Everyone Swims: a community partnership and policy approach to address health disparities in drowning and obesity.

Well-known disparities exist in rates of obesity and drowning, two public health priorities. Addressing these disparities by increasing access to safe swimming and water recreation may yield benefits for both obesity and injury prevention. Everyone Swims, a community partnership, brought community health clinics and water recreation organizations together to improve policies and systems that facilitated learning to swim and access to swimming and water recreation for low-income, diverse communities. Based in King County, Washington, Everyone Swims launched with Centers for Disease Control and Prevention grant funding from 2010 to 2012. This partnership led to multiple improvements in policies and systems: higher numbers of clinics screening for swimming ability, referrals from clinics to pools, more scholarship accessibility, and expansion of special swim programs. In building partnerships between community health/public health and community recreation organizations to develop systems that address user needs in low-income and culturally diverse communities, Everyone Swims represents a promising model of a structured partnership for systems and policy change to promote health and physical activity.

Fostering partnerships and program success.

BACKGROUND: Fostering partnerships was critical to the success of the Colon Health Program (CHP) in Greater Seattle. The CHP was built on the Breast and Cervical Health Program (BCHP) framework. A replicable system to provide quality colorectal screening services for individuals with limited incomes and no health insurance was developed. METHODS: Partners were recruited and engaged during 3 programmatic phases: 1) development and start-up, 2) implementation, and 3) sustainability planning. Several tactics were used to develop trust and build bridges among the partners and to create an effective work group. RESULTS: The partners were critical to developing clinic policies, procedures, and systems to increase colorectal screening and improve follow-up; expanding access to colonoscopies; and initiating statewide dissemination of training and systems as well as policy change. The fecal occult blood test completion rate was 61%, and the colonoscopy completion rate was 78%. The colonoscopy navigation system was effective with a low "no show" rate (8%). The partners were instrumental in helping Washington State obtain funding from the Centers for Disease Control and Prevention to continue the CHP statewide. CONCLUSIONS: During implementation, key elements for success included: building the project on the successful BCHP framework, meticulous training of clinic staff about colorectal cancer and screening methods, frequent consultation to identify and solve problems, active support of the clinic administration, and the presence of a CHP champion in the clinic. Institutionalization of the CHP depended on: assessing progress after the first year, documenting experience with the program, disseminating lessons learned, engaging new partners, and determining steps to expand the program.

Active Seattle: achieving walkability in diverse neighborhoods.

BACKGROUND: The Active Living by Design project based in Seattle (Active Seattle) advocated for policies and projects in diverse communities supporting a more walkable city, while using social marketing and education to get more people walking more often. INTERVENTION: Walking audits were carried out in select diverse neighborhoods, resulting in recommendations for policy change and built-environment improvements. Advocacy for city-scale policies also occurred. Walking maps and other social-marketing products promoted behavior change. Major Safe Routes to School activities occurred and were made possible by separate funding sources. RESULTS: Positive results of Active Seattle included an increase in funding for pedestrian infrastructure, a pedestrian master plan, a Complete Streets policy, substantial increase in Safe Routes to School activity, and institutionalization of active living and active transportation within partner agencies. Challenges included institutional prioritization for improving pedestrian infrastructure, funding inequity, and a community need that was greater than could be fulfilled. LESSONS LEARNED: Efforts to overcome funding inequities or other resistance to pedestrian-oriented physical projects will benefit from high-visibility campaigns that have a lasting impact on public perception and decision makers' political will. To reach vulnerable populations that have substantial barriers to increasing walking frequency, extensive staff time for outreach is needed. Changing the built environment to encourage walking may be a long-term solution in communities with diverse populations. CONCLUSIONS: Influencing and educating local government officials to make active living projects and policies a high budgetary priority is essential for large-scale impact and long-term change.