Evaluating Meso-Level Municipal Barriers to Implementing Obesity Policy Change

The CPPW program, led by the City of San Antonio Metropolitan Health District, is comprised of more than 40 initiatives to reduce and prevent obesity in children and adults through partnerships with local organizations, school districts, and various city departments. Designed around the MAPPS strategies, SA-CPPW goals include increasing physical activity, improving nutrition, and improving the built environment through community-wide and school-based policy, systems and environmental changes. Seven city agencies are charged with changing policy to improve the obesogenic environment. A complicated set of municipal regulations limit the arenas in which municipal agencies are allowed to advocate for policy change. To ultimately impact social determinants of health, both macro- and meso-level policy must be coordinated to support shifting the fundamental causes of disease distribution at the community level. As has been established with individual behavior change, the choices we make are determined by the choices we have. However, little attention has been paid to municipal structures that enable community based and municipal organizations to effect meso-level policy change. Meso-level governance structures have important impacts on the efficacy of any one agency or coalition of agencies to make policy change. The session will focus on the development of a set of measures to document meso-level barriers and facilitators of policy change by organizations attempting to reduce community obesity burden.