In our annual HealthLeaders 20, we profile individuals who are changing healthcare for the better. Some are longtime industry fixtures; others would clearly be considered outsiders. Some are revered; others would not win many popularity contests. All of them are playing a crucial role in making the healthcare industry better. This is the story of Ginny Ehrlich, MPH, D.Ed.
This profile was published in the December, 2012 issue of HealthLeaders magazine.
"Changing childhood obesity is both cultural and systemic. We learn our eating habits from our families and our community. Schools and communities help reinforce those behaviors."
In the pursuit of reducing the cost of healthcare there's a great deal of attention paid to chronic disease, but much of that focus centers on diseases in adulthood. But in the past 20 years childhood obesity has also nearly doubled, according to National Center for Health Statistics, Centers for Disease Control and Prevention, and it has been linked to costly chronic care diseases including adult obesity and diabetes and an increased risk of heart failures and asthma. To help address chronic disease in its later stages, many believe it must be tackled when people are young. And, childhood obesity is preventable if you can connect with the children and teach them good habits early. That's what Ginny Ehrlich, MPH, D.Ed, CEO of the Alliance for a Healthier Generation is doing by taking her organization's programs to the schools and beyond.
"Changing childhood obesity is both cultural and systemic," says Ehrlich. "We learn our eating habits from our families and our community. Schools and communities help reinforce those behaviors."
Ehrlich joined the Alliance in 2006 and has been working to increase children's access to healthy foods and physical activity at schools and communities nationwide. The Alliance was founded by the American Heart Association and the William J. Clinton Foundation and has been led by Ehrlich since 2008. The Healthy Schools Program, one of several initiatives the organization supports, includes more than 15,000 schools across the United States and offers expert advice and resources for school professionals, teachers, students, and parents to encourage healthy eating and exercise.
Ehrlich says a big challenge the Alliances had faced was getting onto the priority list of school administrators, who already have an abundance of demands.
"Administrators have primary accountability to reach state and national levels for education," Ehrlich says and do not focus so much on offering healthier meals and implementing wellness programs—"though we know that these things can influence educational outcomes. So we navigated the systemic barriers by working within the school system educational structure to make it easy to do our program. Our Healthy Schools Program mirrors the training and processes schools are already using so we can put our program seamlessly into place."
What makes HSP unique is has developed evidence-based training and technical assistance for schools to make its school-based obesity prevention program sustainable. That requires the recruitment of HSP managers—individuals already working at the schools—to drive the program and submit action plans.
"We found another barrier to these initiatives succeeding is they become too reliant on the formal leadership, like a principal or superintendent. So instead we try to build a champion with delegated authority of those leaders to cultivate the program," says Ehrlich. Relationship managers undergo preliminary and continual training, which is provided via telephone, webinar, email, and in-school visits.
The program calls for HSP managers to:
- form a school wellness council
- complete an HSP inventory (an assessment of foods at the school and student weight and fitness)
- generate a priority list and action plan
- cultivate technical resources
- implement support program
- monitor progress
"We've seen tremendous success with our Healthy Schools Program. It's now considered an evidence-based approach and is being used to change policies in the school systems nationwide. In March the CDC talked about the efficacy of our model in preventing chronic disease," says Ehrlich. "Eighty percent of schools in this program are making measurable changes, like adding more fruits and vegetables to school breakfast and lunch menus and eliminating sugar beverages in vending machines."
In addition to working with the schools to raise awareness with the children about healthy eating, the Alliance has worked to eliminate barriers not only inside the schools but also outside.
The organization created a landmark agreement with the American Beverage Association that contributed to a 90% reduction in calories in the beverages shipped to schools since 2004, according to the American Journal of Public Health. The agreement calls for the ABA to remove the majority of full-calorie soft drinks. Now drinks available to students at school vending machines and cafeterias are nutritious, sized proportionate to age, and are low or no calorie.
To make it easier for the school cafeterias to get affordable healthy food options, the Alliance has also worked with group purchasing organizations and collaborated with a technology firm to create a free online tool to streamline the healthy food procurement process for schools.
Additional achievements include:
- Building a coalition of major health insurers, employers, and national medical associations to provide more than 2.6 million children with access to at least four follow up visits with their primary care provider and at least four follow up visits with a registered dietitian each year as a part of their regular health insurance benefits.
- Fully 80% of participating schools have made measurable progress in creating a healthier school environment.
- More than half of the participating schools improved the nutritional values of their school meals.
- More than half have dedicated at least 20% of their after-school program time to physical activity.
The Alliance's efforts don't stop at HSP; Ehrlich says it wanted to create a comprehensive program that reached kids in as many ways as possible. So the organization reached out after-school programs to bring national healthy eating and physical activity standards to communities around the country.
The Alliance also partnered with the American Academy of Pediatrics to use the best-selling children's book, The Very Hungry Caterpillar by Eric Carle, to teach families about healthy eating habits at home. Over 17,500 pediatrician offices have received free copies of a specially created version of the book including growth charts and parent handouts. "We are reducing BMI or weight in students who are participating in our program and they're consuming fewer sugar-sweetened beverages, more fruits and vegetables, and are developing healthier eating and exercise habits overall. That's our goal, to ensure this program is really having a positive impact on kids' health," says Ehrlich.
Karen Minich-Pourshadi is a Senior Editor with HealthLeaders Media.
