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    • Mother and daughter buying strawberries at a farmer’s market
      Increasing the acceptance rate of the CalFresh nutritional assistance program at farmers markets is one of CTG's strategies.

Healthy Surroundings

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Fielding School alumni and students are playing an integral role in L.A. County’s innovative efforts to transform communities so that they are more conducive to healthy living.

For decades, public health campaigns have emphasized the importance of healthy living. But if the messages have been heard, they haven’t always been heeded: According to the U.S. Centers for Disease Control and Prevention (CDC), nearly 70 percent of the U.S. population age 20 and older is overweight or obese. Perhaps most telling are the wide disparities in the rates of obesity, diabetes and heart disease between low-income and more affluent communities.

a father and mother with their two little boys at a farmers market.

Faced with these realities, there is a growing consensus among public health leaders that health education isn’t enough – particularly in communities where finding nutritious meals and safe, open spaces for exercise is challenging; mental health and preventive clinical services are difficult to access; and the environment is more likely to promote smoking and other unhealthy behaviors. That conclusion is reflected in the federal Community Transformation Grant (CTG) program. Launched by the CDC in 2011, CTG was rolled out with an initial award of $103 million to 61 state and local government agencies, tribes and territories, and nonprofit organizations, enabling them to work with community partners in creating environments more conducive to healthy living.

In the communities that make up Los Angeles County, millions of people stand to benefit from CTG through healthy lifestyle-promoting changes in their surroundings – from more nutritious food choices and limits on secondhand tobacco smoke to the addition of outdoor spaces for physical activity. “This is an innovative approach to working with communities that addresses the environments where people work, live, learn and play that influence their decisions and outcomes,” says Dr. Tony Kuo, MS ’03, deputy director of the Division of Chronic Disease and Injury Prevention within the Los Angeles County Department of Public Health, one of the CTG recipients. “Instead of investing most of our efforts in educating individuals and putting the onus on them to make healthy choices, we’re partnering with communities to change social norms so that it’s easier to make those healthy decisions. Traditional health education continues to be vitally important, but it is much more likely to be effective when the surrounding environment supports a healthy lifestyle.”

“This is an innovative approach to working with communities that addresses the environments where people work, live, learn and play that influence their decisions and outcomes.”  —Dr. Tony Kuo

In L.A. County, the CTG initiative is addressing five strategic areas: tobacco-free living; active living and healthy eating; clinical and other preventive services; social and emotional wellness; and healthy and safe environments. The department’s effort to transform communities is overseen by Dr. Paul Simon, director of the Division of Chronic Disease and Injury Prevention and a member of the Fielding School faculty. Kuo is among several alumni who are playing important roles in implementing the program.

With the CTG initiative, the public health department and its community partners are building on similar efforts that the department had already launched. But with the infusion of CDC funding (nearly $10 million a year), the department is casting a much wider net – bringing in partners from sectors such as education, transportation and business, as well as faith-based organizations. The initiative provides important funding to community-based organizations to ensure broad participation.

“This has given us the opportunity to be at tables where we haven’t previously been, expanding the scope of what we do in public health,” says Linda Aragon, MPH ’91, chief of programs and policy for the Division of Chronic Disease and Injury Prevention. For example, the public health department has worked with the Los Angeles Department of City Planning on its Health Atlas – used to guide urban planning in the city; has provided comment on transportation plans, including provisions for bicycle paths and safe routes to schools; and has made recommendations on county food procurement contracts. As part of the tobacco-free living strategy, which Aragon oversees, the department is partnering with communities to mobilize residents in working with landlords and city officials to address secondhand smoke in multi-unit housing; and to reduce youth access to tobacco products.

Adults using exercise equipment at a school playground as part of the federal Community Transformation Grant (CTG) in LA county.
One of the wide-ranging strategies to transform communities into healthy living environments in L.A. County include developing shared-use agreements with districts to open school facilities for after-hours and weekend recreational activities in park-poor neighborhoods.

To increase opportunities for physical activity in communities with high rates of obesity, the department is working with school districts to develop a variety of shared-use agreements that would open school facilities for after-hours and weekend use for the area’s residents. “In L.A. County, generally the communities most hard-hit by obesity, hypertension and diabetes are the same ones that are the most park-poor,” says Dr. Eloisa Gonzalez, MPH ’99, the department’s director of cardiovascular and school health, who oversees initiatives under the CTG’s healthy and safe physical environments strategy. “The existing green and open space in most of these communities is the school. Since this is a public resource, we see shared use as a viable way to increase access to safe places for physical activity, as opposed to trying to get more park space.”

“The existing green and open space in most of these communities is the school. Since this is a public resource, we see shared use as a viable way to increase access to safe places for physical activity, as opposed to trying to get more park space.”  —Dr. Eloisa Gonzalez

As part of the active living and healthy eating strategy, the department is working with school districts in low-income communities to improve the nutritional value of school meals; supporting cities within the county in implementing strategies to increase access to healthy food and beverage options; and working to increase the acceptance rate of the CalFresh nutritional assistance program at farmers markets across the county, to name a few. “We’re seeing a paradigm shift in the focus on systems-level interventions, particularly in low-income communities, where it hasn’t always been easy to have a healthy diet,” says Brenda Robles, MPH ’10, a research analyst for the public health department who is co-leading the CTG evaluation. “Instead of a top-down educational approach, we’re addressing the root issues and coupling that with nutrition education so that patrons will understand and embrace the changes. The idea is to empower people to take control of their health, and give them the tools to do so.”

Aragon notes that the CTG funding has necessitated hiring additional staff, and many Fielding School students have been enlisted in the effort as interns – among them Jamie Cassutt, a second-year MPH student. Cassutt has assisted with recruitment for the Choose Health LA Restaurants program, which gives special designation to restaurants that offer smaller portion-size options, healthier children’s meals and free chilled water. “Every time I was able to go into a restaurant and get management excited about this, I felt like I was making a difference,” Cassutt says. “It’s exciting to be out in the community, contributing in some small way to making people healthier.”

LEARN MORE:
Community Transformation Grant (CTG) program
Choose Health LA Restaurants
CalFresh