Mapping Childhood Obesity in Austin Motivates Understanding and Action
For a more complete case study of this experience, see Chapter 6 of Strengthening Communities with Neighborhood Data, by G. Thomas Kingsley, Claudia J. Coulton and Kathryn L. S. Pettit (Washington, DC: Urban Institute, 2014)
The nationwide epidemic of childhood obesity has been well-publicized, and Texas has been one of the hardest-hit states. As of 2007, 20.4 percent of Texas children aged 10 to 17 were obese and 32.2 percent were over-weight. This issue disproportionately affects low-income and minority populations. A 2009 study by the Austin Independent School District (AISD) found that, across grades 3 to 12, students who were rated as having poor cardiovascular fitness had significantly lower attendance and reading and math proficiency than other students.
Recognizing the importance of the issue, the Texas State Senate passed a bill in June 2007 that, among other things, required each school district to assess the physical fitness of their students annually (including measuring body mass index (BMI) and cardiovascular health). Physical education instructors collect the data each October and May by administering fitness tests and measuring each child’s BMI.
NNIP’s partner in Austin, Children’s Optimal Health (COH), saw that reporting these data in the aggregate would be necessary but not sufficient. Only by seeing variations in the results by neighborhood would decision-makers be able to target resources efficiently and devise response programs that really fit the circumstances at hand. Accordingly, beginning in 2008, COH launched a project with AISD to analyze the spatial patterns of overweight and obese children in Austin. COH produced density maps representing the residences of almost 3,800 middle school students who were overweight, obese, or severely obese. They found substantial variation by neighborhood ranging, from 8.6 to 32.1 percent.
COH and IASD also recognized that child obesity levels are affected by numerous factors, such as school physical education curriculum, individual and family behavior, social and neighborhood conditions. The latter include a built environment that may encourage or hinder exercise, crime levels that may cause parents to keep their children indoors, and access to healthy foods. To examine these contextual factors, COH mapped the obesity indicators alongside locations of grocery stores, fast-food outlets, and open space. Even among areas with poor health outcomes, the mix of these positive and negative influences varied widely and demonstrated the need for solutions tailored to the neighborhood context.
Once the map analysis was in hand, the next step was to present the findings to the wider community. Particularly important in this, COH convened a Community Summit (add link) on Childhood Obesity in fall 2009, which attracted about 100 people, including parents, teachers, medical professionals, and staff from more than 50 agencies. Together, the participants reviewed the patterns and discuss potential policy and programs to intervene. Participants suggested interventions ranging from increased access to healthy food to expansion of opportunities for physical activity at home and at school. This event led to actions by the city and county to improve park facilities, improve access to sidewalks and hike and bike trails, and increase access to fresh produce, with special emphasis on neighborhoods of high need. The maps produced by COH were also used as one basis for a Michael and Susan Dell Foundation initiated multiyear place-based initiative in two high-need neighborhoods, extensively engaging community members in decision-making to focus on improving physical activity and nutrition.
Over the next several years, COH continues to map the student health indicators. Annual time series maps documented some improved health status in youth. In one example, an area in North Austin experienced unexpected improvement in health outcomes from the 2007/08 school year to the 2009/10 school year. At the beginning of the period, more than 70 percent of the middle school children in the area had poor cardiovascular health. By 2009/10, the rates had fallen to less than 50 percent for much of the area. COH learned from the school district staff that the district had piloted HOPSports, a program designed to increase physical activity at the three middle schools that served the neighborhood. COH presented this story and updated analysis for the entire district at a second AISD Community Summit in November 2010.
Meanwhile, AISD also continued to rely on the maps and data to design and implement other programs to improve children’s health. The AISD School Board included student health as a core value in its strategic plan for 2010 to 2015. One action step was to “establish goals at each school to prepare children to be healthy, fit, and ready to learn.” For example, the plan lists a goal to move the percentage of middle school students with a healthy BMI from 57 percent in 2008/09 to 100 percent by 2014/15. The plan also included staged strategies and objectives to meet the stated goals, such as enhanced physical education curriculum and health education in schools.
In addition, the philanthropic community played an important role. In late 2009, the RGK Foundation announced a new focus on the “improvement of middle school children’s health through physical activity.” In September 2012, RGK awarded a $150,000 grant to AISD to enable the implementation of HOPSports and other physical education activities at six middle schools. These additional resources ultimately resulted in HOPSports being implemented in all AISD middle schools.
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