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After increasing steadily for decades, the national childhood obesity rate has leveled off. This policy brief examines reports from across the country to learn more about where progress is being made to address childhood obesity.
Over the last two decades childhood obesity has risen at an alarming rate in the United States. In 1999, 13 percent of children ages six to 11 and 14 percent of adolescents ages 12 to 19 were overweight. This prevalence has nearly tripled. Now, the number of overweight children in the nation exceeds 12 million. Evidence shows that children who enter adulthood obese are unlikely to shed the burden. And they also have a higher risk of premature death and disability in adulthood. Sedentary behavior is partly to blame. Forty-three percent of adolescents watch more than two hours of television each day, according to a federal report. But excessive screen time - whether it's the TV or computer - is only one obstacle that limits children's ability to obtain the one hour of daily exercise recommended by the U.S. Surgeon General. The built environment surrounding a child's neighborhood and school can also help or hinder physical activity. Research shows that children who live closer to parks and recreational facilities are more active than those who live further away. And active living, along with eating nutritious foods, plays a key role in maintaining a healthy weight.
A child's health is a key predictor for his or her future success and well-being. Unfortunately, far too many children face barriers that prevent them from reaching their full potential because of where they live, learn and play. The inequitable distribution of social, economic and environmental resources across communities - often called the social determinants of health - create challenges for healthy living. Socioeconomic conditions (e.g., concentrated poverty), access to health care and transportation options, educational and employment opportunities, and aesthetic elements (e.g., green spaces and vibrant public spaces) result in differences in opportunities and exposure to health-promoting resources such as child care, high performing schools, affordable housing, access to healthy food and safe spaces for physical activity. The availability and quality of these neighborhood resources and services have a major impact on the ability of children and families to make choices that support healthy growth and development. When children and families have access to these resources and services, children have more opportunities to thrive. On the contrary, children growing up in communities that lack these often suffer poorer health outcomes than their peers. These differences in health are known as health disparities.
Many schools are surrounded by fast food restaurants, which provide students with easy access to unhealthy foods and undermine schools' efforts to offer nutritious meals. Prohibiting fast food restaurants from locating near schools is one strategy to help reduce childhood obesity and support schools striving to improve students' health. NPLAN has developed a model ordinance that creates a "healthy food zone" by restricting fast food restaurants near schools or other areas children are likely to frequent.
Growing concern over childhood obesity has prompted a focus on underlying epidemics of physical inactivity and poor nutrition. Regarding the former, there is increasing understanding that behavior change promotion alone has not increased population physical activity levels and that an ecological approach is necessary. Therefore, the public health profession has moved beyond traditional behavior change campaigns toward a growing focus on altering policies and the built environment to create settings that support increases in routine, not just exercise or leisure time, physical activity among children. A survey of the literature suggests four broad factors that define settings where routine physical activity, especially active transportation, is more likely to occur: (1) a compact variety of land uses, with a mix of destinations in close proximity; (2) a comprehensive network of bicycle, pedestrian, and transit facilities; (3) inviting and functional site designs for pedestrians, cyclists, and transit users; (4) safety and access for users of all ages, incomes, abilities and disabilities. Although these principles are increasingly accepted as beneficial, not just to health but to a community's economic, environmental, and social well-being, many contemporary ordinances and development practices undermine these outcomes. Therefore, five specific policy and intervention approaches are recommended to guide communities to these outcomes: 1. zoning and development policies to protect open space, contain sprawl, and focus investment toward thriving, mixed downtowns and village centers; 2. Complete Streets policies, which require roadways that are safe and functional for pedestrians, bicyclists, and transit users, as well as motor vehicles; 3. a transportation- (not just recreation-) oriented trail network; 4. creation of bicycle- and transit-friendly infrastructure and incentive policies; 5. development of policy-based Safe Routes to School interventions. This proposed intervention framework requires evaluation both of effectiveness in increasing childhood physical activity and of the most promising means of getting policies implemented.
Anchor institutions can be important drivers of economic growth. Through their spending and investment, employment and contracting, and their ability to generate ideas, information, and talent, they can spark innovative enterprises grounded in place. Their existence can be especially important in older, industrial cities bereft of other major employers, but their presence is felt in virtually all metropolitan regions. In a growing number of places, local and regional organizations are engaging anchors as important partners to advance equitable growth by creating opportunities for low-income residents and communities of color to be the workers, innovators, and leaders who will propel the economy.
A report examining the University of Pennsylvania's economic imapct on Philadelphia and Pennsylvania.
Anchor institutions (often referred to as "eds and meds") are place-based enterprises, firmly rooted in their locales. In addition to universities and hospitals, anchors may include cultural institutions (such as museums), health care facilities (such as nursing homes), and municipal governments. Typically, anchors tend to be nonprofit corporations. Because they are rooted in place (unlike for-profit corporations that may relocate for a variety of reasons, such as lower labor costs, more subsidies, or fewer environmental regulations), anchors have, at least in principle, an economic self-interest in helping ensure that the communities in which they are based are safe, vibrant, and healthy.
Restaurants encourage children and adolescents to choose specific menu items by linking them with free toys and other incentive items. This ordinance states that a restaurant may not provide an incentive item linked to the purchase of a single food item or meal if it includes excessive calories, excessive sodium, excessive fat, excessive saturated fat, trans fat, orexcessive sugars.
For generations, cities have been places where people of every background have sought opportunity. But as urban economies have evolved in recent decades, our cities have experienced sharp growth in economic disparities, and many communities have suffered. Addressing these disparities requires leveraging cities' economic assets in order to better create, prepare people for and connect them to economic opportunity.