Written Testimony: December 10, 2008, Committee on Health, Education, Labor and Pensions focused on "Prevention and Public Health: The Key to Transforming our Sickcare System"

Carol Hibbs, Executive Director, Marshalltown Community Y, Marshalltown, IA Representing: YMCA of the USA's Activate America: Pioneering Healthier Communities®

Good morning, I’m Carol Hibbs, Executive Director of the Marshalltown, IA Community Y.  I’m honored to be here to say a few words about the success of our community change model, focused on chronic disease prevention.  This project has been convened by the YMCA, but is indeed a community success story.

Before I begin I want to thank my Senator, Senator Harkin for his leading role in prioritizing prevention in health care and for serving as the Honorary Chair of the YMCA’s Pioneering Healthier Communities initiative.  Without you, Senator, this program would not be what it has become today—a movement toward the social and cultural change we need to make the healthy choice the easy choice in our communities.

Marshalltown is a rural community of about 27,000.  Over the last two decades, we have rapidly transformed into a much more diverse community -- both culturally and economically. Experts estimate that our Hispanic population has more than doubled since 1990. In the school district, more than 40% of the students are Hispanic.  Also, more than 50% of Marshalltown students qualify for free or reduced priced lunch.  Our YMCA is proud to be open to everyone in our community and we currently provide financial assistance to about 20% of our 6,800 members.

In the summer of 2005, our community applied to participate in the YMCA of the USA's Activate America:  Pioneering Healthier Communities initiative.  Pioneering Healthier Communities focuses on collaborative engagement with community leaders, how environments influence health and well-being, and the role policy plays in sustaining change.  We believe no one organization can effectively solve the nation’s chronic disease crisis; therefore YMCAs joined with others to increase opportunities that ultimately impact healthier lifestyles. 

In Marshalltown we recruited a high-level team of community leaders from all sectors—including the hospital, local business, the school district, economic development and our Mayor-- to come to Washington for three days of information and education.  We heard from national experts about evidence-based strategies that build sustainable healthy communities through changes in policy and the built environment.  Our team left Washington excited and convinced we could collectively help Marshalltown residents become healthier.

The Pioneering Healthier Communities Model takes the macro approach to change.  Again, combining programs and projects for implementation in all sectors of our community; and promoting policy changes --- all of this with a constant, healthy dose of information and education in community-wide forums that explain why we are trying to make a particular policy change.  Our engagement of the community has brought about healthy changes, including:

• Developing a community walking guide distributed through numerous community sites and events.
• Developing wellness policies in two of our local schools that focused on incorporating physical activity throughout the school day, revising the PE curriculum, establishing guidelines and nutrition information for families around school lunches, and providing healthier options in the vending machines.   
• Creating a “Gym in a Box” with a large local hospital to promote healthy eating and active living among their employees.
• Working with the local community college students to plant more trees along biking paths in the city to increase usage.
• Implementing Fit Kids, an afterschool program targeting low-income kids to incorporate healthy activity and healthy snacks into their lives along with the President’s Council physical fitness test every 12 weeks.
• Introducing Healthy University for 17-78 year olds allowing hundreds of individuals to receive assistance with comprehensive behavior change strategies to reduce obesity—including the necessary environmental and emotional support to help individuals be successful.
• Conducted a walkability assessment in our downtown to achieve our goal of Marshalltown becoming a pedestrian/bike friendly community.  The first meeting was attended by 40 interested community leaders and was followed by another meeting of 60 leaders.  We now have City government, community walking & biking advocates, Iowa Department of Transportation officials and the local planning commission working together toward common goals.  As a result:
1. A sidewalk task force was created that mapped sidewalks in the city to assess needs and prioritized a plan for the city with the highest priority being around schools.
2. A commitment was made to creating a Safe Routes to Schools program for the entire community
3. Plans are underway for the development of a pedestrian riverwalk along Linn Creek which flows through the center of the community

This work is not easy.  Silos must come down in communities and money from local, state and federal governments along with that from the private sector much be leveraged.  Community leaders influence the environments of where we live, work, and play must all be on board to create healthy ones.  Community leaders in Marshalltown have been surprised to learn just how many decisions they make weekly or monthly that influence healthier choices. 

We believe keys to our success include:

• Recruiting community leaders and key influencers as part of the team to come Washington to participate in the initial conference – we must reach beyond the public health community to influence public health outcomes
• Creating a healthy community plan that ask all sectors of our community to make a contribution
• Reaching into so many parts of the community and encouraging participation along with constant information and education – several segments of the community are now energized and unified around this healthy community effort
• Challenging the team to not only implement new programs and special projects  – but to constantly look at policy changes that can be made in our schools, worksites and neighborhoods so healthy eating and active living is an easier choice
• Acting as a central coordinating organization, the Marshalltown Community Y convenes the group and coordinates the work – but engages everyone.  This has worked well in Marshalltown because the politics of this work with public officials and the private sector is managed and not a barrier so the community can make these important changes.

This effort involves more than just telling people to eat less and exercise more.  The YMCA has learned that the majority of kids and families need support in achieving their health and well-being goals.  We call these individuals “health seekers – they want to improve, but making everyday healthy choices is frequently a struggle, even when it has obvious advantages.  Yes, people are responsible for their own behavior but too often society creates barriers, or at the least does not provide enough support, to help kids and families realize their health goals.

Today, the YMCA movement has 91 communities engaged in the Pioneering Healthier Communities model (see attached map/list).  There have been significant policy changes, new programs implemented and a great deal of awareness created around evidence-based models that result in 91 healthier communities.  We are anxious to share our model with others and there are hundreds of communities interested and ready to do this work. 

I want to emphasis however that there are no shortcuts.  We have faced challenges.  I believe everyone on our team would say the learning process has had a direct correlation on the outcomes and bringing the community together toward common goals for a healthier Marshalltown.  I’m certain that each of you on this committee would agree that your federal investment into this team of about $50,000 since 2005, is a small investment compared to the change that needs to occur in every city, town and neighborhood in America.  In addition, we have been able to leverage those dollars more than 6 times over with contributions and grants with local funders, hospitals, Safe-Routes-to-School funding and a Carol White PEP Grant.

America’s 2,686 YMCAs, at more than 10,000 sites serving more than 21 million people each year – half of which are children and youth stand ready to enthusiastically support chronic disease prevention policies for the individual, the family and our communities.  Thank you for allowing me to share what I believe is one of the best models of community-based prevention programming.