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Consultancy Proposal to NYC DOHMH
 

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    Consultancy Proposal to NYC DOHMH Consultancy Proposal to NYC DOHMH Document Transcript

    • Final Deliverables Prepared by: The New School Practicum Team Kristina Capron, Ellen Davidson, Talar Khatchadourian, Mina Nabizada, Thea Rome, Brian Stern and Eda Tekeoglu Advisor: Stacey Flanagan Submitted to: The Department of Health and Mental Hygiene May 27th, 2011May 27th 2011 Page 1 of 53
    • Table of ContentsDeliverable I: Comparative Analysis of Physical Activity Programs…..…………4-13Deliverable II: Walking Group Feasibility Case Study………………..…………14-21Deliverable III: Shape-Up Feasibility Study………………………………………22-27Deliverable IV: Nonprofit Assessment of Physical Activity Programmingand Partnership……………………………………………………………………..28-33Deliverable V: Business Wellness Survey……………………………...…………..34-36Deliverable VI: Grant Proposal to Fund Pilot Program………………...……..…37-49Executive Summary………………….…………………...…………………….......…..37Statement of Need…………………………………...……………………..…………...38Organization Mission Statement………………………..……………..………………39Project Description………………………………………….……………………….…39 Short term outputs…………………………………………..……………………39 Long-term outputs………………………………….………………………….…40 Methodology……………………………………………………………..………40 Sessions…………………………………………………………………......……41May 27th 2011 Page 2 of 53
    • Incentives…………………………………………………………………...……41 Personnel……………………………………………………………………...…41 Potential Partnerships with Non-Profits……………………………………...…42 Table 1: Non-Profits……………………………………………….…………42-43Project Duration…………………………………………………………...……………44 Table 2: Timeline…………………………………………………...……………44 Timeline Narrative……………………………………………………………….44Budget…………………………………………………………………………………...45 Table 3: Scenario A……………………………………………………………...46 Table 4: Scenario B………………………………………………………….…..46Evaluation Method……………………………………………………………..………47 Table 6: BMI indicator……………………………………………......................47 Table 5: Knowledge and Participation Indicator………………………………..47 Evaluation Method Narrative ……………………………………………......48-49References………………………………………………………………………..…50-53May 27th 2011 Page 3 of 53
    • Deliverable I: Comparative Analysis of Physical Activity ProgramsParisFrance current total population – 62 million iIn 2002, the National Institute of Statistics and Economic Studies (INSEE) conducted astudy to calculate the rate of overweight and obesity levels in France. Surveys wereconducted via telephone with over 25,770 participants ages 15> from a total populationof nearly 50 million. The study showed that of the total population in 2002, 5.3 millionadults were obese, while 14.4 million people were considered overweight.ii The methodused to collect this data however has some limitations; there may be sampling errors,measurement error, and reporting bias where people over- or under-report during self-reporting questionnaires.Obesity prevalenceAlthough the rate of obesity in France is still much lower than that of many developedcountries, such as the US and Britain where over 50% are overweight,iii the prevalencehas slowly increased from 8% in 1997 to 11% in 2003.iv In comparing the annual ratebetween this time period, the percentage of overweight and obese adults increased from37%-42%: a projected annual increase of 5%.vObesity as a Risk FactorObesity is one of the most important risk factors leading to diabetes, hypertension,arterial disease, and high cholesterol. Studies show that 43% of people who areoverweight or obese have a greater risk of experiencing the multiple symptomsmentioned above, whereas 19% of people who are considered normal-weight experienceonly one symptom.viObesity Rates by Age and GenderStudies show that obesity rates are rising for both men and women. Table 1 illustrates therise in obesity by age group and gender. In comparing obesity rates between that of menand women, we see a greater prevalence for women between the ages of 15-45. However,this trend begins to reverse quite drastically when comparing men and women betweenthe ages of 45-65, where the prevalence for males increases by 4% in comparison tofemales.viiMay 27th 2011 Page 4 of 53
    • Figure 1. Prevalence of obesity by age and sexSource: "ObEpi 2003 Lobesite Et Le Surpois En France." Dossier De Presse. Roche, 17June 2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>.pg2Link Between Obesity and Poverty:Obesity in France has shown to largely affect lower socio-economic and professionalgroups.viii This may be due to the fact that far more people are beginning to purchasecheap processed and frozen foods from large supermarkets, rather than healthier choicesfrom their local markets due to their affordability and convenience. This cultural shift hascreated an economic burden, not only on the small family-run specialty food stores, butalso on government health expenditures.Reported Physical ActivityOver the last 30 years, there has been a major rise in fast food consumption along with adecline in physical activity. Reports show that only half of the population meets the 30-minute recommended amount of physical activity per day.ix Assumptions have beenmade that there is a direct link between the amount of physical activity a person engagesin, and their weight. Those who categorize themselves as normal-weight, will engage in149 minutes of physical activity per day, while those who see themselves as too thin, ortoo fat, engage in 130 minutes of physical activity per day.xPhysical Activity in the WorkplaceFor some, physical activity in the workplace is where they meet their daily-requiredamount of motion. A study was conducted to evaluate where the most common forms ofphysical activity take place (activity in the work place, leisure, commuting) for people of:normal-weight, overweight, and obese. Table 2 illustrates that people in the obese andMay 27th 2011 Page 5 of 53
    • overweight categories engage in more physical activity while in the workplace (54.3, and50.0) and less on their own time, than those who are normal-weight.xi There is not asignificant difference in the percentage of physical activity people engage in due tocommuting.Figure 2. Percentage of people engaging in physical activity based on weight categoryand location: workplace, commuting, and leisureSource: "Barometre Sante Nutrition 2008." Barometres Sante. INPES. Web. 29 Mar.2011. <http://www.inpes.sante.fr/barometre-sante-nutrition-2008/pdf/activite-physique.pdf>Economic Expenses:The rising rates of obesity have led to an increase in medical treatments for a number ofother diseases. The direct cost of obesity is estimated to be between 1% and 2% of thetotal healthcare expenditure.xii In 2008, 11.2% of France‟s GDP was spent on healthcarecosts. Table 3 places France second in line to the US who spends 16% of its GDP onhealthcare.xiiiMay 27th 2011 Page 6 of 53
    • Figure 3. Percent of GDP spent on health care expenditure by country in 2008Source: "Eco-Sante OCDE 2010 Comment La France Se Positionne." OCDE. Web. 28Mar. 2011. <http://www.oecd.org/dataoecd/45/20/38980771.pdf>. pg 1Government ResponseIn 2004, parliament enacted a wide-range of legislation to combat obesity and promote apublic health campaign. Laws have now been passed which prohibit the use ofsnack/soda vending machines in schools, replacing them with healthier choices andnutrition tutorials. A law has also been passed to control advertisements and foodcompanies through a 1.5% tax if they do not promote healthy habits. However, the latarhas yet to be implemented.xivNational Programme for Nutrition and Health (PNNS)Before 2001, and the establishment of the PNNS, there were no public nutrition policiesin France. The first phase of the PNNS was established to measure the progress of publichealth issues such as eating habits and physical activity in the country, which ended in2005. The second phase of the program was approved by the Minister of Health and waslaunched between 2006-2009. The program focused on (1) promoting environmentalchanges to motivate people to engage in physical activity, (2) targeting disadvantagedgroups, based on socio-economic status, and (3) lower obesity in children and adults. xvEPODE Programme – Together Lets Prevent Childhood ObesityFrance launched its first EPODE program in 2003, which aims at changing theenvironment and peoples unhealthy behaviors, (particularly that of school children) byMay 27th 2011 Page 7 of 53
    • working with schools to promote physical activity programs after school, and access tohealthier cafeteria foods. The program now affects 1.8 million French citizens in over167 cities.xvi The methods they use to measure the rates of success are large fieldmobilization and BMI evaluations of children in the pilot cities.xviiPhysical Elements of the ProgramThis fall, the National Institute for Prevention and Health Education (INPES) launched itsfirst national and local physical activity campaign: “Bouger”; “move 30 minutes a day;its that easy!” The campaign uses signs throughout pedestrian walkways and in bicyclelanes to promote physical activity rather than the use of public transportation (Figure 4).The aim of the campaign is to get people moving and to show citizens that getting theirdaily-required amount of physical activity does not necessarily need to include strenuousexercise, nor does it have to be expensive (Figure 5).Figure 4. Walking signsMay 27th 2011 Page 8 of 53
    • Figure 5. AdvertisementsSource: "Bouger 30 Min Par Jour, C‟est Facile - Campagnes." Ministère Du Travail, DeLEmploi Et De La Santé (Secteur Santé). Web. 30 Mar. 2011.<http://www.sante.gouv.fr/bouger-30-min-par-jour-c-est-facile.html>.Program ElementsThe programs affect both urban and rural areas alike. They encourage cities to be morepedestrian and bike friendly to promote activity. A proposal has been made which wouldprovide subsidies for active modes of transportation while accommodating people whoride their bikes to work with free/safe bike parking access. The Ministry of Health hasalso proposed developing leisure sports centers in parks. They encourage schools toestablish walking buses to teach kids at a young age the importance of physicalactivity.xviiiRecommendationsThe physical elements of the “Bouger” campaign in France is well suited for the Frenchculture and scenic views of the major cities. In downtown NYC, there are signs postedfor tourists to use as location references, however, they only mention the physicallocation, and not the amount of time or steps it takes to arrive at their desired location.Although these signs do seem useful for tourists, it does not seem suitable for our targethigh-needs neighborhoods. Posters and advertisements promoting physical activity canencourage people to put their bodies in motion. If however the posters do not properlyconsider the demographics (target audience, language, etc), the advertisements will beineffective.May 27th 2011 Page 9 of 53
    • TaiwanPrevalence of Obesity in TaiwanThere is a great need for physical activity programs within Taiwan with growing rates ofobesity, both in children and adults, among its 23 million residents. According to asurvey conducted in 2001 by the International Association for the Study of Obesity(IASO), 18.6% of boys were overweight and 8.2% were obese. For girls, 13% wereoverweight and 3.6% were obese. The survey was conducted among children aged 6 to18 years, with a sample size of 24,586. Weight, height, systolic and diastolic bloodpressures, and fitness tests were all measured during the survey (IASO, 2011). The IASOdoes not have a survey available on Taiwan‟s adult obesity population. However, anarticle in Obesity Reviews, Prevalence of obesity in Taiwan, states that from 2000-2001,28.9% of men were overweight and 15.9% were obese. For women, 18.7% wereoverweight and 10.7% were obese. The adults in the study group were aged 20 and older.The survey was conducted using Taiwan‟s Department of Health‟s criteria of overweightas BMI > 24 and obese as BMI > 27 (Chu, 2005).Prevention Strategies in Taiwan: “Health 2011” weight-loss CampaignThe Taipei Times reported in February 2011 that the Department of Health in Taiwan haslaunched a “Health 2011” weight-loss campaign. Between 2001 and 2003, Taipei Cityhad been successful in getting its residents to lose 100 tons. With this success, the DOHdecided to expand the battle against obesity nationwide. For each district of Taiwan, theDOH‟s “Health 2011” campaign has set up weight-loss goals. New Taipei city, being themost populated city with 3.9 million residents has been set with a goal to lose 136 tons.Other goals have been set for Taipei City (101 tons), Taichung (75.1 tons), Tainan (98tons), and Kaohsiung (103.8 tons) (Taipei Times, 2011).The goal of the Health 2011 weight-loss campaign is to encourage healthy eating andexercise for “the sake of one‟s health”, instead of taking diet pills or having weight-losssurgery. The director of Taipei City Hospital‟s nutrition department, Chin Hui-min,stated, “that if people consumed 300 fewer calories and burned 200 more calories per daythan they normally would, they could lose 0.5 kg per week” (Taipei Times, 2011).Residents between the ages of 6 and 64 who are either obese or overweight can sign up atlocal public health centers to take part in the free weight-control program. The programprovides guidance in dieting, nutrition, and exercise. A listing of the public health centerswas not available and results thus far have not been recorded.May 27th 2011 Page 10 of 53
    • National Walking DayIn 2002, the Bureau of Health Promotion began encouraging residents to walk 10,000steps a day. In 2006, November 11th was designated as National Walking Day throughoutTaiwan‟s cities and counties. The date November 11th was chosen because the numeralsrepresented a pair of legs. Posters, like the one below, were placed throughout cities toremind and encourage residents to walk 10,000 steps a day. Residents are encouraged totake part in either fitness walking or power walking. Both types are suggested to be doneat a speed of 4.8 kilometers per hour to 9.6 kilometer per hour while keeping the bodyerect, hands level to the waist, swinging the arms while keeping the shoulders relaxed,and taking bigger steps than usual (Taiwan Review, 2009).Junk Food TaxIn December 2009, Taiwan began to plan the world‟s first junk food tax. The Bureau ofHealth Promotion began drafting a bill that would place taxes on unhealthy foods such assugary drinks, candy, cakes, fast food, and alcohol. The revenue gained from the tax isplanned to go towards those groups that have been promoting health awareness and tohelp subsidize Taiwan‟s national health insurance program (AFP, 2009). The tax is tobegin this year, but there have been no reports that it has been passed or what percentagethe tax would be. New York Governor David Paterson was proposing to pass a similarbill in 2009, but with much public opposition he withdrew the bill. The bill was to add an18% tax on soft drinks.Prevention Strategy in ChinaThere is no available public information on Taiwanese elderly exercising in public areas,but this activity seems to be a popular one in China. China, with a population of over 1billion people, has a growing obesity population much like Taiwan. According to a 2002survey conducted by the IASO, 16.7% of Chinese men were overweight and 2.4% wereMay 27th 2011 Page 11 of 53
    • obese. For women, 15.4% were overweight and 3.4% were obese. The survey wasconducted among adults aged 18 and older (IASO, 2011). China‟s elderly population, 60years and older, is over 140 million people. Roughly 54 million of them take part inphysical activity. Many of them gather in public parks across the country to take part inmartial arts like tai chi, dance, and singing (Liang & Hornby, 2009). There is no specificmention of any costs associated with these park gatherings. Rather, it seems that word ofmouth and motivation to stay fit at an old age is what drives China‟s elderly population totake part in some form of physical activity.Additionally, China Daily reported that China has released a set of guidelines for itsNational Fitness Program 2011-2015. The program sets the minimum exerciserequirement to at least 30 minutes for at least three times a week for 32% of itspopulation. The program calls for a raise in the number of gymnasiums and stadiumsthroughout the country, from 1 million to 1.2 million. The program is targeted to have50% of China‟s cities and counties to set up physical training centers, and 50% of itscommunities to have sports facilities that are convenient and in functional condition forthe entire population. A budget has not been introduced, but all levels of the governmentare to plan their investment on promoting the program. A plan to evaluate thesuccessfulness of the program will take place in 2014 (Lei & Yue, 2011).Recommendations for NYCPrograms like the “Health 2011” campaign and National Walking Day would be ideal inNew York City. The city could encourage residents with its own walking day, week,month, or year; placing posters throughout the city asking residents how many steps theytook today, and/or highlighting routes they can take to reach 10,000 steps a day. Posterscan also encourage them to take the stairs, rather than the escalator or elevator. At presentthere are posters depicting the amount of sugar and sodium found in several drinks andfoods. Walking can be viewed as a simple and effective form of exercise that can showmeasurable results. The DOH can team up with a company that would be willing todonate free pedometers for participating New Yorkers. On a nice day, rather than takingthe subway a few blocks, residents can try walking them.Additionally, Taiwan‟s Health 2011 campaign has set up a hotline that people can callinto to gain advice on diet and exercise. The NYC DOH could set up a similar hotlinewhere NYC residents can call toll-free to attain information on diet, exercise, local gymsand their promotions, local YMCAs, local parks, and a listing of healthyrestaurants/markets at affordable prices. The choices are plentiful. To make the concepteven more up-to-date with today‟s technology, a smart-phone application can be set upthat could easily provide this information. Perhaps teaming up with Yelp.com to offerlocal listings of such facilities presents an opportunity as well.Although the “junk food tax” was not a crowd pleaser when the idea was first introducedto New York, a “no refills” rule can be implemented. When patrons go out to eat, eateriesshould no longer place the soda machines in a public area where patrons can fill theirMay 27th 2011 Page 12 of 53
    • own cups. Also, restaurants should no longer give free refills. Rather, they should chargefor each glass filled. This could possibly reduce the amount of sugary drinks that NewYorkers consume, as they would not be willing to pay for several glasses.Lastly, following the Chinese, New Yorkers can take part in a group exercise routine inone of NYC‟s numerous parks. Perhaps teaming up with volunteers who would dedicatetheir time to teach interested individuals easy dance and exercise routines. After the firstmonth, for example, participants can carry out the routines on their own and new comerscan follow the guidance of veteran participants. However, if the program requiresfunding, a $1 fee can be instilled for each participant. A website or a smart-phoneapplication can be set up where individuals can view where and when the next groupexercise routine will take place.May 27th 2011 Page 13 of 53
    • Deliverable II: Walking Group Feasibility Case StudyIntroductionIn light of the obesity epidemic in New York City, the private and public sector has toassume responsibility in increasing access to low-cost physical activity programming.Data from the Department of Health and Mental Hygiene shows that NYC‟s high-needscommunities experience disproportionate overweight and obesity rates in comparison tomiddle-income neighborhoods.Walking is a well-known form of low-impact physical activity that is safe for all ages. Inaddition, organizing walking groups is relativity inexpensive when compared to indooractivities such as dance. The health benefits of walking are undeniable and the low-costcomponent makes walking groups a great form of physical activity that can be healthpromoting, educational, and social all at once.We need to understand what obstacles exist in implementing a walking group initiative inNYC‟s highest-needs communities. In addition, it is beneficial to analyze existing andpast initiatives in order to learn what components have culminated into successful andsustainable walking group programs.Our research on three walking group initiatives in East and Central Harlem has providedimportant information that we have used to design a pilot program.MethodologyOur team reached out to Javier Lopez, the director of the NYC Strategic Alliance forHealth in order to connect with walking groups located in Harlem. He put us in contactwith Lourdes J. Hernández-Cordero, D.PH and Monique Hedmann, MPH, the directorsof the CLIMB project and Walk it Out! Program, respectively. Through email and phoneinterviews the team collected information on these two walking group initiatives. Inaddition, the team conducted an in-person interview with John Falzon, the centermanager of the Thomas Jefferson Recreation Center. Team members also visited therecreation center in order to participate in the walking group. Interviewee contactinformation is included below:Javier LopezDirector, NYC Strategic Alliance for Healthjlopez@health.nyc.gov(212) 996-8738Lourdes J. Hernández-Cordero, D.PHAssistant Professor of Clinical Sociomedical SciencesSMS Practicum DirectorAssociate Director Columbia Center for Youth Violence PreventionMay 27th 2011 Page 14 of 53
    • Columbia University Mailman School of Public Health722 West 168th Street Room 514New York, NY 10040Phone: (212) 305-1077ljh19@mail.cumc.columbia.eduMonique Hedmann, MPHAssistant Director, Department of NeurologyHarlem Hospital Center506 Lenox Avenue, 16th floorNew York, NY 10037Office (212) 939-4239Monique.Hedmann@nychhc.orgJohn Falzon, Center ManagerThomas Jefferson Park Recreation Center2180 1st Avenue at East 12th StreetNew York, NY 10128(212) 860-1371john.falzon@parks.nyc.govFindingsCLIMB Program BackgroundThe City Life is Moving Bodies project (CLIMB) is a partnership between ColumbiaUniversity Medical School and community organizations based in Northern Manhattanxix.The project‟s mission is to address various social and health issues endemic to the area ofwhich some are obesity, inactivity, youth violence, and drug abusexx. CLIMB believesthat increasing access to parks and ensuring that it is safe to enjoy them will help alleviatesome of the problems noted abovexxi. In order to increase safety and accessibility CLIMBhas created and linked trails within the cliff-like ridges that characterize the terrain ofNorthern Manhattan‟s parks. CLIMB aims to create park and neighborhood ownership bytargeting all levels of involvement: individual, family, neighborhood, and cityxxii.On June 4, 2011, CLIMB is hosting the seventh annual Hike the Heights eventxxiii. Thisevent promotes CLIMB and its community partners‟ initiatives by inviting thecommunity to enjoy the park trails.May 27th 2011 Page 15 of 53
    • CLIMB FindingsThrough a phone interview with Lourdes J. Hernández-Cordero, the team learned moreabout City Life is Moving Bodies (CLIMB) xxiv. The project was created by theCommunity Research Group more than 17 years ago in order to address the issue of safeparks and neighborhoods. According to Lourdes, the need for safe parks evolved from thereality that the parks of Northern Manhattan (including Inwood, Washington Heights, andHarlem) were abandoned and unsafe. The project aims to reinvigorate the area bymaking public spaces such as parks accessible for safe and multi-generational use.Currently, the CLIMB project is part of the Columbia Center for Youth ViolencePrevention. According to Lourdes, obtaining funding is more feasible when the target ischildren and adolescence. In addition, targeting youth has been an effective avenue forreaching other generations. For example, the annual Hike the Heights event promotesmulti-generational activities in a safe outdoor setting.While the Hike the Heights event is only held once a year in June, the project promotesthe event and its initiatives year round. Lourdes aims to “bring a diversity of users to thepark” because it “increases use around the clock and makes the parks safer. And it‟s away to have folks more physically active, but also provides an opportunity to be morecivically active and socially active”xxv.The CLIMB Project‟s institutional review board (IRB) evaluates its efforts by designingquestionnaires that asks participants how they found out about the event and the parks.These questionnaires are helpful because it allows the project to design its initiativearound the needs of the community.CLIMB partners with many community-based organizations in Northern Manhattan. Oneof their biggest collaborators is the Northern Manhattan Community Voices AsthmaBasics for Children initiative. ABC holds its annual asthma awareness walk on the day ofthe Hike the Heights event and the walk culminates at the event. The collaborationenables a large range of participants to become aware of the accessibility of NorthernManhattans parks.One of CLIMB‟s main initiatives is to promote physical activity in NYC‟s parks.According to Lourdes, walking is a great form of exercise that is appropriate for all ages.However, in order to motivate people to walk together, you must add an additionalcomponent. For example, as part of the youth violence prevention initiative, CLIMBorganizes youths into teams that go out into Northern Manhattan‟s parks to clean up thearea. In addition, CLIMB organizes educational walking tours. These tours are designedto educate participants about the rich social and ecological history of NorthernManhattan.According to Lourdes, there are challenges in organizing walking groups, especially forelders. She argues, “walking groups for seniors are difficult because promoting healthbenefits [only] is not effective.”xxvi Lourdes recommends that seniors will more likely beinterested in participating in a walking group if it is socially engaging.May 27th 2011 Page 16 of 53
    • Walk it Out! Program BackgroundThe Walk it Out! Program is a Harlem Hospital Center initiative that aims to promotephysical activity among senior citizens residing in Harlem. In addition to emphasizinghealth benefits for senior citizens, Walk it Out! promotes multi-generational activities andpeer bondingxxvii. The Harlem Hospital Center held The Walk it Out! Family Walk andRun event last year on August 1, 2010 at the Riverbank State Park. This event promotedthe program‟s goals while bringing the community together in a healthy setting filledwith physical activities and healthy foods.The Walk it Out! program was created in February of 2010 and is sponsored by theHealthy Heart Program of the New York State Department of Health and otherdonorsxxviii.Walk it Out! FindingsThrough a phone interview with Monique Hedmann, the team learned about the Walk itOut! initiative of the Harlem Hospital Centerxxix. According to Monique, since itsinception in [February] 2010, the program has had its ups and downs, but boasts overallsuccess in supporting a culture of wellness among Harlem seniors”xxx.One of the main reported obstacles is obtaining funding. The program receives a smallgrant from the Healthy Heart Program of the New York State Department of Health,which covers personnel costs. An additional $1,500 is provided by AARP, a nonprofitorganization committed to helping persons aged 50 and older. The Friends of HarlemHospital Center support efforts to help their patients by providing grants; so far, theyhave awarded the Walk it Out! program $5,000. Monique Hedmann, as director of thisinitiative has had to be innovative in cutting costs because donor funding, whilegenerous, is not enough to sustain the program.Through partnerships with academic institutions and community organizations, theprogram has effectively lowered overall costs. For example, Walk it Out! currentlypartners with the Joseph L. Mailman School of Public Health of Columbia University.The graduate program provides Walk it Out! with graduate student volunteers. Thesestudents are trained by the program to lead walking groups and receive a volunteertraining manual. Currently, the student volunteers do not receive certification, butaccording to Monique, this is something that they may explore. In regards to liabilityissues, all participants sign an acknowledgement of risk and must be cleared by a doctorbefore engaging in any physical activity organized by the program.Monique Hedmann argues that one of the benefits of having student walking instructorsis that elders enjoy interacting with youth. Participants have expressed their appreciationfor multi-generational interaction and some have told Monique directly that they continueto participate because the walks are led by young and energetic students.While student volunteers are an effective way to lower program costs, Monique has citedsome obstacles in this partnership. On several occasions, students have failed to show upMay 27th 2011 Page 17 of 53
    • for their delegated walking group and this has had a negative impact on the programsreputation. The credibility of the program depends on the professionalism of the walkinginstructors and not showing up to lead a walk will deter future participation. Moniquesuggested that there should be a form of accountability for unexcused absences fromstudents. Monique feels that if volunteering for leading walks could be incorporated intoa for credit class, this might eliminate the issue at hand.In addition to utilizing student volunteers as walking instructors, the Walk it Out!program trains senior citizens to be walking guides. Having a peer leader (alongside thestudent volunteer) promotes individual ownership of the program. Monique Hedmannbelieves that the combination of a peer leader and a student volunteer walking instructorhas been a factor in the programs popularity. When Walk it Out! promotes the program,they find that emphasizing the multi-generational component as well as the opportunityfor peer bonding is highly effective in motivating senior citizens to engage in physicalactivity.Walk it Out! effectively targets senior citizens by collaborating with senior centers.Currently, Walk it Out! partners with 10 senior centers located in Central Harlem. Theprogram provides the student volunteer instructors, training for peer instructors,incentives for participations, and the overall framework so that the program can run at all10 senior centers simultaneously.The majority of the partner senior centers hold walking groups three times a week from9:00 - 10:00 a.m. since senior centers usually serve lunch around 11:30 a.m. Also, asMonique points out, most adults, regardless of age, prefer to exercise during the early tomid-morning.Monique Hedmann would like to engage senior citizens residing in East Harlem;however, the current budget does not allow for this expansion. With that said, Walk itOut! has recently expanded its programming beyond senior centers and is collaboratingwith the SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and TransgenderElders), an organization that aims to support the needs of LGBT older adultsxxxi.Another partnership offers a solution for inclement weather or cold winters. The Walk itOut! program has partnered with the 369th Regiment Armory, located in Central Harlem.Through this partnership, the walking groups have an indoor space to engage in physicalactivities when walking outdoors is not possible.Not only does Walk it Out! lower program costs through its partnerships, it ensures thatthe program‟s initiative is reaching senior citizens beyond the senior centers. One of theobstacles in promoting the program is reaching seniors that do not belong to seniorcenters. In response, Walk it Out! partners with the NORC (Naturally OccurringRetirement Community) program. Monique attempted to advertise the program to seniorsliving in NYCHA (New York City Housing Authority) housing developments; however,she did not receive approval. Additional strategies include advertising with flyers inchurches, hospitals, and promoting the initiative at community board meetings.May 27th 2011 Page 18 of 53
    • With a tight budget, the Walk it Out! program allocates a portion of funding to coverincentives for participation. Monique Hedmann argues that offering incentives is a veryimportant motivator. The provision of incentives is carefully allocated by providingparticipants with a “loyalty card” which is stamped by the instructor at every walkinggroup they attend.On the first day, the participants receive a Walk it Out! t-shirt and they are encouraged towear it whenever they walk for fitness. Monique Hedmann argues that senior citizenswho wear the t-shirts are a great form of advertisement for the program. For example,several elders who were not participants of a senior center have shown up to participatebecause they saw their peers wearing the t-shirts.After the first day, incentives are given as participants accumulate stamps; some of theincentives given out: pedometers, drawstring bags, water bottles and gift certificates.The health benefits of walking are undeniable. However, the Walk it Out! program doesnot monitor important health indicators such as BMI and blood pressure. Again, budgetand time constraints do not allow for a comprehensive evaluation. However, as requestedby the New York State Department of Health, the program tracks the amount of timeparticipants engage in physical activity. The participants fill out a questionnaire that asksthem how many minutes they engage in physical activity per week. The NYS Departmentof Health recommends that people of all ages engage in at least 150 minutes of physicalactivity weekly.As the program moves forward, Monique aims to address the fact that the participants arealmost exclusively female. Males belong to senior centers; however, they do notparticipate in the walking groups led by the Walk it Out! program. She claims, “There aremostly females at the walking groups. There are more senior women anyway, but acrossall ages women participate more in group physical activities”xxxii.According to Monique, elderly males argue that they prefer to run instead of walking.While running is another low-cost form of physical activity, there are liability issues inleading a running group. Overall, Monique emphasizes, “You have to make walking funin order to motivate people”xxxiii.Walk NYC Program BackgroundWalk NYC is a walking for fitness partnership between the New York City Departmentof Parks and Recreation and Empire Blue Cross Blue Shield. The program is held atrecreation centers citywide and is open to all ages. Empire BCBC provides funding toParks and Recreation in order to finance certified walking instructorsxxxiv. In addition tohiring and training instructors, Parks and Recreation provides the space (recreationcenters) for participants to meet and promotes the program. Walk NYC is in its secondyear after launching in June of 2010xxxv and is currently operating in all five boroughs,including all of the five high-needs communities.May 27th 2011 Page 19 of 53
    • Walk NYC FindingsWhile participating in a Shape-Up class at the Thomas Jefferson Recreation Center, teammembers noticed a sign advertising the Walk NYC program. Through an interview withJohn Falzon, the center manager of the Thomas Jefferson Recreation Center, the teamgathered additional information about the Walk NYC programxxxvi. According to Falzon,Empire BCBC approached Parks and Recreation about starting a walking for fitnessprogram because they want to target blood pressure and promote fitness, particularlyamong senior citizens. Falzon believes that Empire BCBS thinks that walking groups willattract their target audience, senior citizens, because it is low impact and a social activity.Empire sponsors the program by providing funds so that Parks and Recreation can recruitand hire certified instructors. Parks and Recreation also provides the space andadvertisement throughout all five boroughs.The Walk NYC program began citywide the week of April 18, 2011 and concludes inDecember. At the Thomas Jefferson Recreation Center, located in East Harlem, thewalking group meets outside of the center three times a week on Mondays, Wednesdays,and Fridays from 10:00 a.m.- 11:00 a.m. According to Falzon, the group will start theirwalk by circling the tracks at the center and then they will walk down the East RiverWalkway. If there is inclement weather, Falzon forecasts that the group will engage inindoor activities at the Recreation Center.Empire BCBS has a target attendance of 25 participants per class; however, John Falzonpredicts that participants may complain that it‟s “too hot or too cold outside”xxxvii, whichwill affect attendance during NYC‟s hot summers and cold winters. If the “Walk NYC”program does not meet their goal of 25 people per class, it will be cancelled at the lowturn-out locations. In addition, Falzon worries that, “when something is free, peopledon‟t take advantage because it‟s not exciting.”According to Falzon, Adrian Benepe, the Commissioner of the Department of Parks &Recreation, is aware of budget cuts and is searching for alternative resources for funding.The “Walk NYC” program is a perfect example of a partnership that offers thecommunity a free program while not affecting NYC‟s budget.The team decided that the Walk NYC program was an interesting walking group toobserve since it is a private/public partnership that reduces city spending on physicalactivity programs. We returned to the Thomas Jefferson Recreation Center onWednesday April 27th hoping to participate in the walking group and collect feedbackfrom participants and the instructor. However, after a half hour, neither the instructor norany participants had arrived. We spoke with a security guard and she told us that that thewalking instructor had only showed up on the first day, April 18th, and had not returnedsince. On the previous Wednesday, two participants arrived but left after the walkinginstructor did not show up. We decided to try again on Friday April 29th, but no oneshowed.The advertising for the Walk NYC program is a flyer with the text, “free fitness walks ledby experienced instructors,” and has the following slogan: “Get out to the park and walkMay 27th 2011 Page 20 of 53
    • the City!” Our research indicates that this may not be enough to motivate people toengage in this program.Top Key RecommendationsIn order to lower overall costs, we recommend that the piloted walking program in EastHarlem utilize student volunteers in place of hiring certified walking instructors. Theprogram should partner with academic institutions that offer Public Health programs orother health related majors because these students will most likely understand the benefitsphysical activity has on overall health. Lessons learned from the Walk it Out! programshow that accountability is necessary for program credibility. Therefore, studentvolunteers must be enrolled in a for-credit class that deducts points for unexcusedabsences and no-shows.The program should partner with a nonprofit organization that is willing to offer indoorspace as an alternative to outdoor activities during inclement weather. It is important thatthe walking program continue to run regardless of weather and climate changes. This willensure that participants are not turned-off when the program is cancelled due to weather.There is evidence that offering incentives to participants is an effective motivator forparticipating in a walking group. A low-cost option would be to partner with a privatesector corporation that can fund or offer healthy lifestyle incentives such as water bottles,pedometers, and jump ropes.We recommend that the program offer multi-generational activities and promote peerbonding. In addition to student volunteer walking instructors, a peer walking instructorshould lead the week alongside the student. This allows for group ownership andpromotes peer bonding.The program should be multi-dimensional and include educational, social and “walkingwith a purpose” components. Evidence from the Walk NYC program shows thatpromoting a program as walking solely for fitness may not be enough to motivateparticipants to engage in walking groups.An additional study of walking groups in NYC‟s other high-needs neighborhoods may behelpful in fully understanding how to motivate people to engage in group and individualphysical activity. It will also offer additional insight on strategies for running a low-costwalking group program.May 27th 2011 Page 21 of 53
    • Deliverable III: Shape-Up Feasibility StudyIntroductionGaining an understanding of Shape Up NYC and its participants is a critical componentto finding best practices as relates to executing a free-to-low-cost physical activityprogram for high-needs New York City neighborhoods.Conducting surveys of Shape Up NYC is designed to answer several questions, all ofwhich will feed into our proposal for a pilot program.Quantitatively, we need to understand who attends Shape Up NYC classes; which classesthey attend; how many, if any, would be open to paying to participate in a physicalactivity program; how many have and would potentially participate in walking groups;and, to determine multi-generational participation, how many have children present in thehousehold.Qualitatively, we need to understand how well Shape Up NYC meets their physicalactivity interests and needs; if a substitute program carried out by a nonprofit with arequirement to pay would meet their needs similar to Shape Up; and how having childrenpresent impacts their time to participant and if a program that brings together parent andchild would empower parents to participant more often.Our surveys across several Shape Up classes spanning the three high-needsneighborhoods specified by the DOHMH have answered these questions and haveprovided us with the necessary information to craft a credible proposal for a pilotprogram.MethodologySurveys were designed using Survey Monkey and take into account age, gender, locationof class, and queries that would satisfy the quantitative and qualitative requirementsdiscussed in the preceding section.Participants across the three boroughs of highest need were approached prior tocommencing their Shape Up class, with the consultant taking the participant through thesurvey asking the participant the designed questions. The consultant manually entered allparticipant answers into Survey Monkey for analysis.May 27th 2011 Page 22 of 53
    • High-Level FindingsThe consulting team spoke to fifty-three participants, all female. As the chart belowshows, an aggregate of 87% of all Shape Up respondents are between the ages of 35-64. Participants by Age 25-34 35-44 45-54 55-64 65+ 8% 6% 25% 30% 32%A similar percentage of respondents said they have an interest in participating in awalking group. Additionally, of those in the 45-54 age group, 100% said they would beinterested in leading a walking group.May 27th 2011 Page 23 of 53
    • Interest in Walking Group by Age 25-34 35-44 45-54 55-64 65+ 5% 5% 26% 28% 36%The below chart illustrates that the majority of respondents, 53%, said they are notwilling to pay a fee to participant in a physical activity program, while slightly more thanone third, 38%, said they would be willing to pay between one and five dollars. Only 9%said they would be willing to pay more than five dollars. % Willing to Pay 60% 50% 40% 53% 38% 30% 20% 10% 9% 0% Will Not Pay Under $5 Over $5May 27th 2011 Page 24 of 53
    • Survey results indicate areas for program growth, most specifically as relates to the typesof classes to offer. Our findings show that more than half, 53%, would like to see moredance classes, dance being an umbrella term that includes belly, salsa, zumba, andmeringue dance forms as an aggregate. Both aerobics and yoga were also mentioned asclasses respondents were interested in but could not find in their local areas. % Requesting More Classes 60% 50% 40% 53% 30% 20% 18% 18% 10% 0% Dance Aerobics Yoga ClassesAnswers regarding multi-generational activity were revealing. Eighty-seven percentreported that they have children present in the household. Of those, 33% said caring fortheir children‟s needs limits their access to physical activity to some degree. Of those,100% said they would bring their children to a physical activity program provided thatthe program brings together the parent and the child. This does not necessarily mean theparent and the child must be taking part in the same activity together, but that the parentand the child are in the same venue with easy access to each other in case a need arises.High-Level Borough by Borough FindingsThe following is a breakdown of the more salient findings by borough.In all cases, the 35-64 age range dominates:May 27th 2011 Page 25 of 53
    • Age Group by BoroughEast Harlem 25-34 7.4% 35-44 33.3% 45-54 37.0% 55-64 18.5% 65+ 3.7%Brooklyn 25-34 6.7% 35-44 26.7% 45-54 13.3% 55-64 46.7% 65+ 6.7%Bronx 35-44 42.9% 45-54 57.1%East Harlem shows demand for innovative programming, both in terms of walkinggroups and dance classes:Walking Group Participation by BoroughEast Harlem 61%Brooklyn 35%Bronx 4%In most cases, participants say they are not willing to pay for a physical activity program;if asked to pay, the cost must remain under $5 to achieve a turnout:Willing to Pay by BoroughEast Harlem No 48.1% Under $5 33.3% Over $5 18.5%Brooklyn No 46.6% Under $5 53.3% Over $5Bronx No 85.7% Under $5 14.2% Over $5May 27th 2011 Page 26 of 53
    • There are opportunities to grow programs to meet interests:Request for More Programs by BoroughEast Harlem Dance 35.7% Aerobics 28.5% Yoga 14.2%Brooklyn Dance 60% Aerobics 20% YogaBronx Dance 33.3% Aerobics 66.6% YogaMulti-generational activity represents an opportunity for program innovation:Children Present by BoroughEast Harlem 41.5%Brooklyn 24.5%Bronx 13.2%Top Key RecommendationsProgram messaging and initiatives should target a female constituency between the agesof 35-64, with an emphasis on women in the 45-54 age group.There is a clear demand for dance classes; sourcing dance instructors with diverseexperience in offering different forms of dance as physical activity will meet the interestsof the core constituency and generate greater turnout.Keeping cost-to-participant low is critical; creating a self-sustaining model can be donethrough proper, in-demand programming, such as offering a variety of dance; carefultargeting of the core constituency; and requiring a modest fee not to exceed five dollars.Additional study may be helpful to determine if a pay-as-you-go pricing model would bebest, or if a one-time fee for a set number of weeks would be an option. Furthermore,determining price elasticity of demand would also prove beneficial to find theintersection between the right price and where maximum weekly participation occurs.May 27th 2011 Page 27 of 53
    • Deliverable IV: Nonprofit Assessment of Physical ActivityProgramming and PartnershipIntroductionIn light of forecasted budget-cuts, the New York City Department of Health and MentalHygiene must investigate alternative strategies that can sustain physical activityprogramming. Addressing obesity and inactivity is a necessary step towards overall cityhealth, particularly in NYC‟s high-needs communities. So far, NYC‟s Shape-Up programhas effectively provided group fitness classes for people in all boroughs. However,funding is limited and these programs are at risk of being cancelled.The chronic diseases associated with obesity (i.e., heart disease, hypertension, and type 2diabetes) disproportionately affect the residents in these five targeted communities.Considering the health benefits of being active, physical activity programming cannot becut from vulnerable high-needs communities.We need to investigate if nonprofits that are already conducting physical activityprogramming are willing to collaborate with the city in its efforts in combating obesity.Additionally, we must expand partnerships beyond nonprofits that already providesimilar programming and seek out nonprofits that we can learn from.The goal is to create a physical activity program that will be free to participants and low-cost to the program organizers.MethodologyWe designed a nonprofit assessment questionnaire on Survey Monkey and Javier Lopez,director of the Strategic Alliance for Health, and Stacey Flanagan, director ofNeighborhood WIC at Public Health Solutions distributed it via their listservs. The 16-question survey sought to investigate if NYC based nonprofit organizations would beinterested in partnering with the Department of Health and Mental Hygiene in its physicalactivity initiatives. We asked nonprofits who are engaged in physical activity programs tospecify which activities they offer (walking groups, group fitness classes, recreationalsports, etc.).We asked respondents if they targeted low-income communities and asked them tospecify their funding sources. Additionally, the survey asked which age groups theytarget, how often they run their physical activity programming and in which communitytheir services targeted.The survey asked if nonprofits were interested in partnering with the DOHMH. Thosewho replied yes were asked what resources they could offer (space, equipment, supportstaff, interns and funding assistance). Additionally, we asked respondents to describetheir physical activity programming if they believed it to be innovative.May 27th 2011 Page 28 of 53
    • FindingsThe team received a limited response to the nonprofit assessment survey. However, wewere able to pick seven nonprofits that we believe are possible candidates for apartnership with the DOHMH. The chosen organization‟s contact information,background information, and highlights from their responses are summarized below:1. Organization: CHALK at New York-Presbyterian Hospital Columbia UniversityMedical CenterContact name: Stephanie Pitsirilos-BoquinContact Email Address: chalk@nyp.orgContact Phone Number: 212.305.2771CHALK at New York-Presbyterian Hospital Columbia University Medical Center is anonprofit that focuses on health care (including hospitals, mental health, and medicalresearch). This nonprofit caters to children up to the age of 12 in low-incomecommunities. This organization receives funding through government grants. CHALKfocuses on physical activity programming programs focusing on group fitness classes,recreational sports and family fitness night at the Y. These events take place up to tentimes a month. The organization feels that their program is innovative and they focus onculturally appropriate sports. CHALK currently partners with the YM and YWHA, JsBig Gym-Asociacion de Mujeres Progresistas, and Parks Department. CHALK isinterested in partnering with the NYC Department of Health and Mental Hygiene‟sphysical activity initiatives, and would be able to offer funding assistance, interns, andexercise supplies (jumping ropes, balls, pedometers). CLIMB recently partnered withSHAPE UP NYC as well.2. Organization: Northern Manhattan Perinatal Partnership, Inc.Contact Name: Maria GuevaraContact Email Address: nmpp_chwp@yahoo.comContact Phone Number: 212.289.8800ZIP: 10035Northern Manhattan Perinatal Partnership, Inc. is a nonprofit that focuses on humanservices in Manhattan. This organization focuses on thirteen year olds and up in low-income communities. They currently receive funding from government grants. NorthernManhattan Perinatal Partnership, Inc. currently does not focus on physical activityprogramming but is interested in implementing physical activity programming. NorthernManhattan Perinatal Partnership, Inc. is interested in partnering with the NYCDepartment of Health and Mental Hygiene‟s physical activity initiatives, and would beable to offer space including indoor and outdoor space.May 27th 2011 Page 29 of 53
    • 3. Organization: Fort Tryon Park TrustContact Name: Nancy BruningContact Email Address: nbruning@aol.comContact Phone Number: 646.318.8544ZIP: 10040Fort Tryon Park Trust is a nonprofit that focuses on recreation and sports, communityimprovement, and capacity building in Manhattan. The organization focuses on all agegroups and low-income communities. The organization receives funding throughdonations, fundraising, government grants, private grants, and nonprofit grants. FortTryon Park Trust focuses on physical activity programming and focuses on walkinggroups and group fitness classes. These activities run between 21 to 30 days a monthwhen the weather is in good condition, and less physical activity programs are offered inthe winter. Fort Tryon Park Trust believes that their physical activity programming isinnovative because they follow a “Green Exercise” Philosophy. It goes all year round,and uses only the parks features and furniture; it is led by trained fitness professionalsand has been in operation since 2004.This program is supported with a printed brochure providing instructions for 10 exercisesin addition to 10 suggested routes through the park which range from easy to moderate tointense. A 15-minute DVD/video "101 Things to Do on a Park Bench" has just beenreleased to further support the use of park benches for a range of exercises that aredesigned to improve flexibility, strength, and balance. This program is complemented inthe summer with Tai Chi, Yoga, Dance, and Qigong classes led by certified volunteers.All classes are free and open to all levels.Fort Tryon Park Trust is interested in partnering with the NYC Department of Health andMental Hygiene‟s physical activity initiatives and would like to have help distributing the15-minute video, "101 Things to Do on a Park Bench", which motivates and inspirespeople to use their parks for exercise on their own and in informal groups, without theneed for special, expensive, or inconvenient equipment. The video helps people gobeyond just walking or jogging to do a complete workout including strengtheningexercises, as the government recommends.Fort Tryon Park Trust partners with CLIMB (City Life is Moving Bodies), PS 187,Asociacion de Mujeres Progresistas, The YM/YWHA on Nagle Ave, and CHALK inphysical activity initiatives. Fort Tryon Park Trust is interested in partnering with theNYC Department of Health and Mental Hygiene‟s physical activity initiatives, and wouldbe able to offer support staff (trainers, instructors) space including indoor and outdoorspace.May 27th 2011 Page 30 of 53
    • 4. Organization: Randalls Island Sports FoundationContact Name: Laurence VargasContact Email Address: laurence.vargas@parks.nyc.govContact Phone Number: 212.860.1899ZIP: 10023Randall‟s Island Sports Foundation is a nonprofit that focuses on recreation and sports inManhattan, Bronx, and Queens. This organization focuses on physical activityprogramming for all ages. Randall‟s Island Sports Foundation receives funding fromdonations, fundraising, government grants, income generating activities, private grants,and nonprofit grants. The physical activity programming focuses on walking groups,group fitness classes, recreational sports, water sports, and bicycling. These activitiesoccur during March through November from 21 to 30 days a month.The organization feels that their physical activity programming is innovative becausethey partner with a wide variety of CBOs, schools, and other groups. They also offerunusual sports like rugby and golf. The nonprofit partners with Department of EducationPSAL and CHAMPS in its physical activity initiatives. Randall‟s Island SportsFoundation is interested in partnering with the NYC Department of Health and MentalHygiene‟s physical activity initiatives, and would be able to offer space, especially thepark, during weekdays before 3pm. They need outreach and funding from thedepartment of health to assist their physical activity programming.5. Organization: Mount Sinai SOM/Little Sisters of the AssumptionContact Name: Perry SheffieldContact Email Address: perry.sheffield@mssm.eduContact Phone Number: 212-241-2265ZIP: 10029Mount Sinai SOM/Little Sisters of the Assumption is a nonprofit that focuses on healthcare in Manhattan, Bronx, Brooklyn, and Staten Island. The organization focuses on ages0 to 19 in low-income communities. The organization earns funding through donations,government grants, and private grants. Mount Sinai SOM/Little Sisters of theAssumption focuses on walking groups, recreational sports, and after school activities forchildren. The nonprofit runs the physical activity programs from 1 to 10 days a month.The organization feels that their physical activity programming is innovative becausethey combine nutrition, exercise education, and practice for children from low-income,mostly 1st generation American Latino group. Mount Sinai SOM/Little Sisters of theAssumption is interested in partnering with the NYC Department of Health and MentalHygiene‟s physical activity initiatives, and would be able to offer funding assistance.May 27th 2011 Page 31 of 53
    • 6. Organization: FC HARLEMContact Name: Irvine Smalls, Executive DirectorContact Email Address: irv.smalls@fcharlemlions.orgContact Phone Number: 917 572 1994ZIP: 10026FC HARLEM Assumption is a nonprofit that focuses on recreation and sports inManhattan. The nonprofit focuses on 19 and under ages in low-income communities. Theorganization earns funding through donations, fundraising, and government grants. FCHARLEM Assumption focuses on physical activity programming especially recreationalsports 1 to 10 days a week.The nonprofit feels that their physical activity programming is innovative because theyutilize small spaces to teach the game of soccer similar to how it‟s done in LatinAmerican and African countries. FC HARLEM Assumption is interested in partneringwith the NYC Department of Health and Mental Hygiene‟s physical activity initiatives,and would be able to offer funding assistance, space, exercise supplies, support staff, andinterns.7. Organization: Partnerships for Parks - Catalyst ProgramContact Name: Carlos MartinezContact Email Address: Carlos.Martinez@cityparksfoundation.orgContact Phone Number: 212-788-8067ZIP: 10007Partnerships for Parks is a nonprofit organization that focuses on recreation and sports,youth development, community improvement and capacity building, foundations, andphilanthropy. The organization focuses on Manhattan, Bronx, Queens, Brooklyn, andStaten Island. The nonprofit focuses on all age groups and low-income communities. Theorganization receives funding through donations, fundraising, government grants, privategrants, and nonprofit grants. Partnerships for Parks focuses on physical activity programsincluding walking groups, group fitness classes, recreational sports, water sports, andbicycling 21 to 30 days a month.They believe their physical activity programs are innovative. Partnerships for Parks andits Catalyst for Neighborhood Parks is a multi-year initiative, working in historicallyunder-served neighborhoods that galvanize support for and commitments to: physicalrenovations of the parks; sports, arts, and education programming; local parksstewardship; and collaborative work amongst the partners, including those between thecommunities and municipal agencies. Partnerships for Parks are currently working on aproject that the Department of Health and Mental Hygiene physical activity initiativewould be able to assist. For their project, they would need assistance accessing resourcesfor local groups, physical activity volunteers, and healthy programs for low-incomecommunities.May 27th 2011 Page 32 of 53
    • They are currently partnering with CityParks Foundation in its physical activityinitiatives.Partnerships for Parks is interested in partnering with the NYC Department of Health andMental Hygiene‟s physical activity initiatives, and would be able to offer fundingassistance, space, exercise supplies, support staff, and interns.Top Key RecommendationsWe recommend that the Department of Health and Mental Hygiene consider partneringwith the seven selected nonprofit organizations. Collaborating with nonprofits will allowthe DOHMH to receive support in its physical activity programming in the form ofindoor and outdoor space, funding opportunities, trainers, interns, equipment and otherresources.In addition, four out of the seven selected nonprofits have already implemented walkinggroups in their physical activity programming. We recommended that the DOHMHanalyze their practices and put them at the top priority of future partnerships.Also, as highlighted in our findings, the DOHMH can apply innovative components ofthe selected nonprofits to its own programming.Finally, five of the selected nonprofit organizations already collaborate with otherorganizations. We can learn from these partnerships and they can offer additionalconnections and resources for the DOHMH.May 27th 2011 Page 33 of 53
    • Deliverable V: Business Wellness SurveyIntroductionOur business wellness deliverable was created in order to develop possible partnershipsbetween private organizations and the Department of Health and Mental Hygiene.Fostering these partnerships is crucial for the DOHMH given that its physical activityprograms such as Shape-Up are subject to budget cuts. There must be secured capital forfunding, as well as interested parties to participate.Stressing the importance of good health and an active lifestyle should start where a largemajority spend most of their day, at work. Implementing an employee wellness programcan lower the overall cost of healthcare and increase the health of employees. Takinginitiatives to improve the health of employees can lower the amount of doctor visits theymake, lowering the cost of healthcare for businesses and lowering the amount of sickdays employees would take from work. Furthermore, when employees are healthy theirproductivity is bound to increase and improve. We took the initiative to understandwhether or not businesses throughout the South Bronx, Harlem, and Brooklyn alreadytake part in a business wellness program or would be interested in partnering with theDOHMH to establish such a program.MethodologyThe first step in this analysis was to develop a survey to measure the following: howmany companies offer full time employees health insurance, how many businesses arecurrently offering wellness incentives to their employees, and finally, how many of theseorganizations would be willing to partner with the DOHMH. It is important to determinethe rate of health insurance offered to full time employees as health insurance is the firststep to leading a healthy lifestyle.Examples of wellness incentives include: offering non-smokers breaks for exercise or toget fresh air, reimbursement or free gym memberships, and money for quitting smoking..While few businesses surveyed actually have these incentives in place, a large majority ofthe employees said they would participate in the programs if they were offered. The finalstep in our survey process was to determine how many private businesses would like topartner with the DOHMH on future endeavors. This response was about half, many ofthese companies already partner with other local businesses, but were not connected tothe NYC health community.The survey was conducted throughout the South Bronx, East Harlem, and CentralBrooklyn among 27 different businesses. These businesses included fast food franchises(ie. Taco Bell, Subway, Dominos), other franchises (ie. weight loss centers),independently owned establishments, and corporate chains.May 27th 2011 Page 34 of 53
    • Overall Findings70% of the 27 surveyed businesses offer their full time employees health insurance.4% offer wellness incentives to their employees in the form of reimbursements/free gymmemberships, or financial incentives to take the stairs instead of the elevator or escalator.89% of businesses reported that their employees would take advantage of wellnessincentives if they existed in their establishment.52% are interested in partnering with the DOHMH to establish a business wellnessprogram and/or offer incentives.15% are already partnered with local gyms, restaurants, and other businesses offeringincentives to their employeesBorough-to-Borough FindingsAll East Harlem and South Bronx businesses that we surveyed do not already partnerwith local businesses to offer incentives to their employees.4 out of 6 businesses in Central Brooklyn have partnered with local businesses.3 businesses in East Harlem, 6 in Central Brooklyn, and 5 in the South Bronx, out of the27 total surveyed businesses, are interested in partnering with the DOHMH to increasebusiness wellness programs and initiatives.May 27th 2011 Page 35 of 53
    • Top Key RecommendationsDevelop a generic partnership plan for any interested businesses wanting to team up withthe DOHMH to provide comprehensive business programs and initiatives for theiremployees.Encourage businesses to provide health insurance to all of their employees and providean informative database of affordable health insurance options.Become a liaison for businesses wanting to partner with other local businesses to provideemployees wellness incentives.May 27th 2011 Page 36 of 53
    • Deliverable VI: Grant Proposal to Fund Pilot ProgramEXECUTIVE SUMMARYGiven the increase in obesity rates in the United States and in New York Cityspecifically, the New School Practicum Team set out to determine the feasibility ofincreasing access to free or low-cost physical activity programs among three low-incomeneighborhoods, specifically East and Central Harlem, North and Central Brooklyn, andthe South Bronx. Through national and international comparative analyses, on-the-ground quantitative/qualitative surveying, research of applicable best practices, and anassessment of how to effectively operate a self-sustaining program without reliance oncity funds, the team has established several key recommendations on how best to carryout programming that will increase access for the three low-income neighborhoods notedpreviously. Recommending a six-month pilot program in East Harlem, a minimumparticipant goal of 1,800 participants has been established for the period, followed byroll-outs in Central Brooklyn and the South Bronx, subsequent to a period of performanceevaluation. By creating greater accessibility to physical activity programming not subjectto city budget cuts, persons residing in the communities in question will have theopportunity to participate in activities that will reduce the negative effects of anunhealthy lifestyle, thereby reducing health care costs over the long term. This grant willinclude: the organization mission statement; a thorough project description, both shortand long term goals which will also include methodology, the use of incentives, staffingprocedures, and potential partnerships with non-profit organizations. The grant will alsohighlight a budget proposal, timeline and project duration, and evaluation strategy.May 27th 2011 Page 37 of 53
    • STATEMENT OF NEEDData shows that regular physical activity can reduce obesity and obesity related illnesses,which are endemic in NYC. According to the Department of Health, over 42% of NewYorkers are overweight, while more than 700,000 have diabetes. Through programevaluation methods using surveys and assessments, it has been determined that walkinggroups are in fact feasible in the high-needs neighborhoods, as long as the programprovides incentives for participants. These programs can allow better health andincreased quality of life for people living in: the South Bronx, East and Central Harlem,and North and Central Brooklyn. As a result, we are expecting to see: reduced obesity-related illness within these communities, decreased dependence on medications, andfewer trips to the hospital. It is also likely that greater physical fitness and awareness willresult in overall lifestyle changes such as improved eating habits and greater mentalwellness. Our conclusions and basis for our project are based on best practices of currentprograms such as Walk It Out and Shape-Up. Having surveyed Shape-Up participants inthe formally mentioned neighborhoods, our data indicated that women ages 34-54 aremore willing to participate in walking groups. They are also demanding more physicalactivity programs, such as outdoor walking groups and are willing to pay an average of 5dollars to participate. The women we surveyed throughout the three boroughs mentionedhow effective programs such as Shape-Up are in relation to their fitness goals.Anecdotally, some also said that they have seen greater results from these classes thanthey could ever get from a gym: “I lost 20 pounds since I began the Shape-Up program inOctober” said one of the participants. Unfortunately, because of a lack of space, theseclasses are unable to meet the demands of the participants. In East Harlem, women standin line for over an hour to receive an entry ticket, and some even fight for a spot in line. Itis critical that the DOHMH establish new programs to fit the demands of the public, aswell as continue to provide support for current physical activity programs. Without theestablishment of walking groups or other physical activity programs, the DOHMH‟s goalof reducing the impact of obesity will fail.May 27th 2011 Page 38 of 53
    • ORGANIZATION MISSION STATEMENTThe New York City Department of Health and Mental Hygiene (DOHMH) is one of theoldest health departments in the nation. The DOHMH stands out among local healthdepartments in its level of commitment to, and its activities in chronic disease preventionand control. Recent domestic and internationally progressive initiatives include theintroduction of regulations that ban trans fats and that require calorie labeling in NYCrestaurants.The DOHMH is also involved in active living through addressing opportunities for dailyphysical activity through environmental change. Initiatives include both Take the StairsCampaign, as well as Active Design Guidelines, which were launched in January 2010(www.nyc.gov/adg). Additionally the District Public Health Offices of DOHMH, focusagency resources in the three poorest communities in New York City, and seek to reducethe gaps in health between these and other NYC neighborhoods.PROJECT DESCRIPTIONGoals and ObjectivesShort Term Outputs That the implementation of walking groups and activities will engage/interest community members. The goal is to maintain an excellent turnout, which will be measured by a minimum of 25 people per walking group; a total of 75 participants per week. In the six-month period of the pilot program in East Harlem, we will expect a minimum of 1,950 participants in a total of 78 classes to consider the program as successful before rolling it out to the other high-needs neighborhoods: Central Harlem, East and Central Brooklyn, and the Bronx. Community members will play an active role in the walking group programs. Partnering with Universities such as Columbia, NYU, and the New School, will allow students to lead the walking groups, which will create room for community leadership, ties, and intergenerational interaction.May 27th 2011 Page 39 of 53
    •  The financial component to the classes will motivate and interest community members to take part in the walking groups. We would keep the walking group at no- cost to the individual, while also providing a loyalty program through the use of incentives such as: heart rate monitors, pedometers, jump ropes, t-shirts, water bottles etc., to keep participants engaged and interested.Long Term Outputs: The walking group will roll-out into all high-needs neighborhoods These programs will be self-sustaining, and sustained through private-public partnerships with nonprofit organizations. Classes and activities will continue to operate at low-or-no-cost. The activities will have a high-turnout rate with more individuals in the community engaging in walking groups; they will reduce BMI and blood pressure levels. Obesity, and obesity related illnesses will have decreased in the high-needs neighborhoods by a minimum of 20%.MethodologyThe walking group pilot program will target female participants ages 34-54, and will takeplace from April 1st – October 31st 2012 for a six-month duration. In Year 1, the pilotprogram will first commence in East Harlem due to the great demand, turnout andfeedback received from surveyed participants attending Shape-Up classes within thisneighborhood. Evaluation and monitoring will occur throughout the entire pilot program(April 1st – October 31st 2012), and will extend for 2 months (November-December 2012)after the end date in order to ensure that data is collected and analyzed effectively.Success will be measured by: the number of participants who attend walking groups andthe percentage of those who lower their BMI, and blood pressure. In year 2 (2013), afterdetermining the program‟s success through thorough evaluation, walking groups willthen be replicated in Central Brooklyn. In year 3 (2014), if the program continues toshow growth and success, walking group programs will be implemented throughout all ofMay 27th 2011 Page 40 of 53
    • NYC‟s high-needs communities, which include Central Harlem, North and CentralBrooklyn and the South Bronx.Sessions:Walking group sessions will be held 3 days a week: Monday/Wednesday/Friday from9:00am – 10:00am. We expect a minimum of 25 participants per walking group. The 60-minute session will include 10 minutes of stretching prior to 40 minutes of walking, andanother 10 minutes of cooling down and stretching to avoid injury.Incentives:As a means to keep participants engaged in these activities, we will provide a loyaltyprogram which will include incentives to attend the walking groups. On an individualsfirst time attending a walking group, they will receive a T-shirt, which will also act asfree advertisement. Day 5, they will receive a water bottle, day 10 – a pedometer, day 20– jump ropes, day 30 – heart rate monitor, day 40 – blood pressure cuffs, etc.Personnel:Personnel include the following: monitoring and evaluation coordinators, focus groupleaders, facilitators, and walking group leaders. Through the evaluation of best practices,we have determined that we can lower our costs by collaborating with NYU, Columbia,and the New School Universities public health departments for student volunteers andinterns. Student volunteers will be trained and certified in CPR and first aid to becomewalking group leaders. Student interns can work as monitoring and evaluationcoordinators, focus group leaders and facilitators for academic credit. Through the use ofstudent volunteers, we also expand community ties, and intergenerational activity. Ifstudent volunteers are determined to not be feasible due to liability issues, we will thenhire certified trainers at $100 an hour.May 27th 2011 Page 41 of 53
    • Potential partnerships with nonprofits: The following table (Table 1) presents the nonprofit organizations that are currently interested in partnering with the DOHMH to implement walking groups, and who can provide support through staff, incentives, venue, data, etc. Table 1: Possible Partnerships with Non-Profit Organizations Non-Profit Contact About the Organization Their interest What they canOrganization Name: provide in Email: partnering with Phone: the DOHCHALK at New Stephanie Pitsirilos-Boquin Focuses on health care CHALK focuses on Would be able toYork- chalk@nyp.org including hospitals, mental physical activity offer fundingPresbyterian 212-305-2771 health, and medical research programs, particularly on assistance, interns,Hospital This organization receives group fitness classes, and exerciseColumbia funding through government recreational sports and supplies (jumpUniversity grants family fitness ropes, balls,Medical Center pedometers).Northern Maria Guevara Focuses on human services Currently does not focus Would be able toManhattan Nmpp_chwp@yahoo.com in Manhattan. This on physical activity offer spacePerinatal 212-289-8800 organization focuses on programming but are including indoorPartnership, Inc. ages thirteen and up, in low- interesting in and outdoor space. income communities. They implementing physical currently receive funding activity programming. from government grantsFort Tryon Park Nancy Bruning Fort Tryon Park Trust is a Focuses on physical Would like to haveTrust nbruning@aol.com nonprofit that focuses on activity programming help distributing 646-318-8544 recreation and sports, and and focuses on walking the 15-minute community improvement groups and group fitness video, "101 Things and capacity building in classes to Do on a Park Manhattan. The Bench", and would organization focuses on all also be able to age groups and low income offer support communities. The staff(trainers, organization receives instructors) space funding through donations, including indoor fundraising, government and outdoor space. grants, private grants, and non-profit grants. May 27th 2011 Page 42 of 53
    • Randall’s Island Laurence Vargas Focuses on recreation and The physical activity Would be able toSports Laurence.vargas@parks.nyc.go sports in Manhattan, Bronx, programming focuses on offer outdoor spaceFoundation v and Queens. This walking groups, group during the 212-860-1899 organization focuses on fitness classes, weekdays before physical activity recreational sports, water 3pm. They need programming for all ages. sports, and bicycling outreach and Randall‟s Island Sports funding from the Foundation receives funding department of from donations, fundraising, health to assist government grants, income their physical generating activities, private activity grants, and nonprofit grants programming.Mount Sinai Perry Sheffield Focuses on health care in Focuses on walking Would be able toSOM/Little Perry.sheffield@mssm.edu Manhattan, Bronx, groups, recreational offer fundingSisters of the 212-241-2265 Brooklyn, and Staten Island. sports, and after school assistanceAssumption The organization focuses on activities for children. ages 0 to 19 in low income communities. The organization earns funding through donations, government grants, and private grantsFC HARLEM Irvine Smalls Focuses on recreation and Focuses on physical Would be able to Irv.smalls@fcharlemlions.org sports in Manhattan. The activity programming offer funding 917-572-1994 organization earns funding especially recreational assistance, space, through donations, sports 1 to 10 days a exercise supplies, fundraising, and week support staff, and government grants internsPartnerships for Carlos Martinez Focuses on recreation and Focuses on physical Would be able toParks-Catalyst Carlos.Martinez@cityparksfou sports, youth development, activity programs offer fundingProgram ndation.org community improvement including walking assistance, space, 212-788-8067 and capacity building. The groups, group fitness exercise supplies, organization focuses on classes, recreational support staff, and Manhattan, Bronx, Queens, sports, water sports and interns. Brooklyn, and Staten Island. bicycling 21 to 30 days a The nonprofit focuses on all month. age groups and low income communities. The organization receives funding through donations, fundraising, government grants, private grants, and nonprofit grants. May 27th 2011 Page 43 of 53
    • TIMELINEPROJECT DURATIONTable 2: Timeline for East Harlem Walking Group Pilot ProgramTimeline NarrativeDonor prospecting will take place from June – August of 2011. Once a list of fundingcandidates is compiled, grant proposals outlining the pilot program will be sent out todonors from September – December of 2011. Training instructors and personnel as wellas community outreach should run from January through April of 2012. The goal is tobegin the pilot program in East Harlem on April 1st of 2012 until October 31st of the sameyear, totaling 6 months. Evaluation and monitoring will occur throughout the entire pilotprogram (April 1st – October 31st 2012) and will extend for 2 months (November –December) after the end date in order to ensure that data is collected and analyzedeffectively. If the pilot program is successful, we recommend that the program bereplicated in Central Brooklyn in 2013. In Year 3 (2014), the program will beimplemented in all of NYC‟s high-needs communities, which includes East and CentralHarlem, North and Central Brooklyn, and the South Bronx.May 27th 2011 Page 44 of 53
    • BUDGET We are requesting $1.2 million over a three-year period. Budget: Walking Group Pilot Program East Harlem April - October Mon/Wed/Fri 9AM - 10AM Table 3: Budget with Student Volunteers SCENARIO ATYPE OF QTY AMOUNT REASON FOR EXPENSEEXPENSEEQUIPMENT $5,860Safety: First Aid Kit 1 $60 Volunteer trained instructor will carry a first aid kit while conducting the walking group should the need arise to provide care to a participantIncentives: Water Bottles 200 $800 Best practice shows that an incentive must be offered to drive participation; Start- T-Shirts 200 $1,000 up volume purchased will be minimal; Incentives used in the form of a “frequent Pedometers 200 $4,000 buyer or loyalty program”; participation will be tracked with every 5th visit awarded with an incentive to continue. Variety of incentives to be widened to include gift certificates and savings at neighborhood drug stores and supermarketsPERSONNEL --Certified instructor 1 -- In accordance with best practices, all personnel will be providing their servicesM&E coordinators 2 -- pro bonoFocus group leader 1 --Creative designer 1 --TRAVEL $1,560Instructor RT MTA 1 metro card $390 In accordance with best practices, all personnel will receive reimbursement forM&E RT MTA 2 metro cards $780 their MTA subway expenditures; Assumes $5 round-trip, 3x/week over 26 weeksFG leader RT MTA 1 metro card $390MARKETING/ $20,000COMMCreative -- -- Assumes creative will be provided pro bono; Social media (Facebook, Twitter,(logo/messaging) YouTube, targeted blogs), will be absorbed by the nonprofit staff or intern; PrintOnline Social Media -- -- advertising, using the creative, must be carried out to drive awareness of thePrint Advertising $20,000 walking groups and spur participationTOTAL $27,420 We will ask for $30,000 per borough for the 6 month program May 27th 2011 Page 45 of 53
    • Budget: Walking Group Pilot Program East Harlem April - October Mon/Wed/Fri 9AM - 10AM Table 4: Budget with Paid Staff and Trainers SCENARIO BTYPE OF QTY AMOUNT REASON FOR EXPENSEEXPENSEEQUIPMENT $5,860Safety: First Aid Kit 1 $60 Volunteer trained instructor will carry a first aid kit while conducting the walking group should the need arise to provide care to a participantIncentives: Water Bottles 200 $800 Best practice shows that an incentive must be offered to drive T-Shirts 200 $1,000 participation; Start-up volume purchased will be minimal; Incentives Pedometers 200 $4,000 used in the form of a “frequent buyer or loyalty program”; participation will be tracked with every 5th visit awarded with an incentive to continue. Variety of incentives to be widened to include gift certificates and savings at neighborhood drug stores and supermarketsPERSONNEL $7,800Certified instructor 1 $7,800 In the event a volunteer certified instructor cannot conduct the walkingM&E coordinators 2 -- groups, a certified instructor will require payment; this figure assumes aFocus group leader 1 -- high of $100/hour, 3x/week over 26 weeksCreative designer 1 --TRAVEL $1,560Instructor RT MTA 1 metro card $390 In accordance with best practices, all personnel will receiveM&E RT MTA 2 metro cards $780 reimbursement for their MTA subway expenditures; Assumes $5 round-FG leader RT MTA 1 metro card $390 trip, 3x/week over 26 weeksMARKETING/COMM $20,000Creative (logo/messaging) -- -- Assumes creative will be provided pro bono; Social media (Facebook,Online Social Media -- -- Twitter, YouTube, targeted blogs), will be absorbed by the nonprofitPrint Advertising $20,000 staff or intern; Print advertising, using the creative, must be carried out to drive awareness of the walking groups and spur participationTOTAL $35,220 We will ask for $40,000 per borough for the 6 month long program May 27th 2011 Page 46 of 53
    • EVALUATION METHOD  Monitoring and evaluation will measure two key performance indicators: Awareness among the residents of the presence of walking groups and its features in the immediate neighborhood  The degree to which participating in the walking group is reducing Body Mass Indices Table 5: Are marketing tools informing the population and participants about the benefits of walking groups? Proposed Indicator Target Definition Recommended level Participant knowledge of the Percentage of peoplebenefits physical activity such as who know about walking groups can provide in Women ages 34-54 walking groups and Minimum: 75% terms of improving overall can identify at least 1 health, and reducing obesity benefit CalculationNumerator Number of survey respondents who are aware of walking groups and can identify at least one benefit – multiplied by 100Denominator Total number of respondents (Goal is minimum of 1,800 over six-month period) May 27th 2011 Page 47 of 53
    • Table 6: Is the program effectively lowering participants Body Mass Index Proposed Indicator Target Definition Recommended level Proportion of Minimum: participants who haveLower self-reported BMI as a result Women ages 34-54 self-reported BMI of 20% of participants of adherence and participation in 25 or below seeing results and walking groups lower BMI CalculationNumerator Total number of participants on April 1st 2012 – multiplied by 100Denominator Total number of participants on October 31st 2012 Evaluation Method Narrative Measuring awareness of the walking group will provide the non-profit organization, with insight into how effectively they are targeting the core constituency, and how much reach they are achieving within the target constituency. Additionally, this indicator will evaluate the clarity of messaging and the appropriateness of the branding, both of which will play a crucial role in driving participation. Finally, an awareness indicator will provide insight into how well the overall value proposition is being messaged to and interpreted by the target constituency. For example, the incentive package, the physical benefits of participation, and the psychological benefits of participation must all be taken into account to determine what is driving attendance or lack thereof. May 27th 2011 Page 48 of 53
    • Measuring self-reported BMI will provide insight into how beneficial the walking groupsare to achieving a loss in weight. By providing participants with a pre/post report of theirBMI, participation in the walking groups could grow through word-of-mouth referrals,while demonstrating to attendees that regular physical activity in a walking group,coupled with their commitment to a balanced diet, provides them with a credible weightloss and disease-reducing solution.The timeline for the pilot program indicates a six-month pilot, with monitoring activitiestaking place simultaneously. The timeline takes into account a two-month post-evaluationperiod, where number of attendees (unique and returning), awareness of programming,and resulting BMI‟s will be analyzed. Should the metrics indicate a success, roll-out forCentral Brooklyn will follow in January 2013 with a similar cycle of monitoring andevaluation. Roll-out for the South Bronx would follow in 2014 provided the metrics fromEast Harlem and Central Brooklyn indicate strong performance.May 27th 2011 Page 49 of 53
    • REFERENCESI: Comparative Analysis of Physical Activity Programs Referencesi "WHO Global Infobase: Country Profiles." Web. 30 Mar. 2011.<https://apps.who.int/infobase/CountryProfiles.aspx>.ii "ObEpi 2003 Lobesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 1iii Rosenthal, Elisabeth. "Even the French Are Fighting Obesity." The New York Times. 4May 2005. Web. <http://www.nytimes.com/2005/05/03/world/europe/03iht-obese.html>.iv "ObEpi 2003 Lobesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 1v "ObEpi 2003 Lobesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 1vi "ObEpi 2003 Lobesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>. pg 2vii "ObEpi 2003 Lobesite Et Le Surpois En France." Dossier De Presse. Roche, 17 June2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>.viii Rosenthal, Elisabeth. "Even the French Are Fighting Obesity." The New York Times. 4May 2005. Web. <http://www.nytimes.com/2005/05/03/world/europe/03iht-obese.html>.ix Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Optionsfor Responding to the Growing Challenge from Obesity in France: Findings from thePorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing ServiceSelection Page. 2007. Web. 26 Mar. 2011.<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 1x Bouges Tes Fesses." Prete Moi Paris. Web.<http://pretemoiparis.com/2010/12/07/bouges-tes-fesses/>.xi "Barometre Sante Nutrition 2008." Barometres Sante. INPES. Web. 29 Mar. 2011.<http://www.inpes.sante.fr/barometre-sante-nutrition-2008/pdf/activite-physique.pdf>xii Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Optionsfor Responding to the Growing Challenge from Obesity in France: Findings from thePorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing ServiceSelection Page. 2007. Web. 26 Mar. 2011.May 27th 2011 Page 50 of 53
    • <http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 1xiii "Eco-Sante OCDE 2010 Comment La France Se Positionne." OCDE. Web. 28 Mar.2011. <http://www.oecd.org/dataoecd/45/20/38980771.pdf>. pg 1xiv Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Optionsfor Responding to the Growing Challenge from Obesity in France: Findings from thePorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing ServiceSelection Page. 2007. Web. 26 Mar. 2011.<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 2xv Holdsworth, M., Y. Kameli, and F. Delpeuch. "Stakeholders Views on Policy Optionsfor Responding to the Growing Challenge from Obesity in France: Findings from thePorGrow Project." Obesity Reviews 8 (2007): 53-61. EBSCO Publishing ServiceSelection Page. 2007. Web. 26 Mar. 2011.<http://web.ebscohost.com/ehost/pdfviewer/pdfviewer?vid=9&hid=127&sid=5881b826-92ba-4240-ae84-d7b039791975@sessionmgr110>. Pg 2xvi "EPODE - Together Lets Prevent Childhood Obesity." European Public HealthAlliance. Web. 26 Mar. 2011. <http://www.epha.org/a/3149>.xvii "EPODE - Together Lets Prevent Childhood Obesity." European Public HealthAlliance. Web. 26 Mar. 2011. <http://www.epha.org/a/3149>.xviii "Consultation Ouverte Pour Preparer Ensemble Le PNNS." Société Française DeSanté Publique. Web. 28 Mar. 2011.<http://www.sante.gouv.fr/IMG/pdf/Consultation_ouverte_sur_le_site_de_la_Societe_Francaise_de_Sante_Publique_SFSP_pour_preparer_ensemble_le_PNNS-_Restitution_des_propositions_et_actions_-_Automne_2010.pdf>.Google Translate. Web. 30 Mar. 2011.<http://translate.google.com/translate?hl=en&sl=fr&tl=en&u=http://www.mangerbouger.fr/bouger-plus/espace-vitalite/bouger-c-est-facile.html>. pg 10AFP. (2009, December 21). Taiwan „considering world‟s first junk food tax‟. RetrievedFrom<http://www.google.com/hostednews/afp/article/ALeqM5hDETMvo0Cr0qUIGrWiiX4hz3OPIw>Chu, N.F. (2005). Prevalence of obesity in Taiwan. Obesity Reviews, 6, 271-274.International Association for the Study of Obesity. (2011). Obesity prevalenceworldwide. Retrieved from http://www.iaso.org/May 27th 2011 Page 51 of 53
    • Lei, L. & Yue, T. (2011, February 25). Population urged to exercise more. China Daily. Retrieved from http://www.chinadaily.com.cn/china/2011-02/25/content_ 12075220.htmLiang, G. & Hornby, L. (2009, October 22). China‟s elderly find life and joy in exercise. Reuters. Retrieved from http://www.reuters.com/article/2009/10/22/us-china- elderly-idUSTRE59L0R620091022Taipei Times. (2011, February 8). DOH launches campaign to trim nation‟s waistline. Retrieved from http://www.taipeitimes.com/News/taiwan/archives/2011/02/08/ 2003495365/1Taiwan Review. (2009, January 3). The Walk of Life. Retrieved from http://taiwanreview.nat.gov.tw/site/tr/ct.asp?xItem=48269&CtNode=1337&mp=1II: Walking Group Feasibility Case Study Referencesxix The Earth Institute, Columbia University, Urban Design Lab. C.L.I.M.B (City Life isMoving Bodies), 155 Street. Web.<http://www.urbandesignlab.columbia.edu/?pid=climb>xx Metropolitan Waterfront Alliance. City Life is Moving Bodies.CLIMB<http://www.waterfrontalliance.org/partners/city-life-moving-bodies-climb>xxi The Earth Institute, Columbia University, Urban Design Lab. C.L.I.M.B (City Life isMoving Bodies), 155 Street.Web.<http://www.urbandesignlab.columbia.edu/?pid=climb>xxii CLIMB Handout. Web.<http://stnicholaspark.files.wordpress.com/2009/05/climb-handout-update-3-31-08.pdf>xxiii IOBY New York City. Hike the Heights 2011. Web.https://ioby.org/project/hike-heights-2011xxiv Lourdes J. Hernández-Cordero, interview held over the phone, New York, New York,May 3, 2011xxv Carla Zanoni, DNA.info, Annual Hike the Heights‟ Provides a Breath of Fresh Air forNorthern Manhattan Residents, 7 June 2010< http://ec2-174-129-17-40.compute-1.amazonaws.com/20100607/manhattan/annual-hike-heights-provides-breath-of-fresh-air-for-northern-manhattan-residents>May 27th 2011 Page 52 of 53
    • xxvi Lourdes J. Hernández-Cordero, interview held over the phone, New York, New York,3 May 2011xxvii NYC.gov. Harlem Hospital Center, Press Release, 21 July 2010<http://www.nyc.gov/html/hhc/harlem/html/news/press-hiphop-education.shtml>xxviii NYC.gov. Harlem Hospital Center, Press Release, 21 July 2010<http://www.nyc.gov/html/hhc/harlem/html/news/press-hiphop-education.shtml>xxix Monique Hedmann, interview held over the phone, New York, New York, 5 May2011xxx Monique Hedmann, interview held over the phone, New York, New York, 5 May2011xxxi SAGE. Mission Statement. Web.<http://www.sageusa.org/about/index.cfm>xxxii Monique Hedmann, interview held over the phone, New York, New York, May 5,2011xxxiii Monique Hedmann, interview held over the phone, New York, New York, May 5,2011xxxiv New York City Department of Parks and Recreation, Walk NYC<http://www.nycgovparks.org/sub_things_to_do/programs/walk_nyc.html>xxxv New York City Department of Parks and Recreation. The Daily Plant. Volume XXV,Number 5233, 7 July, 2010. Web.<http://www.nycgovparks.org/sub_newsroom/daily_plants/daily_plant_main.php?id=22212>xxxvi John Falzon, interview held at the Thomas Jefferson Park Recreation Center, NewYork, New York, 16 April 2011xxxvii John Falzon, interview held at the Thomas Jefferson Park Recreation Center, NewYork, New York, 16 April 2011May 27th 2011 Page 53 of 53