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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.
Chronic Diseases: The Facts
- Heart disease and stroke remain the first
and third leading causes of death, accounting for more than
30% of all mortality. One million Americans are disabled
from strokes; many can no longer perform daily tasks, such
as walking or bathing, without help.
- Nearly 24 million Americans have diabetes, and an
estimated 57 million American adults have prediabetes and
are at increased risk for developing type 2 diabetes.
Diabetes is the leading cause of kidney failure,
nontraumatic lower-extremity amputations, and blindness
among adults aged 20–74 years.
- Cancer claims more than half a million lives each
year and remains the nation’s second leading cause of death.
The total number of Americans living with a previous
diagnosis of cancer is currently estimated at 11 million.
- 1 in every 3 adults and almost 1 in 5 children between
the ages of 6 and 19 are obese. Obesity has been
linked to increased risk for heart disease, high blood
pressure, type 2 diabetes, arthritis-related disability, and
some cancers.
- An estimated 46 million adults in the United States
reported being told by a doctor that they have some form of
arthritis, rheumatoid arthritis, gout, lupus, or
fibromyalgia. Arthritis results in activity limitations for
nearly 19 million Americans
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Health disparities continue to be a serious threat to the
health and well-being of specific population groups. For example,
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Death rates for heart disease are 23.4% higher among
African Americans than whites; death rates for stroke are 31.4% higher.
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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
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For more information please contact
Centers for Disease
Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
4770 Buford Highway NE, Mail Stop K–93, Atlanta, GA 30341-3717
Telephone: 770-488-6452 • E-mail:
cdcinfo@cdc.gov
Web: http://www.cdc.gov/HealthyCommunitiesProgram
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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
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