Welcome to the State of California 
Systems and Environmental Changes

The purpose of this toolkit is to support optimal nutrition, physical activity, and breastfeeding through fostering partnerships between local health jurisdiction’s Maternal, Child, and Adolescent Health (MCAH) Programs and existing organizations to promote healthy environmental changes. The resources that this toolkit links to were chosen as they appear to be feasible projects for MCAH Program involvement. This is not intended to be a comprehensive toolkit; however, it does provide concrete examples of environmental change projects that are specific for supporting optimal nutrition, physical activity and breastfeeding within the maternal, child and adolescent population.

See Systems and Environmental Interventions Backgrounder (PDF)Opens in a new browser window. for selected evidence on the effectiveness of these chosen strategies.

 Webinar: Systems and Environmental Change to Improve the Health of the MCAH Population (presented Thursday, December 13, 2012)

AlertLinks to non-California government web site addresses are provided for informational purposes only, and this listing does not imply California Department of Public Health endorsement of these programs.

Breastfeeding Physical Activity Nutrition General Worksite Environment Childcare Environment Safe Routes to Schools Hosptial Environment Joint Use Agreements Pedestrian Presentations Farm to School Community Gardens Framers's Markets California Mother-Baby Friendly Workplace Awards Funding Opportunities Toolkit Menu Menu Legend - Click a Branch for main topics, Leaf for LHJ supportable topics, or an apple for quick and easy solutions

Branch–main focus areas of this ToolkitGeneral

These are general resources that relate to both nutrition and physical activity or to the relationship between the built environment and health in general. Included are presentation slides from various sources as well as a template PowerPoint presentation to use to develop your own PowerPoint presentation promoting environment and system change activities. Although many of the links in each focus area include grant resources, there is a separate funding opportunities section under General Resources for frequent grant postings to help start and sustain your proposed projects.

A Guide to Integrating Healthy Eating and Active Living into Colorado’s Rural and Small Town Communities (PDF, 2.8MB)Opens in a new browser window.

A comprehensive approach to advancing policy, environmental, and life style changes in rural Colorado that can be applicable to other rural settings as well. Includes various community resources, partners and community-level action strategies developed by Livewell Colorado.

Active Living by Design

Aims to increase physical activity and healthy eating through community design. This website allows you to explore initiatives and the work of communities across the country.

Active Living and Social Equity: Creating Healthy Communities for All Residents – a Guide for Local Governments (PDF)Opens in a new browser window.

Provides a toolbox of local government strategies for promoting active living equitably and success stories from around the country. Developed by International City/County Management Association

Built Environment and Health Handbook (PDF, 4.7MB) Opens in a new browser window.

Provides tools and resources for land use planning, community design, the built environment and health such as community food and walkability assessments in both English and Spanish. Developed by Tri-County Health Department, Colorado.

California Project LEAN

Project LEAN, or Leaders Encouraging Activity and Nutrition, is a joint California Department of Public Health and Public Health Institute program that works to prevent obesity and other chronic diseases by partnering with communities and schools. Their website includes toolkits, lesson plans, fact sheets, and brochures along with training, technical assistance, and expert consultation on policy and environmental change strategies.

Center for Disease Control (CDC) Designing and Building Healthy Places

CDC’s Healthy Community Design Initiative’s website gives an overview of health and the built environment, along with easy-to-read fact sheets and resources.

Centers for Disease Control (CDC) Health Equity Resource Toolkit for State Practitioners Addressing Obesity Disparities (PDF, 3.89 MB)Opens in a new browser window.

This toolkit focuses on how to create systems and environmental changes related to nutrition and physical activity that will reduce obesity disparities and achieve health equity. It is developed at a state level for health departments and practitioners who work with and through communities to help plan, implement, and evaluate state obesity and health equity programs.

CityMatch Women’s Health Prevention Brief: The Built Environment (PDF)Opens in a new browser window.

Highlights MCAH roles and opportunities to improve health in women before and between pregnancies through the built environment.

County Health Rankings and Roadmap

An interactive County Health Rankings and Roadmap tool to assess how healthy people are in each county, considering factors such as the physical environment.

Design for Health

A collaborative project that bridges community design research and the everyday realities of local governments. It has a rich resource library that includes original work developed by the project as well as links to other resources, plan case studies, and funding resources, covering topics such as safety, food access, and accessibility.

Environmental and societal factors affect food choice and physical activity: rationale, influences, and leverage points (PDF, 1.5MB)Opens in a new browser window.

An article that includes a database of hypothesized environmental influences on physical activity and nutrition, with changability and impact ratings, leverage points, setting and influence for each influence.

Health Impact Assessment

This project aims at advancing smarter policies for healthier communities by offering practical recommendations to minimize risks and improve health. Their website has numerous resources, including presentation and webinars, literature and data sources, other toolkits and guides as well as funding opportunities.

Completed Health Impact Assessments

Browse through sample health impact assessments to see what others are doing to promote health in the environment.

Health in All Policies (HiAP)

A multi-agency work group for California agencies and departments to collaborate on supporting healthier policies to address the complex relationship between sustainability and health.

Leadership for Healthy Communities: Action Strategies Toolkit (PDF)Opens in a new browser window.

A guide created by the Robert Wood Johnson Foundation for local and state leaders working to create healthy communities and prevent childhood obesity. This contains strategies on activity living, the built environment, and healthy eating.

Licensing and Zoning: Tools for Public Health

A useful guide on how regulating local businesses and land use through licensing and zoning can promote public health by addressing nutrition and bike parking. There are also additional resources included, such as Zoning Talking Points

Local Government Commission

Provides technical assistance, networking, and inspiration to elected officials and community leaders working to create healthy and walkable communities. Look under Resources.

National Association of County and City Health Officials (NACCHO)

This is a free, online collection of local public health tools that include presentations, fact sheets, and templates. You can browse for the tools or use the search option to type in keywords. Just create a free user name to access the tools.

Nutrition Education and Obesity Prevention Branch

A collaboration of local, state, and national partners that promote increased fruit and vegetable consumption and daily physical activity to improve the health status of low-income Californians.

PolicyLink’s Equitable Development Toolkit

Various toolkits, including promotion of ideas and strategies for improving corner stores, starting and sustaining farmer’s markets, and improving access to healthy foods.

Putting Business to Work for Health: Incentive Policies for the Private Sector

A ChangeLab guide that shows how local government incentives can motivate worksites to make choices that promote public health.

Prevention Institute: Strategic Alliance

A hub for policies and practices aimed at improving food and physical activity environments in California, including the role of corporate and government policies. Includes various policy links from the local to federal level as well as tools to improve the built environment.

Strategies for Enhancing the Built Environment to Support Healthy Eating and Active Living (PDF, 2MB)Opens in a new browser window.

Supported by the Healthy Eating Active Living Convergence Partnership and prepared by the Prevention Institute, this brief outlines a range of organizational practices and community factors being considered to improve the built environment in terms of nutrition and physical activity.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can support Funding Opportunities

Community Transformation Grants

This Centers for Disease Control (CDC) program supports community-level efforts to reduce chronic diseases by promoting healthy lifestyles. Applicants must demonstrate how they can improve their communities by increasing the availability of healthy food options and improving access to safe places for physical activity, among others.

Kaiser Permanente Community Benefits Division

Invests in environmental change initiatives focused on healthy eating and physical activity at both local and regional levels. Click here for Northern California applications and guidelines. Click here for Southern California, applicants must first write a Letter of Inquiry to receive an invitation to apply for a grant.

Healthy Food Financing Initiative

This US Department of Health and Human Services program supports projects that increase access to healthy and affordable food in communities that are lacking, especially rural communities. Check funding opportunities for the application checklist and other information.

Safe Routes to School (SRTS) Technical Assistance Resource Center

SRTS funding resources include transportation, safety and injury prevention, obesity prevention and physical activity promotion, education, and environmental protection.

The Kresge Foundation

A private, national foundation that funds various community projects to improve the quality of life through seven programs.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can support Presentations

We Are What We Eat and Breath, and Build: Preventing Chronic Diseases and Protecting the Environment by Building Healthy Communities

Dr. Richard Jackson’s lecture from the Cal Environmental Protection Agency’s monthly speaker presentation on how environmental strategies can improve a community’s health. Provides quantitative data, policy solutions, and relevant headlines and articles.

Built Environment PowerPoint Presentation Template (PPT, 7.295 MB)Opens a new browser window.

Refer to this template when preparing a presentation on systems and environmental change. You can customize the existing slides with data and images from your own local health jurisdictions.

Go to Top

Branch–main focus areas of this ToolkitNutrition

The nutrition environment is a significant contributor to the epidemic of childhood and adult obesity in the United States. This can include convenient access to high fat and low nutrient foods as well as a lack of access to and the high cost of nutritious foods, such as fruits and vegetables. We can address both community and consumer nutrition environments through understanding the food landscape in our counties or local health jurisdictions and employing certain strategies for change. The community nutrition environment includes type and location of food outlets (stores and restaurants), and accessibility (hours of operation, drive-through, etc.). The consumer nutrition environment includes available healthy options as well as price, promotion, placement, and nutrition information.

California Statewide Nutrition Surveys

Data from three statewide surveys of diet and physical activity, including research briefs from the surveys, data tables, and fact sheets.

Communities of Excellence (CX3)

A project of the Network for a Healthy CA in partnership with local health departments. Their website provides tools for collecting and measuring food quality, availability and affordability in low-income communities.

Community Design for Healthy Eating: How land use and transportation solutions can help (PDF)Opens a new browser window.

A Robert Wood Johnson Foundation paper that explores how the built environment affects food access. It also provides eight specific recommendations to improve healthy eating and success stories for each of them.

Healthy Eating Research

A research website for policy and environmental factors that influence nutrition. The page includes strategies for reversing the childhood obesity epidemic and grant funding.

California Center for Public Health Advocacy’s General Policy Recommendations (PDF) Opens a new browser window.

Addresses healthy local food environment policies.

Retail Food Environment Index (PDF) Opens a new browser window.

This index divides the total number of fast-food outlets and convenience stores by the total number of supermakets and produce vendors and provides a “score” for counties and cities. Developed by the California Center for Public Health Advocacy.

Zoning for Healthy Food Access Varies by Community Income (PDF, 1.4MB) Opens a new browser window.

Bridging the Gap's research examines the extent to which local zoning ordinances allow food outlets within a community and whether the zoning provisions vary based on community income.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can support Farm to School

National Farm to School Network

The National Farm to School Network aims to enable every child to have access to nutritious food while simultaneously benefiting communities and local farmers.

Center for Ecoliteracy: Change School Food

A planning framework to “Rethinking School Lunch” for improving school food and teaching nutrition.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can supportCommunity Gardens

Community Gardens and Public Health PowerPoint (PDF) Opens a new browser window.

A presentation template to explain why public health should be involved with gardens and what role the government and policy plays. Developed by NPLan Policy and Program Associates.

A Legal Toolkit for Community Gardens

Includes sample lease agreement, rules and discussion checklists for starting a community garden. Developed by ChangeLab Solutions.

Go to Top

Apple or “low hanging fruit” a course of action that can be undertaken relatively quick and easy Farmers ' Markets

ChangeLab’s Publications on Farmers' Markets

Great fact sheets on certified farmers' markets, establishing land use protections, and creating permit programs for farmers' markets.

Go to Top

Success Story

Success Story
"The Alameda County Public Health Department’s Maternal, Paternal, Child and Adolescent Health Section partnered with the Building Blocks Collaborative and applied for a Kresge Foundation Grant. They succeeded and received a three-year, $750,000 grant to work to improve the availability of fruits and vegetables in local corner stores in two low-income areas of Alameda County."

Go to Top

Branch–main focus areas of this ToolkitPhysical Activity

Communities that are designed to promote physical activity improve the health of our population. Safe and accessible recreational facilities and streets and programs that encourage walking, biking, or playing allow families to engage in daily physical activity.

Active Living Research

A wide range of tools and resources, including research briefs, summary slides, tools and measures to help public health professionals create more activity-friendly environments. Check out the Rural Active Living Assessment Tools.

California Active Communities

Works to create opportunities for safe, everyday physical activity through environmental and policy change strategies and strategic alliances.

Centers for Disease Control (CDC) Vital Signs

This webpage provides a quick and easy-to-read overview on physical activity through walking. Included are talking points, data, and suggestions for individuals, employers, and state/local governments  to increase walking.

Local Public Health and the Built Environment (LPHBE) Network

These projects support and promote community design solutions to increase physical activity and decrease the risk for chronic disease such as obesity and diabetes. This site includes links to resources, partners, and case studies for county-level implementation.

Center for Disease Control and Prevention (CDC’s) Quick Start Resources on Environmental Strategies to Promote Physical Activity (PDF)Opens a new browser window.

Provides key references, tools, and components for the planning, implementation, evaluation and maintenance of environmental interventions to promote physical activity.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can support Pedestrian Safety and Walkability

ChangeLab Pedestrian Friendly Code Directory

A comprehensive list of resources to learn how zoning and subdivision codes can create safe, comfortable, and convenient physical environments for pedestrians, transit users, and bicyclists.

ChangeLab Complete Streets

Resources to support complete streets initiatives.

Healthy Transportation Network

Works with communities to promote safe bicycle and pedestrian behaviors, create walkable and bicycle-friendly environments, and foster more walking and biking for routine transportation. This website includes funding resources and project assistance. A project of California Active Communities.

California Pedestrian Safety (PedSafe) Program

California Department of Public Health’s tools to improve healthy lifestyles through walkable communities and increased physical activity.

National Center for Bicycling and Walking Publications

Includes guides for public health practitioners and local governments to create more walkable and bikeable communities.

Transportation and Health Fact Sheet (PDF)Opens a new browser window.

Fact sheet about how walking and biking can improve health. Developed by the US Department of Transportation.

Walkability Checklist (PDF)Opens a new browser window.

A tool to help evaluate your community’s walkability and provides solutions for improvement. Developed by Walkable America.

Walk Friendly Communities

Applications for designating your community as Walk Friendly. The website also includes an extensive resources page.

Walk or Bike to School Day

Schools and communities can use this website as the first step to encourage their students to walk or bike to school and change the community culture. This site includes planning and outreach tools, as well as information specifically geared toward parents, the media, and members of participating schools or states.

Walking 101:  The Role of Maternal, Child, and Adolescent Health Programs. The webinar highlights the opportunities to promote walking for those working in Maternal, Child, and Adolescent Health.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can supportJoint Use Agreements

Joint Use

Provides organizations the opportunity to share resources through joint use agreements to keep costs down and communities healthy by increasing access to physical activity environments for people to be more physically active. This is an ideal project for rural communities with limited resources.

ChangeLab Solutions Joint Use publications

User-friendly fact sheets on joint use agreements, including state rules, checklists for developing an agreement, and other resources to make it easier for communities to access local school facilities like gyms, fields, basketball courts and playgrounds.

Joint Use of School Facilities

Information on joint use grants led by CA Project LEAN and CA Active Communities, including webinars and a fact sheet.

Go to Top

Apple or “low hanging fruit” a course of action that can be undertaken relatively quick and easySafe Routes to Schools

California Safe Routes to School (SRTS)

Well-established and sustained program to make bicycling and walking to school easier and more appealing to encourage healthy and active lifestyles from an early age. Assists local communities with creating SRTS programs by providing trainings, technical assistance, and resources.

  • National Center for SRTS
  • Includes various funding opportunities, marketing resources, and data collection forms for SRTS.

  • STRS National Partnership
  • Includes a network of over 500 agencies that work with SRTS, along with educational and programmatic resources.

Original research on why Safe Routes benefits the entire community

Results published by the CDC suggest that SRTS projects in urban areas can increase physical activity by improving the walking and bicycling environment for target users, adults and children.

Safe Routes to School Improves the Built Environment (PDF, 1.3MB)Opens a new browser window.

Provides a summary SRTS and case studies across the nation. Prepared for the CDC.

ChangeLab Safe Routes to School Talking Points

This factsheet provides talking points and information to help create SRTS, available in both English and Spanish.

Go to Top

Success Story

Success Story
“Along with the Safe Communities Coalition of Stanislaus County and the City of Modesto, Stanislaus County’s Maternal, Child, and Adolescent Health Department participated in applying for two Safe Routes to School Infrastructure Grants. Their efforts paid off and now, $785,910 funding will allow for new and improved curbs, gutters and sidewalks along with flashing beacons, a lighted crosswalk, and better rainwater drainage." For more examples of California Safe Routes to School success stories, visit this page.

Go to Top

Branch–main focus areas of this ToolkitBreastfeeding

Breastfeeding is beneficial to babies, moms, and society as a whole. Supporting a built environment that promotes breastfeeding through lactation accommodation, Baby Friendly initiatives, and recognition is a way to ensure the well-being of our maternal and infant population and to reduce the risk of obesity.

Women, Infants, and Children (WIC) Breastfeeding Resources

Includes a training toolkit for hospitals and providers and information for moms, employers and health professionals, plus brochures, training presentations, publications and other websites.

California Department of Public Health’s Breastfeeding Data

Provides various links to breastfeeding data and statistics, as well as other resources such as reports, briefs, presentation slides, and breastfeeding report cards.

California Women, Infants, and Children (WIC) Association Breastfeeding Policy

A comprehensive list of resources addressing worksite lactation, childcare, hospital care, state and federal data and organizations, and prenatal and postpartum support compiled with the California Breastfeeding Coalition

Go to Top

Leaf–selected topics that LHJ MCAH Directors can supportHospital Environments

Baby Friendly USA

The website for the accrediting body for our nation’s baby-friendly hospital initiative which includes step by step instructions, forms, and general information.

Model Hospital Policy Recommendations Toolkit

Developed by the California Department of Public Health's Maternal, Child and Adolescent Health Division, this toolkit includes resources created by hospitals and other agencies to promote breastfeeding support in hospitals.

Increasing Exclusive Breastfeeding Rates in California Hospitals: A Workshop for Hospital Administrators and Key Decision Makers

Developed by the CDPH in response to California Health and Safety Code section 1257.9 (SB22) this workshop includes trainings toolkits with presentations, guides, curriculum, and data.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can supportWork Environments

The Business Case for Breastfeeding

The Business Case for Breastfeeding is a well-researched program distributed by the Department of Health and Human Services. It includes booklets and kits for supporting breastfeeding friendly worksites.

Breastfeeding Works Resources

Breastfeed LA has developed resources for employees and employers to implement policies and programs to support lactation in the workplace.

Investing in Workplace Breastfeeding Programs and Policies: An Employer's Toolkit (PDF)Opens a new browser window.

The National Business Group on Health's toolkit covers the essential information employers need to understand the components of breastfeeding programs, get started and measure success. Valuable resources include breastfeeding program options, employer case studies and materials for employees. Employers can create tailored workplace breastfeeding programs and policies.

Breastfeeding and Healthy Living: Going Back to Work or School

The CDPH webpage contains resources for parents, employers, CDPH employees, child care workers, and community leaders.

Go to Top

Leaf–selected topics that LHJ MCAH Directors can supportChildcare Environments

Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs; 3rd Edition

These standards include the best evidence for feeding and use of breastmilk in childcare settings.

Ten Steps to Breastfeeding Friendly Child Care Centers (PDF)Opens a new browser window.

A resource kit to assist childcare providers to promote and support breastfeeding women. Developed by the Wisconsin Nutrition, Physical Activity and Obesity Program of the Wisconsin Department of Health Services.

WIC Nutrition – How to Support a Breastfeeding Mother: A Guide for the Childcare Center

Useful module for supporting breastfeeding mothers in childcare centers. Includes handouts, evaluation forms, and sample PowerPoint presentations and other materials for supporting breastfeeding in childcare environments. Developed by Texas Department of State Health Services.

Go to Top

Apple or “low hanging fruit” a course of action that can be undertaken relatively quick and easyCalifornia Mother-Baby Friendly Workplace Awards

California Breastfeeding Coalition

Nominate employers throughout the state that provide outstanding support for breastfeeding employees. This website also includes useful fact sheets and local breastfeeding awareness walk planning toolkit.

Look Out

Look Out
“The City of Pasadena’s Maternal, Child, and Adolescent Health Program is partnering with WIC and Choose Health LA to make Pasadena a Mother-Baby Friendly community.  They are developing a Pasadena Health Department Mother-Baby Friendly workplace policy.”

Go to Top

Last modified on: 9/21/2015 11:43 AM