In the Community

February 22, 2007

Health Without Borders

Kaiser Permanente's continuing work in the area of childhood obesity

At the third annual California conference on childhood obesity, Raymond J. Baxter, PhD, Kaiser Permanente's senior vice president, Community Benefit, addressed an audience of caregivers, policymakers and other key constituencies, on KP's work in the area of childhood obesity, and what is yet left to do in the fight to turn the tide on the epidemic among our nation's children.

Here is an edited excerpt from
Baxter's Jan. 26 address "Health Without Borders":

"We all have so much to celebrate since our last meeting in San Diego two years ago. In a short time, we have enacted historic school nutrition reforms. The governor has articulated an ambitious vision for obesity prevention in California that includes government, individuals, and business.  And a growing number of communities are mobilizing sweeping changes to make it easier for all children to eat better and be more active. You here in this room have been at the forefront of these victories. Thank you, and congratulations.

"And still, we have so much to do. Our next set of actions will require us to work even more closely together. It will require us to cross the many borders that limit our collective power and influence - borders in terms of the sectors we work in, our professional orientations and ideologies.  We can no longer afford to work only in our areas of comfort - talking only to the people in our own sectors, or our own fields, or to people who share our same values.  We need to break through those boundaries to secure health for all the children in our state, and advance California as a model for the nation. 

"Medical care alone is not enough
"We at Kaiser Permanente realized that we had to cross the boundary that defined childhood obesity as a medical problem.  We now take a comprehensive approach to obesity prevention that integrates clinical and behavioral interventions, organizational practice change and community work.  We are focused on making significant and lasting changes in the settings where we live, work, learn and play - in other words, a public health model.  In a toxic environment, it's impossible for many of our members to follow their caregivers' advice - to eat better and be more active.   The very nature of the epidemic has required us to work across professional boundaries and beyond the physical boundaries of our medical offices, into the communities and into the policy environments.

"Policy and environmental change"This comprehensive, public health approach is the focus of our HEAL effort.  Our Healthy Eating, Active Living (HEAL) initiative is rooted in our prevention-driven approach to health.  It brings together health care providers, community-based organizations, schools and public health departments to make changes in institutional practices and the built environment to make it easier for people to eat better and get physical activity as part of everyday life. 

"Kaiser Permanente has committed $18.5 million over a 5-year period to support community-based healthy eating and active living efforts throughout California. In Northern California alone, we have just committed $4.5 million in grant funding to three community collaboratives in Modesto, Richmond and Santa Rosa, each of which has developed a long-term strategy for curbing the obesity trend in their communities. We also committed $1 million in evaluation and technical assistance. And we are proud partners with The California Endowment in their groundbreaking Healthy Eating Active Communities (HEAC) work in six other communities throughout California.  We are undertaking similar efforts in Atlanta, Denver, Portland, Cleveland, and the Washington, D.C., area. 

"All of these communities are taking on the high impact, sustainable strategies that will make a real difference in the health of the populations we serve - changing clinical practice, getting unhealthy food out of schools and worksites, making communities more walkable and bikeable, bringing farmers' markets and grocery stores into neighborhoods that don't have them, etc.

"Each of these initiatives has at the center of it a multi-sectoral collaborative that is building the bridges between schools, public health departments, city planners, park and recreation department staff, local businesses, unions, doctors and health educators, community-based organizations and -the residents who are the real power behind these efforts.  Great changes in just one setting -  healthy school environments, for instance, or great parks, or even a great new grocery store or farmers market that brings fresh produce to a community that did not have it before - won't move the needle on the dial.  We need the reach, the intensity, the multiple exposure that comes with community-wide change. These collaboratives that are at the heart of Kaiser Permanente's HEAL initiative, and the HEAC communities, among others, are crossing borders in the common interest of total health for their communities. 

"Crossing borders"When it comes to advocating for public policy, we also need to cross borders.  We are learning how we need to talk about policy change in a political environment that is still charged and polarized - especially in the area of obesity prevention. One side says it's all about personal responsibility. The other focuses on policy solutions and the role of the government.  It's time to get beyond this false dichotomy.  The truth is both, and more, are necessary.  We all need to agree that individuals and families are vital to turning the obesity epidemic around.  Parents are the ultimate role models and decision-makers for their children.  At the same time, we need to ensure that families have access to healthy choices: healthy, affordable food and safe places to be physically active.  And that our public policies and institutional practices make that possible.

Childhood Obesity – Partnership Project Makes a Big Impact Kaiser Permanente, in partnership with UCSF and UCLA, produced a 24-page magazine insert on the topic of childhood obesity. The special supplement appeared in the Jan. 15, 2006, California edition of the Sunday New York Times. The supplement, similar in appearance to the Sunday New York Times magazine, was distributed to 118,000 California subscribers of the newspaper.  Kaiser Permanente also distributed an additional 20,000 copies toopinion/policy leaders, media, community clinics, and pediatrician offices. UCSF and UCLA also distributed the project to key contacts. The project was thoroughly reviewed by clinicians at all three institutions. Kaiser Permanente was proud to sponsor this project at such a critical time. To download a free copy of the supplement, go to www.kp.org/childhoodobesity and click on "24-page supplement."

"Walking our talk
"As we have worked on policy and organizational practice change outside our organization, we have also changed what we do inside our walls, like changing food choices for our staff and patients.  At Kaiser Permanente, this has meant making our vending machines healthier, and putting more than 30 farmers' markets in our parking lots and hospital lobbies across the organization. We are now increasing access to healthy, fresh and local food in our cafeterias and on our inpatient trays.  A diverse group of people has been involved in this boundary-crossing work - procurement and supply people, hospital operations leaders, dieticians, front-line staff, vendors.

"The HIV analogy
"We often use the tobacco movement as an analogy for what we are all doing.  I think there is another:  HIV/AIDS.  This epidemic demands that we act urgently and forcefully - not only with our heads, drawing on a still- emerging evidence base, but also with an activist "throw-everything-at-it" approach. 

"AIDS is an important analogy, not just for the lives at stake.  It is a model for the kinds of solutions we need to put into place - medical interventions, behavioral changes, social change and policy change, people connecting with one another, challenging the way things are.  It wasn't a "campaign" or "initiative" that turned the HIV epidemic around - it was the convergence of a number of movements - gay rights, civil rights, consumers, political activists, affected business as well as labor, and community groups.  And yes, the entertainment industry played a role.  Every social institution became engaged in some way. And all of this happened in the context of deeply held cultural boundaries and highly charged social values.  The organizations, institutions and people involved in the response to HIV did not let these many boundaries stop them.  They were border crossers.  They got involved with things they hadn't ever imagined.  Because this is what it took.

"No choice but forward
"In the end, we have no choice.  If we are able to cross the borders and boundaries I have described, we can really stop this epidemic.  We want to be able to hear speakers at the 2011 Childhood Obesity Conference report that rates of childhood obesity are in decline, every child has health coverage, and we don't need to meet any more.  We want to hear from kids who know what a tomato tastes like; school administrators who really have PE at every school, every day.  We want to hear about children who play, free from television and billboards advertising junk food, safe neighborhoods for kids to walk to school, new schools getting built in communities where the children already live - not just where the land is cheapest.  We want to look at apples instead of candy at check-out aisles, and be proud of public policy that supports all of this.

"It will take us working together... crossing the boundaries, working out of our comfort zones, finding common ground: Health without Borders."