Preventing Childhood Obesity - Evidence Policy and Practice.pdf

CHAPTER 26
Community i nterventions — planning
for s ustainability
Anne Simmons, 1 Jean Michel Borys 2 and Boyd Swinburn 1
1 WHO Collaborating Centre for Obesity Prevention, Deakin University, Geelong and
Melbourne, Australia
2 EPODE European Network, Paris, France
Summary and recommendations
for research and practice
• Well-evaluated community-based obesity prevention
programs are needed to provide the evidence
of effectiveness of such approaches.
• Selection of priority communities for program
implementation should take account of needs (e.g.
level of disadvantage) as well as likelihood of success.
• A capacity building approach should underpin
implementation of obesity prevention programs.
• Health promotion principles are applied to community
engagement, program planning and implementation,
and evaluation design, but these are
inherently complex and contextual.
• Sustainability must be built in from the start, and
means placing a higher priority on policies and
capacity building than on events, awareness raising
and education.
• Future challenges include securing sufficient investment
in programs and evaluations, incorporating
socio - cultural aspects, and moving from implementing
individual projects to reorienting existing
systems towards contributing to the obesity prevention
efforts.
Introduction
Community level action to promote healthy eating
and physical activity is a central component of obesity
Preventing Childhood Obesity. Edited by
E. Waters, B.A. Swinburn, J.C. Seidell and R. Uauy.
© 2010 Blackwell Publishing.
prevention efforts. Ideally, these actions should
complement wider state - or national - level action,
particularly policy actions needed to make environments
less obesogenic. 1 In practice, programs at
the community level are being established much
more rapidly than policies at a state or national level.
At this stage, however, the evidence base for what
works and what does not work at a community level
is relatively narrow, 2,3 therefore there is an imperative
to properly evaluate major programs that are
being implemented. 4 Establishing well evaluated
demonstration projects is critical for creating the
evidence about what works for whom, why, and for
“ what cost? ”
The planning, implementation and evaluation of
community intervention programs takes several years.
This is especially the case if the programs are large and
multi - faceted, if the structures and organizational
relationships need to be built from scratch, if the
stakeholder groups are numerous or require substantial
relationship building, or if the resources and leadership
support are low. Sustainability issues are often
not high on the agenda in the early stages as people
are immersed in community consultations, hiring
staff, setting up governance structures, developing
action plans, and so forth. However, as the evidence
of long - term effectiveness of interventions emerges,
the focus of choosing more sustainable action should
increase.
Basic health promotion principles for the implementation
of any community programs include:
the need for community engagement and capacity
building; program design and planning, including
governance and management structures; implementa-
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