menus, a drop from 83 percent in 2012. Second, low-fat milk, characterized by being fat free or 1 percent, was offered by 69 percent, a sharp increase from 40 percent in 2012.

Information about drink options in restaurants is increasingly important as Americans are eating out more now than ever before. According to CSPI, over half (50.1 percent) of the money used for food is spent at venues away from the home, like restaurants and cafeterias. This is nearly double the 1970 rate of 26 percent.

As sugary drinks continue to be a part of children’s meals at restaurants, kids remain at a greater risk for developing health issues like obesity, type 2 diabetes, and dental disease. Although trending in the right direction, additional restaurants need to trade unhealthy drinks for healthier ones in order to minimize rates of childhood obesity and prevent the onset of associated chronic health conditions.

The 26 percent of restaurants that do not offer sugary drinks comprise nine restaurants that decided to remove these kinds of beverages from their children’s menus. While complete elimination of sugary drinks is ideal, CSPI offers alternative measures that can be taken. The report’s three recommendations involve making healthy beverage options the default, ensuring that nutrition guidelines are met, and restricting advertising to feature children’s meals that are healthy.

Setting healthy options as the default in children’s menus is an action that is overwhelmingly supported by New York City residents. A recent poll by the American Heart Association found that “87% of New Yorkers agree: restaurants should make healthy drinks the default option on kids’ menus.”

This sentiment is also reflected in the goals of the New York State (NYS) Prevention Agenda (NYSPA), which calls upon state and local actors to “create community environments that promote and support healthy food and beverage choice and physical activity.”

As a part of the Academy’s commitment to the NYSPA, our Advancing Prevention Project and Designing a Strong and Healthy New York project teams support the NYS recommendations and strongly encourage restaurants to either remove sugary drinks from their children’s menus or implement CSPI’s suggestions.

Beyond this, there is opportunity for action in the legislative arena as well. The Academy recommends amending and passing Introduction 442 to promote children’s health by ensuring that healthy drinks are the default option in kids’ meals in every New York City restaurant. Permissible beverages to be sold with a children’s meal include (1) water, sparkling water, or flavored water, with no added natural or artificial sweeteners; (2) milk or non-dairy milk alternatives; and (3) 100% juice. This bill was introduced to by Council Member Ben Kallos (D-Manhattan) to The New York City Council in 2014, yet it remains undecided.

Most recently, the bill, which has 16 co-sponsors, was discussed in a committee hearing in January of 2016. Introduction 442 was laid over in committee at this hearing, and has not been revisited since. The Academy urges New York City Council Members to use the momentum generated from CSPI’s recent, promising findings to move forward with this legislation. We must hold our local lawmakers accountable to ensure that they take this crucial step towards making children’s meals healthier, ultimately reducing both the rate of childhood obesity as well as the risk of developing chronic conditions like type 2 diabetes and heart disease.