community contribution to solving existing problem

Childhood obesity is a common problem. It has a relationship with short and long-term adverse outcomes. It affects ethnic/racial minority and children who are deprived economically and disproportionately. There is no doubt that it is a great threat to public health. Multi-sector and multilevel prevention and management strategies are the best touted for resolving the problem (Taveras, et al., 2015).

Obesity and overweight rates among black and Latino girls in high school and women in Boston are alarmingly high. Black men have been reported to indicate the highest rates of obesity. Although there is no data on the number of children affected in Boston, the national statistics show that Latino and black children show significantly high rates at a relatively early age. It is expected that the trend is the same in Boston city. The populations highlighted not only demonstrate higher incidence of both adult and childhood obesity, but has also been observed to worsen faster than its prevalence among white communities (Ferrer, 2012).

A third of all students in public high schools in Boston showed a BMI that was regarded as either overweight or obese. On the other hand, when the same measurements focused on racial ethnic groups, 35% of Latino and black students weighed above recommended levels and qualified as overweight or obese. The figure among white students was at a lower rate of 27%. Over half of all adults in Boston are either overweight or obese. Still, 3% of black adults and 61% of Latinos had overweight BMI scores as compared to the 49% that represented white adults (Ferrer, 2012). A study conducted in Boston showed that parents who were given fitness and health status reports were nearly twice more likely to accept the truth about their child's overweight problems. This was not the trend among parents who hadn't been made aware of their weight status. The ones who had received the health reports were twice more likely to pursue some kind of weight control program for the benefit of their children who were overweight.

A lot of the community run programs in Boston have directed their attention to interventions made at individual level. These interventions primarily aim at influencing knowledge, behaviors and attitudes. With time, these programs need to adopt strategies that deal with the community, interpersonal and societal influencing elements of transmission of disease and health, in general. They should seek to understand how poverty and racism have limited opportunities for a lot of people among those most affected by these realities in making pro health choices. They need to see how these factors have contributed to worse health outcomes for a huge number of blacks in Boston. Their health is affected by residential areas, the type of jobs, awareness on the level of risk, and access to support systems and resources. It is therefore critical that Boston's public health initiatives confront these wider contexts and realities (Kar, Dube, & Kar, 2014). One of the options to consider is to cut down on the sale of foods that qualify as junk foods in restaurants within neighbourhoods by zoning embargoes. They should primarily target convenience stores located in high density neighbourhoods that have been observed to show poor health outcomes. They can alternatively engage existing convenience stores to sell foods that are healthier (Kar, Dube, & Kar, 2014).

Lower social and economic position is strongly linked to high disease rates of various types, comparatively short life spans and poorer health, generally. The narrative also holds true for obesity. The varying social, economic, educational and environmental conditions account for these inequalities to a large extent. Additional emotional and physical stress in racially segregated neighbourhoods and housing, healthcare services that tend to discriminate against the vulnerable groups, lower paying jobs, attending schools that are poorly funded and equipped, not being part of the dominant culture and the ever-present racial signals that undermine people's self-esteem in social interactions have all added to the burden of overweight and obesity through a series of interrelated physiological and emotional reactions.

Hormones released as a result of excessive stress, generate fat that accumulates around the waist area. These occurrences increase one's chances of developing diabetes and heart disease (Kar, Dube, & Kar, 2014).

The success in preventing and fighting obesity among youths and children depends on community involvement. The efforts must transcend individual, family and even geographic boundaries to include groups and institutions (Pate et al., 2000). The need for community involvement in the improvement of health outcomes has caught the eye of many leaders, experts and opinion shapers. These experts have emphasized on the need to make use of naturally occurring setups, strengths, social structures and capacities of the local communities to stir positive change in health (Koplan, Liverman, & Kraak, 2005).

Studies in cardiovascular risk factors have demonstrated the effectiveness of using community-based strategies to gain positive health outcomes. The change agents in these studies have been focused on encouraging communities to embrace better nutrition and pursue physical activity. The awareness campaigns have used a range of strategies, including community mobilization, media campaigns, educational workshops and programs for professionals in the health sector and members of the public. Other useful strategies have included changing health screening, referrals and changing of physical environments for the affected individuals. In some areas, school based intervention measures were also included (Koplan, Liverman, & Kraak, 2005).

Community focused programs for youth and children: Programs that involve CBOs have been observed to assist in health promotion campaigns. Studies relating to civic, faith based and social organizations have laid the feasibility of developing programs on a wide range of settings that work to improve the nutritional choices and knowledge. They also increase the rate of physical activity and occasionally help to reduce body weight or just maintain a healthy body weight (IOM, 2003). In a study conducted by Cullen and Colleagues (1997), it was found that girl scouts who took part in their troop in nutrition classes, which included sessions for tasting and the materials subsequently sent home showed higher levels of vegetable and fruit consumption. In addition, community focused programs target high risk population groups and provide the opportunity to implement interventions that are culturally appropriate, including evaluating their impact (Yancey et al., 2004).

Community Coalitions: In order to build coalitions, organizations in both the public and the private sector must be involved. These entities collectively focus on the target and utilize resources between and within them to help via joint actions. It has been observed that while coalitions are effective in mobilizing towards working for the purpose of change, they are not meant to manage any specific activities or services for the community (Chavis, 2001).

There is no doubt that collaborative interest is gaining ground in the US. There are various models being developed for the purpose of interlinking the various stakeholders, including universities, research agencies, professionals and other similar outfits (Lasker et al., 2001; Lasker and Weiss, 2003).

BPHC has put lots of effort in finding ways to reduce obesity rates, particularly in low income localities and black communities. The work is spearheaded by initiatives within the Chronic Disease Prevention and Control Division (CDPC). There are several policies and programs at city level that involve BPHC. Many of these can also be used in Boston to prevent obesity. Some of these include the Mayor's Food Council, a multi-sector initiative that promotes healthy eating and fights against hunger in Boston. There are markets for farmers being spread across the city. The authorities have also made sure that food stamps can be used with ease at the markets. There is also an initiative named Boston Bounty Bucks. It is meant to enhance the buying power of food stamps for low income earners and WIC participants at the farmers markets by matching the purchases they make by a maximum of $10 in added funds (Mair, Pierce, & Teret, 2005).

BPHC center for health, Equity, and social Justice along with the Boston Collaborative for Food and Fitness have supported farmer's markets by giving food access grants to several community organizations in Boston. CDPC on its part coordinates nutrition awareness programs and the weekly markets for farmers (Taveras E. M., 2010).

Bicycling is also supported by BPHC through the Boston Bikes program; an initiative of the Mayor. BHPC supports community events and bike safety too via the Injury Prevention Program and the Operations Department. Several interventions have been launched and continue to be launched by these coalitions that target high risk and communities that have limited resources. Some of these interventions include:

The Sugar-Sweetened Beverages Campaign: It is an effort to discourage consumption of sugar filled beverages such as sodas, juices and sweetened water.

Active Living & Transit Initiative: It is aimed at increasing opportunities for biking and walking. Programs such as the bike sharing program of the city are meant to support the initiative by making it practical. There are youth bike training programs and even distribution of low cost helmets and bikes. The complete Streets initiative is meant to sensitize the stakeholders on the need to provide equal rights and treatment to all these forms of transport as a way of promoting healthy transportation alternatives. Other efforts tied in the initiative include increasing green space by planting more trees and providing resting benches in public places. BPHC has also launched programs that target low income localities using grants channeled to local community organizations that support biking, walking and prevention of violence efforts (Hatsu, McDougald, & Anderson, 2008).

"Grow Your Own Initiative": it focuses on promoting fruit and vegetable access and consumption by encouraging people to establish backyard gardening and community horticulture. They seek to establish a greenhouse that measures 10 000 square feet. They aim at supporting families on food production in the neighbourhood.

School Interventions: There are ongoing initiatives to enhance physical education programs and physical activity initiatives. Fitness testing are then conducted to monitor the improvement rates (Kar, Dube, & Kar, 2014).

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