The Steps to a HealthierUS five-year cooperative agreement program
aims to help Americans live longer, better, and healthier lives by reducing the
burden of diabetes, overweight, obesity, and asthma and addressing three related
risk factors—physical inactivity, poor nutrition, and tobacco use.
For FY 2003, this U.S. Department of Health and Human Services (HHS) program
allocated $13.6 million to fund 23 communities, including several in Washington,
to implement community action plans to reduce health disparities and promote
quality health care and prevention services.
Project Area
- Chelan, Douglas, and Okanogan Counties in north central Washington
(population 138,783).
- Confederated Tribes of the Colville Reservation (population 8,900).
- Clark County, located on the border between Washington and Oregon
(population 363,400).
- Thurston County in the South Puget Sound region (population 212,300).
Target Populations for Steps Interventions
Hispanic adults at risk for or diagnosed with diabetes and asthma, obese
adults at high risk for diabetes, elementary and secondary students at risk for
or diagnosed with diabetes and asthma, American Indian youth at risk for or
diagnosed with diabetes or overweight, school-aged children and public school
employees, low-income individuals and families of all ages, women aged 35–54,
primary care physicians, and rural communities.
Proposed Interventions
Media
- Develop and implement a public awareness campaign focused on obesity
prevention
(Chelan-Douglas-Okanogan).
- Launch public awareness and education campaign promoting the availability
of diabetes education for adults with diabetes (Colville Confederated
Tribes).
- Develop and initiate a multiyear public awareness campaign on nutrition
and exercise, building on the existing Fit Clark County program
(Clark).
- Increase community knowledge of the environmental triggers of asthma and
low cost ways to reduce related household hazards (Thurston).
Policy
Each community has included at least one intervention addressing
policy/environmental change for each of the Steps components. Examples
include:
Increase the amount of time that students in grades K–6 spend being
physically active.
Increase access to healthy foods and decrease access to competitive foods
in grades K–12.
Implement voluntary smoke-free policies with local restaurants and bars.
Implement curricula in the schools that address comprehensive school
health.
Develop health care provider policies to implement patient registries and
adhere to appropriate standards of care for patients with diabetes, asthma,
and obesity.
Develop and implement public planning policies that promote active
living.
School-Based
Support implementation of the state-mandated Educational Academic
Learning Requirements for health and fitness (all project areas).
Implement new legislation that requires student health plans for all
students with diabetes or other life-threatening diseases, such as asthma
(all project areas).
Implement Asthma Management in Educational Settings (AMES) in local
schools to provide school nurses with guidelines for the care of students
with asthma (Chelan-Douglas-Okanogan).
Remove or mitigate perceived disincentives for schools to offer more
fruits and vegetables (Colville Confederated Tribes).
Work with schools and families to identify alternatives to high-fat,
high-sugar foods in school vending machines and implement plan such as
"Changing the Scene" (Clark).
Adapt the National Institutes of Health Asthma Awareness Curriculum to
grades 1–3 (Thurston).
Community-Based
Support policies that build connectivity among trails, paths,
neighborhoods, schools, and sidewalks to enhance community members’ ability
to be physically active. Support access to local and city parks and
recreational facilities that offer low-cost, high-demand activities and are
used by disadvantaged populations (Chelan-Douglas-Okanogan).
Develop and fund community partnerships to promote physical activity and
healthy eating in groups at risk for developing Type 2 diabetes
(Colville Confederated Tribes)
Develop and implement plans to support the Washington State Secondhand
Smoke Campaign and expand the Passport to Wellness Program throughout the
community (Clark).
Implement a community-based walking program in three target communities
or neighborhoods (Thurston).
Workplace
Form partnerships with community employers, medical providers, and
retailers to conduct healthy food choices campaigns with their employees,
clients, and customers (Chelan-Douglas-Okanogan).
Implement programs such as Health House and Master Home Environmentalist
that improve indoor air quality in public and private buildings (Colville
Confederated Tribes).
Engage business partnerships in education campaign to improve physical
activity and nutrition for employees (Clark).
Implement a community-based campaign with food service establishments to
label heart and body healthy menu items (Thurston).
Health Care
Develop and implement information-sharing agreements among the public
health community, health care providers, and school districts on the care of
people with diabetes in the community (Chelan-Douglas-Okanogan).
Improve the quality of medical care by educating providers on how to
appropriately recognize and treat metabolic syndrome, prediabetes, and
diabetes (Colville Confederated Tribes).
Assess health care system capacity to decrease complications of diabetes
in community (Clark).
Help health care professionals use body mass index (BMI) as a vital sign
for children aged 2–20 (Thurston).
Evaluation
HHS will provide training and technical assistance to help each Steps
community develop measurable program objectives and specific indicators of
progress and use relevant data to support ongoing program improvement. HHS also
will conduct a national evaluation of the overall program. Existing data
sources, such as the Behavioral Risk Factor Surveillance System and the Youth
Risk Behavior Surveillance System, will be used to identify and measure program
outcomes and assess progress toward program goals.
Community Consortium
Washington State Departments of Education, Health, Transportation, and Social
and Health Services; state WIC Program; Office of the Superintendent of Public
Instruction; Washington State Board of Health; American Lung Association of
Washington; American Heart Association; American Diabetes Association;
Washington State Chapter of the Asthma and Allergy Foundation of America;
Washington Health Foundation; Washington State Hospital Association; Central
Washington Hospital; Washington Coalition for Promoting Physical Activity;
University of Washington School of Public Health and Community Medicine;
Washington State University; Comprehensive Heath Education Foundation; and
representatives of local public health organizations, school districts,
hospitals, health care providers, health plans, community-based organizations,
businesses and food service vendors.
Washington Steps Contact
- Robbi Kay Norman
- Washington State Department of Health
- Division of Community & Family Health
- (360) 236-3704
- (360) 236-3646 fax
- robbikay.norman@doh.wa.gov
Note: Steps communities have until May 2004 to finalize their
community action plans. Proposed interventions may change accordingly.
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