Aligning Communities - U.S. Chamber Of Commerce Foundation

businesses, particularly those with corecompetencies in food, in combating obesityis increasing the access of healthy food intheir communities. Some accomplish this bysponsoring healthier options at food banks,facilitating the delivery of healthier food tolower income areas, or strongly marketinghealthier food at certain grocery stores.Offering better health care access tothe community. Local obesity preventionprograms often reach out to insurersand health providers working in thecommunity to improve access and ensurethat members of the community can takeadvantage of available programs to reducetheir weight and improve their health.In some cases, health care companieswork directly with public health officials tostreamline care for the impoverished. Inothers, insurers and health care providerswork directly with cities or larger businessesto create specific programming to helpindividuals reduce their weight.Supporting infrastructure changes andimprovements. Another way that businessesget involved is to support infrastructureimprovements in their cities. Thoseimprovements may be significant, such asestablishing new bike lanes or long andconnected walking paths, or it may be aone-time construction of a small park orfitness center.Offering skill-based volunteers. In skillbased volunteering, companies providetheir logistical, administrative, andnetworking expertise to help a programincrease its capacity to perform its work inthe community.Significantly, how businesses can do thework in conjunction with a local programis not always clear. The US Chamber ofCommerce Foundation’s (USCCF) membercompanies wanted its issue directors andresearchers to investigate these programs.The ProblemEven though businesses, nonprofitorganizations, and governments all participatein obesity prevention programming, obesityrates remain stubbornly high. USCCFresearched why this is the case, and whatbusinesses can do to help resolve it.A previous USCCF report, NavigatingObesity, found that while national-levelobesity program coordination was done at ahigh level, this coordination did not alwaysreach the local-level programs because localorganizations do not have the resources orsupport of a national program.That need for better coordination amongmajor community stakeholders is beingmet by a number of programs, and all ofthe stakeholders believe that they havethe resources to solve obesity, but thoseresources need to be better employed.This need for better resource directioninvolves what we have coined “stakeholderalignment,” where businesses, nonprofits,and local governments work togetherand use their comparative advantagesto develop an effective program for theircommunities.According to Gallup’s Healthways Well-Being Index, overweight and obese people with no other chronicconditions take 5.9% more unhealthy days per month than normal weight workers who also have nochronic conditions, resulting in 513.5 million in lost productivity. For workers who are overweight orobese with one or two chronic conditions, a group that constituted 30.2% of full-time workers in theUnited States in 2011, they took 217.6% more unhealthy days per month than those who were normalweight with no chronic conditions, resulting in 32.2 billion in lost productivity.104Aligning Communities: How Four Cities are Preventing Obesity

Our SolutionFollowing Navigating Obesity, andfollow-up work including white papers,presentations, and meetings, USCCF’sCorporate Citizenship Center (CCC)has fine-tuned its research focus in itsHealth and Wellness Shape Networktoward helping businesses becomemore involved in local obesity preventionprogramming. In Navigating Obesity, theFoundation took a telescopic view ofthe wide array of national networks thatwere managing local obesity preventionprogramming. Specifically, it investigatedhow those organizations engage withdifferent groups of stakeholders toimplement their programs, but it did notdelve deeply into any specific communityprogram.Many USCCF members wanted some moreinformation on the mechanics of local-levelprogramming, specific ways that companiesget involved, where they may have the mostimpact, and where they can align mosteffectively with current efforts. AligningCommunities: How Four Cities are PreventingObesity takes a more microscopic view of theprograms to help explain important aspectsof community-based wellness programs,challenges they face, and how businessesare stakeholders in those programs. Byshowcasing four different community-basedprograms: Wellness Now in Oklahoma City,Get Healthy Philly in Philadelphia, CampbellHealthy Communities in Camden, New Jersey,and LiveWell Colorado in Denver, AligningCommunities illustrates the importance ofcommunity obesity prevention programming.ME THODSTo take a more microscopic view of the issues surrounding local-level obesityprevention programming, The U.S. Chamber of Commerce Foundation undertook aqualitative analysis to investigate the background and structure of local-level obesityprograms around the country.First, researchers surveyed local-level obesity prevention programs by expanding uponearlier work in Navigating Obesity, and conducting some new work on recent trendsin the local obesity prevention space. This resulted in calls to leaders of eight localprograms to get more information on how their programs operated. Researchers thenfine-tuned the questions and interviews for a closer study on four of those programs.Those four were chosen based on their representative nature of all the programs.Then, USCCF undertook delegation trips to the four programs highlighted in this report(Camden, Oklahoma City, Philadelphia, and Denver). During those trips, researchersconducted multiday interviews with program, community, and business leaders. Whenpossible, the researchers conducted ethnographic analysis of active programming.The research and insights gained from these two waves of work resulted in this report.U.S. Chamber of Commerce Foundation5

COMMUNIT Y-BASED WELLNESS PROGR AMSCommunity-based wellness programsthat concentrate on obesity andweight management result froman expressed need to help acommunity’s citizens. Decades of increasingrates of obesity have brought nationalattention to the problem, which, in turn, hasspurred community stakeholders into action.Despite the size of the city or the scope ofthe problem, obesity is a tough challengefor any local-level organization to address.Preventing and reducing obesity presents anumber of issues that require a very longterm strategy.The main thrust for creating obesityprevention programming typically comesfrom local governments looking to improvethe health and image of their cities,nonprofit organizations that adopt localizedprogramming to solve the problem, orbusinesses that are interested in improvingthe health of a specific community.One of the most essential early aspects toestablishing a good program is stakeholderalignment, the ability of these differentcommunity members to interweave theirefforts. In some cases, as in the programsDespite the size of the city or the scope of the problem, obesity is a tough challenge for any local-levelorganization to address. Preventing and reducing obesity presents a number of issues that require a verylong-term strategy.6Aligning Communities: How Four Cities are Preventing Obesity

in Camden and Denver, they are explicitlyfollowing what is known as CollectiveImpact, a model of action where a leadorganization serves as an organizingbackbone for a group working from thesame agenda (see What Is Collective Impactat the end of this section).Obesity prevention programs almostalways evolve out of other well-fundedprograms. For some of the cities, includingPhiladelphia, it was an extension ofprogramming funded through federalCommunity Transformation Grants (CTG).The ability of a city to use long-term fundingto grow a program proved to be a greatasset for those programs, but as CTG fundsran out in 2014, there was a growing impetusto find other ways to grow capacity andsustainability, including public and corporatefoundations.When a program has potential, no matterwhich of the three groups is the primaryagent, the other two groups need to beinvolved to ensure success. Often, programsstarted by nonprofits do not materialize untilat least one of the other stakeholders ison board. Obesity programming offered bybusinesses needs the infrastructure and localpresence of cities and nonprofits. Two ofthe main examples of this are GSK workingwith LiveWell in Denver and CampbellSoup Company, through their HealthyCommunities Program, working directly withlocal organizations in Camden.Programs run by cities need the greateroutreach and capacity of nonprofits andbusinesses. Oklahoma City’s programrelies on food banks, university extensionprograms, and business partnershipsto extend their reach in the community.Philadelphia uses a wide array of cityresources to interact with businesses andnonprofits. In many cases, some members ofthe business community, particularly thosein insurance or health care, will be early andU.S. Chamber of Commerce Foundation7

willing partners of an obesity program nomatter who initiates it.How They Choose Their FocusThe national obesity rate in the United Statesis 27.1%, and only a handful of cities havean adult obesity rate lower than 20%.11Decreasing health outcomes of a communityas obesity rates rise are tracked in healthdepartments, school health checkups, andeven by anecdotal observations. However,the precise way to tackle obesity can differfrom program to program.Most programs decide to focus on particulargroups of citizens, instead of on themall. In most cities, obesity rates can varygreatly between individuals of differentsocioeconomic classes, so the programmay focus in lower-income neighborhoods,like in Oklahoma City or in Denver, wherea lot of programming occurs in poorerneighborhoods.Essentially every program supports a broadhealthy living message to address issueswith food choice, healthy food availability,exercise, and health care, and each willtailor programming to communities thatneed to focus on one of those issues morethan the others. In lower socioeconomiccommunities, it may be more importantto ensure that people can purchase andprepare healthy foods; whereas in middleclass neighborhoods, encouraging activitymay have a greater impact.Some programs focus on children, sinceinvestments made in their health can havethe longest lasting impact and a vastmajority of children are in school manyhours a week, which offers a captive andtarget audience for long periods of time. Forprograms dealing primarily with children,such as the ones in Camden (young children)and Denver (teenagers), they believe that byencouraging the youth they will make lifelong8Aligning Communities: How Four Cities are Preventing Obesitychanges and take it to their homes to sharetheir enthusiasm with adults in their familywho might need it.How They Make Themselves SustainableLike other nonprofit organizations, eachobesity prevention program needs to securethe resources and funds necessary tosustain its work.Programs that are located primarily within alocal government structure have the greatestvariety of ways to secure resources. Sincethe cities and counties are the center ofthese types of programs, these programshave a number of options that theseprograms use. Some, especially with a morecounty-based focus, receive money fromproperty tax revenue, and these efforts oftenhave been initiated with ballot initiatives.Oklahoma City pursued a separate ballotinitiative for funding, while Philadelphiasecured funding through a separate taxmechanism. All of the programs pursuefederal and state grants as well.Nonprofit based programs have to finddifferent funding possibilities since they areunable to find direct funding from a localgovernment revenue stream. Many of themhave staff with grant preparation experienceand the programs often work to develop apartnership with a major corporate or privatefoundation, like LiveWell in Colorado workingwith GSK. Some also work with localgovernments to help with funding, or morecommonly, in-kind support with physicallocations or staffing assistance.In conversations with community-basedprograms, one of the largest challenges all ofthem cited was figuring out how to measure theimpact of obesity in their communities and theeffectiveness of their solutions.

While businesses that serve as a majorpart of an obesity prevention program alsoprovide significant funding, those programsalso work to find additional externalsupport. GSK in Denver and Campbell SoupCompany in Camden have worked to bringin other corporate partners to help executeand promote the obesity program. Likenonprofit organizations, the businesses alsopursue some grant funding from foundationsand local governments.How They Measure Goals and SecureCommunity SupportDespite the main source of funding for anobesity prevention program, ensuring thatthere are resources available for long-termprogramming is the only way to achievesuccess. Obesity is a problem created overthe course of decades, and it may takethat long to reverse it. How effectively andquickly these programs can reverse it is amajor factor in how they are able to bolstertheir sustainability.For obesity specifically, if doctors and schoolpersonnel are not taking the height and weightof patients or students, and are not reportingthat information to a centralized system,then basic information about determining theseverity of a community’s obesity problem ismissing. That does not count the nearly 18%of American adults and 7.2% of Americanchildren who had no contact with any healthcare professional whatsoever during 2012.12In conversations with community-basedprograms, one of the largest challenges all ofthem cited was figuring out how to measurethe impact of obesity in their communitiesand the effectiveness of their solutions.Even in communities with strong publichealth departments and reliable informationon the health of their citizens, gaps exist incommunity health data.U.S. Chamber of Commerce Foundation9

WHAT IS COLLECTIVE IMPACT?Stakeholder Alignment is a general term used in this report to describe the generalprocess where community stakeholders work together in an obesity preventionprogram, but the term could be used generally to identify community membersworking together to work towards any social or community goal. Collective Impactis a specific type of stakeholder alignment used explicitly in the obesity programs inCamden and Denver.Collective Impact as a term came into use in 2011 when John Kania and Mark Kramer,managing directors at nonprofit consulting firm FSG, wrote Collective Impact for theStanford Social Innovation Review.13 Their short definition of collective impact as“the commitment of a group of important actors from different sectors to a commonagenda for solving a specific social problem,” is a good start to understanding whatcollective impact is, but their list of five conditions of collective success really outlineshow collective impact works1) Common Agenda – All of the participants (who should be from a widerepresentation of stakeholders) need to have a shared vision of change, whichincludes a common understanding, though not necessarily complete agreement, ofthe problem.2) Shared Measurement Systems – All groups must agree on how success will bemeasured and reported.3) Mutually Reinforcing Activities – Each participant undertakes a specific set ofactivities where it has a comparative advantage. Coordinating activities in this wayis more effective than just piling on more partners with no order.4) Continuous Communication – Develop trust, and spending time together to showfairness and ensure each program is reading from the same page5) Backbone Support Organization – An leading organization with a dedicated staffthat works on coordinating the communications and activities of all partners, inCamden, Campbell Healthy Communities is the backbone and a major funder, whilein Denver, LiveWell is the backbone using significant funding from GSK.10Aligning Communities: How Four Cities are Preventing Obesity

These challenges surrounding theimplementation and measurement of a programhighlight the two main obstacles that obesityprevention programs experience when theywanted to execute programming in theircities—the disconnect between funders andimplementers, and ensuring community buy-infor a long-term program.So, if an obesity program wants to analyzeany other related data around obesity, suchas exercise level, access to healthy food,or nutritional training, it needs to rely oneven more widely distributed sets of datato find appropriate baselines. Althoughmany local programs are using data ofthis type, especially with the new RobertWood Johnson Foundation County HealthRankings, it can be difficult to really hone inon specifics on the community level.Assuming a program is able to addressthese challenges, and establish a startingpoint for their community before theyinstitute programming; there is a different setof obstacles. To secure significant resourcesfor a social impact project of any type,most funders require that any nonprofit orcharitable program show results. Doing socan be quite difficult, especially when realchange may take years to track and prove.One point that came up, especially inPhiladelphia, was the fact that obesityprograms cannot feasibly conduct thegold standard evaluation of any program’seffectiveness: a randomized control trial(RCT). By conducting an RCT, a programcould track the progress of one groupof people who receive the programmingversus a group who did not. Some, thoughnot all, of the progr

2 Aligning Communities: How Four Cities are Preventing Obesity Obesity Issues Obesity and being overweight are major problems around the world, but they are particularly endemic in the developed western world and in the United States. Worldwide, obesity rates have nearly doubled since 1980. By 2010, in the United