Innovative Efforts Have Philadelphia Seeing Big Drops in Obesity Among Youth of Color
The Philadelphia Department of Public Health's persistent, multi-pronged population health approach to get residents of one of America's poorest big cities to live healthier is getting some eye-catching results, particularly among the city's youth. A 24 percent drop in kids' intake of soda along with healthier eating and increased physical activity, has helped drive a 6.3 percent reduction in childhood obesity rates.
What really sets Philadelphia apart from other cities: the larger reductions in obesity among kids of color, which have been tougher for other jurisdictions to achieve. The City of Brotherly Love (and Sisterly Affection), for example, saw the largest drops among Asian and African-American boys—18.8 percent and 11.3 percent, respectively—between the 2006/07 and 2012/13 school years. This is even more compelling when compared to national numbers, where there was no change in obesity prevalence between 2007 and 2012 (according to the National Health and Nutrition Examination Survey).
The achievements have come as a part of the health department-led Get Healthy Philly initiative, an innovative and collaborative public health approach that brings together government agencies, community-based organizations, academic institutions and the private sector to lower obesity and smoking rates in the Philadelphia. (Smoking rates have dropped 18% among adults and 30% among youth since 2007).
With the 2010 Get Healthy Philly launch, officials wanted to revitalize environments to make it easier to engage in healthy habits. The poorest of America’s 10 largest cities, Philadelphia for too long provided many residents with an overabundance of unhealthy choices: school children could buy almost 350 calories of candy, chips or soda for about one dollar at more than 1,500 corner stores in the city; city schools had minimal physical education requirements; and safe recreation places were a rarity. As a result, some 1,600 Philadelphians died each year as a result of poor diet and physical inactivity, with obesity adding $750 million annually to health care costs in the city.
Key activities that primed the pump for Get Healthy Philly included a “universal feeding” initiative in the 1990s that provided greater access to free and low-cost school meals to students in schools with high levels of poverty; a large-scale, school-based nutrition education program begun in 1999; and a comprehensive school wellness policy in 2006 that removed soda from vending machines and set nutrition standards for all foods served in cafeterias. These were supplemented by city-wide policy changes, such as the 2007 trans-fat ban and 2008 menu labeling law. “These were important successes, but we needed to do more,” said Giridhar Mallya, MD, MSHP, the department’s former Director of Policy and Planning. “We wanted to give Philadelphians the opportunity to be healthy where they live, learn, work, and play.”
Through Get Healthy Philly, city health officials fostered health-promoting environments for all city residents. By building on earlier achievements, the initiative has:
- Seen nutritional-related successes: 13 new farmers’ markets opened in low-income communities, which helped increase an innovative SNAP (food stamp) redemption at farmer’s markets by 335 percent; 650 corner stores today sell healthy items, such as produce, water and low-fat dairy; 200 Chinese take-out restaurants are reducing the sodium content of popular dishes by 20 to 30 percent; and removed junk foods from classrooms and school stores.
- Adopted physical activity infrastructure and policies: 9.7 miles of conventional bicycle lanes, 6.7 miles of new buffered bike lanes, 2.0 miles of green bicycle lanes and 8.9 miles of “sharrows” or shared bicycle lanes installed; and Wellness Councils in 171 public schools serving 100,000 students have incorporated physical activity into the school day.
- Led to policy change: healthy living and health impact assessments are integrated into Philadelphia 2035, the city’s new comprehensive plan, and into 5 district plans; Mayoral executive order establishing nutrition standards for all 22 million meals and snacks purchased and served by City agencies passed; and
- Launched mass media efforts: campaigns have been implemented to focus on reducing sugary drink and sodium consumption.
To make Get Healthy Philly truly effective, “we needed to have interventions in several settings,” says Mallya. “This required partnerships across government and with the private sector.” The effort works on many levels, including a big emphasis on media and public awareness, policy changes from healthy vending standards to removing barriers in the operations of the city’s robust farmers’ markets, and youth-based initiatives that include offering free, healthy meals in summer and after-school programs. Public health officials also work with retailers and manufacturers to improve healthy eating options, collaborate with city planners to make walking-and biking-friendly improvements, and with employers, insurers and health care providers on ways to control hypertension and diabetes.
“The results are awesome,” notes Yael Lehmann, executive director of The Food Trust, one of the many Get Healthy Philly partners. The success lies in the effort’s focus “to remove as many barriers as possible, while looking at the larger context.”
While Philadelphia public health officials have made substantial progress, Mallya knows there is a long way to go to make healthy lifestyles the easy option for residents. While the city has seen drops in youth obesity rates overall and among some racial/ethnic minority groups, reductions among girls have been more limited, particularly among Hispanic girls. Already, city officials are partnering with key organizations to develop initiatives and gather insight on how better to reach these groups.