Investing in children’s health is a sound economic decision with a long-term impact on achieving sustainable human, social, and economic development. The Foundation for a Healthy Kentucky’sInvesting in Kentucky’s Future initiative was designed as a partnership with local community health coalitions to reduce the risk that today’s children will develop chronic diseases as they grow into adults.
The Foundation for a Healthy Kentucky is a statewide nonprofit organization working to address the unmet health needs of Kentuckians. In 2012 the foundation launched a six-year, $3 million initiative called Investing in Kentucky’s Future. Under this initiative, the foundation selected seven diverse community health coalitions across Kentucky, based on the commitment of civic leaders to work together to promote the physical and behavioral health and well-being of children by engaging local systems and supporting environments and policies that help children and youth practice healthy behaviors for a lifetime. The coalitions were asked to look at the health needs of their communities’ children and to develop an intervention plan to address one priority health issue. Six health coalitions chose childhood obesity, and one coalition prioritized adverse childhood experiences (ACEs).
Childhood Obesity And ACEs In Kentucky
The health issues prioritized by the coalitions, through an assessment and prioritization process under planning grants, did not come as a surprise. Nearly 36 percent of Kentucky’s young people are overweight or obese, with Kentucky ranking third among states in obesity rates for high school students. In addition, 64 percent of Kentucky residents have experienced two or more ACEs.
The negative health effects of obesity have been extensively documented and include Type 2 diabetes, high blood pressure, and coronary heart disease and stroke, among others. Not as commonly known are the long-term behavioral, mental, and health risks of ACEs, despite nearly twenty years of research demonstrating that incidents of abuse, neglect, and household dysfunction that happen to children under age eighteen directly correlate to poor health outcomes in adulthood. These negative health outcomes include coronary heart disease, obesity, depression, autoimmune disease, and substance use disorders, among others. The more ACEs a child experiences, the greater his or her chances of experiencing these lasting, poor health outcomes.
Children in poverty live at much greater risk and have higher incidences of both of these health problems in Kentucky. A review of data from the National Survey of Children’s Health demonstrates a significantly higher frequency of ACEs for children living at or below the federal poverty level (FPL), an ACEs rate that decreases dramatically as income rises. For example, 11.9 percent of Kentucky respondents living in poverty had experienced three ACEs compared with 1.4 percent of those from families earning four times or more of the FPL.
Given the foundation’s commitment to health equity, we selected communities with higher levels of poverty for the Investing in Kentucky’s Future initiative. The six coalitions that focused on childhood obesity prevention are in rural Kentucky (three of them in Appalachian Kentucky). The ACEs coalition works in the Louisville metro area.
The initiative required the health coalitions to use population health interventions, develop a business plan to address the health issue chosen, and co-invest with the foundation through a 50 percent cash match. The business plan requirements included interventions involving more than one local government agency, which, in the case of those working on obesity prevention, meant strategies related to physical activity and nutrition, changes in the built environment, and local policies that would enhance and sustain the efforts. The foundation has provided the coalitions with ongoing training, coaching, evaluation support, and technical assistance since the planning phase of the grant started.
Community Change For Obesity Prevention
In the years since the initiative launched, Investing for Kentucky’s Future has contributed to progress in policy, environmental, and systems changes in all seven funded communities. All of the obesity-focused coalitions are working in their local schools and public recreation areas to create environments that are supportive of physical activity and good nutrition. Baseline student and teacher surveys administered in the schools indicated that the initiative’s obesity interventions meet the needs of the community. The results of the Investing in Kentucky’s Future initiative are noteworthy:
- In terms of policy changes, the initiative’s coalitions have contributed to seventeen policy changes in their schools and communities, including shared-use agreements between two government entities (regarding public property or facilities), healthier foods at park concessions, and complete streets.
- The policies have been supported by built-environment enhancements, such as improvements to community and school infrastructure promoting physical activity (for example, playgrounds, walking paths at schools, sidewalks to schools, and basketball courts).
- Additional system changes include youth engagement in some of the community and behavior change efforts (for example, youth health councils, youth serving on coalition boards, youth conducting walkability assessments, and youth presenting at city council meetings). Coalitions working on obesity prevention also have been implementing a school-based curriculum related to nutrition and physical activity.
The Bounce coalition is the Investing in Kentucky’s Future grantee addressing ACEs to foster the skills children need to bounce back from adversity with resiliency. This is a collaboration of seventeen diverse community organizations that are implementing a trauma-informed model for Jefferson County Public Schools, which is the largest school district in Kentucky and includes schools in the city of Louisville.
Bounce facilitates resiliency in children in both school and out-of-school-time (OST) settings, and its activities include the following:
- Infusing trauma awareness, knowledge, and skills into the organizational cultures, practices, and policies of school staff and OST provider agencies;
- A mechanism for referring youth to additional services and supports; and
- Awareness-raising programs—for parents—on ACEs and building children’s resilience.
The Bounce coalition has developed a training curriculum about the correlation between ACEs and chronic disease, which has been used to train pilot schools’ staff (the coalition is piloting the program in five schools in the Jefferson County district); bus drivers; and the site-based decision making (SBDM) council, which includes parents, teachers, and a school administrator, and sets certain school policies and makes certain decisions, as outlined by statute. Bounce also provides training to school staff on recognizing and responding to symptoms of ACEs and integrates that work into ongoing professional development processes.
Bounce is closely tracking student, staff, and parent outcomes, which to date have shown considerable progress. Bounce also has been working with the Louisville Metro Government and Jefferson County Public Schools on policy changes related to ACEs and has led the creation of the Building Resilience in our Community’s Kids (BRICK) network to coordinate trauma-informed approaches in Louisville.
The strength of the Investing in Kentucky’s Future initiative is that it is fostering the capacity of these seven Kentucky communities to improve the health of their residents long after the grant period ends by supporting lasting partnerships, by changing policies, and by enhancing the skills of these seven cross-sector coalitions committed to making a healthier future for their children.
James Knickman, “The Battle Plan To Fight Diabetes And Obesity,” GrantWatch section of Health Affairs Blog, January 13, 2016.
Stephen Isaacs, David C. Colby, and Amy Woodrum, “The Robert Wood Johnson Foundation’s Efforts To Reverse Childhood Obesity,” GrantWatch section of Health Affairs Blog, April 14, 2015.
Lee-Lee Prina, “Toxic Stress In Children And The Importance Of Listening Between The Lines To What Kids Say,” GrantWatch section of Health Affairs Blog, April 29, 2014.