What Works

What the signs are telling us....

There is a rich array of data available to monitor the health status of individuals and families in Erie County, and the overall picture is decidedly mixed. Overall, adults in Erie County have a slightly better health status than is founds in adults across the state or nationwide, and the number of children with access to healthcare has grown as a result of aggressive coverage initiatives at the state and federal level.

On the other hand, Erie County trails the state and nation in a number of key health indicators: the number of adults who are overweight or obese, the incidence of smoking and binge drinking, numbers of pregnant and parenting teens, and the incidence of child abuse. These problems are often found in communities where poverty is high, and, indeed, the growing rate of poverty and its correlation with these critical health factors has been of concern recently in Erie County.

The pursuit of primary prevention strategies in each of these health areas will be critical in boosting the likelihood of other health outcomes and in enhancing the overall quality of life in the city and county.

What Works: Traffic Patterns, Promising Practices and Pilots

From a national scan of programs led by nonprofits that are making a difference in other communities, we see hope in strategies that focus on:

Overweight and obese adults and children

The prevalence and depth of the problems associated with obesity, combined with the catastrophic costs of losing ground in this global problem, argue strongly for a public health campaign approach similar to those that have been successful in the past with smoking and drunk driving. While community-wide campaigns have compelling features that touch every segment of the population, efforts commonly start with a community’s schools in order to build a culture of change within young people. Notable promising practices fall generally into three areas:

• Comprehensive Wellness Initiatives Based in Schools

Given the importance of developing healthy lifestyle choices and patterns among children, some of the most dramatic community-wide successes seen to date have grown out of school pilot wellness programs:
* The School Health Initiative Program is a partnership between the Williamsburg (VA) Community Health Foundation and the local schools that offer challenge clubs for students, staff wellness programs, and an innovative effort to integrate physical activity into core subjects.
* Shape Up Somerville began in 2003 as a school initiative around serving healthier food, revamping the health curriculum, and introducing healthy cooking, eating, and exercise in the after-school regimen. In later years, the program expanded to involve new, healthier menus and oprtion control in restaurants and a culture of walking city-wide.
* Healthy Eating, Active Communities is a multi-year initiative of the California Endowment that includes resources for collaborating and building partnerships and working on policy advocacy.
* Charter schools, because of their small size and flexibility, have been leading the way with new curriculum, healthy food initiatives, school-run gardens, and building a culture of youth leadership in this critical area. Efforts are detailed by What Kids Can Do..

• Nutrition Strategies

In addition to regulatory initiatives designed to make school food healthier, efforts to create incentives for fast-food chains to offer healthy alternatives, tax unhealthy food, and improve the nutritional value of WIC packages, there is much more to be done at the local level to improve the quality and availability of healthy food choices in urban and very rural areas. Promising practices include:

• Creating incentives for grocery stores to locate in underserved communities or for emerging community hubs to offer food.
• Supporting community groups and farmer’s markets in their efforts to acquire technology to accept credit, debit, and food stamp cards at all local and mobile venues.
• Mobilizing community organizations and school to connect all eligible families with publicly available supplement programs: WIC, Food Stamps, SNAP, and the like.

• Physical Activity Strategies

From a policy and design perspective, governments at all levels can promote walking, biking, and physical activity with the design of new public spaces, roadways, schools, and public facilities. Businesses, nonprofit organizations, schools, and churches can do their part to promote walking and maximizing appropriate physical activity. Other initiatives include:

• Maximizing physical education time and elevating standards at schools.
• Creating new partnerships between community organizations and schools for physical activity after school and promote the expansion of sports programs for young people to develop a culture of physical activity.

For more details, see information compiled and maintained by the Robert Wood Johnson Foundation

Substance Abusing Behaviors and Addictions

Erie County’s high incidence of smoking and binge drinking behaviors are indicative of a growing incidence of poverty and patterns of addictive behavior. Cessation practices that hold promise need to:

• Adopt a public health approach that works to change the social climate and redefine social norms,
• Develop a health systems approach that incorporates clinical best practices in combatting addictive behaviors,
• Utilize research that promotes the exchange of information on effectiveness and changing social norms, and
• Employs market-based incentives such as taxes and user fees that discourage consumption.

Common elements of successful programs across the country are:

• All are theory-based.
• Specific behavior goals are targeted.
• Skill-based components comprise the foundation of activity.
• A written curriculum and trainer feedback are provided.
• Substantial duration and intensity are necessary.
• Multiple-component interventions are especially promising.

Teen Pregnancy and Teen Parenting

Many communities across the country that have wrestled with the problem of teen pregnancy have found during a decade and a half of decline between 1991 and 2005, instilling a belief in a bright future and establishing goals for higher education and a career were among the most promising and successful prevention strategies available. Other best practices cited in the literature of the field include:
• The involvement of family and other caring adults matters when it comes to affecting a teenager’s sexual behavior and risk of early pregnancy.
• Male involvement maximizes prevention efforts.
• Community-wide campaigns with multiple strategies are more effective that single solution efforts.
• Service Learning connects meaningful community service with academic learning, civic responsibility, empathy, and personal growth – all important protective factors that can combat the risk of pregnancy.
• Outreach, education, and access to reproductive health services are all important for their roles in providing the knowledge and skills necessary to make healthy decisions, minimize the risk of disease and infection, and to reduce isolation through connection to needed support and intervention services.

For more information, see Best Start.

Child Abuse Prevention

Given the relentless correlation between child abuse and poverty, solid anti-poverty strategies shape a promising path with the prevention of child abuse. The promotion of strong bonds in infancy and the capacity to nurture and strengthen those bonds in early childhood through home visitation programs, peer mentoring, and other community-based interventions that reduce isolation and increase connection represent the most promising set of directly-targeted community-based abuse prevention interventions. For more information, see www.ounceofprevention.org.

Philanthropic On-Ramps

Modest, strategic investments that can get health initiatives in Erie County moving in the fast lane:

• School- and community-based wellness initiatives that combine knowledge of nutrition and healthier eating opportunities with physical activity and a wellness orientation that redefines community norms around nutrition, eating, and exercise.

• Food supply initiatives that combat the growth of urban food deserts by encouraging the location of grocery stores in urban areas, the sale of healthy food in non-food stores, and the promotion of access and convenience with the location, design, and business model utilized by farmer’s markets.

• Incentivizing and funding progressive urban design that encourages and promotes physical activity in the physical landscape, school schedule, and out-of-school time.

• Public health campaigns and evidence-based addiction interventions that have proven to be effective in reducing the incidence of smoking and binge alcohol consumption.

• Teen pregnancy prevention strategies that are focused on school engagement, career exploration, and future goal setting as well as the involvement of many caring adults to create protective factors that minimize risk.

• Child abuse prevention strategies that promote bonding and nurture strong attachment throughout early childhood through home visiting, mentoring, and the connection to a system of health and support services that minimizes isolation of the child and family, thereby reducing the risk of abuse.