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HEALTHY COMMUNITIES
Preventing Chronic Disease by Activating Grassroots Change

At A Glance 2009

A National Chronic Disease Crisis: The Time to Act is Now

Our nation faces a crisis in the burden of chronic disease. Today, 7 of the 10 leading causes of death in the United States are chronic diseases, and almost 50% of Americans live with at least one chronic illness. People who suffer from chronic diseases, such as heart disease, stroke, diabetes, cancer, obesity, and arthritis, experience limitations to function, health, activity, and work, affecting the quality of their lives as well as the lives of their families.

Treatment for people with chronic conditions accounts for more than 75% of the $2 trillion spent on annual U.S. medical care costs. Effectively addressing the national chronic disease crisis is central to the future of health care in our nation and a priority for policy makers and those who pay for public and private health insurance plans.

Preventable health risk factors such as lack of physical activity, poor diet, and tobacco and excessive alcohol use contribute to the development and severity of many chronic diseases. For example,

• In the last 15 years, the number of people in the United States with diagnosed diabetes has more than doubled, reaching 17.9 million in 2007. If current trends continue, one-third of all children born in 2000 will develop type 2 diabetes during their lifetime.
   
• More than one-third of all adults do not meet recommendations for aerobic physical activity based on the 2008 Physical Activity Guidelines for Americans.
   
• Tobacco use is the single-most avoidable cause of disease, disability, and death in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke. Despite these risks, more than 43 million (approximately 1 in 5) American adults still smoke.
   
• During 2001–2005, there were approximately 79,000 deaths annually caused by excessive alcohol use. Excessive alcohol use is the third leading lifestyle-related cause of death for Americans each year.

Health disparities continue to be a serious threat to the health and well-being of specific population groups. For example,

• Death rates for heart disease are 23.4% higher among African Americans than whites; death rates for stroke are 31.4% higher.
   

• Native American adults are twice as likely as white adults to have diabetes.

Producing Results

Strong action at the community level is critical to reversing chronic disease trends. Communities have responded with a groundswell of energy, ideas, and the will to make needed changes by targeting chronic diseases and their major risk factors including tobacco and excessive alcohol use, insufficient physical activity, and poor nutrition. CDC’s investments in local communities are producing results. For example, CDC invested in 40 Steps communities during Fiscal Years 2003–2008, with the following impressive outcomes:

• Broome County, New York, increased fruit and vegetable consumption by 14% in all 46 elementary and middle schools by using a consolidated bid to purchase healthy foods at lower costs. More than 50,000 people enrolled in an innovative walking program and the percentage of adults who walked for more than 30 minutes on 5 or more days each week increased from 47% to 54% in 1 year.
   
• Austin, Texas, established a work site wellness program at Capital Metro, the Austin transit authority. Employee absences dropped more than 44% and the annual increases in health care costs were reduced from 27% to 9%.
   
• The River Region of Alabama worked with communities to control diabetes. Emergency room visits among participants decreased by more than 50%.
   
• Across the 40 funded communities, the percentage of adult smokers who were advised to quit by a health care provider increased from 63% to 71% during 2004–2006, and the percentage of adults with diabetes who reported having a foot exam in the past year increased from 71% to 77%.

Building upon the lessons learned from these communities, CDC is expanding its efforts to assist hundreds of communities across the nation.

CDC Expands Efforts

CDC and its partners—local and state health departments and national organizations—are working through CDC’s Healthy Communities Program to create healthier, thriving communities
and help those communities most severely effected by chronic disease. The program mobilizes community resources to bring change to the places and organizations that touch people’s lives every day—at work sites, schools, community centers, and health care settings—to stem the growth of chronic disease.

Local Investments

CDC funds and supports local communities for 5-year periods. Participating communities create online action guides, which give step-by-step instructions for replicating effective strategies from their communities. CDC currently provides guidance, technical assistance, and training to 12 Strategic Alliance for Health (SAH) communities selected to represent a mix of urban, rural, and tribal communities. During 2003–2008, CDC supported 40 SAH communities.

CDC will train and support over 200 ACHIEVE (Action Communities for Health, Innovation, and Environmental Change) communities over the next several years. ACHIEVE selects communities to participate in an Action Institute, in which community leaders receive technical assistance and support to start a local action plan. Technical assistance is provided by national and state experts for a minimum of 3 years, and communities also receive modest financial support. CDC collaborates with five key national organizations to provide this technical and financial support, including

• The National Association of Chronic Disease Directors
   
• The National Association of County and City Health Officials
   
• The National Recreation and Park Association
   
• The Society for Public Health Education
   
• The YMCA of the USA

CDC also supports the YMCA of the USA’s Pioneering Healthier Communities initiative. Since 2004, CDC has provided funding and technical support to the YMCA and used its vast network to bring together key local leaders to improve health and confront the national crises of obesity and chronic disease. Through its Pioneering Healthier Communities Program, the YMCA of the USA has developed innovative models for community change and has convened, trained, and supported teams of key leaders in 81 communities. By 2010, approximately 100 communities will have made changes to their communities to support healthy lifestyles and reduce risk factors for chronic disease.

Action Institutes

CDC provides Action Institutes, which convene community action teams and train community leaders making policy, systems, and environmental changes to prevent and control chronic diseases and their risk factors. Community action teams receive training from innovative national experts and develop a plan of action during the 3-day institute. They also hear from peer communities about how to undertake an effective community-change process and gain access to a range of tools and resources for putting programs into action.

Mobilizing National Networks for Community Change

Through its Healthy Communities Program, CDC is engaging in innovative new partnerships that reach across communities and engage local planners, decision makers, and community organizations whose primary mission is not necessarily health, but whose efforts can have a profound impact on health and chronic disease.

Tools for Community Action

CDC provides national leadership in health promotion at the community level by making the following tools for local action universally available to individuals and organizations:

Community Health Resources Web Site. This CDC Web site (http://www.cdc.gov/communityhealthresources) gives communities a searchable portal through which they can access a wide range of tools and data for local health promotion.

Action Guides. CDC and Partnership for Prevention® have developed The Community Health Promotion Handbook, available at http://www.prevent.org/actionguides,*  which provides communities with step-by-step guidance for implementing five effective community-level health promotion strategies identified in The Guide to Community Preventive Services. Additional Action Guides are planned.

CHANGE (Community Health Assessment and Group Evaluation). This tool provides community leaders with a snapshot of local policy, systems, and environmental change strategies currently in place in their community; identifies areas where such health strategies are lacking; and assists communities in defining and prioritizing areas for improvement.

Promoting Health Equity — A Resource to Help Communities Address Social Determinants of Health. This workbook, available at http://www.cdc.gov/nccdphp/dach/chaps, shows communities how to address social determinants of health as part of health and social service efforts through real examples from communities that are using this approach.

Future Directions: Spreading Change Across the Nation

Turning the tide on chronic disease requires changes in our communities that support health where we live, learn, work, and play. To date, more than 240 communities have received funding and technical support through CDC’s Healthy Communities Program, which has resulted in measurable changes at the local level. An additional 260 communities will receive funding to improve the health of their communities during the next 5 years. The Healthy Communities Program will continue to disseminate effective strategies and provide communities with funding; tools; and training for creating policy, systems, and environmental changes. Working with key partners, CDC will activate these changes in a widening network of communities that are ready to take action.

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Producing Results (Success Stories)

Ensuring Physical Activity in Schools, After-School Settings, and Work Sites

• In Clearwater, Florida, key leaders on the YMCA of the USA’s Pioneering Healthier Communities leadership team are leading by example. As part of the team’s community action plan, the two largest providers of after-school programs in the area (R’Club Child Care, Inc. and the YMCA of the Suncoast) decided to provide all children in their 15 programs with 30 minutes of daily physical activity. As a result of their leadership, the county licensing board now requires that all such programs in Pinellas County (which includes Clearwater) provide children with at least 30 minutes of physical activity 5 days a week.
  
  In addition, the leadership team provided information that helped support the passage of a state law requiring all elementary schools to provide 30 minutes of physical education 5 days a week. As a result of these changes, children across Pinellas County who participate in both school and after-school programs are now achieving the recommended 60 minutes of daily physical activity.
   
• Tacoma-Pierce County, Washington, through ACHIEVE (Action Communities for Health, Innovation, and Environmental Change), is focused on helping underserved communities in its efforts to increase access to opportunities for physical activity and improve nutrition for youth. The program is using change strategies, such as joint-use policies, which give the general public permission to use schools’ exercise facilities during nonschool hours.
   
• Stark County, Ohio, through ACHIEVE, has assisted local employers with creating workplace policies that promote employee physical activity during work time, lunch, and breaks.

Getting Healthy Foods to Underserved Communities

• In Pittsburgh, Pennsylvania, the YMCA of the USA’s Pioneering Healthier Communities has given children and families with low incomes access to low-cost fruits and vegetables. Its leadership team partnered with Good Apples, the world’s first full-scale online produce retailer, which sells high-quality fruits and vegetables for up to 40% less than supermarket prices. Five markets, which buy produce from Good Apples, have been established in YMCA after-school programs that serve under-resourced communities. As a result, 5,500 children from diverse backgrounds and more than 1,000 teenagers from families with low incomes have access to healthy foods each week.
   
• Cleveland, Ohio, has been working through Steps with the Community Gardening Program at Ohio State University Extension to create community gardens in intervention neighborhoods. The gardens have helped neighborhood residents increase their physical activity in addition to providing them access to fresh produce. The gardening program offers Starting a Community Garden workshops, meets with neighborhood block and street clubs, and partners with social service agencies to provide gardening tools and resources.
  
  The program is also focusing outreach efforts on schools and City of Cleveland recreation centers to help plant new community gardens. Since the program began, approximately 50 gardens have been established, 1,400 new gardeners have participated in physical activity, and hundreds of families have received fresh produce. Thousands of pounds of fresh fruits and vegetables have also been donated to area food pantries. A new farmers’ market was created in Cleveland’s Central neighborhood where young people are employed to sell the fresh produce that they grew in local gardens. More new gardens are being cultivated and serve as an example of positive change in the built environment.

Promoting Tobacco-Use Cessation for Children and Adults

• Salamanca, New York, through ACHIEVE, passed an ordinance that protects children and adults from exposure to secondhand smoke and encourages nonsmoking by banning smoking in all city parks and playgrounds.
   
• Chautauqua County, New York, through ACHIEVE, collaborated with the local tobacco control program and hospital staff members to introduce a new policy at the Women’s Christian Association (WCA) Hospital, which requires health care providers to directly address patients’ tobacco use and cessation efforts. As of May 2006, more than 547 health care providers were trained on the 2-minute intervention, and the WCA Hospital changed its patient intake and education forms to reflect the new process.
  
  As a result of the new policy, calls from health care provider referrals to the New York State Smokers’ Quitline quadrupled from 2005 to 2006. The Chautauqua County Behavioral Risk Factor Surveillance System data show that the percentage of adults who smoked decreased from 2004–2005 (29%) to 2005–2006 (24%).

Reducing Emergency Room Visits Through Community-Based Diabetes Management

• The River Region of Alabama, through Steps, partnered with the Montgomery Area Community Wellness Coalition and Baptist Center for Diabetes to train diabetes wellness advocates in nutrition, physical activity, disease prevention and detection, diabetes management, and cultural competency.
  
  Wellness Advocates are assigned to patients with diabetes to provide them with one-on-one assistance in setting health and wellness goals, self-management guidance, and vital disease prevention education. Diabetes monitoring kits, lancets, and testing strips are donated to clients who are taught how to correctly use the supplies. Eighty percent of wellness care management clients were assigned to a health care team, which included a physician coordinating comprehensive primary care. As a result of this program, emergency room visits among participants decreased more than 50% during 2004–2007. Coordinated and systematic health care has been shown to decrease emergency room and inpatient visits and hospital costs.

Improving Community Health through Policy, Systems, and Environmental Changes

• Southeast Alaska, through Steps, brought together public health workers and community agencies representing diverse sectors of the seaside town of Sitka to plan a health summit. This spearheaded a new approach to health promotion in Sitka, which has a significant population of Native Alaskans. Four health goals were established at the inaugural 2006 Sitka Health Summit: (1) to create a bike- and pedestrian-friendly community, (2) to improve the nutritional environment in schools, (3) to develop an indoor community recreation center, and (4) to bring employers and insurance companies together to improve the health status of employees.
  
  Following the summit, Sitka became the first community in Alaska to be designated as a Bicycle Friendly Community by the League of American Bicyclists, developed and implemented a healthy vending machine policy for Sitka schools, created a community recreation center in an abandoned university gymnasium, and formed an Alaska Working Well coalition, which made employee wellness programs available to a large portion of the Sitka workforce. A second Sitka Health Summit, held in May 2008, resulted in the creation of a community garden, farmers’ and fish markets, and plans for promoting and enhancing walking and biking to school in Sitka.

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Related Materials

• Healthy Communities—At A Glance 2009 (PDF–1.4Mb)
• Healthy Communities—Producing Results (Success Stories) (PDF–402Kb)
• CDC's Healthy Communities Program Web site

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Page last reviewed: March 11, 2009
Page last modified: March 11, 2009
Content source: National Center for Chronic Disease Prevention and Health Promotion