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The Cross-Sector Promotion of Public Health Across the United States

The month of April 2013 was a particularly active one in terms of health promotion at my place of employment, Villanova University, located on the outskirts of Philadelphia. In addition to hosting its annual Wellness Fair on April 16, where a range of helpful information was provided for the Villanova community regarding physical fitness, nutrition and healthy dining, the University participated in the Independence Blue Cross (IBC) National Walk @ Lunch Day on April 24 in an effort to promote the benefits of a healthy lifestyle for all Americans. More and more, employers, nonprofit leaders and public administrators are recognizing that a nutritious diet, frequent medical check-ups and consistent exercise are valued public goods in the United States. According to the National Network of Libraries of Medicine (NNLM), this is an especially important message for vulnerable populations in the United States – the elderly, ethnic and racial minorities, immigrants and low income individuals and families – who tend to have lower rates of health literacy.

In the report, Health Literacy: A Prescription to End Confusion (2004), The Institute of Medicine defines health literacy as “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions.” The two events above are just a sampling of the many ways employers are encouraging their employees to increase their levels of health literacy through: regular offerings of onsite health screenings, suggestions for reducing stress and finding solutions to stressful situations, and the circulation of recipes that contribute to a “heart-healthy” lifestyle. This employer-led involvement in the realm of public health education has been accompanied and inspired by a twofold movement on the part of public, private and nonprofit actors across the United States: (1) targeted wellness initiatives taking place at the federal, state, and local levels and (2) the formation of cross-sector partnerships in advancing comprehensive health and fitness education. These efforts are all part of a larger national effort to enhance health literacy for Americans as a whole, with particular attention paid to addressing the barriers of health literacy for vulnerable populations in our midst.

First Lady Michelle Obama’s comprehensive health initiative, Let’s Move!, is a public information campaign dedicated to promoting health literacy at the federal level. Established in 2010, the central purpose of the campaign is to provide solutions to the epidemic of childhood obesity through delivering educational content to its target audiences – schoolchildren, educators, parents and caregivers, and healthcare professionals – on the long-term value of healthy food choices and physical activity. Meanwhile, the Maine Governor’s Council on Physical Fitness, Sports, Health, and Wellness – originally founded in 1987 – is an instance of a state-level approach to educating and nurturing a healthy citizenry. Consisting of twenty-five appointees and an additional group of thirty liaisons, the Council promotes strategies for increased citizen participation in physical activity as well as serves to educate citizens and legislators on a range of public health issues of importance to the community.

Local government also boasts a bevy of public health activity in cities as geographically—and demographically –diverse as Columbia, Missouri and San Antonio, Texas. In 1999, the Columbia City Council issued a resolution formally establishing the Columbia Mayor’s Council on Physical Fitness and Health—whose charge has been to educate the public on the benefits of physical fitness and recognize outstanding achievements by residents committed to issues like smoking cessation, dieting, youth mentorship and exercise. Like Columbia, San Antonio established a Mayor’s Fitness Council in 2010 under the leadership of Mayor Julian Castro. As quoted in the Summer 2011 edition of Peak Life SA, Castro remarked that the intention of the Council was to build a “fitness culture” in San Antonio in order to reduce the incidences of child and adult obesity in the region, which oftentimes can lead to diabetes, heart attacks and hypertension. Already, the Council has developed interactive health stations in public libraries throughout the city where residents regularly can check personal health indicators. The Council also provides a list of Farmers Markets in the region on its website so that residents can have access to fresh fruits and vegetables.

Public administrators realize that improving citizens’ health literacy hinges on community outreach and cross-sector collaboration with nonprofits and private corporations. Whereas federal, state and local governments continue to advance targeted health initiatives in their respective locales, cross-sector collaborations further these initiatives by representing a broader array of actors involved in the larger public health discussion. Indeed, the Columbia Mayor’s Council on Physical Fitness and Health prides itself on working alongside local businesses, schools and community organizations in developing fitness programs and increasing health literacy in the region. Identifying itself as a “comprehensive initiative,” Let’s Move! partners with the interagency White House Task Force on Childhood Obesity as well as the nonpartisan nonprofit organization, Partnership for a Healthier America (PHA) in its goal of empowering more consumers to make healthier lifestyle choices.

Despite this sustained and multipronged attention to the cause of public health, vulnerable populations—the elderly, ethnic and racial minorities, immigrants and low income individuals and families—continue to face greater health literacy difficulties. This is the case since these populations frequently lack basic access to health information and services due to limited English proficiency (LEP) as well as other social, cultural, and economic barriers. According to the NNLM, not only does low health literacy contribute to higher economic inefficiencies in the U.S. health care system, but it also leads to undiagnosed medical conditions, a higher probability of hospitalization, and a higher risk of patient death. Public administrators, educators, employers and health providers alike should make sure that all health communication reflects an awareness of and respect for cultural diversity. Jennifer Bennett Kimbrough (2007) suggests that this communication could take the form of ongoing outreach to community based organizations as well as the translation of health-related materials into less technical language and the languages of community residents. After all, if “your health is the most precious asset you have,” as Mayor Castro of San Antonio maintains, communicating that public health is also a public good is a task shared equally by all.


Author: Catherine E. Wilson is an associate professor and nonprofit coordinator in the Department of Public Administration at Villanova University. Email: [email protected]


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