HKHC: Philadelphia, Pennsylvania

July 2014

It’s the same one-two punch that had hit many urban settings. Yet in the nation’s sixth biggest city, the combination of an often unsafe environment for physical activity and limited access to healthy food led to a real public health crisis. By 2008, almost half of Philadelphia’s children were overweight or obese. The specific barriers that kept many urban youth from playing outside, particularly in poorer neighborhoods, were not uncommon and included safety issues, missing or cracked sidewalks, and narrow or congested streets. These problems were further exacerbated by structural and environmental conditions, such as too few supermarkets for the city’s population of 1.4 million. For residents with limited transportation, grocery stores that were either hard to reach, or out of reach, left them little choice for obtaining healthy food. Such conditions resulted in nearly one-third of Philadelphia’s children eating at fast food or local chain restaurants more than three times a week.

Fortunately, the Health Promotion Council of Southeastern Pennsylvania (HPC) recognized a window of opportunity: a well-utilized network of out-of-school time programs could be Philadelphia’s chance to respond to these conditions. HPC assumed the leadership to address these issues and applied for a Healthy Kids, Healthy Communities (HKHC) grant in 2008. With this funding, HPC designed a thorough and comprehensive systems and policy approach to begin to reverse its childhood obesity epidemic.

HPC developed a new partnership with Philadelphia’s Department of Human Services (DHS) and their nearly decade-old Out-of-School Time (OST) Program, which provides funding for afterschool and summer youth programs at parochial, charter, and public schools, community organizations, churches, recreation centers and libraries. In 2009, DHS supported 20,000 youth, mostly from low-income families, in 200 OST programs at 125 locations, managed by the Public Health Management Corporation. This provided the opportunity to ensure that youth in OST would be in an environment that supports their healthy growth, development and fitness.

With HKHC funding, HPC expanded the partnership to collaborate with the Public Health Management Corporation, National Nursing Centers Consortium, the University of Pennsylvania, the Philadelphia office of Health and Opportunity, The Food Trust and the OST Resource Center. Together the partnership and a diverse OST Leadership Team worked to create a customized, age-specific and place-based policy to improve youth access to nutritious food and physical activity in OST programs.

Subsequent to HKHC funding, HPC was approached by the Philadelphia Department of Public Health to be part of their Communities Putting Prevention to Work initiative. With this additional funding and their relationship firmly solidified with their OST partners, they leveraged this momentum to expand the HKHC goals and provide support for extra resources.

Key accomplishments include:

• In 2011, Healthy Living Guidelines for Out-of-School Time Programs were created and implemented in nine pilot sites. A year later, after successful implementation of the nine pilot sites, the Healthy Living Guidelines were approved by the Philadelphia Department of Public Health.
• DHS OST programs incorporated and mandated three of the 10 guidelines for DHS-funded, Public Health Management Corporation-managed OST sites.
• As of July 2013, the Philadelphia Department of Public Health mandated the ten Healthy Living Guidelines (six nutritional guidelines and four physical activity guidelines) that were created by the OST Partnership for over 220 OST sites.
• The Philadelphia Department of Recreation adapted the OST Healthy Living Guidelines for over 100 Philadelphia Recreation Center sites as a result of participation in the development process of the OST guidelines.
• The HKHC partnership also created professional development trainings, a resource toolkit, website and training videos as part of their technical assistance and OST engagement strategy to further support OST sites.
• HPC has convened an OST Food Sponsors learning group to learn and share strategies to improve food served for OST youth.

Robin Rifkin, the HKHC Project Manager said, “Having the city as partners and obtaining their regular feedback helped us learn how we needed to shape the Healthy Living Guidelines and eventually get them approved.”

The HKHC partnership allowed for a more iterative and evolving process, while the CPPW initiative was more “top down.” The Philadelphia partnership found that there were advantages to both. The CPPW and HKHC partnership includes OST programs, city government, food services, nutrition and physical activity experts, evaluators, OST youth and their families. Together, it has positively shaped the environment in afterschool and summer programs in Philadelphia.