A Much-Needed Policy Perspective

Martha Coven, Dan Christenson, and Kate Coler

This afternoon, conference participants were joined by a panel of representatives from the White House and Senate Committee on Agriculture, Nutrition and Forestry, who heard participant’s priorities and offered their own feedback.

Martha Coven, director of the White House Office of Mobility and Opportunities, Dan Christenson, professional staff member of Committee Chairwoman Blanche Lincoln, and Kate Coler, senior policy director for Committee Ranking Member Saxby Chambliss, provided a much-need policy perspective to the discussion.

Need for Research

Because obesity is influenced by so many factors, and numerous federal agencies have a role to play, the Administration and Hill staff emphasized the need to have solid, specific research at their fingertips. As Christenson put it, “we need data on what’s going on in childcare across the country. We need information on how much physical activity they’re getting, what they’re eating, and how much time they’re spending in front of the TV.” All three panelists expressed enthusiasm for the first waves of research being presented at the conference.

Importance of Collaboration

Several conference participants had questions about how they could most effectively inform the various agencies and Congressional committees on health, education and human services – so that effective policies and recommendations are developed in sync.

Coler emphasized that “innovation starts at the state and local level. We are here to learn from your examples and extend those innovations.” Additionally, Coven noted that, to the extent the researchers and advocates can identify specific barriers to their progress, the policy-makers and Administration can help them break those down. Adding that “we’re here to encourage and reward the programs that are the most promising.”

Moving Forward

Although Christenson noted that Sen. Lincoln is deeply involved in the Finance committee’s markup of health reform legislation, he emphasized that she is still strongly committed to passing a robust reauthorization of the Child Nutrition program. In their closing remarks, the panelists asked conference participants to:

• Continue to push innovative state and local programs and practices,
• Show them how federal programs, and CACFP in particular, can be used to prevent chronic disease, and
• Extend their strong commitment to the issue and begin working more with parents and families as well.

A Chat with Bill Dietz

Bill Dietz

Bill Dietz is director of the Department of Nutrition, Physical Activity, and Obesity at the CDC.

On Vilsack’s speech:

• “He hit the high points. It’s great that the Child Nutrition Act and the Child and Adult Care Food Program are on his priority list.”

On the issue of childcare and obesity prevention:

• “We’ve elevated this issue to a different level. More and more people are thinking about it and acting where they can.”

On the American Recovery and Reinvestment Act:

• “There are opportunities for intervention in childcare programs in the scope of this funding. And there is $373 million to support tobacco cessation programs and nutrition and physical activity programs. ”

On what the CDC hopes to get out of this conference:

• “We want to outline strategies for reaching target behaviors in childcare. Part of why we’re here is to hear what’s working at the state level.”

Update: Dietz had some encouraging words for participants in his closing remarks:

“I’m speaking in two weeks to the Association of State and Territorial Health Officials and I’ll be sure to share with them what I’ve heard here.”

“The cross-departmental collaboration is underway at the federal level, and it’s going to continue.”

“We need to be prepared for the release of the Institute of Medicine’s report on the Child and Adult Care Food Program, and use that to leverage media and other attention to create national standards.”

“Our planning committee needs to have a life beyond this conference. It can move our recommendations forward.”

Ah-Ha Moment: We can’t be Intimidated

“At first, it was daunting to me,” recalls Margo Wootan, describing the challenge of improving nutrition and physical activity for kids in childcare.   Wootan, director of Nutrition Policy at the Center for Science in the Public Interest, said it was a matter of fragmentation.

“You can’t pass one law and fix the food and the physical activity environment in every childcare center,” she said.  “There are so many different childcare settings.”

On the surface, the challenge seems very different than improving health in schools.  Compared with childcare, schools enroll most kids in the U.S. and a federal change in policy can trickle down to affect all of them.  It’s an area where Wootan has worked for more than a decade, and it’s on the cusp of eliminating soda and junk food, she said.

But while there has been much great work done in schools, “the obesity problem starts so young,” Wootan said.  “We also need to focus on the little guys – the kids before they get to school.”

As she listened to the discussions today, she had a realization: schools are a fragmented place too.  “Every district, every state, has a very different way of doing things,” she said.  And that, she says, is promising for the future of healthier childcare.

“If we’ve made such significant progress in schools, despite the fragmentation,” Wootan explained, “we can’t be intimidated to take on nutrition and physical activity in childcare.”

Photo Post: The conference so far

Read on after the jump for more photos from the conference.  (Click to enlarge.)
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What Does 6 Cents Buy?

Six cents. When the California Department of Education (DoE) and California Food Policy Advocates (CFPA) started working together to help childcare providers offer kids healthier foods, they supported a six cent increase in the state reimbursement rate for each meal, to enable providers to buy more fruits and vegetables, offer healthier cereal and make other changes. But in a state with a $50 billion budget deficit, even that couldn’t make it through a price-conscious legislature.

Kumar Chandran and Phyllis Bramson-Paul

The good news is, the DoE and CFPA have found ways to help get healthier foods to children anyway. Working together, and with other public agencies and private advocacy groups, they developed a plan to strengthen the Child and Adult Care Food Program in the state.

“One thing we realized,” said Phyllis Bramson-Paul, director of Nutrition Services at the California DoE, “was that we needed to provide consistent messaging related to nutrition and physical activity across programs.” Once they recognized this need, several programs, including the state Women, Infants, and Children program, the 5-a-Day program and childcare programs, started working together to develop consistent standards and regulations.

After starting this conversation, they realized that, for little or no cost, childcare programs could switch the milk they serve from full-fat to low-fat or skim. They could improve the nutritional quality of the cereals they provide to kids. And, instead of offering two fruits as a snack, they could provide one fruit and one vegetable.

Kumar Chandran, nutrition policy advocate with CFPA, noted a few specific lessons they learned when trying to get these updated standards passed, as part of the Child Care Nutrition Bill. “The biggest obstacle we faced was the fiscal environment. There were no policy reasons for not improving these nutrition standards.”

“Being able to point to the support of other key stakeholder groups was extremely important when we introduced this language.”

Guest Post: Ideas for Sharing Best Practices Among States

Lloyd Werk

The author of this post is Lloyd Werk , MD, MPH, of Nemours.

During our discussion today, I thought of some possible ways to implement the desire to share best practices among the states.  Some ideas:

1. Let’s create an online clearinghouse to graphically link state statistics on childhood obesity and Sara Benjamin’s findings on adherence with best practices.  It could have a framework that then lists the resources in each state including: policies (bills and regulations in place), quality rating systems, agencies’ contact information,  and related programs.  A search engine would allow a keyword search so that if an advocate in state x was interested in proposing a quality rating system for childcare, they could review existing systems in other states.

2. There are some great programs out there, but we have some difficulty in dissemination of best practices.  Perhaps an outside funder or government agency could challenge states with an “x-prize competition” to demonstrate dissemination of a program.  Like a Baldridge award, the prize would recognize great programs and further promote dissemination.

Feeding America’s Hungry and Reducing Levels of Obesity

USDA Under Secretary Kevin Concannon

Kevin Concannon, Under Secretary for Food, Nutrition, and Consumer Services in the United States Department of Agriculture, explained the goal that he, USDA Secretary Vilsack and President Obama share:

“We’re very deeply committed to trying to feed hungry children and adults in this country.  But we want to have a positive impact on reducing obesity in this country as well.”

Accomplishing both goals, Concannon said, will require innovations in the programs he oversees and partnerships with the communities they serve.  He outlined several promising ideas:

New Grocery Stores in New York City Food Deserts

An article in today’s New York Times details a proposal by Mayor Bloomberg’s administration to bring full-service grocery stores – and fresh foods and vegetables – to underserved areas of the city.  For the residents in these communities where obesity and diabetes are prevalent, the change could be a boon for health.

“That’s the kind of innovation that we can encourage and bring to other areas of the country,” Concannon said.

Supplemental Nutrition Assistance Program (SNAP) to Serve Families and Improve the Economy

SNAP, formerly known as Food Stamps, helps 36 million Americans buy healthy food each month.  Simplifying the program to remove barriers and extend access to all eligible people is an important goal, Concannon said.  But increasing aid to children and families is not the only benefit.

“It also benefits the grocery stores, the communities, the families,” Concannon said.  “SNAP brings economic stimulus to cities and regions.”

October Launch of New Food Package for Women, Infants and Children (WIC)

Next month, WIC is rolling out a new food offering for mothers and children across all 50 states.  Concannon says the 9 million participants, which includes 49% of all infants in the US,  will receive more nutritious food, including whole grains, fruits and vegetables.  And, he added, additional stores are joining WIC as suppliers, which could bring healthier foods to all residents in the community.

What’s Next?  Partnerships to Share Innovation

“We do not have all the expertise, and we cannot alone solve the President’s very ambitious and worthy goal of eliminating childhood hunger by 2015,” Concannon said to the audience of early child care and health experts.  “People like you, who are engaged in these issues day to day, are some of the most potent sources of ways for us to introduce innovation.”

To address hunger and obesity in this country, he explained, we’ll need all the good ideas as we can find.

A Bright Idea: How to Eliminate Fried Food from Daycare Diets

How do you eliminate fried foods from the diets of children in daycare?  Cynthia Lara, director of the South Carolina Department of Social Services, suggested a conversation with your fire marshal.

Frying food, Lara explained, requires an expensive commercial hood to meet fire code.  Smaller, mom-and-pop childcare facilities often fry without one. Once alerted to this, a fire marshal will be glad to eliminate a safety hazard – and the kids in daycare will be healthier as a result.

Want to follow South Carolina’s example?  Follow Lara’s advice: “check with your fire marshal!”

Health and Education Working Together

“The funding is important. The policy is important. The strategies are important. But we also have to focus on our relationships, and having ongoing conversations with people across departments,” says Melissa Courts, the Healthy Child Care Ohio coordinator at the Ohio Department of Health.

In a break-out session this morning, the discussion focused on how to coordinate positive efforts from people in multiple state agencies. Courts described efforts Ohio has made to involve representatives from health and education departments in writing the standards and guidelines for early childcare. And, how those representatives have worked together to insure that childcare program directors receive the training they need to implement the standards successfully.

Participants also heard about similar initiatives underway in Arkansas, California and Delaware.

“People just need to be reminded,” said Courts. “Having local advocates at every level is important,” because, she said, that’s how effective plans addressing children’s educational and health development are created and implemented.

Guest Post: Jim Sallis on Physical Activity and Childcare

Jim Sallis

Jim Sallis is the author of this post.  Sallis is the director of Active Living Research.

I have three reactions to the Healthy Kids, Healthy Future conference thus far:

1. We had a lesson in how easy it is to integrate physical activity into routines.  Mary Story called for a quick activity break to perk up the group.  In about a couple of minutes, we got people up, walking in place, and acting out favorite activities they did as young children.  I was glad for all the childcare experts to experience this, because they could encourage similar activities in childcare centers.  These centers need more easy, quick, and fun activities, in addition to longer structured and unstructured activity times.

2. About 25 years ago, our research group was preparing for a study of activity and nutrition in preschool children.  We visited several preschools to learn how they operated and observe how the day was organized.  What was most striking was the detailed thought and planning that went into keeping the kids quiet and sitting all day.  They devised engaging listening, reading, arts & crafts, and sharing activities, all of which required children to be sitting.  Physical activity was strictly controlled and limited to specific times and places.  Most centers only let the children outdoors once per day.  I have been pleased to hear about “I’m Moving I’m Learning” several times during this meeting.  I would like to see much more research on this topic, with quick dissemination to childcare centers across the country.  A key part of the training needs to prepare teachers to tolerate kids being active in class.

3. There were several encouraging opportunities in Ms Rudisill’s presentation.  The Child Health Bureau provides substantial support for infrastructure in childcare.  A National Center for Physical Development and Outdoor Play is being developed as part of Head Start.  I would like to see both of these efforts to improve the play equipment at childcare centers.  To make sure those funds are well spent, we need more research on the characteristics of play equipment and playgrounds that stimulate active play most effectively.