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Healthy Communities

Preventing Chronic Disease by Activating Grassroots Change
At A Glance 2011

Healthy Communities At A Glance cover

A National Chronic Disease Crisis: The Time to Act is Now

Our nation faces a crisis due to the burden of chronic disease. Today, 7 of the 10 leading causes of death in the United States are chronic diseases, and nearly 50% of Americans live with at least one chronic illness. People who suffer from chronic conditions such as heart disease, stroke, diabetes, cancer, obesity, and arthritis experience limitations to function, health, activity, and work. These limitations affect the quality of their lives, as well as the lives of their families.

Treatment for people with chronic conditions accounts for more than 75% of the $2 trillion spent annually on medical care in the United States. Effectively addressing the national chronic disease crisis is central to the future of health care in our nation and a priority for policy makers and those who pay for public and private health insurance plans.

Preventable health risks such as tobacco and excessive alcohol use, insufficient physical activity, and poor nutrition contribute to the development and severity of many chronic diseases. For example,

  • Tobacco use is the single most avoidable cause of disease, disability, and death in the United States. Each year, an estimated 443,000 people die prematurely from smoking or exposure to secondhand smoke. Despite these risks, more than 43 million (about 1 of 5) U.S. adults smoke.

  • During 2001–2005, about 79,000 deaths were caused by excessive alcohol use annually. Excessive alcohol use is the third leading lifestyle-related cause of death for Americans each year.

  • In 2009, more than 80% of high school students and more than half (56%) of all adults did not meet recommendations for aerobic physical activity from the 2008 Physical Activity Guidelines for Americans. These guidelines call for at least 60 minutes each day of physical activity for children and adolescents and 75–150 minutes each week (depending on activity intensity) for adults.

  • In 2009, only 34% of high school students ate at least 2 servings of fruit each day, and only 14% ate at least 3 servings of vegetables daily. Only 23% of U.S. adults ate 5 or more servings of fruits and vegetables each day.

In addition, some population groups in the United States suffer disproportionately from chronic diseases and associated risk factors. For example,

  • Death rates for heart disease are 23% higher among African Americans than among whites; death rates for stroke are 31% higher.

  • African American, Hispanic, American Indian, and Alaska Native adults are twice as likely as white adults to have diabetes.

The Burden of Chronic Disease

  • Heart disease and stroke remain the first and third leading causes of death, accounting for more than 30% of all U.S. deaths. One million Americans are disabled from strokes, and many can no longer perform daily tasks such as walking or bathing without help.

  • Nearly 26 million Americans have diabetes. An estimated 79 million U.S. adults have prediabetes, which places them at increased risk of developing type 2 diabetes. Diabetes is the leading cause of kidney failure, nontraumatic lower-extremity amputations, and blindness among adults aged 20–74 years.

  • Cancer claims more than half a million lives each year and remains the nation's second leading cause of death. The total number of Americans living with a previous diagnosis of cancer is currently estimated at 11 million.

  • One of every 3 U.S. adults and nearly 1 of 5 children aged 6–19 years are obese. Obesity has been linked to increased risk for heart disease, high blood pressure, type 2 diabetes, arthritis-related disability, and some cancers.

  • An estimated 50 million U.S. adults reported being told by a doctor that they have some form of arthritis, such as osteoarthritis, rheumatoid arthritis, gout, lupus, or fibromyalgia. Arthritis results in activity limitations for nearly 21 million Americans.

Producing Results

Strong action at the community level is critical to addressing chronic disease trends. CDC's Healthy Communities Program provides funding and technical assistance to select communities, states, and national groups to help them prevent chronic diseases at the local level. The program adheres to the following key principles and strategies to create and sustain health improvements in funded communities:

  • Respond to community needs through partnerships.

  • Implement large-scale interventions in multiple settings.

  • Reach diverse population groups to promote health equity.

  • Make interventions sustainable.

CDC's investments are producing impressive results. In 2010, for example, CDC's investments facilitated the following policy and environmental changes:

  • The city of North Miami, Florida, with help from the Worksite Wellness Committee of the Consortium for a Healthier Miami-Dade, adopted a policy to expand healthy food options in vending machines at city work sites. The city will serve healthy food at city functions and meetings and offer only healthy food options at public recreational facilities in North Miami.

  • The Manistique Strategic Alliance for Health Coalition, in partnership with city officials in Manistique, Michigan, drafted a "complete streets" resolution that was adopted by the city council in September. The resolution requires communities to consider all users when designing and constructing streets, sidewalks, bike paths, and other transportation infrastructure.

  • In Ypsilanti, Michigan, the YMCA of the USA, with support from the Pioneering Healthier Communities team, city council, and the city's recreation commission, began offering recreational programs in city parks. About 300 children attended summer programs, and about 250 students attended afterschool programs in city parks and school gymnasiums during the 2009–2010 school year.

Building on the lessons learned from these communities, CDC is expanding its efforts to help hundreds of communities across the nation prevent chronic diseases.

CDC Expands Its Efforts

CDC and its partners work through the Healthy Communities Program to create healthier communities and help communities most affected by chronic disease. The program mobilizes community resources to bring change to places and organizations such as community centers, schools, health care settings, and work sites.

States and Territories Collaborative

CDC funds and trains state and territorial health departments through a 5-year cooperative agreement that supports efforts to prevent chronic disease. Health departments, in turn, provide technical assistance, training, and consultation to communities within their jurisdictions to help them develop and implement policy, system, and environmental changes.

Local Investments

CDC also funds and supports Strategic Alliance for Health (SAH) communities for 5-year periods. These communities create online action guides that give instructions for replicating effective strategies. CDC currently provides guidance, technical assistance, and training to 14 SAH communities. In addition, CDC will train and support community leaders in more than 200 ACHIEVE (Action Communities for Health, Innovation, and EnVironmental changE) communities during the next several years. ACHIEVE community leaders participate in Action Institutes where they receive training to develop local action plans. Technical assistance is provided by national and state experts for at least 3 years, and communities also receive modest financial support. CDC collaborates with the following five national organizations to provide this support:

  • National Association of Chronic Disease Directors.

  • National Association of County and City Health Officials.

  • National Recreation and Park Association.

  • Society for Public Health Education.

  • YMCA of the USA.

CDC also supports the YMCA's Pioneering Healthier Communities. Since 2005, CDC has given funding and technical support to the YMCA and used its network to bring together local leaders to improve health and confront the crises of obesity and chronic disease. Through Pioneering Healthier Communities, the YMCA has convened, trained, and supported teams of key leaders in more than 118 communities. By 2013, about 150 communities will be funded.

Action Institutes

CDC provides Action Institutes, which convene community action teams and train community leaders to make policy, system, and environmental changes to prevent and control chronic diseases. Community action teams receive training from national experts and develop a plan of action during the 3-day institutes. They hear from peer communities about how to undertake an effective community-change process, and they gain access to tools and resources for implementing programs.

National Networks for Community Change

CDC is forming new innovative partnerships that reach across communities and involve local planners, decision makers, and community organizations whose primary mission is not necessarily to promote health but who have an important role to play in improving community health.

Tools for Community Action

CDC provides national leadership in health promotion at the community level by creating tools for local action. These tools (available at include the following:

  • Community Health Resources Web Site. This CDC Web site gives communities a searchable portal to access tools and data for local health promotion.

  • Action Guides. These publications provide step-by-step "how to" guidance for implementing effective strategies for local policy, system, and environmental change.

  • CHANGE (Community Health Assessment aNd Group Evaluation). This tool gives community leaders a snapshot of local policy, system, and environmental change strategies in their community. It also helps community leaders identify areas where health strategies are lacking and then define and prioritize areas for improvement.

  • Promoting Health Equity: A Resource to Help Communities Address Social Determinants of Health. This workbook shows communities how to address social determinants of health as part of their health and social service efforts by providing examples from communities that are using this approach.

  • Media Access Guide: A Resource for Community Health Promotion. This guide is designed to help communities develop effective working relationships with the media and gain news coverage for health-related issues.

Future Directions

Turning the tide on chronic disease requires changes in our communities that support health where we live, learn, work, and play. By spring 2011, more than 306 communities will have received funding and technical support through CDC's Healthy Communities Program, an investment that has brought measurable changes at local levels.

More communities are expected to receive funding during the next 2 years. CDC will continue to disseminate effective strategies and provide communities with funding, tools, and training for creating policy, system, and environmental changes.

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Success Stories

Tahlequah, Oklahoma: Cherokee Nation City Outlaws Tobacco Use in Parks

As a Strategic Alliance for Health (SAH) community, the Cherokee Nation receives funding and support from CDC for its efforts to make policy and environmental changes to reduce tobacco use and exposure to secondhand smoke.

In June 2010, just 2 years after becoming an SAH community, the Cherokee Nation achieved a significant success when the City of Tahlequah became only the fourth city in Oklahoma to adopt a law banning tobacco use in city parks. The new law includes all city parks and recreational facilities and will affect the 16,000 residents of Tahlequah and the 45,000 residents of Cherokee County.

To support the new law, the city

  • Developed signs for parks and recreational facilities.

  • Raised awareness with local law enforcement agencies and monitored the number of citations issued by local officers.

  • Educated the public through television, print, and social media outlets.

Allentown, Pennsylvania: Schools Promote Physical Activity to Combat Childhood Obesity

Nearly half of school-aged children in Allentown are either overweight or obese. To address this problem, CDC funded and supported Allentown as an ACHIEVE (Action Communities for Health, Innovation, and EnVironmental changE) community to help local leaders provide more ways for students to be physically active before, during, and after school.

A local ACHIEVE team worked with the school district and the Allentown Bureau of Health to support policies designed to improve physical education (PE) in city schools. On the basis of recommendations in a CDC action guide called School-Based Physical Education: Working with Schools to Increase Physical Activity Among Children and Adolescents in Physical Education Classes, school officials pilot tested a PE curriculum called SPARK (Sports, Play and Active Recreation for Kids).

This evidence-based curriculum was tested in an elementary, middle, and high school in Allentown during the 2009–2010 school year. Forty-five PE teachers, representing all of the district's 20 schools, were trained to use SPARK.

To assess the effect of SPARK on student activity levels, school officials will use an evaluation tool called SOFIT (System of Observing Fitness Instruction Time). This tool will measure, among other things, changes in the amount of time students are active during PE classes. If officials continue to use the SOFIT evaluation method at various intervals in the future, it will help them determine whether students are more active at schools that use the SPARK curriculum.

Itasca County, Minnesota: Promoting Trails and Sidewalks to Increase Physical Activity

In Itasca County, about 11% of students in grades 9 and 12 are overweight, compared with 9% for the state overall, according to the Minnesota Department of Public Health. In addition, a large percentage of Minnesota youth, especially girls, fail to meet national recommendations for physical activity. These trends continue into adulthood, with nearly one-third of Minnesota adults failing to get the recommended amount of physical activity, according to the 2007 Minnesota Physical Activity Survey.

Family riding bikesTo address this problem, Itasca County received CDC funding to develop a community partnership to find ways to help residents make healthy choices and participate in activities that can improve their quality of life. The partnership includes leaders from the Itasca County Public Health Department, Itasca Community College, University of Minnesota Extension, Grand Itasca Clinic and Hospital, Blandin Foundation, and City of Grand Rapids.

Through this public-private partnership, Itasca County is making measurable strides toward creating an active community that supports walking and biking for transportation and recreation.

In 2008, for example, the Itasca County team partnered with the National Center for Bicycling and Walking and Blue Cross Blue Shield of Minnesota to assess area trails and sidewalks. The assessment identified 61.5 miles of biking, hiking, and walking trails; 42 miles of walkable sidewalks; and 152 miles of cross-country ski trails. However, all were underused because many residents did not know they existed.

In 2009, the Itasca County team partnered with the Grand Rapids planning department and other stakeholders to develop the Get Fit Itasca Active Living Work Plan, which called for promoting and developing the existing trails and sidewalks by

  • Publishing maps that show existing trails and recreational areas.

  • Adding kiosks in high-traffic walking and biking areas to show residents where trails and sidewalks are located.

  • Promoting the 61.5 miles in the current trail system.

  • Promoting citizen involvement in Grand Rapids' city plan.

  • Connecting the gaps in existing trails and sidewalks in Grand Rapids.

  • Placing bike racks throughout Grand Rapids to promote active transportation.

The Itasca County team also worked with community leaders to adopt changes to Grand Rapids' city plan, which now includes a "complete streets" policy. This policy requires that planners and engineers consider the needs of all users—including bicyclists, pedestrians, and people who use public transportation—in the design of all road projects.

As a result of its many strong partnerships, including those with the City of Grand Rapids, Minnesota's State Health Improvement Program, and Blue Cross Blue Shield of Minnesota, Itasca County is improving its trail systems, bike paths, and streets to support healthier lifestyles for the county's 44,000 residents.

Visit for more success stories from communities that participate in CDC’s Healthy Communities Program.

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For more information, please contact the Centers for Disease Control and Prevention
National Center for Chronic Disease Prevention and Health Promotion
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Telephone: 800-CDC-INFO (232-4636) • TTY: 888-232-6348

E-mail: CDC-INFO


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