Cutting Fat with Coordination
SOURCE: AP/Rogelio V. Solis
First Lady Michelle Obama recently unveiled the nationwide Let’s Move campaign that aims to reduce childhood obesity. Its goal is ambitious. Let’s Move strives to ensure that within one generation the one-third born today who now become obese will instead reach adulthood at a healthy weight.
The Let’s Move campaign believes it can reach its goal of eliminating childhood obesity by advancing four different priorities: helping parents make healthy family choices; serving healthier food in schools; expanding access to healthy, affordable food in all communities and neighborhoods, including low-income ones; and increasing physical activity.
What makes this initiative unique is that it requires interagency coordination. Government agencies typically operate in silos, so when a government policy falls under the jurisdiction of multiple agencies, the execution of such a policy presents a challenge to the normal patterns of coordination and communication.
Despite the challenge, the administration has already begun smart efforts to enlist a wide variety of federal agencies—sometimes working together and sometimes working on their own—to advance those priorities.
The administration proposed as part of the president’s proposed fiscal year 2011 budget, for example, a new Healthy Food Financing Initiative. The program is a partnership between the U.S. Departments of Treasury, Agriculture, and Health and Human Services that would invest $400 million a year to help bring grocery stores to underserved areas and help smaller food vendors such as convenience stores and bodegas carry healthier food options. If Congress supports and the administration implements the initiative, the agencies would have the following roles:
- The Treasury Department would support private-sector financing for the program through the New Markets Tax Credit and financial assistance to Treasury-certified community development financial institutions.
- The Department of Agriculture would support public and private investments in the form of loans, grants, promotion, and other programs that can provide financial and technical assistance to enhance access to healthy foods in underserved communities, expand demand and retail outlets for farm products, and increase the availability of locally and regionally produced foods.
- The Department of Health and Human Services would dedicate Community Economic Development program funds to award competitive grants to Community Development Corporations to support projects that finance grocery stores, farmers markets, and other sources of fresh, nutritious food.
These are vital first steps, but federal agencies and nongovernment partners will have to do more. They will need to overcome the implementation challenges posed by the interagency quality of these efforts to succeed.
It isn’t always easy to surmount solidified agency jurisdictions. I worked during the Clinton administration with Secretary of Agriculture Dan Glickman who, with strong backing from the White House, launched a unique initiative that involved public-private partnerships and spanned various federal agencies. The Food Recovery and Gleaning Initiative increased the amount of excess wholesome food donated to feeding charities from restaurants, farms, cafeterias, and food manufacturers. The broader Community Food Security Initiative grew out of that effort and built partnerships between the federal government and nonprofit groups, businesses, and communities to reduce hunger and increase local food self-reliance. I also worked on cross-agency initiatives to promote the AmeriCorps national service program and boost volunteerism.
While coordinating the Community Food Security initiative, I learned that at least five different USDA agencies had responsibility for fostering farmers markets in the Department of Agriculture alone. Many employees from the varied agencies working on farmers markets had never even met each other, much less worked together collaboratively. But we began to improve how they jointly carried out their missions by starting to bring them together for common purpose in a joint task force that produced a comprehensive community food security action plan that included specific roles for all the relevant agencies.
Governmentwide operations may be complex, but they are not impossible. These strategies can help the Obama administration find success in moving forward with its interagency obesity initiatives:
1) The White House should ask agencies to develop concrete, measurable, and time-certain goals that advance both the presidential initiative and the agency’s main mission. The White House Domestic Policy Council, the White House of Cabinet Affairs, and the Office of Management and Budget should work together to hold the agencies accountable for achieving those goals in a timely manner.
2) Each agency head should appoint one person with serious authority to act on his or her behalf to implement the initiative across divisions of that agency. That person should be senior enough to have real authority, but not be so high as a deputy secretary who may not have enough personal time to devote to the issues.
3) The White House should convene monthly meetings and site visits with agency point people. Rather than having every meeting at the White House, the meetings should rotate by agency location, and each host agency should be asked to make a presentation and/or show a site to demonstrate how they are advancing the initiative. Civil servant program managers—not just political appointees—should be included in the meetings. Agencies should consistently send the same attendees to the meetings.
4) The White House should prioritize collaboration between related presidential initiatives. Obesity and hunger are flip sides of the same malnutrition coin, and the president has pledged to end U.S. child hunger by 2015 as a first step toward ending all hunger in America. The administration’s Let’s Move initiative and its antihunger efforts should therefore work hand-in-hand to make more nutritious foods both economically affordable and physically available in low-income neighborhoods. The administration should ensure that its United We Serve initiative to promote volunteerism and national service includes a special focus on community-based obesity prevention efforts.
5) Agencies should check their egos and turf at the door. Agencies’ top consideration should be what’s good for the American people, not what’s good for the agency. Agency heads should lead by example by working cooperatively with their peers and giving strict orders for all their staff to do so as well.
6) The White House’s Congressional Affairs, Intergovernmental Affairs, Public Engagement, Communications, and Faith-Based and Neighborhood assistance functions as well as all participating agencies should be intimately engaged in every part of the initiative. Staff from all those functions should be involved in key meetings so everyone is on the same page with message and outreach. But staff with content expertise must remain responsible for decisions that substantively implicate policies and programs.
7) Key congressional leadership and staff—particularly for each agency’s authorizing and appropriations committee—must be involved in the process early and fully. It is vital to help Congress understand that the proposed activities enhance and don’t drain resources from the main mission of the agency they are overseeing.
Perhaps the most important overarching lesson is that success for all such efforts hinges largely on the buy-in of rank-and-file civil servants who are tasked with carrying out each initiative. Only about 3,500 of the roughly 2 million civilian federal employees are political appointees selected by the president—that’s about 0.2 percent.
If a presidential initiative is perceived by the bureaucracy as mostly public relations fluff that provides agency leaders with opportunities for photo ops, it will earn only tepid support from the bureaucracy. But if an effort has serious leadership, resources—even existing resources that are re-directed specifically to aid an initiative—and is charged with the implementation of programs that also help meet that agency’s core mission (as seems to be the case with the Let’s Move), such initiatives will stand a stronger chance of achieving the buy-in of federal employees whose support is necessary to ensure success.
Substantive overlap between an agency’s jurisdiction and a presidential initiative is, in my experience, critical to obtaining agency buy-in. A presidential initiative will likely fail if it creates more work for an agency without helping solve the agency’s prime challenges. If it enables the agency to carry out work that the agency deems vital, the agency will likely embrace it.
How does this apply to Let’s Move? Consider the Forest Service, which is part of the Department of Agriculture. If Forest Service employees were asked to hand out flyers urging visitors to exercise more, it is unlikely that they would enthusiastically embrace such an effort. But the agency would likely welcome it if it was asked to promote physical activity by increasing the amount of trail construction and maintenance or tree planting programs available to volunteers, youth groups, and national service participants. These activities advance one of the obesity initiative’s key priorities, and also address the Forest Service work backlog.
Below are some other ways that federal agencies might be able to help accomplish the goal of eliminating childhood obesity within a generation, while also advancing their own missions. Note that agencies can implement many of these ideas with their existing funding and legislative authorities simply by redirecting existing resources, adjusting already existing practices, or using the agency’s bully pulpit—especially if the agencies have buy-in from key congressional appropriators and authorizers.
Agriculture: Reform and properly implement food programs. The Department of Agriculture is already working with Congress to pass a Child Nutrition and Reauthorization bill that ensures that government school breakfast, school lunch, WIC, after-school supper, and summer meal benefits for kids do even more to fight hunger and reduce obesity. Following this process, the Agriculture Department should consider developing helpful implementation regulations and guidance that help advance the national goal of reducing obesity. This bill would benefit from greater involvement by the Department of Education, an agency that can be a key partner in obtaining buy-in and implementation help from educational stakeholders such as teachers, school
administrators, school boards, and PTAs.
Education: Evaluate state and local antiobesity policies. The Department of Education could undertake an effort to evaluate state and local policies for reducing obesity and hunger. It could help identify best practices at the state and local levels, which could then be promoted through incentives such as cash awards. It could recognize programs that, for example, effectively encourage coordination between schools and the Department of Agriculture on school lunches to increase the amount of fresh produce. Or it could recognize districts that integrate physical education in schools with fitness recommendations from the Department of Health and Human Services.
Health and Human Services: Integrate obesity prevention efforts in plans to implement the new health reform legislation. Implementation of the health care reform bill, the Patient Protection and Affordable Care Act, could better promote obesity prevention efforts. This would improve the health of the nation and could also save money. Obesity increases the likelihood of developing chronic diseases, and 75 percent of what the nation spends on health care goes to treating these chronic conditions.
Food and Drug Administration: Ensure that consumers have better information. The FDA could accelerate its efforts to work with retailers and manufacturers to adopt packaging and labeling practices that help consumers better understand the nutritional impact of the food they are purchasing. The health care bill provided a good start to this effort by requiring chain restaurants to post calorie counts for their foods.
Corporation for National and Community Service: Include an obesity focus in existing programs. The corporation, which administers AmeriCorps and other volunteer programs, should look at including obesity projects into its existing AmeriCorps, Learn and Serve, VISTA, and Retired Senior Volunteer Program projects. It could ramp up funding for programs that engage more Americans in exercise or increase the amount of fresh produce distributed through community gardens, for example.
Defense: Alter recruitment activities. A recent report by retired military officers concluded that 9 million young adults, or 27 percent of all Americans ages 17 to 24, are too heavy to join the military. The Department of Defense could build food and fitness education into its recruitment activities, such as recruitment advertisements, manuals, and public presentations.
Transportation: Create pedestrian-friendly communities. Transportation projects could be much more pedestrian friendly. Transportation Department projects should prioritize inclusion of biking paths, cross country skiing paths, and jogging trails on transportation right of ways.
Labor and Commerce: Encourage private employers and unions to take concrete obesity-fighting steps. Private employers can contribute to the effort to reduce obesity. The Departments of Labor and Commerce should team up to work collaboratively with employers and unions to look at ways to build in healthier conditions in workplaces, including healthier work cafeteria foods and more opportunities and incentives for exercise. This may not always directly combat childhood obesity, but healthy habits at work could inform habits at home.
Housing and Urban Development: Ensure properties and facilities support healthy living. HUD, in conjunction with the Department of Agriculture, which funds rural housing and community facilities, could ensure that housing projects and other community development activities include easy-to-use exercise facilities, walking paths, safe places to play, and opportunities for healthy food production and distribution such as community gardens and community supported agriculture distribution sites.
The Department of Justice: Ensure safety at neighborhood parks and exercise facilities. DOJ can target use of the Weed & Seed program and other community-based crime prevention efforts to help create “safe spaces” for exercise in every community in the nation.
All agencies: Serve as a model for obesity prevention by making government land fitness-friendly. The federal government can be a model for how cities and other entities can efficiently use land to advance fitness. Agencies that own land in urban areas such as Veterans Affairs and the Interior Department could consider setting aside land for exercise courses and community gardens. They could promote this availability through comprehensive maps (available online and as hard copies) of such locations. All agencies could also encourage good health among their employees via such means as making healthy foods available in cafeterias, making exercise facilities available, providing healthand nutrition information, and incentivizing good habits.
An important part of Doing What Works is laying out a clear goal and then ensuring that your policies and programs are effective at accomplishing the goal. The Obama administration has set out a clear goal for childhood obesity and now it needs to develop a broad policy response to accomplish that goal. The administration should consider the ideas outlined here in developing such a strategy, as well as many others that will be generated within and outside federal departments and agencies.
The Obama administration needs to look at all the evidence available to choose ideas that are most likely to succeed, such as those that have been tested and proven to be successful in the states or in other countries. It also needs to treat the strategy as a living document—so that what matters most is not whether each promised action is delivered, but whether the overall mix of actions are likely to accomplish the goal. And as initiatives are rolled out, some will be more successful than initially expected and others less so. Doing What Works requires the administration to constantly monitor which initiatives are working and quickly eliminate those that are not working and replace them with ones that have a greater chance of success.
The American obesity epidemic, which has been building steam for decades, has been caused by a complex set of economic and cultural issues. The problem won’t be solved overnight, and it won’t be solved by the federal government alone. States, localities, tribes, businesses, health care facilities, nonprofit groups, faith-based and neighborhood organizations, families, doctors—and yes, individuals—must all play a role. Still, if implemented properly, an interagency federal effort can produce effective results and empower groups outside of the agency. Let’s all move, starting with federal agencies.
Joel Berg is the executive director of the New York City Coalition Against Hunger.
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