Go For Health Plan-- EmailWeb version

Go for Health! 2004 1

The Go for Health!Planning Process wasunderwritten by a grantfrom the Pajaro ValleyCommunity Health TrustJune 2004

Executive Summary

Vision for SantaCruz County:All children in SantaCruz County will bephysically fit andwell-nourishedthrough healthyeating and regularphysical activity.

Go for Health!

Table of ContentsExecutive Summary...........................................1The Crisis at Hand .............................................2

Overweight and Obesity: An Overview........2Prevalence of Childhood Overweight ........2Obesity: A Complex Problem withMany Causes .................................................. 3Consequences of Obesity ............................4Definitions of Healthy Eating& Physical Activity...........................................4Eating Patterns................................................5Physical Activity...............................................5Special Needs Children.................................5

A Community Course of Action:The Go for Health! Planning Process............6Go for Health! Framework ................................7

Structure ............................................................7 Goals................................................................... 7 Logic Model....................................................... 8

Community Outcomes &Action Steps............................................................9Call to Action....................................................... 16Partners................................................................. 17Go for Health! Member Organizations.....18References...........................................................19

Childhood obesity rateshave doubled and tripledover the past decades,becoming a nationalpublic health crisis.Children who are over-weight are at risk ofdeveloping a host of healthproblems. Health carecosts for illnesses due tooverweight are currentlyestimated to account for$117 billionannually.

Childhood obesity is a publichealth epidemic with complexcauses. Two key causes are lack ofphysical activity and unhealthyeating, but the underlyingcontributing causes are many.Modifying these behaviors ischallenging but crucial. Building ahealthy lifestyle from the start will translate intofewer cases of diabetes, stroke, heart attack andobesity for youth and adults, as well as reducedhealth care costs for chronic illnesses caused byoverweight and obesity.

Children and families, however, cannot do italone. Some of the factors which families cannotovercome independently include: commercialpressure from food industry advertising;inadequate nutrition and physical education inthe schools; a lack of safe walkways and bikeways;urban sprawl; and access to healthy food andphysical activity opportunities due to incomeand other social factors. This crisis demands acommunity-wide, multi-pronged andcomprehensive prevention and interventionstrategy. We must work together.

The Go for Health! five-yearplan provides a communityblueprint for Santa Cruz Countypolicy-makers, funding agencies,schools, parents, community-basedorganizations, health care providers,food industry, businesses and themedia to take action to improvechildren’s health through healthyeating, regular physical activity and

changing community norms. The plan outlinesproblems, outcomes and action steps to improvechildren’s eating and physical activity habits.The plan will be used to guide funding requeststo implement a comprehensive call to action.

A Comprehensive Plan to Increase HealthyNutrition and Regular Physical Activity AmongChildren and Youth in Santa Cruz County

Childhood obesity is ahealth problem with

complex causes. A multi-pronged, comprehensive

approach is needed tocombat it.

Go for Health! 20042

Executive Summary, cont.

The Crisis at HandWhile childhood overweight has always been a health issue forsome children, our nation has been astounded that the inci-dence of child overweight has more than doubled in the pasttwo decades. In Santa Cruz County many organizations arededicated to improving the health and well being of children,yet we have seen our children’s weights keep pace with thenational upward trends. The Go for Health! Collaborativeconvened to answer: Why? What does this mean? What shouldwe do? How do we do it?

The severity of this epidemic and the resulting costs to theindividual, community and nation, have inspired an immediatecall to action, even with limited studies that demonstrateeffective prevention strategies. Nationally, health care costs forillnesses due to overweight are estimated at $117 billionannually and rising.2

Nutrition and physical activity have an enormous impacton health and mortality as well as health care costs. Oneestimate shows that diet and inactivity contribute to 310,000to 580,000 deaths per year, even more than tobacco (260,000to 460,000 deaths per year).3 The Journal of the AmericanMedical Association (JAMA),4 offers a more cautious analysis,

Go for Health! is a broad-based collaborative in SantaCruz County with over 150 members and first convened inAugust 2003 by the United Way of Santa Cruz County, theChildren’s Network, the Children’s Food and Fitness Coalitionand the Pajaro Valley Community Health Trust. Go forHealth! developed this plan over a nine-month period withinput from funders, businesses, students, parents, electedofficials and health and nutrition professionals.

The Go for Health! Plan identifies 24 outcomes andrelated action steps to increase children’s healthy eating andphysical activity opportunities by improving children’s and

families’ environments, engaging health care providers,changing food industry practices and enlisting the media.

The action steps will require the collaboration of allstakeholders. A number of the action steps build on existingefforts. Others require new or expanded resources. Go forHealth! is confident of its ability to succeed in this endeavor;the stakes are so high we cannot afford to fail: we are facing ahealth crisis of unprecedented proportions and are ready torespond as a community to support children and families indeveloping and maintaining habits of healthy eating andregular physical activity.

indicating that the leading causes of death in 2000 weretobacco (435,000 deaths, representing 18.1% of the totaldeaths in the U.S.) and poor diet and physical inactivity(400,000 deaths, 16.6% of the total). Whichever estimate iscorrect, because of the increase in overweight Americans, theauthors project that within a few years deaths caused by poordiet and inactivity will certainly overtake those due totobacco use.

The public health community, pediatricians and thepublic at large identify childhood obesity as a serious problem.A California Field Poll of 1,000 Californians in English andSpanish released on March 31, 2004 found that 92% ofCalifornians believe that childhood obesity is a serious prob-lem.5 Eighty percent felt that the problem has increased in thepast five years. The majority identified unhealthy eating habitsas nearly as big a health threat to children as illegal drug use.

A comprehensive survey of San Francisco Bay Area residentsby the San Jose Mercury News and the Henry J. Kaiser Foun-dation found that respondents were more likely to holdindividuals rather than the government or food industryresponsible for overweight.6 Even parents who were concernedabout childhood obesity reported engaging in everyday habitsthat contributed to obesity. Children cannot eat healthy andbe physically active without the full support of their family,schools and community.

Prevalence of ChildhoodOverweightThe U.S. Surgeon General has identified overweight in chil-dren and adolescents as a major health problem. Nationwide,the number of obese children is increasing at an alarming rate.In the past 20 years the incidence of obesity has doubled inchildren ages 6–11 and tripled for children ages 12–19.7

Children who are overweight are at risk of developing highblood pressure, high cholesterol, asthma and Type 2 diabetes.

Overweight and Obesity: An Overview■ Overweight and obesity result from an energy

imbalance. This involves eating too many caloriesand a lack of adequate physical activity.

■ Body weight is the result of genes, metabolism,behavior, environment, culture andsocioeconomic status.

■ Behavior and environment play a large rolecausing people to be overweight and obese.These are the greatest areas for preventionand treatment actions.Adapted from The Surgeon General�s report, 20011


The Crises at Hand, cont.

■ Advertising—Restaurants and the food industry spend$10 billion on advertising each year while the NationalCancer Institute spent $7.75 million on advertising the“5-A-Day” fruits and vegetables diet recommendations ina seven year period (1992–1999).12

■ Fast Foods Meals—Cost less but have more calories.■ Limited Access to Healthy Food—Stores in low-income

areas generally do not offer quality fresh fruit or veg-etables. Healthy food is usually more expensive.

■ Screen Time—TV, computer and computer games.Children age 2–17 reported spending over six hours perday engaged in media activities.13

■ Changing Culture—Evolved from a nation of farmers(50% of population lived on farms in 1900) to a nationof commuters. Family time is increasingly spent onsedentary activities, e.g., eating out, going to movies,watching TV and driving.

■ Urban Sprawl—Increases use of cars for transportationto school, shopping, work, recreation.

■ Inadequate Infrastructure—Lack of adequate sidewalks,bike paths and walking paths.

■ Unsafe neighborhoods—Or perception of lack of safety,result in children who don’t play outside.

Obesity: A Complex Problem with Many Causes

As they are more likely to be overweight inadulthood, they are at risk of developing stroke,high blood pressure, heart disease and arthritis.

Type 2 diabetes results when the body’sinsulin is no longer effective in processing glucosein the blood. Type 2 diabetes was previouslyreferred to as “adult onset diabetes” to distinguishit from Type 1 diabetes, which often strikes inchildhood when the pancreas stops being able tomake insulin at all. No longer only an adultproblem, Type 2 diabetes is being found inchildren for the first time and at increasing rates.

Santa Cruz County ranks in the top tencounties in California for the incidence ofchildhood overweight. The resulting healthproblems of overweight children are a majorpublic health challenge facing the county.

In 2003, 16.2% of low-income Santa CruzCounty children under two were identified bydoctors as overweight, as were 19.7% of thoseover two. Compare this to 16.2% and 17.3%respectively for California and 13.1% and 13.4%respectively for the U.S. as a whole.9 According tothe self-reported heights and weights on theCalifornia Healthy Kids Survey administered inSanta Cruz County schools, 13% of seventhgraders were overweight and another 17% wereat risk of being overweight.10 Overweightadolescents are more likely to be overweight orobese as adults.11

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Santa Cruz County Children Above 95th Percentilefor Weight By Age and Ethnicity, 2002

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Perhaps the greatest immediate negative consequences ofobesity for children are psychological and social. On a dailybasis, overweight children are exposed to cultural pressure tobe thin. With the sudden focus of an “obesity epidemic” theoverweight child is a now a target,viewed by some as “the problemthat needs to be solved.” As westrive to improve child health, it isimperative to understand thatpressuring youngsters to be thinhas not helped reduce the preva-lence of overweight; instead it hasled to new health problems such asrampant body dissatisfaction, poorbody image, low self-esteem,eating disorders, depression andsubstance abuse.

Because children are stilldeveloping physically and psychologically, nutritionists havetraditionally avoided putting children on “weight reductiondiets.” Instead they have worked with families to promote

Consequences of Obesity


healthy eating and physical activity, with the goal of slowingthe rate of weight gain, while allowing the child’s height to“grow into” his/her own weight. Within an environment thatprovides healthy eating and regular physical activity, children

will naturally and healthily grow intoa wide variety of shapes and sizes,some smaller, some larger. Thiswisdom still stands.

The focus of any preventionstrategy must be on whole health, notjust weight. Linking physical activityand healthy eating to weight losscarries the risk of obscuring therelationship among movement, play,eating and joy. Healthy childrenshould enjoy eating nutritious foodsand enjoy a variety of regular physicalactivities and also feel emotionally

strong, free of mental illness, substance abuse, teen pregnancyand painful discrimination related to body size. When it comesto children, we must first do no harm.

Healthy Eating, as defined by the DietaryGuidelines for Americans14

■ Use plant food as the foundation of your meals: buildyour eating pattern on a variety of plant foods, includingwhole grains, fruits and vegetables

■ Keep an eye on servings: compare your calorie needs withthe calories per serving of the foods you eat

■ Engage in healthful eating patterns: use the Food GuidePyramid as a starting point to shape your eating patterns

■ Assess your nutrient needs: growing children, teenagers,women and older adults have higher needs forsome nutrients

■ Check the food label before you buy: check theingredients, nutrients and serving sizes to ensure that theymeet your personal food needs

■ Eat to meet your nutrient needs: don’t rely on dietarysupplements alone to meet your nutrient needs

*For more information: http://www.health.gov/dietaryguidelinesdga2000/document/build.htm#pyramid

Definitions of Healthy Eating and Physical ActivityRegular Physical Activity15

■ 30 minutes per day for adults. Complete at least 30minutes of moderate physical activity most days of theweek, preferably daily.

■ 60 minutes per day for children. Children should get 60minutes of moderate physical activity most days of theweek, preferably daily.

■ Adults and children who are meeting these standards cangain even more health benefits by increasing the amountof time they are physically active or by taking part inmore vigorous activities.

■ Activities can be done all at once, or spread out two orthree times during the day.


Eating PatternsMany foods eaten both as snacks and meals are now nutrientpoor and of a significantly larger portion size, often providingempty calories without adequate nourishment. In the 1980s,Americans spent $6 billion on fast foods in 1,000 restaurants.By the 2000s, we were spending $100 billion on fast food in atotal of 23,000 outlets. Conversely, in the 1980s 75% of mealswere eaten from home; by the 2000s, the majority of mealswere being eaten away from home.16 The number of new snackfood products introduced each year increased from 1,000 to2,000 during this period.17 At the same time, only a fifth of allchildren are eating five servings a day of fruits and vegetables inthe 2000s.18

The average intake for men grew from 2,450 calories in1971 to 2,618 calories in 2000. For women, caloric intakegrew from 1,542 calories to 1,877 calories during the sametime period.19 Teens drink twice as much soda as milk20 and anaverage 12-ounce soda has 150 calories.21 Billions are spentannually on advertising snack food, fast food and soft drinksand millions more on lobbying.

Physical ActivityPhysically fit children have better memory, concentration andenergy levels, are healthier physically and emotionally and arelikely to carry their healthy lifestyle over into adulthood. Thistranslates into less obesity, heart disease, stroke, high bloodpressure, Type 2 diabetes, cancer, fractures and depression. It isrecommended that children have at least an hour ofmoderate physical activity most days of the week.22

Schools have reduced physical education classes due totime and money constraints. The Robert Wood JohnsonFoundation identifies the reduction in physical educationprograms in schools as an important problem; only 8% ofelementary schools, 6.4% of middle schools and 5.8% of highschools provide students in all grades with daily P.E. or itsequivalent (150 minutes per week for elementary schools and225 minutes per week for middle and high schools).23

Children are increasingly sedentary at home as well, morelikely to stay inside watching TV or playing video games thanto play outside after school. Only 31% of children, livingwithin one mile of school, walk to school daily.24 The averagechild ages 8–18 spends more than three hours a day watchingTV and another three to four hours with other screen media,e.g., computer and video games.25

Special Needs ChildrenAs obesity rates climb for the generalchild population, the rates are alsoclimbing among special needs childrenas well. Physical activity and healthyeating are vital to the health and self-esteem of children with disabilities.Obesity intensifies disabilities. We mustensure that these special populations areincluded in family and communityactivities as described in this Plan.


�Santa Cruz County�s Go for Health! is a great example for California�and thenation�of a strong multifaceted approach and of the effectiveness

of a diverse coalition in promoting community health

Larry CohenExecutive Director

Prevention InstituteOakland, CA

.�


As many organizations in Santa Cruz County beganrecognizing childhood obesity as a problem they should beaddressing, one thing became abundantly clear: childoverweight cannot be solved on an individual basis; this hasbeen tried and this has failed. This publichealth epidemic requires a collective effort, acomprehensive plan and collaborativestrategies among all sectors of the SantaCruz County community. Childhoodobesity is a multifaceted problem andrequires a multi-pronged approach. A broad-based community coalition with a commonvision of healthy eating and regular physicalactivity for all children is needed.

The Santa Cruz County Go for Health!collaborative was convened in August 2003by the United Way, the Children’s Networkof Santa Cruz County, the Children’s Foodand Fitness Coalition and the Pajaro ValleyCommunity Health Trust. Go for Health!has more than 150 members representingelected officials, hospitals and healthproviders, county public health, K–12schools, higher education, community based organizations,food banks, businesses including food processors anddistributors, transportation, city planning, parks andrecreation, fitness and martial arts, farmers, labor, child care,advocates, researchers, media and funders. When asked toparticipate, people were enthusiastic and ready to be involved.Members came to the table with diverse backgrounds,experiences and perspectives and have demonstrated theircommitment to grapple with this issue.

The premise of the Santa Cruz County Go for Health!approach is that healthy eating and regular physical activityprovide a foundation for the child’s healthy growth anddevelopment. Building healthy lifestyles from the start willtranslate into less obesity among youth and adults.

The Go for Health! plan provides a blueprint for policy-makers, funding agencies and local schools, health careproviders, service providers, business and the media to takeaction to improve children’s health through healthy eating,regular physical activity and changing community norms.The purpose of the Go for Health! plan is to present aconsensus document outlining the community outcomes andaction steps needed to improve children’s eating and physicalactivity habits.

A Community Course of Action:The Go for Health! Planning Process

To develop this plan, Go for Health! held nine monthlymeetings attended by 45–55 people at each meeting. Mem-bers were informed about childhood obesity and local statis-tics. They then brainstormed desired community changes,

identified outcomes and chose action steps.Input and feedback were sought from diversestakeholders and regional and nationalexperts. The draft was presented to over 250people in 19 community and civic groups.Promising models of community interven-tions around the country were explored.

Go for Health! also incorporated thenational directives set forth in HealthyPeople 2010. Healthy People 201026 is acomprehensive set of health objectivesdeveloped by the U.S. Department of Healthand Human Services for the nation to achieveby 2010. Created by scientists both insideand outside of government, Healthy People2010 identifies a wide range of public healthpriorities and specific, measurable objectivesto increase health and longevity and toeliminate health disparities. The Healthy

People 2010 goals for childhood obesityand healthy eating are to:

■ Reduce the proportion of children and adolescents ages6–19 who are overweight or obese from 11% in 1988-94 to5% in 2010. Overweight and obesity are defined as at orabove the gender- and age-specific 95th percentile of BodyMass Index (BMI)27 based on the revised CDC GrowthCharts for the United States. A BMI of 25-29.9 is consid-ered overweight, while a BMI over 30 is considered obese.

■ Increase the proportion of persons aged two years and olderwho consume at least two daily servings of fruit from 28% in1994–96 to 75% in 2010.

■ Increase the proportion of persons aged two years and olderwho consume at least three daily servings of vegetables, withat least one-third being dark green or orange vegetables,from 3% in 1994–96 to 50% in 2010.

■ Increase the proportion of persons aged two years and olderwho consume at least six daily servings of grain products,with at least three being whole grains, from 7% in 1994–96to 50% in 2010.


Presentations to Stakeholder Groups:Child Care Planning Council

Community Bridges�Board of Directors

Community Bridges�Management Team

Community Foundation of Santa Cruz County

First 5 Santa Cruz County�Commission

Santa Cruz County Head Start�Staff

Health Improvement Partnership MedicalProfessionals

Migrant Parents in Watsonville

Pajaro Valley Community Health TrustBoard of Directors

Regional Diabetes Collaborative�Education &Prevention Committee

Regional Diabetes Collaborative�Steering Committee

Safety Net Clinic Coalition

Santa Cruz City Council

Shoreline Middle School�After School Program

United Way of Santa Cruz County�Board of Directors

Watsonville City Council

Women, Infants and Children (WIC)�Staff

Go for Health! FrameworkStructureA Steering Committee meets monthly to oversee and facilitatethe implementation of the five-year plan. The Steering Com-mittee chose United Way to provide staff to the collaborative.Go for Health! is comprised of the following committees:Public Policy; Public Education / Media / Communication;Health Care System; Business / Industry / Employers; Child’sEnvironment—Schools / Community / Family / Child Care;Steering; Evaluation.

GoalsGo for Health! has adopted the community goal that“Children in Santa Cruz County will be physically fit throughhealthy eating and regular physical activity.” The communitygoal describes the condition of well being we want for ourchildren and youth.

The core of the Go for Health! plan is the development ofa series of community outcome objectives that link to thiscommunity goal. Outcomes are the specific and measurablechanges in the behavior and health of community andresidents that reflect progress towards the community goal. Foreach outcome, a series of action steps have been identified thatneed to be undertaken in order to accomplish the outcome.

Go for Health! recognizes that a comprehensive approachis required involving all sectors: families, government, schools,businesses and workplaces, food industry, health care systemand media. Go for Health! takes a holistic approach—improvements in eating and activity must include theentire family.

The Go for Health! logic model is presented on the nextpage. The logic model approach is often used to articulate the“theory of change” underlying service interventions. In general,it includes a description of the resources, the activities and howthey are counted and the outcomes. The Go for Health! logicmodel identifies the inputs—available resources andconstraints; activities that are part of the plan; outputs whichallow the activities to be quantified; and the outcomes. Theoutcomes are the changes expected to take place as a result ofthe constellation of Go for Health! activities—changes inknowledge, attitude, behavior and health.


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Community Outcomes and Action StepsArena Community Outcome Objective Action StepsStrategy Existing Activities

By December 2010, there willbe a 10% increase in thenumber of parents who have aknowledge of healthy eatingand regular physical activityas measured by the CAPbiannual parent survey.

Provide variouseducationalopportunities forparents to learnabout the benefits ofhealthy nutritionand regularphysical activity

1. Provide culturally appropri-ate nutrition educationworkshops for parents.

2. Distribute health informa-tion on a countywide level ata variety of venues.

Latino 5-A-day;WIC NutritionEducation;Head StartNutritionEducation

Families

By December 2010, there willbe a 10% increase in thenumber of parents whopractice and promote healthyeating with their children asmeasured by pre-post tests thatinclude behavior questions atworkshops and other events.(Or to get countywide infor-mation, use the CAP biannualparent survey.)

Provide a variety ofprograms thatencourage familiesto cook and eattogether.

1. Train parents about theimportance of being positiverole models in using healthynutrition and familiescooking and eating together.

2. Offer cooking classes/contestsfor children and theirparents using fruits andvegetables and healthier foodoptions for comfort andtraditional foods.

3. Teach parents to reward anddiscipline their childrenwithout using food.

NutritionNetwork;Project LEAN;Ready...Set...Grow!;AnswersBenefitingChildren;WIC Foods

By December 2010, thebreastfeeding rate willincrease by 10% as measuredby WIC County data.

Support breast-feeding througheducation andadvocacy withparents, hospitalsand businesses.

1. Educate expectant parents onthe short- and long-termbenefits of breastfeeding.

2. Promote breast-feeding in allbusinesses and workplaces.

3. Increase access tobreastfeeding resources.

4. Educate public healthworkers on breastfeeding andthe risks associated withinfant formula.

Santa CruzCountyBreastfeedingCoalition;lactation centersin hospitals; WIC;Nursing MothersCoalition; LaLeche League

By December 2010, therewill be a 10% increase in thenumber of parents whoparticipate in regularphysical activity with theirchildren as measured by pre-post tests that includebehavior questions atworkshops and other events.(Or to get countywideinformation, use the CAPbiannual parent survey.)

Provide a variety ofprograms thatencourage familiesto be physicallyactive together.

1. Train parents on theimportance of being positiverole models in demonstratingregular physical activity.

2. Provide and promoteopportunities for walking andbiking to school and work.

3. Provide educational work-shops and events thatdecrease “screen time” andincrease healthy lifestyles.

Walking Clubs;Capitola Walks;Bike to Work/School


Life Lab Garden-based ScienceCurriculum;Ready...Set...Grow!

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Support the inclu-sion of K–12nutritioncurriculum so thatall young peoplewill have accurateinformation abouthealthy eating. Offercommunity-wideresources forteachers and schoolstaff to accessnutrition andcooking curricula, aswell as support tooffer these programsin their classroom

Schools

Support schools inmaking the schoolenvironment onethat promoteshealthy eatingamong students.

Food on the Run;Project LEAN;LASERS; Life LabSchool FoodService

Community Outcomes and Action Steps, cont.

Community OutcomeObjective

By December 2010, therewill be a 10% increase inthe number of nutritioneducation sessions offeredand integrated in allcurriculums, K–12 asmeasured by the resultsfrom the School HealthIndex (SHI).

By December 2010, therewill be a 10% increase inthe number of childreneating healthy foods atschool as measured byfood service statisticscollected by the schools,compliance with districtfood policy andevaluation of standards inschool food policies.

Action Steps

1. Integrate nutrition educationinto all schools subjects at everygrade level.

2. Provide nutrition counseling inK–12 schools using a registereddietician.

3. Provide opportunities for studentsto be involved in determiningwhat they eat and how they arephysically active at school.

4. Offer field trips for students tolearn about food origins anddistribution (e.g., local farms,farmers markets, etc).

5. Offer cooking classes in schools.6. Establish a Life Lab program at

all schools.7. Establish a school nutrition

advisory council at everyschool site.

1. Assist school districts in providinghealthy universal breakfasts inschools.

2. Increase school participation infederal school meals programs.

3. Involve children in growing foodsas part of curriculum.

4. Share information on modelprograms with schools to showthe profitability of offeringhealthy foods in school lunchprograms, such as salad bars andfarm-to-school programs.

Ensure that allstudents have theopportunity forphysical activityduring the schoolday and providethem with the skillsthey need to engagein physical activityoutside of schooltime.

5-A-Day;Power Play!

By December 2010, therewill be fun, robust dailyphysical educationprograms of at least 30minutes a day for allgrade levels in all schools,K–12, as measured bysurveying school adminis-trators countywideregarding compliancewith state PE require-ments and results fromthe School Health Index(SHI) in Watsonville.

1. Offer after-school programs thatpromote healthy nutrition andphysical activity. (e.g., nutritionand cooking classes, yoga, etc).

2. Advocate for one school period ofdaily physical activity in schools;use trained physical educators/sports aides to help.

3. Ensure schools meet or exceedrequirements for minimumminutes of P.E.

4. Provide various physical activityoptions that reflect the interestand diversity of participantsduring physical education classes.



Community


Reach out tocommunity mem-bers to train andinvolve them inpromoting healthyeating and regularphysical activity.

Fruit/Vegetable ofthe Month;5-A-Day’sieatwell.org Website

Increase opportuni-ties for physicalactivity inresidential neighbor-hoods and increasethe perception ofcommunity safetyso that children andfamilies will takeadvantage of theseopportunities.

Soquel & SanLorenzo ValleyTeen Nights


By December 2010, therewill be a 10% increase inthe number of commu-nity members aware ofand involved inchildhood obesityprevention efforts asmeasured by the CAPbiannual survey.

By December 2010, therewill be a 10% increase inthe number of neighbor-hoods that are safe forrecreation and physicalactivities as measured bya survey of lawenforcement jurisdictionsto determine the numberof registered Neighbor-hood Watch programs.

Action Steps

1. Create a clearinghouse of grantopportunities related to address-ing childhood obesity issues.

2. Develop coordinated campaignsto foster communication andparticipation across communitysectors.

3. Develop a nutrition informationand resource guide.

1. Develop and promote programsand activities that enable commu-nity members to feel safe outside(e.g., Neighborhood Watch, safehouses, self-defense and otherneighborhood programs).

2. Promote teen nights at schools orcommunity centers that offer avariety of physical activitiesoptions, with adult supervision.

Fit WIC Kids;Martial Arts;Capitola Walks;Bike to Work/School;Head StartWalking Club

By December 2010, therewill be a 10% increase inthe number of opportu-nities for physicalactivity of all types foryoung people.

Promote non-competitive physicalactivities for youngpeople in schools,parks and recreationprograms andat home.

1. Identify and promote non-competitive physical activities incommunities and schools.

Picture This;Marin InstituteMedia AdvocacyTraining; FoodOn The Run;Live in Your Skin

By December 2010, therewill be a 10% increase inthe number of childrenand youth who are medialiterate as measured bypre-post tests at work-shops on media literacyand body image. Medialiterate children andadolescents will be lesssusceptible to marketingand other messages thatpromote unhealthyeating, sedentary lifestylesand unrealistic bodyimage.

Educate childrenand adolescents tobecome more medialiterate and lesssusceptible tomarketing and othermessages thatpromote unhealthyeating, sedentarylifestyles andunrealistic bodyimage expectations.

1. Provide educational programs andworkshops for children on medialiteracy, including accessing,analyzing, evaluating andcreating media.

2. Provide educational programs andworkshops for children on positivebody image.


Arena Existing Activities

Gameface

Provide resources tohelp CBOs developways to buildhealthy eating intotheir services.

Latino 5-A-Day;5-A-Day PowerPlay!; NutritionNetwork Grant;Food ForChildren;USDA FoodDistribution;Project LEAN;Diabetes HealthCenter; DiabetesSupport Group



By December 2010, therewill be a 10% increase inthe number of girlsplaying organized teamsports as measured bythe CAP biannualparent survey.

Strategy

Promote athletics asa catalyst for girls’self-esteem, self-expression andmental and physicalwellness.

Action Steps

1. Provide “girls only” sport oppor-tunities, classes and workshops atlow cost or free of charge to low-income families (e.g., climbinggym, surf schools).

2. Identify and connect with na-tional campaigns that promotefemale involvement, self-confi-dence and pride in sports.

3. Train parents about the benefitsof their daughters’ participationin sports so they will encouragethem to participate.

Community

By December 2010, therewill be a 10% increase inthe number ofcommunity-basedorganizations thatintegrate healthy eatinginto their services andprograms as measured bya survey of community-based organizations.

1. Promote healthy nutrition inevery setting (e.g., churches,parks and recreation programs,pre-schools, clubs, adult schools,agricultural fields, youth andteen programs, camps, familyresource centers, etc).

2. Conduct outreach & training toclinical and social service provid-ers working with children andfamilies. Provide training byregistered dieticians; materials fordissemination; and technicalassistance for integrating thepromotion of healthy nutritioninto their services.

3. Provide bilingual mental healthcounselors to address the connec-tion between eating disorders andobesity in Spanish speakingpopulations.



Community Provide resources tohelp CBOs developways to buildregular physicalactivity into theirservices.

Diabetes HealthCenter



By December 2010, therewill be a 10% increase inthe number ofcommunity-basedorganizations thatintegrate regular physicalactivity into their servicesand programs as measuredby a survey of commu-nity-based organizations.

Action Steps

1. Promote regular physical activityin every setting (e.g., churches,parks and recreation programs,pre-schools, clubs, adult schools,agricultural fields, youth andteen programs, camps, familyresource centers, etc).

2. Conduct outreach and training toclinical and social service provid-ers working with children andfamilies. Provide technicalassistance for integrating thepromotion of regular physicalactivity into their services.

3. Identify, develop and implementa consistent physical educationmodel for families of obesechildren served through homevisiting programs.

Business andWorkplace

By December 2010, therewill be a 20% increase inthe number of localemployers that promotehealthy eating and regularphysical activity amongemployees and theirfamilies as measured byChamber of Commercesurveys.

Local businessesmake healthy eatingand physical activitypossible and acces-sible to theiremployees.

1. Promote workplace wellness andexercise programs, healtheducation and healthy practices(e.g., healthy options wheneverfood is served in the workplace).

2. Member organizations of Go forHealth! members will instituteworkplace wellness plans.

3. Employers provide employeeswith incentives and schedules tobike/walk/bus to and from work.

4. Adopt nutrition standards formeals and snacks served by allfood service providers.

EmployeeWellnessPrograms;Get Movin’;Bike to Work;American CancerSociety “MeetingWell”; MCHD;County of SantaCruz HealthServices Agency

Educate and involvepolicy leaders inpromoting healthylifestyles of healthyeating and regularphysical activity.

Surgeon General’sguidelines onhealthy eating andregular physicalactivity

Public Policy By December 2010, 80%of school boards, citycouncils and the Board ofSupervisors will haveadopted policies thatpromote healthy eatingand regular physicalactivity as measured bysurveys of school boardsand jurisdictions.

1. Create sample policies on healthyeating and regular physicalactivity; monitor adoption andimplementation of policy.

2. Advocate with schools and schoolboards to adopt nutritionstandards for meals and snacksserved in schools.

3. Conduct a public forum toeducate local policy makers andcommunity members regardingthe long-term health effect ofpolicy decisions and importanceof changing social norms. Solicitendorsements of the Go forHealth! Plan.



Identify and resolveissues that impedesafe walking andbiking for childrenand families andpromote a moreactive lifestyle forall families.

CommunityTraffic SafetyCoalition;Capitola Walks;Mission Pedes-trian; Pace CarProgram; SafeRoutes to School;Traffic Busters;Active Living ByDesign; WalkableCommunitiesSubcommittee ofCentral CoastFitness andNutritionCollaborative;RegionalTransportationCommission’sBike Committeeand BikewaysMap

By December 2010, therewill be a 20% increase inthe number of childrenand families who walkand bike regularly asmeasured by theCommunity AssessmentProject biannualparent survey.

1. Incorporate pedestrian and bikefriendly designs, such asenhanced medians, separatebike lanes, walking paths andcurb extensions.

2. Advocate for policies thatpromote community andneighborhood infrastructuredesigns that encouragephysical activity.

3. Conduct a community audit ofbikeways, walkways, sidewalks,trails and neighborhoods.


Public Policy


Action Steps

Provide tools andeducation onnutrition formedical providersand offices.

CHDP ProviderEducation;5-A-Day Toolkits

By December 2010, therewill be a 10% increase inthe number of health careproviders who activelypromote healthy eatingand regular physicalactivity as measured byprovider surveys.

1. Identify and distribute culturallyappropriate educational materialsto families through pediatricians,family practitioners and otherprofessionals working withchildren and families.

2. Partner with local doctors to offerprograms for kids in schoolsregarding the risks of obesity.

3. Develop and implement aconsistent nutrition educationmodel for families of obesechildren served through homevisiting programs.

Health CareSystem

Support breast-feeding througheducation andadvocacy withparents, hospitalsand businesses.

Santa CruzCountyBreastfeedingCoalition;lactation centersin hospitals; WIC;Nursing MothersCouncil;La Leche League

By December 2010, thebreastfeeding rate willincrease by 10% asmeasured by WICCounty data.

1. Advocate with all hospitals toimplement formal “Baby-Friendly” policies.

2. Train public health workers onbreastfeeding and the risksassociated with infant formula.



Promote informa-tion about healthynutrition in storeswhere people buyfood.

5-A-DayBy December 2010, therewill be a 100% increase inthe number of food storesthat provide nutritioneducation as measured bythe number of 5-A-Dayretail kits in use atlocal stores.

1. Encourage stores to providenutrition information, tastetesting, healthy cooking tips anddemonstrations and recipes fordisplay/distribution.


Food Industry


Action Steps

Support positivemarketing practices,including productdevelopment,advertising, pricingand placement.

Statewide5-A-Day RetailAdvisory Board

By December 2010, therewill be a 10% increase inthe number ofcorporations that marketfood responsibly.

1. Identify and reward “best market-ing practices” for food, beverageand supermarket/grocery storeindustry.

Increase theavailability andattractiveness oflocally grownhealthy food.

Electronic BenefitCard ad hocworking group;Latino 5-A-Day;CAFF/CentralCoast HungerCoalition;Food agencymonitoring visits;Ag AgainstHunger

By December 2010, therewill be a 10% increase inthe number of Santa CruzCounty residents that haveaccess to fresh localproduce as measured bythe volume of EBT/foodstamp dollars spent atFarmers Markets andpounds of fruits andvegetables distributedthrough food bank

1. Ensure that food stamps,Electronic Benefit Cards and WICcoupons are accepted as paymentoptions at farmer’s markets andstores with healthy food.

2. Train small storeowners inunderserved areas and providethem with incentives to carryhealthier food items such asquality fresh produce.

3. Publicize and promote farmer’smarkets, community gardens andCommunity SupportedAgriculture programs.

4. Monitor food banks and mealprograms for low-income familiesto be sure that they offer healthyoptions and provide informationabout healthy nutrition.

5. Ensure access to more freshproduce at the Food Bank.

Promote healthyfood alternatives atrestaurants servingyouth and otherbusy communitymembers.

By December 2010,90% of local fast foodrestaurants will offerand promote healthychoices as measured bypre and post-tests of fastfood restaurant menus.

1. Advocate for healthy alternativesat fast food restaurants.



Create and promotelocal mediamaterials andcampaigns thatprovide informationabout healthynutrition andregular physicalactivity.

Statewide5-A-Day; FoodStamp PromotionPSA; CoastWeekly Commu-nity Fund;Sentinel HealthyLiving Section;Radio Bilingue—KHDC—Salinasaffiliate; Fast FoodHigh Schoolfotonovela; freepublications (e.g.,Growing Up inSanta Cruz, GoodTimes, MetroSanta Cruz).

By December 2010, therewill be a 20% increase inmedia promotion ofhealthy eating and regularphysical activity asmeasured by airtime andprint space devoted topromotional messages.

1. Use existing media to deliver abroader, more complete messageto the community about the risksof obesity and who is susceptible;information on dangers ofovereating, healthy eating tipsand the availability of fresh,locally grown foods.

2. Train local media representativesto become experts on obesityissues and prevention strategies.

3. Create a locally produced cookingshow in Spanish and English.


Media


Action Steps

Call to ActionThis is an ambitious plan. With 24 outcomes and relatedaction steps to reach the community goal of “Children in SantaCruz County will be physically fit through healthy eating andregular physical activity,” Go for Health!collaborative members recognize thechallenges ahead. The risk of failure palesin comparison to the consequences ofdoing nothing. We are facing a healthcrisis of unprecedented proportions ifwe do not create changes in communitynorms that help children and familiesdevelop and maintain habits of healthyeating and regular physical activity.

The community needs electedofficials, including county supervisors,city councils and school boards, to adoptpolicies that promote healthy eating andregular physical activity. Businesses and workplaces need thetools to promote health and wellness among their employees.

The food industry needs to market and distribute food that ishealthful and the media plays a crucial role by being responsiveto community needs.

The Go for Health! Plan is a five-year plan.It will take time to identify resources andimplement the action steps. During 2005,baseline data will be gathered where it does notcurrently exist. It is crucial to success thatchange in behavior is measured over time.As work in these areas is relatively new, manyevaluation methods will be tried for the firsttime. Go for Health! will need to monitor theeffectiveness of the measurement tools and makeadjustments over time.

By working together, Go for Health!members are confident that Santa Cruz Countycan become a model for healthy eating, regular

physical activity and reduced childhood obesity.

�The life expectancy of babiesborn today may well be shorter

than their parents unless wesignificantly improve our unhealthylifestyles, which is why we need to

Go for Health!�David R. McNutt, MD

County Health Officer/Medical DirectorCounty of Santa Cruz


PartnersGo for Health! has reviewed and incorporated the ideas from avariety of statewide organizations including:

■ Strategic Alliance for Health Food and ActivityEnvironments (Strategic Alliance)28 staffed by thePrevention Institute and coordinates strategydevelopment, outreach, training, media and research

■ California Food Policy Advocates (CFPA)29 whose 2004agenda includes universal school breakfast and improvedschool lunch

■ California Project LEAN30 (Leaders EncouragingActivity and Nutrition), administered by the CaliforniaDepartment of Health Services and the Public HealthInstitute and whose goals include policy/environmentalchanges to support healthy eating and physical activity,educating Californians to choose healthier foods and bemore physically active, conducting research-driven andconsumer-focused nutrition and physical activity cam-paigns; and helping coordinate state and local efforts

■ California Obesity Prevention Initiative (COPI),31

established in 2000 to reduce obesity and its associatedhealth risks; Project LEAN is a lead partner

■ California Nutrition Network (CNN),32 a part of theCalifornia Department of Health Services, whose missionis to enable low-income Californians to eat healthy foodsand be more physically active. CNN funds local projects,works with the media and retail, facilitates the efforts ofcommunity collaboratives, health departments andschools to promote healthy eating and regular physicalactivity and promotes policy and environmental changeat the local level

Go for Health! works closely with other collaboratives on theCentral Coast that are addressing obesity, including:

■ Central Coast Hunger Coalition,33 established in1985 to eliminate hunger and promote nutrition inthe tri-county area of Santa Cruz, Monterey andSan Benito counties

■ Regional Diabetes Collaborative (RDC),34 formed in2002 to coordinate diabetes efforts in the tri-county area

■ Children’s Food and Fitness Coalition (CFFC),35

formed in 2001 to improve fitness and health in SantaCruz County

■ Health Improvement Partnership (HIP),36 establishedin 2002 to bring together health care leaders in SantaCruz County to address key health issues

■ Nutrition and Fitness Collaborative of the CentralCoast (NFCCC),37 organized in 2003 to reducechildhood obesity in the tri-county area

�Healthy Kids and a healthy community must be apriority for all of us.�Peggy FlynnETR Associates

�Second Harvest looks forward to working withGo for Health! to promote healthy eating and

nutrition among the 42,000 people fed eachmonth through the food bank network

Lee MercerEducation and Outreach Director

Second Harvest Food Bank ofSanta Cruz and San Benito Counties

.�


Answers Benefiting Children

American Heart Association

American Lung Association

Assemblymember John Laird�s Office

Bike to Work

California Food Policy Advocates

Capitola Mall / The Macerich Company

California Nutrition Network�Ready, Set, Grow

Capitola Walks

Central Coast Alliance for Health

Central Coast Center for Independent Living

Child Care Planning Council

Child Development Resource Center

Children�s 5-A-Day Power Play! Campaign

Child Health and Disability PreventionProgram (CHDP)

City of Santa Cruz Parks and RecreationDepartment

City of Santa Cruz Public Works Department

City of Scotts Valley Parks and RecreationDepartment

City of Watsonville

City of Watsonville�Parks and CommunityServices Department

Clinic Operations�SCMF

Coast Commercial Bank

Community Food Security Coalition

Community Bridges

Community Alliance with Family Farmers

Community Foundation of Santa CruzCounty

Community Organizing for RelationalPower in Action

Community TV of Santa Cruz County

Congressman Sam Farr�s Office

County of Santa Cruz Health ServicesAgency

County of Santa Cruz Parks, Open Spaceand Cultural Services

County of Santa Cruz ProbationDepartment

Diabetes Health Center/Centro de Diabetes

Dominican Hospital

ETR Associates

Familia Center

Financial Strategies

First 5 Santa Cruz County

Girl Scouts of Monterey Bay

Granite Rock Company

Health Improvement Partnership of SantaCruz County

Santa Cruz County Head Start

La Manzana Community Resources

Latino 5-A-Day Campaign

Live Oak Family Resource Center�Community Bridges

Live Oak School District Child NutritionProgram

Monterey County Health Department/

Nutrition Network/Project LEAN

New Leaf Community Markets

Pajaro Valley Community Health Trust

Pajaro Valley Unified School District�Migrant Education, Region XI

Pajaro Valley Unified School District�Nutrition Services

Pajaro Valley Unified School District�Healthy Start Program

Planned Parenthood Mar Monte

Population Services International

Prosperity Ed

Resource Center for Nonviolence

Safe Routes to School

Safety Net Coalition

Go for Health! Member OrganizationsSanta Cruz Area TransportationManagement Association

Santa Cruz Bicycle Industry Coalition

Santa Cruz City Schools

Santa Cruz County Farm Bureau

Santa Cruz County Office of Education

Santa Cruz County Regional TransportationCommission

Santa Cruz County Sentinel

Santa Cruz Medical Society

Santa Cruz Sports Central

Scotts Valley Unified School District

Second Harvest Food Bank

SEIU Local 415

Soquel Union Elementary School District

Special Parents Information Network

State Assembly Representative 28thDistrict

Santa Cruz County Office of Education�The Ark

Stellar Productions

SunRidge Farms/Falcon Trading Company

The Core

The Epilepsy Network

The Healthy Way

Tiger Martial Arts

Traffic Busters

United Way of Monterey County

United Way of Santa Cruz County

University of California Santa Cruz

Walnut Avenue Women�s Center

Watsonville Community Hospital

Watsonville Health Center

We Write Corporation

WIC�Community Bridges

YMCA of Watsonville


References1. CDC. The Surgeon General�s Call to Action to Prevent and Decrease

Overweight and Obesity. Rockville, MD: 2001

2. Greenblatt, Alan. �Obesity Epidemic.� Congressional QuarterlyResearcher. Washington, D.C.: January 31, 2003

3. McGinnis, JM, Foege, WH. �Actual Causes of Death in the UnitedStates.� Journal of the American Medical Association. Chicago, Ill:1993; 270:2207-2212

4. Mokdada, A., et al. �Actual Causes of Death in the United States,2000.� Journal of the American Medical Association. Chicago, Ill:March 10, 2004; 291:1238-1245

5. The California Endowment. A Survey of Californians about theProblem of Childhood Obesity. March 31, 2004.http://www.calendow.org/news/press_releases/2004/03/TCE_ExecutiveSummaryOBESITY.pdf

6. San Jose Mercury News/Kaiser Family Foundation. Survey onChildhood Obesity. March 2004.http://www.kff.org/kaiserpolls/7043.cfm

7. CDC. National Health & Nutrition Exam Survey (NHANES) 1999-2000. http://www.cdc.gov/nchs/about/major/nhanes/NHANES99_00.htm

8. County of Santa Cruz Health Services Agency. California Health andDisability Prevention. (2002 unpublished data)

9. CDC. 2002 Pediatric Nutrition Surveillance Report. http://www.cdc.gov/nccdphp/dnpa/pdf/PedNSS_2002_Summary.pdf

10. California Safe and Healthy Kids Office. California Healthy KidsSurvey, Module A (7th, 9th, 11th). Technical Report, Fall 2002

11. Whitaker, R.C., Pepe, M.S., Wright, J.A., Seidel, K.D., & Dietz, W.H.Early Adiposity Rebound and the Risk of Adult Obesity. Pediatrics.1998; 5:101-103

12. National Health Institute. National Cancer Institute. 5-A-Day forBetter Health Program Evaluation Report: Evaluation. Cancer Control& Population Sciences. http://dccps.nci.nih.gov/5ad_6_eval.html

13. The Annenberg Public Policy Center of the University ofPennsylvania. Media in the Home 2000. The Fifth Annual Survey ofParents and Children. http://www.annenbergpublicpolicycenter.org/05_media_developing_child/mediasurvey/survey7.pdf

14. Adapted from the fifth edition of Nutrition and Your Health: DietaryGuidelines for Americans: Joint publication of the Departments ofHealth and Human Services and Agriculture: 2000.http://www.health.gov/dietaryguidelines/dga2000/dietgd.pdf

15. Adapted from the fifth edition of Nutrition and Your Health: DietaryGuidelines for Americans: Joint publication of the Departments ofHealth and Human Services and Agriculture: 2000. http://www.health.gov/dietaryguidelines/dga2000/document/aim.htm

16. James, Kathy. Treatment of Childhood Obesity: 18th AnnualAmerican Academy of Nurse Practitioners (AANP) NationalConference. Hahn School of Nursing, University of San Diego.(Presentation slide). 2003.

17. Nestle, Marion, Jacobsen, Michael. �Halting the Obesity Epidemic: APublic Health Policy Approach.� Public Health Reports. January �February 2000; 115(1):12-24

18. James, Kathy. Treatment of Childhood Obesity: 18th AnnualAmerican Academy of Nurse Practitioners (AANP) NationalConference. Hahn School of Nursing, University of San Diego.(Presentation slide). 2003.

19. Trends in Intake of Energy and Macronutrients�United States,1971�2000. MMWR, 6 February 2004; 53(4):80-82.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5304a3.htm

20. Jacobson, Michael F. Liquid Candy: How Soft Drinks are HarmingAmericans� Health.http://www.cspinet.org/sodapop/liquid_candy.htm

21. Texas Department of Health. Alternate Beverage Campaign and Guideto Healthier Beverage Choices.http://www.tdh.state.tx.us/wellness/sodavh.htm

22. Adapted from the fifth edition of Nutrition and Your Health: DietaryGuidelines for Americans, a joint publication of the Departments ofHealth and Human Services and Agriculture: 2000.http://www.health.gov/dietaryguidelines/dga2000/dietgd.pdf

23. CDC. The Surgeon General�s Call to Action to Prevent and DecreaseOverweight and Obesity. Rockville, MD: 2001

24. CDC. Barriers to Children Walking and Biking to School � UnitedStates, 1999. MMWR. 16 August 2002; 51(32):701-704.http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5132a1.htm

25. The Annenberg Public Policy Center of the University ofPennsylvania. Media in the Home 2000. The Fifth Annual Survey ofParents and Children. http://www.annenbergpublicpolicycenter.org/05_media_developing_child/mediasurvey/survey7.pdf

26. CDC. Healthy People 2010. 2001.http://www.healthypeople.gov/document/tableofcontents.htm

27. BMI is weight in kilograms divided by the square of height in meters.It can also be calculated as weight in pounds divided by the square ofheight in inches and multiplying the resulting number by 704.5.http://www.cdc.gov/nccdphp/dnpa/bmi/calc-bmi.htm

28. Strategic Alliance for Health Food and Activity Environments.http://www.preventioninstitute.org/sa

29. California Food Policy Advocates. http://www.cfpa.net

30. California Department of Health Services, Chronic Disease and InjuryControl/Epidemiology and Health Promotion Section. CaliforniaProject LEAN. http://www.californiaprojectlean.org

31. California Department of Health Services, Chronic Disease and InjuryControl/Epidemiology and Health Promotion Section. CaliforniaProject LEAN/California Obesity Prevention Initiative.http://www.californiaprojectlean.org/programs/obesity

32. California Department of Health Services, Chronic Disease and InjuryControl/Cancer Prevention and Nutrition Section. CaliforniaNutrition Network.http://www.dhs.ca.gov/ps/cdic/CPNS/network/default.htm

33. Central Coast Hunger Coalition�California Hunger Action Coalitionhttp://www.hungeraction.net

34. Regional Diabetes Collaborative. 85 Nielson St., Watsonville, CA95076. (831) 761-5695.

35. Children�s Food and Fitness Coalition. 12 West Beach St.,Watsonville, CA 95076. (831) 763-8821.

36. Health Improvement Partnership. 375 Encinal Ste. A, Santa Cruz, CA95060. (831) 466-4316.

37. Nutrition and Fitness Collaborative of the Central Coast.1299 Aguajito Rd. #103, Monterey, CA 83849. (831) 647-7819.


Norene BaileyClark BeattieBruce BrinkerKerry Brown

Cathy CavanaughJudy DarnellPeggy Flynn

These organizations were instrumental in convening and guiding this planning process:Children�s Food and Fitness CoalitionChildren�s Network of Santa Cruz CountyPajaro Valley Community Health TrustUnited Way of Santa Cruz County

Layout and design by ETR Associates

©2004 Go for Health!

A special thanks to those individuals who gave of their time and energy from the beginning, to serve on the PlanningCommittee, provide extra input and guidance to the writing of the plan and who were always willing to go the extra mile:

Mary Lou GoekeJered LawsonHeidi Lidtke

Laurel McCombsLee MercerLisa A. Russell

Documents

Go For Health Plan-- EmailWeb version