McIntosh is a project manager for APHA’s Community Transformation Grant work in the Center for Public Health Policy.

Shawn McIntosh is a project manager for APHA’s Community Transformation Grant work in the Center for Public Health Policy. In the final guest contribution of our series, McIntosh reflects on the impact of CTG investments across the country and shares how they are bringing unprecedented systemic changes to community health through transportation improvements, disease prevention programs, healthy food initiatives and much more since the historic passage of the Affordable Care Act three years ago.

Current health trends indicate that one in three adults in the U.S. will develop diabetes by 2050, and that obesity rates could exceed 44 percent by 2030.  With the passage of the Affordable Care Act three years ago, an opportunity was created through Community Transformation Grants to completely change the way public health works within communities. The grants seek to implement evidence-based preventive health activities to reduce chronic disease, prevent related risk factors, improve health equity and develop a stronger evidence base of effective prevention programming.  Not only did the grant program change the way public health departments and other health organizations work together to address the growing crisis of higher rates of chronic disease, but it changed the way other sectors work with public health.

In September 2011, the CTG Program, which is funded by the U.S. Department of Health and Human Services and administered by the Centers for Disease Control and Prevention, awarded $103 million to 61 entities in 36 states, including state and local health departments, tribes and territories and nonprofit organizations. In 2012, an additional $70 million was award to 40 communities with fewer than 500,000 people to prevent chronic disease and promote health.  In 2013, CTG programs are beginning to realize their potential to create a culture of health.

Across the country, there are unprecedented systemic changes occurring, with collaborations between community development agencies, transportation departments and health departments to create comprehensive health improvement plans that look at the entire health system and community infrastructure for ways to make the healthy choice the easy choice. Communities are increasing access to healthy food and physical activity, workplaces are finding ways to support community level changes and encourage healthy habits among their employees through workplace wellness programs and schools are finding ways to provide healthier meals, increased physical education and opportunities for physical activity beyond the traditional physical education class.

Examples of early successes include:

  • Oklahoma City has one of the highest rates of smoking related deaths in the nation.  Working collaboratively with local housing authorities and multi-unit housing managers and community groups, Oklahoma County is establishing smoke-free housing for more than 80,000 units in the community.  Additionally, officials are partnering with employers to implement tobacco-free worksites, which will reduce secondhand smoke for at least 60,000 residents.
  • In Austin, Texas, an estimated 16 percent of school-aged children, including an estimated 19 percent of Hispanic children, are obese.  Austin/Travis County is working with school districts to increase healthy food and beverage consumption by creating Healthy Food Zones and reducing access to competitive, low-nutrition foods and beverages in close proximity to K-12 schools.  This will ensure that approximately 86,000 school aged children will have access to healthy food options.
  • In Maryland, nearly 28 percent of high school students are overweight or obese and only 39 percent of high school students engage in recommended physical activity levels.  Maryland is working with 19 school districts, including both urban and rural districts, to implement and monitor local wellness initiatives that include comprehensive physical activity practices.  The state is also implementing strategies that involve other physical activity opportunities, including the creation of walking/biking-to-school programs, physical activity breaks and intramural or physical activity clubs.

In each of these examples, communities are working together to create sustainable changes to the environment or existing systems that will make the healthy choice the easy choice.  As healthy choices become easier, our entire culture will shift. As our culture shifts towards one that embraces health, there will be measurable changes in rates of chronic disease and related risk factors. The return on investment will be immeasurable.