Consultancy Proposal to NYC DOHMH

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, 2011

May 27th 2011 Page 1 of 53

Table of Contents

Deliverable I: Comparative Analysis of Physical Activity Programs…..…………4-13

Deliverable II: Walking Group Feasibility Case Study………………..…………14-21

Deliverable III: Shape-Up Feasibility Study………………………………………22-27

Deliverable IV: Nonprofit Assessment of Physical Activity Programming
and Partnership……………………………………………………………………..28-33

Deliverable V: Business Wellness Survey……………………………...…………..34-36

Deliverable VI: Grant Proposal to Fund Pilot Program………………...……..…37-49

Executive Summary………………….…………………...…………………….......…..37

Statement of Need…………………………………...……………………..…………...38

Organization Mission Statement………………………..……………..………………39

Project Description………………………………………….……………………….…39

Short term outputs…………………………………………..……………………39

Long-term outputs………………………………….………………………….…40

Methodology……………………………………………………………..………40

Sessions…………………………………………………………………......……41


Incentives…………………………………………………………………...……41

Personnel……………………………………………………………………...…41

Potential Partnerships with Non-Profits……………………………………...…42

Table 1: Non-Profits……………………………………………….…………42-43

Project Duration…………………………………………………………...……………44

Table 2: Timeline…………………………………………………...……………44

Timeline Narrative……………………………………………………………….44

Budget…………………………………………………………………………………...45

Table 3: Scenario A……………………………………………………………...46

Table 4: Scenario B………………………………………………………….…..46

Evaluation Method……………………………………………………………..………47

Table 6: BMI indicator……………………………………………......................47

Table 5: Knowledge and Participation Indicator………………………………..47

Evaluation Method Narrative ……………………………………………......48-49

References………………………………………………………………………..…50-53


Deliverable I: Comparative Analysis of Physical Activity Programs

Paris
France current total population – 62 million i
In 2002, the National Institute of Statistics and Economic Studies (INSEE) conducted a
study to calculate the rate of overweight and obesity levels in France. Surveys were
conducted via telephone with over 25,770 participants ages 15> from a total population
of nearly 50 million. The study showed that of the total population in 2002, 5.3 million
adults were obese, while 14.4 million people were considered overweight.ii The method
used 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 prevalence
Although the rate of obesity in France is still much lower than that of many developed
countries, such as the US and Britain where over 50% are overweight,iii the prevalence
has slowly increased from 8% in 1997 to 11% in 2003.iv In comparing the annual rate
between this time period, the percentage of overweight and obese adults increased from
37%-42%: a projected annual increase of 5%.v

Obesity as a Risk Factor
Obesity is one of the most important risk factors leading to diabetes, hypertension,
arterial disease, and high cholesterol. Studies show that 43% of people who are
overweight or obese have a greater risk of experiencing the multiple symptoms
mentioned above, whereas 19% of people who are considered normal-weight experience
only one symptom.vi

Obesity Rates by Age and Gender
Studies show that obesity rates are rising for both men and women. Table 1 illustrates the
rise in obesity by age group and gender. In comparing obesity rates between that of men
and 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 between
the ages of 45-65, where the prevalence for males increases by 4% in comparison to
females.vii


Figure 1. Prevalence of obesity by age and sex
Source: "ObEpi 2003 L'obesite Et Le Surpois En France." Dossier De Presse. Roche, 17
June 2003. Web. <http://www.mangerbouger.fr/pro/IMG/pdf/EtudeObepi_obesite.pdf>.
pg2

Link Between Obesity and Poverty:
Obesity in France has shown to largely affect lower socio-economic and professional
groups.viii This may be due to the fact that far more people are beginning to purchase
cheap processed and frozen foods from large supermarkets, rather than healthier choices
from their local markets due to their affordability and convenience. This cultural shift has
created an economic burden, not only on the small family-run specialty food stores, but
also on government health expenditures.

Reported Physical Activity
Over the last 30 years, there has been a major rise in fast food consumption along with a
decline 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 been
made that there is a direct link between the amount of physical activity a person engages
in, and their weight. Those who categorize themselves as normal-weight, will engage in
149 minutes of physical activity per day, while those who see themselves as too thin, or
too fat, engage in 130 minutes of physical activity per day.x

Physical Activity in the Workplace
For some, physical activity in the workplace is where they meet their daily-required
amount of motion. A study was conducted to evaluate where the most common forms of
physical 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 and


overweight categories engage in more physical activity while in the workplace (54.3, and
50.0) and less on their own time, than those who are normal-weight.xi There is not a
significant difference in the percentage of physical activity people engage in due to
commuting.

Figure 2. Percentage of people engaging in physical activity based on weight category
and location: workplace, commuting, and leisure
Source: "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 of
other diseases. The direct cost of obesity is estimated to be between 1% and 2% of the
total healthcare expenditure.xii In 2008, 11.2% of France‟s GDP was spent on healthcare
costs. Table 3 places France second in line to the US who spends 16% of its GDP on
healthcare.xiii


Figure 3. Percent of GDP spent on health care expenditure by country in 2008
Source: "Eco-Sante OCDE 2010 Comment La France Se Positionne." OCDE. Web. 28
Mar. 2011. <http://www.oecd.org/dataoecd/45/20/38980771.pdf>. pg 1

Government Response
In 2004, parliament enacted a wide-range of legislation to combat obesity and promote a
public health campaign. Laws have now been passed which prohibit the use of
snack/soda vending machines in schools, replacing them with healthier choices and
nutrition tutorials. A law has also been passed to control advertisements and food
companies through a 1.5% tax if they do not promote healthy habits. However, the latar
has yet to be implemented.xiv

National Programme for Nutrition and Health (PNNS)
Before 2001, and the establishment of the PNNS, there were no public nutrition policies
in France. The first phase of the PNNS was established to measure the progress of public
health issues such as eating habits and physical activity in the country, which ended in
2005. The second phase of the program was approved by the Minister of Health and was
launched between 2006-2009. The program focused on (1) promoting environmental
changes to motivate people to engage in physical activity, (2) targeting disadvantaged
groups, based on socio-economic status, and (3) lower obesity in children and adults. xv

EPODE Programme – Together Lets Prevent Childhood Obesity
France launched its first EPODE program in 2003, which aims at changing the
environment and peoples unhealthy behaviors, (particularly that of school children) by


working with schools to promote physical activity programs after school, and access to
healthier cafeteria foods. The program now affects 1.8 million French citizens in over
167 cities.xvi The methods they use to measure the rates of success are large field
mobilization and BMI evaluations of children in the pilot cities.xvii

Physical Elements of the Program
This fall, the National Institute for Prevention and Health Education (INPES) launched its
first national and local physical activity campaign: “Bouger”; “move 30 minutes a day;
its that easy!” The campaign uses signs throughout pedestrian walkways and in bicycle
lanes 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 their
daily-required amount of physical activity does not necessarily need to include strenuous
exercise, nor does it have to be expensive (Figure 5).

Figure 4. Walking signs


Figure 5. Advertisements

Source: "Bouger 30 Min Par Jour, C‟est Facile - Campagnes." Ministère Du Travail, De
L'Emploi 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 Elements
The programs affect both urban and rural areas alike. They encourage cities to be more
pedestrian and bike friendly to promote activity. A proposal has been made which would
provide subsidies for active modes of transportation while accommodating people who
ride their bikes to work with free/safe bike parking access. The Ministry of Health has
also proposed developing leisure sports centers in parks. They encourage schools to
establish walking buses to teach kids at a young age the importance of physical
activity.xviii

Recommendations
The physical elements of the “Bouger” campaign in France is well suited for the French
culture and scenic views of the major cities. In downtown NYC, there are signs posted
for tourists to use as location references, however, they only mention the physical
location, 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 target
high-needs neighborhoods. Posters and advertisements promoting physical activity can
encourage people to put their bodies in motion. If however the posters do not properly
consider the demographics (target audience, language, etc), the advertisements will be
ineffective.


Taiwan

Prevalence of Obesity in Taiwan

There is a great need for physical activity programs within Taiwan with growing rates of
obesity, both in children and adults, among its 23 million residents. According to a
survey 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% were
overweight and 3.6% were obese. The survey was conducted among children aged 6 to
18 years, with a sample size of 24,586. Weight, height, systolic and diastolic blood
pressures, and fitness tests were all measured during the survey (IASO, 2011). The IASO
does not have a survey available on Taiwan‟s adult obesity population. However, an
article 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% were
overweight 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 overweight
as BMI > 24 and obese as BMI > 27 (Chu, 2005).

Prevention Strategies in Taiwan: “Health 2011” weight-loss Campaign

The Taipei Times reported in February 2011 that the Department of Health in Taiwan has
launched a “Health 2011” weight-loss campaign. Between 2001 and 2003, Taipei City
had been successful in getting its residents to lose 100 tons. With this success, the DOH
decided to expand the battle against obesity nationwide. For each district of Taiwan, the
DOH‟s “Health 2011” campaign has set up weight-loss goals. New Taipei city, being the
most 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 (98
tons), and Kaohsiung (103.8 tons) (Taipei Times, 2011).

The goal of the Health 2011 weight-loss campaign is to encourage healthy eating and
exercise for “the sake of one‟s health”, instead of taking diet pills or having weight-loss
surgery. 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 day
than 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 at
local public health centers to take part in the free weight-control program. The program
provides guidance in dieting, nutrition, and exercise. A listing of the public health centers
was not available and results thus far have not been recorded.


National Walking Day

In 2002, the Bureau of Health Promotion began encouraging residents to walk 10,000
steps a day. In 2006, November 11th was designated as National Walking Day throughout
Taiwan‟s cities and counties. The date November 11th was chosen because the numerals
represented a pair of legs. Posters, like the one below, were placed throughout cities to
remind and encourage residents to walk 10,000 steps a day. Residents are encouraged to
take part in either fitness walking or power walking. Both types are suggested to be done
at a speed of 4.8 kilometers per hour to 9.6 kilometer per hour while keeping the body
erect, hands level to the waist, swinging the arms while keeping the shoulders relaxed,
and taking bigger steps than usual (Taiwan Review, 2009).

Junk Food Tax

In December 2009, Taiwan began to plan the world‟s first junk food tax. The Bureau of
Health Promotion began drafting a bill that would place taxes on unhealthy foods such as
sugary drinks, candy, cakes, fast food, and alcohol. The revenue gained from the tax is
planned to go towards those groups that have been promoting health awareness and to
help subsidize Taiwan‟s national health insurance program (AFP, 2009). The tax is to
begin this year, but there have been no reports that it has been passed or what percentage
the tax would be. New York Governor David Paterson was proposing to pass a similar
bill in 2009, but with much public opposition he withdrew the bill. The bill was to add an
18% tax on soft drinks.

Prevention Strategy in China

There 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 1
billion people, has a growing obesity population much like Taiwan. According to a 2002
survey conducted by the IASO, 16.7% of Chinese men were overweight and 2.4% were


obese. For women, 15.4% were overweight and 3.4% were obese. The survey was
conducted among adults aged 18 and older (IASO, 2011). China‟s elderly population, 60
years and older, is over 140 million people. Roughly 54 million of them take part in
physical activity. Many of them gather in public parks across the country to take part in
martial arts like tai chi, dance, and singing (Liang & Hornby, 2009). There is no specific
mention of any costs associated with these park gatherings. Rather, it seems that word of
mouth and motivation to stay fit at an old age is what drives China‟s elderly population to
take part in some form of physical activity.

Additionally, China Daily reported that China has released a set of guidelines for its
National Fitness Program 2011-2015. The program sets the minimum exercise
requirement to at least 30 minutes for at least three times a week for 32% of its
population. The program calls for a raise in the number of gymnasiums and stadiums
throughout the country, from 1 million to 1.2 million. The program is targeted to have
50% of China‟s cities and counties to set up physical training centers, and 50% of its
communities to have sports facilities that are convenient and in functional condition for
the entire population. A budget has not been introduced, but all levels of the government
are to plan their investment on promoting the program. A plan to evaluate the
successfulness of the program will take place in 2014 (Lei & Yue, 2011).

Recommendations for NYC

Programs like the “Health 2011” campaign and National Walking Day would be ideal in
New 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 they
took today, and/or highlighting routes they can take to reach 10,000 steps a day. Posters
can also encourage them to take the stairs, rather than the escalator or elevator. At present
there are posters depicting the amount of sugar and sodium found in several drinks and
foods. Walking can be viewed as a simple and effective form of exercise that can show
measurable results. The DOH can team up with a company that would be willing to
donate free pedometers for participating New Yorkers. On a nice day, rather than taking
the subway a few blocks, residents can try walking them.

Additionally, Taiwan‟s Health 2011 campaign has set up a hotline that people can call
into to gain advice on diet and exercise. The NYC DOH could set up a similar hotline
where NYC residents can call toll-free to attain information on diet, exercise, local gyms
and their promotions, local YMCAs, local parks, and a listing of healthy
restaurants/markets at affordable prices. The choices are plentiful. To make the concept
even more up-to-date with today‟s technology, a smart-phone application can be set up
that could easily provide this information. Perhaps teaming up with Yelp.com to offer
local listings of such facilities presents an opportunity as well.

Although the “junk food tax” was not a crowd pleaser when the idea was first introduced
to New York, a “no refills” rule can be implemented. When patrons go out to eat, eateries
should no longer place the soda machines in a public area where patrons can fill their


own cups. Also, restaurants should no longer give free refills. Rather, they should charge
for each glass filled. This could possibly reduce the amount of sugary drinks that New
Yorkers 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 in
one of NYC‟s numerous parks. Perhaps teaming up with volunteers who would dedicate
their time to teach interested individuals easy dance and exercise routines. After the first
month, for example, participants can carry out the routines on their own and new comers
can follow the guidance of veteran participants. However, if the program requires
funding, a $1 fee can be instilled for each participant. A website or a smart-phone
application can be set up where individuals can view where and when the next group
exercise routine will take place.


Deliverable II: Walking Group Feasibility Case Study

Introduction
In light of the obesity epidemic in New York City, the private and public sector has to
assume responsibility in increasing access to low-cost physical activity programming.
Data from the Department of Health and Mental Hygiene shows that NYC‟s high-needs
communities experience disproportionate overweight and obesity rates in comparison to
middle-income neighborhoods.
Walking is a well-known form of low-impact physical activity that is safe for all ages. In
addition, organizing walking groups is relativity inexpensive when compared to indoor
activities such as dance. The health benefits of walking are undeniable and the low-cost
component makes walking groups a great form of physical activity that can be health
promoting, educational, and social all at once.
We need to understand what obstacles exist in implementing a walking group initiative in
NYC‟s highest-needs communities. In addition, it is beneficial to analyze existing and
past initiatives in order to learn what components have culminated into successful and
sustainable walking group programs.
Our research on three walking group initiatives in East and Central Harlem has provided
important information that we have used to design a pilot program.

Methodology
Our team reached out to Javier Lopez, the director of the NYC Strategic Alliance for
Health in order to connect with walking groups located in Harlem. He put us in contact
with Lourdes J. Hernández-Cordero, D.PH and Monique Hedmann, MPH, the directors
of the CLIMB project and Walk it Out! Program, respectively. Through email and phone
interviews the team collected information on these two walking group initiatives. In
addition, the team conducted an in-person interview with John Falzon, the center
manager of the Thomas Jefferson Recreation Center. Team members also visited the
recreation center in order to participate in the walking group. Interviewee contact
information is included below:
Javier Lopez
Director, NYC Strategic Alliance for Health
jlopez@health.nyc.gov
(212) 996-8738

Lourdes J. Hernández-Cordero, D.PH
Assistant Professor of Clinical Sociomedical Sciences
SMS Practicum Director
Associate Director Columbia Center for Youth Violence Prevention


Columbia University Mailman School of Public Health
722 West 168th Street Room 514
New York, NY 10040
Phone: (212) 305-1077
ljh19@mail.cumc.columbia.edu

Monique Hedmann, MPH
Assistant Director, Department of Neurology
Harlem Hospital Center
506 Lenox Avenue, 16th floor
New York, NY 10037
Office (212) 939-4239
Monique.Hedmann@nychhc.org

John Falzon, Center Manager
Thomas Jefferson Park Recreation Center
2180 1st Avenue at East 12th Street
New York, NY 10128
(212) 860-1371
john.falzon@parks.nyc.gov

Findings

CLIMB Program Background
The City Life is Moving Bodies project (CLIMB) is a partnership between Columbia
University 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 of
which some are obesity, inactivity, youth violence, and drug abusexx. CLIMB believes
that increasing access to parks and ensuring that it is safe to enjoy them will help alleviate
some of the problems noted abovexxi. In order to increase safety and accessibility CLIMB
has created and linked trails within the cliff-like ridges that characterize the terrain of
Northern Manhattan‟s parks. CLIMB aims to create park and neighborhood ownership by
targeting all levels of involvement: individual, family, neighborhood, and cityxxii.
On June 4, 2011, CLIMB is hosting the seventh annual Hike the Heights eventxxiii. This
event promotes CLIMB and its community partners‟ initiatives by inviting the
community to enjoy the park trails.


CLIMB Findings
Through a phone interview with Lourdes J. Hernández-Cordero, the team learned more
about City Life is Moving Bodies (CLIMB) xxiv. The project was created by the
Community Research Group more than 17 years ago in order to address the issue of safe
parks and neighborhoods. According to Lourdes, the need for safe parks evolved from the
reality that the parks of Northern Manhattan (including Inwood, Washington Heights, and
Harlem) were abandoned and unsafe. The project aims to reinvigorate the area by
making public spaces such as parks accessible for safe and multi-generational use.
Currently, the CLIMB project is part of the Columbia Center for Youth Violence
Prevention. According to Lourdes, obtaining funding is more feasible when the target is
children and adolescence. In addition, targeting youth has been an effective avenue for
reaching other generations. For example, the annual Hike the Heights event promotes
multi-generational activities in a safe outdoor setting.
While the Hike the Heights event is only held once a year in June, the project promotes
the event and its initiatives year round. Lourdes aims to “bring a diversity of users to the
park” because it “increases use around the clock and makes the parks safer. And it‟s a
way to have folks more physically active, but also provides an opportunity to be more
civically active and socially active”xxv.
The CLIMB Project‟s institutional review board (IRB) evaluates its efforts by designing
questionnaires 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 initiative
around the needs of the community.
CLIMB partners with many community-based organizations in Northern Manhattan. One
of their biggest collaborators is the Northern Manhattan Community Voices Asthma
Basics for Children initiative. ABC holds its annual asthma awareness walk on the day of
the Hike the Heights event and the walk culminates at the event. The collaboration
enables a large range of participants to become aware of the accessibility of Northern
Manhattans 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 additional
component. For example, as part of the youth violence prevention initiative, CLIMB
organizes youths into teams that go out into Northern Manhattan‟s parks to clean up the
area. In addition, CLIMB organizes educational walking tours. These tours are designed
to educate participants about the rich social and ecological history of Northern
Manhattan.
According to Lourdes, there are challenges in organizing walking groups, especially for
elders. She argues, “walking groups for seniors are difficult because promoting health
benefits [only] is not effective.”xxvi Lourdes recommends that seniors will more likely be
interested in participating in a walking group if it is socially engaging.


Walk it Out! Program Background
The Walk it Out! Program is a Harlem Hospital Center initiative that aims to promote
physical activity among senior citizens residing in Harlem. In addition to emphasizing
health benefits for senior citizens, Walk it Out! promotes multi-generational activities and
peer bondingxxvii. The Harlem Hospital Center held The Walk it Out! Family Walk and
Run event last year on August 1, 2010 at the Riverbank State Park. This event promoted
the program‟s goals while bringing the community together in a healthy setting filled
with physical activities and healthy foods.
The Walk it Out! program was created in February of 2010 and is sponsored by the
Healthy Heart Program of the New York State Department of Health and other
donorsxxviii.

Walk it Out! Findings
Through a phone interview with Monique Hedmann, the team learned about the Walk it
Out! initiative of the Harlem Hospital Centerxxix. According to Monique, since its
inception in [February] 2010, the program has had its ups and downs, but boasts overall
success in supporting a culture of wellness among Harlem seniors”xxx.
One of the main reported obstacles is obtaining funding. The program receives a small
grant 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 nonprofit
organization committed to helping persons aged 50 and older. The Friends of Harlem
Hospital Center support efforts to help their patients by providing grants; so far, they
have awarded the Walk it Out! program $5,000. Monique Hedmann, as director of this
initiative has had to be innovative in cutting costs because donor funding, while
generous, is not enough to sustain the program.
Through partnerships with academic institutions and community organizations, the
program has effectively lowered overall costs. For example, Walk it Out! currently
partners with the Joseph L. Mailman School of Public Health of Columbia University.
The graduate program provides Walk it Out! with graduate student volunteers. These
students are trained by the program to lead walking groups and receive a volunteer
training manual. Currently, the student volunteers do not receive certification, but
according to Monique, this is something that they may explore. In regards to liability
issues, all participants sign an acknowledgement of risk and must be cleared by a doctor
before engaging in any physical activity organized by the program.
Monique Hedmann argues that one of the benefits of having student walking instructors
is that elders enjoy interacting with youth. Participants have expressed their appreciation
for multi-generational interaction and some have told Monique directly that they continue
to participate because the walks are led by young and energetic students.
While student volunteers are an effective way to lower program costs, Monique has cited
some obstacles in this partnership. On several occasions, students have failed to show up


for their delegated walking group and this has had a negative impact on the programs
reputation. The credibility of the program depends on the professionalism of the walking
instructors and not showing up to lead a walk will deter future participation. Monique
suggested that there should be a form of accountability for unexcused absences from
students. Monique feels that if volunteering for leading walks could be incorporated into
a 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 the
student volunteer) promotes individual ownership of the program. Monique Hedmann
believes that the combination of a peer leader and a student volunteer walking instructor
has 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 opportunity
for peer bonding is highly effective in motivating senior citizens to engage in physical
activity.
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. The
program provides the student volunteer instructors, training for peer instructors,
incentives for participations, and the overall framework so that the program can run at all
10 senior centers simultaneously.
The majority of the partner senior centers hold walking groups three times a week from
9:00 - 10:00 a.m. since senior centers usually serve lunch around 11:30 a.m. Also, as
Monique points out, most adults, regardless of age, prefer to exercise during the early to
mid-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 it
Out! has recently expanded its programming beyond senior centers and is collaborating
with the SAGE (Services and Advocacy for Gay, Lesbian, Bisexual and Transgender
Elders), 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 it
Out! 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 physical
activities when walking outdoors is not possible.
Not only does Walk it Out! lower program costs through its partnerships, it ensures that
the program‟s initiative is reaching senior citizens beyond the senior centers. One of the
obstacles in promoting the program is reaching seniors that do not belong to senior
centers. In response, Walk it Out! partners with the NORC (Naturally Occurring
Retirement Community) program. Monique attempted to advertise the program to seniors
living in NYCHA (New York City Housing Authority) housing developments; however,
she did not receive approval. Additional strategies include advertising with flyers in
churches, hospitals, and promoting the initiative at community board meetings.


With a tight budget, the Walk it Out! program allocates a portion of funding to cover
incentives for participation. Monique Hedmann argues that offering incentives is a very
important motivator. The provision of incentives is carefully allocated by providing
participants with a “loyalty card” which is stamped by the instructor at every walking
group they attend.
On the first day, the participants receive a Walk it Out! t-shirt and they are encouraged to
wear it whenever they walk for fitness. Monique Hedmann argues that senior citizens
who 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 participate
because they saw their peers wearing the t-shirts.
After the first day, incentives are given as participants accumulate stamps; some of the
incentives given out: pedometers, drawstring bags, water bottles and gift certificates.
The health benefits of walking are undeniable. However, the Walk it Out! program does
not monitor important health indicators such as BMI and blood pressure. Again, budget
and time constraints do not allow for a comprehensive evaluation. However, as requested
by the New York State Department of Health, the program tracks the amount of time
participants engage in physical activity. The participants fill out a questionnaire that asks
them how many minutes they engage in physical activity per week. The NYS Department
of Health recommends that people of all ages engage in at least 150 minutes of physical
activity weekly.
As the program moves forward, Monique aims to address the fact that the participants are
almost exclusively female. Males belong to senior centers; however, they do not
participate in the walking groups led by the Walk it Out! program. She claims, “There are
mostly females at the walking groups. There are more senior women anyway, but across
all 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 in
leading a running group. Overall, Monique emphasizes, “You have to make walking fun
in order to motivate people”xxxiii.

Walk NYC Program Background
Walk NYC is a walking for fitness partnership between the New York City Department
of Parks and Recreation and Empire Blue Cross Blue Shield. The program is held at
recreation centers citywide and is open to all ages. Empire BCBC provides funding to
Parks and Recreation in order to finance certified walking instructorsxxxiv. In addition to
hiring and training instructors, Parks and Recreation provides the space (recreation
centers) for participants to meet and promotes the program. Walk NYC is in its second
year after launching in June of 2010xxxv and is currently operating in all five boroughs,
including all of the five high-needs communities.


Walk NYC Findings
While participating in a Shape-Up class at the Thomas Jefferson Recreation Center, team
members noticed a sign advertising the Walk NYC program. Through an interview with
John Falzon, the center manager of the Thomas Jefferson Recreation Center, the team
gathered additional information about the Walk NYC programxxxvi. According to Falzon,
Empire BCBC approached Parks and Recreation about starting a walking for fitness
program because they want to target blood pressure and promote fitness, particularly
among senior citizens. Falzon believes that Empire BCBS thinks that walking groups will
attract 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 recruit
and hire certified instructors. Parks and Recreation also provides the space and
advertisement throughout all five boroughs.
The Walk NYC program began citywide the week of April 18, 2011 and concludes in
December. At the Thomas Jefferson Recreation Center, located in East Harlem, the
walking 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 their
walk by circling the tracks at the center and then they will walk down the East River
Walkway. If there is inclement weather, Falzon forecasts that the group will engage in
indoor activities at the Recreation Center.
Empire BCBS has a target attendance of 25 participants per class; however, John Falzon
predicts that participants may complain that it‟s “too hot or too cold outside”xxxvii, which
will 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 low
turn-out locations. In addition, Falzon worries that, “when something is free, people
don‟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 the
community a free program while not affecting NYC‟s budget.
The team decided that the Walk NYC program was an interesting walking group to
observe since it is a private/public partnership that reduces city spending on physical
activity programs. We returned to the Thomas Jefferson Recreation Center on
Wednesday April 27th hoping to participate in the walking group and collect feedback
from participants and the instructor. However, after a half hour, neither the instructor nor
any participants had arrived. We spoke with a security guard and she told us that that the
walking instructor had only showed up on the first day, April 18th, and had not returned
since. On the previous Wednesday, two participants arrived but left after the walking
instructor did not show up. We decided to try again on Friday April 29th, but no one
showed.
The advertising for the Walk NYC program is a flyer with the text, “free fitness walks led
by experienced instructors,” and has the following slogan: “Get out to the park and walk


the City!” Our research indicates that this may not be enough to motivate people to
engage in this program.

Top Key Recommendations
In order to lower overall costs, we recommend that the piloted walking program in East
Harlem utilize student volunteers in place of hiring certified walking instructors. The
program should partner with academic institutions that offer Public Health programs or
other health related majors because these students will most likely understand the benefits
physical activity has on overall health. Lessons learned from the Walk it Out! program
show that accountability is necessary for program credibility. Therefore, student
volunteers must be enrolled in a for-credit class that deducts points for unexcused
absences and no-shows.
The program should partner with a nonprofit organization that is willing to offer indoor
space as an alternative to outdoor activities during inclement weather. It is important that
the walking program continue to run regardless of weather and climate changes. This will
ensure 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 for
participating in a walking group. A low-cost option would be to partner with a private
sector 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 peer
bonding. In addition to student volunteer walking instructors, a peer walking instructor
should lead the week alongside the student. This allows for group ownership and
promotes peer bonding.
The program should be multi-dimensional and include educational, social and “walking
with a purpose” components. Evidence from the Walk NYC program shows that
promoting a program as walking solely for fitness may not be enough to motivate
participants to engage in walking groups.
An additional study of walking groups in NYC‟s other high-needs neighborhoods may be
helpful in fully understanding how to motivate people to engage in group and individual
physical activity. It will also offer additional insight on strategies for running a low-cost
walking group program.


Deliverable III: Shape-Up Feasibility Study

Introduction
Gaining an understanding of Shape Up NYC and its participants is a critical component
to finding best practices as relates to executing a free-to-low-cost physical activity
program for high-needs New York City neighborhoods.
Conducting surveys of Shape Up NYC is designed to answer several questions, all of
which will feed into our proposal for a pilot program.
Quantitatively, we need to understand who attends Shape Up NYC classes; which classes
they attend; how many, if any, would be open to paying to participate in a physical
activity program; how many have and would potentially participate in walking groups;
and, to determine multi-generational participation, how many have children present in the
household.
Qualitatively, we need to understand how well Shape Up NYC meets their physical
activity interests and needs; if a substitute program carried out by a nonprofit with a
requirement to pay would meet their needs similar to Shape Up; and how having children
present impacts their time to participant and if a program that brings together parent and
child would empower parents to participant more often.
Our surveys across several Shape Up classes spanning the three high-needs
neighborhoods specified by the DOHMH have answered these questions and have
provided us with the necessary information to craft a credible proposal for a pilot
program.

Methodology
Surveys were designed using Survey Monkey and take into account age, gender, location
of class, and queries that would satisfy the quantitative and qualitative requirements
discussed in the preceding section.
Participants across the three boroughs of highest need were approached prior to
commencing their Shape Up class, with the consultant taking the participant through the
survey asking the participant the designed questions. The consultant manually entered all
participant answers into Survey Monkey for analysis.


High-Level Findings
The consulting team spoke to fifty-three participants, all female. As the chart below
shows, 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 a
walking group. Additionally, of those in the 45-54 age group, 100% said they would be
interested in leading a walking group.


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 not
willing to pay a fee to participant in a physical activity program, while slightly more than
one 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 $5


Survey results indicate areas for program growth, most specifically as relates to the types
of classes to offer. Our findings show that more than half, 53%, would like to see more
dance classes, dance being an umbrella term that includes belly, salsa, zumba, and
meringue dance forms as an aggregate. Both aerobics and yoga were also mentioned as
classes 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
Classes

Answers regarding multi-generational activity were revealing. Eighty-seven percent
reported that they have children present in the household. Of those, 33% said caring for
their 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 that
the program brings together the parent and the child. This does not necessarily mean the
parent and the child must be taking part in the same activity together, but that the parent
and the child are in the same venue with easy access to each other in case a need arises.

High-Level Borough by Borough Findings
The following is a breakdown of the more salient findings by borough.
In all cases, the 35-64 age range dominates:


Age Group by Borough
East 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 walking
groups and dance classes:

Walking Group Participation by Borough
East 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 Borough
East Harlem
No 48.1%
Under $5 33.3%
Over $5 18.5%
Brooklyn
No 46.6%
Under $5 53.3%
Over $5
Bronx
No 85.7%
Under $5 14.2%
Over $5


There are opportunities to grow programs to meet interests:

Request for More Programs by Borough
East Harlem
Dance 35.7%
Aerobics 28.5%
Yoga 14.2%
Brooklyn
Dance 60%
Aerobics 20%
Yoga
Bronx
Dance 33.3%
Aerobics 66.6%
Yoga

Multi-generational activity represents an opportunity for program innovation:

Children Present by Borough
East Harlem 41.5%
Brooklyn 24.5%
Bronx 13.2%

Program messaging and initiatives should target a female constituency between the ages
of 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 diverse
experience in offering different forms of dance as physical activity will meet the interests
of the core constituency and generate greater turnout.
Keeping cost-to-participant low is critical; creating a self-sustaining model can be done
through proper, in-demand programming, such as offering a variety of dance; careful
targeting 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 be
best, 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 the
intersection between the right price and where maximum weekly participation occurs.


Deliverable IV: Nonprofit Assessment of Physical Activity
Programming and Partnership

Introduction

In light of forecasted budget-cuts, the New York City Department of Health and Mental
Hygiene must investigate alternative strategies that can sustain physical activity
programming. Addressing obesity and inactivity is a necessary step towards overall city
health, particularly in NYC‟s high-needs communities. So far, NYC‟s Shape-Up program
has 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 2
diabetes) disproportionately affect the residents in these five targeted communities.
Considering the health benefits of being active, physical activity programming cannot be
cut from vulnerable high-needs communities.

We need to investigate if nonprofits that are already conducting physical activity
programming are willing to collaborate with the city in its efforts in combating obesity.
Additionally, we must expand partnerships beyond nonprofits that already provide
similar 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.

Methodology

We designed a nonprofit assessment questionnaire on Survey Monkey and Javier Lopez,
director of the Strategic Alliance for Health, and Stacey Flanagan, director of
Neighborhood WIC at Public Health Solutions distributed it via their listservs. The 16-
question survey sought to investigate if NYC based nonprofit organizations would be
interested in partnering with the Department of Health and Mental Hygiene in its physical
activity initiatives. We asked nonprofits who are engaged in physical activity programs to
specify which activities they offer (walking groups, group fitness classes, recreational
sports, etc.).

We asked respondents if they targeted low-income communities and asked them to
specify their funding sources. Additionally, the survey asked which age groups they
target, how often they run their physical activity programming and in which community
their services targeted.

The survey asked if nonprofits were interested in partnering with the DOHMH. Those
who replied yes were asked what resources they could offer (space, equipment, support
staff, interns and funding assistance). Additionally, we asked respondents to describe
their physical activity programming if they believed it to be innovative.


Findings

The team received a limited response to the nonprofit assessment survey. However, we
were able to pick seven nonprofits that we believe are possible candidates for a
partnership 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 University
Medical Center
Contact name: Stephanie Pitsirilos-Boquin
Contact Email Address: chalk@nyp.org
Contact Phone Number: 212.305.2771

CHALK at New York-Presbyterian Hospital Columbia University Medical Center is a
nonprofit that focuses on health care (including hospitals, mental health, and medical
research). This nonprofit caters to children up to the age of 12 in low-income
communities. This organization receives funding through government grants. CHALK
focuses 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 ten
times a month. The organization feels that their program is innovative and they focus on
culturally appropriate sports. CHALK currently partners with the YM and YWHA, J's
Big Gym-Asociacion de Mujeres Progresistas, and Parks Department. CHALK is
interested in partnering with the NYC Department of Health and Mental Hygiene‟s
physical activity initiatives, and would be able to offer funding assistance, interns, and
exercise supplies (jumping ropes, balls, pedometers). CLIMB recently partnered with
SHAPE UP NYC as well.
2. Organization: Northern Manhattan Perinatal Partnership, Inc.
Contact Name: Maria Guevara
Contact Email Address: nmpp_chwp@yahoo.com
ZIP: 10035

Northern Manhattan Perinatal Partnership, Inc. is a nonprofit that focuses on human
services in Manhattan. This organization focuses on thirteen year olds and up in low-
income communities. They currently receive funding from government grants. Northern
Manhattan Perinatal Partnership, Inc. currently does not focus on physical activity
programming but is interested in implementing physical activity programming. Northern
Manhattan Perinatal Partnership, Inc. is interested in partnering with the NYC
Department of Health and Mental Hygiene‟s physical activity initiatives, and would be
able to offer space including indoor and outdoor space.


3. Organization: Fort Tryon Park Trust
Contact Name: Nancy Bruning
Contact Email Address: nbruning@aol.com
ZIP: 10040

Fort Tryon Park Trust is a nonprofit that focuses on recreation and sports, community
improvement, and capacity building in Manhattan. The organization focuses on all age
groups and low-income communities. The organization receives funding through
donations, fundraising, government grants, private grants, and nonprofit grants. Fort
Tryon Park Trust focuses on physical activity programming and focuses on walking
groups and group fitness classes. These activities run between 21 to 30 days a month
when the weather is in good condition, and less physical activity programs are offered in
the winter. Fort Tryon Park Trust believes that their physical activity programming is
innovative because they follow a “Green Exercise” Philosophy. It goes all year round,
and uses only the park's features and furniture; it is led by trained fitness professionals
and has been in operation since 2004.
This program is supported with a printed brochure providing instructions for 10 exercises
in addition to 10 suggested routes through the park which range from easy to moderate to
intense. A 15-minute DVD/video "101 Things to Do on a Park Bench" has just been
released to further support the use of park benches for a range of exercises that are
designed to improve flexibility, strength, and balance. This program is complemented in
the 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 and
Mental Hygiene‟s physical activity initiatives and would like to have help distributing the
15-minute video, "101 Things to Do on a Park Bench", which motivates and inspires
people to use their parks for exercise on their own and in informal groups, without the
need for special, expensive, or inconvenient equipment. The video helps people go
beyond just walking or jogging to do a complete workout including strengthening
exercises, 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 in
physical activity initiatives. Fort Tryon Park Trust is interested in partnering with the
NYC Department of Health and Mental Hygiene‟s physical activity initiatives, and would
be able to offer support staff (trainers, instructors) space including indoor and outdoor
space.


4. Organization: Randall's Island Sports Foundation
Contact Name: Laurence Vargas
Contact Email Address: laurence.vargas@parks.nyc.gov
ZIP: 10023

Randall‟s Island Sports Foundation is a nonprofit that focuses on recreation and sports in
Manhattan, Bronx, and Queens. This organization focuses on physical activity
programming for all ages. Randall‟s Island Sports Foundation receives funding from
donations, 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 activities
occur during March through November from 21 to 30 days a month.
The organization feels that their physical activity programming is innovative because
they partner with a wide variety of CBOs, schools, and other groups. They also offer
unusual sports like rugby and golf. The nonprofit partners with Department of Education
PSAL and CHAMPS in its physical activity initiatives. Randall‟s Island Sports
Foundation is interested in partnering with the NYC Department of Health and Mental
Hygiene‟s physical activity initiatives, and would be able to offer space, especially the
park, during weekdays before 3pm. They need outreach and funding from the
department of health to assist their physical activity programming.

5. Organization: Mount Sinai SOM/Little Sisters of the Assumption
Contact Name: Perry Sheffield
Contact Email Address: perry.sheffield@mssm.edu
Contact Phone Number: 212-241-2265
ZIP: 10029

Mount Sinai SOM/Little Sisters of the Assumption is a nonprofit that focuses on health
care in Manhattan, Bronx, Brooklyn, and Staten Island. The organization focuses on ages
0 to 19 in low-income communities. The organization earns funding through donations,
government grants, and private grants. Mount Sinai SOM/Little Sisters of the
Assumption focuses on walking groups, recreational sports, and after school activities for
children. The nonprofit runs the physical activity programs from 1 to 10 days a month.

The organization feels that their physical activity programming is innovative because
they combine nutrition, exercise education, and practice for children from low-income,
mostly 1st generation American Latino group. Mount Sinai SOM/Little Sisters of the
Assumption is interested in partnering with the NYC Department of Health and Mental
Hygiene‟s physical activity initiatives, and would be able to offer funding assistance.


6. Organization: FC HARLEM
Contact Name: Irvine Smalls, Executive Director
Contact Email Address: irv.smalls@fcharlemlions.org
Contact Phone Number: 917 572 1994
ZIP: 10026

FC HARLEM Assumption is a nonprofit that focuses on recreation and sports in
Manhattan. The nonprofit focuses on 19 and under ages in low-income communities. The
organization earns funding through donations, fundraising, and government grants. FC
HARLEM Assumption focuses on physical activity programming especially recreational
sports 1 to 10 days a week.

The nonprofit feels that their physical activity programming is innovative because they
utilize small spaces to teach the game of soccer similar to how it‟s done in Latin
American and African countries. FC HARLEM Assumption is interested in partnering
with 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, and
interns.

7. Organization: Partnerships for Parks - Catalyst Program
Contact Name: Carlos Martinez
Contact Email Address: Carlos.Martinez@cityparksfoundation.org
Contact Phone Number: 212-788-8067
ZIP: 10007

Partnerships for Parks is a nonprofit organization that focuses on recreation and sports,
youth development, community improvement and capacity building, foundations, and
philanthropy. The organization focuses on Manhattan, Bronx, Queens, Brooklyn, and
Staten Island. The nonprofit focuses on all age groups and low-income communities. The
organization receives funding through donations, fundraising, government grants, private
grants, and nonprofit grants. Partnerships for Parks focuses on physical activity programs
including walking groups, group fitness classes, recreational sports, water sports, and
bicycling 21 to 30 days a month.

They believe their physical activity programs are innovative. Partnerships for Parks and
its Catalyst for Neighborhood Parks is a multi-year initiative, working in historically
under-served neighborhoods that galvanize support for and commitments to: physical
renovations of the parks; sports, arts, and education programming; local parks
stewardship; and collaborative work amongst the partners, including those between the
communities and municipal agencies. Partnerships for Parks are currently working on a
project that the Department of Health and Mental Hygiene physical activity initiative
would be able to assist. For their project, they would need assistance accessing resources
for local groups, physical activity volunteers, and healthy programs for low-income
communities.


They are currently partnering with CityParks Foundation in its physical activity
initiatives.

Partnerships for Parks is interested in partnering with 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, and interns.


We recommend that the Department of Health and Mental Hygiene consider partnering
with the seven selected nonprofit organizations. Collaborating with nonprofits will allow
the DOHMH to receive support in its physical activity programming in the form of
indoor and outdoor space, funding opportunities, trainers, interns, equipment and other
resources.
In addition, four out of the seven selected nonprofits have already implemented walking
groups in their physical activity programming. We recommended that the DOHMH
analyze their practices and put them at the top priority of future partnerships.
Also, as highlighted in our findings, the DOHMH can apply innovative components of
the selected nonprofits to its own programming.
Finally, five of the selected nonprofit organizations already collaborate with other
organizations. We can learn from these partnerships and they can offer additional
connections and resources for the DOHMH.


Deliverable V: Business Wellness Survey

Introduction
Our business wellness deliverable was created in order to develop possible partnerships
between private organizations and the Department of Health and Mental Hygiene.
Fostering these partnerships is crucial for the DOHMH given that its physical activity
programs such as Shape-Up are subject to budget cuts. There must be secured capital for
funding, as well as interested parties to participate.
Stressing the importance of good health and an active lifestyle should start where a large
majority spend most of their day, at work. Implementing an employee wellness program
can lower the overall cost of healthcare and increase the health of employees. Taking
initiatives to improve the health of employees can lower the amount of doctor visits they
make, lowering the cost of healthcare for businesses and lowering the amount of sick
days employees would take from work. Furthermore, when employees are healthy their
productivity is bound to increase and improve. We took the initiative to understand
whether or not businesses throughout the South Bronx, Harlem, and Brooklyn already
take part in a business wellness program or would be interested in partnering with the
DOHMH to establish such a program.

Methodology
The first step in this analysis was to develop a survey to measure the following: how
many companies offer full time employees health insurance, how many businesses are
currently offering wellness incentives to their employees, and finally, how many of these
organizations would be willing to partner with the DOHMH. It is important to determine
the rate of health insurance offered to full time employees as health insurance is the first
step to leading a healthy lifestyle.
Examples of wellness incentives include: offering non-smokers breaks for exercise or to
get 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 of
the employees said they would participate in the programs if they were offered. The final
step in our survey process was to determine how many private businesses would like to
partner with the DOHMH on future endeavors. This response was about half, many of
these companies already partner with other local businesses, but were not connected to
the NYC health community.
The survey was conducted throughout the South Bronx, East Harlem, and Central
Brooklyn 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.


Overall Findings
70% 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 gym
memberships, or financial incentives to take the stairs instead of the elevator or escalator.
89% of businesses reported that their employees would take advantage of wellness
incentives if they existed in their establishment.
52% are interested in partnering with the DOHMH to establish a business wellness
program and/or offer incentives.
15% are already partnered with local gyms, restaurants, and other businesses offering
incentives to their employees

Borough-to-Borough Findings
All East Harlem and South Bronx businesses that we surveyed do not already partner
with 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 the
27 total surveyed businesses, are interested in partnering with the DOHMH to increase
business wellness programs and initiatives.


Develop a generic partnership plan for any interested businesses wanting to team up with
the DOHMH to provide comprehensive business programs and initiatives for their
employees.
Encourage businesses to provide health insurance to all of their employees and provide
an informative database of affordable health insurance options.
Become a liaison for businesses wanting to partner with other local businesses to provide
employees wellness incentives.


Deliverable VI: Grant Proposal to Fund Pilot Program

EXECUTIVE SUMMARY

Given the increase in obesity rates in the United States and in New York City
specifically, the New School Practicum Team set out to determine the feasibility of
increasing access to free or low-cost physical activity programs among three low-income
neighborhoods, specifically East and Central Harlem, North and Central Brooklyn, and
the South Bronx. Through national and international comparative analyses, on-the-
ground quantitative/qualitative surveying, research of applicable best practices, and an
assessment of how to effectively operate a self-sustaining program without reliance on
city funds, the team has established several key recommendations on how best to carry
out programming that will increase access for the three low-income neighborhoods noted
previously. Recommending a six-month pilot program in East Harlem, a minimum
participant goal of 1,800 participants has been established for the period, followed by
roll-outs in Central Brooklyn and the South Bronx, subsequent to a period of performance
evaluation. By creating greater accessibility to physical activity programming not subject
to city budget cuts, persons residing in the communities in question will have the
opportunity to participate in activities that will reduce the negative effects of an
unhealthy lifestyle, thereby reducing health care costs over the long term. This grant will
include: the organization mission statement; a thorough project description, both short
and long term goals which will also include methodology, the use of incentives, staffing
procedures, and potential partnerships with non-profit organizations. The grant will also
highlight a budget proposal, timeline and project duration, and evaluation strategy.


STATEMENT OF NEED

Data 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 New
Yorkers are overweight, while more than 700,000 have diabetes. Through program
evaluation methods using surveys and assessments, it has been determined that walking
groups are in fact feasible in the high-needs neighborhoods, as long as the program
provides incentives for participants. These programs can allow better health and
increased 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, and
fewer trips to the hospital. It is also likely that greater physical fitness and awareness will
result in overall lifestyle changes such as improved eating habits and greater mental
wellness. Our conclusions and basis for our project are based on best practices of current
programs such as Walk It Out and Shape-Up. Having surveyed Shape-Up participants in
the formally mentioned neighborhoods, our data indicated that women ages 34-54 are
more willing to participate in walking groups. They are also demanding more physical
activity programs, such as outdoor walking groups and are willing to pay an average of 5
dollars to participate. The women we surveyed throughout the three boroughs mentioned
how 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 than
they could ever get from a gym: “I lost 20 pounds since I began the Shape-Up program in
October” said one of the participants. Unfortunately, because of a lack of space, these
classes are unable to meet the demands of the participants. In East Harlem, women stand
in line for over an hour to receive an entry ticket, and some even fight for a spot in line. It
is critical that the DOHMH establish new programs to fit the demands of the public, as
well as continue to provide support for current physical activity programs. Without the
establishment of walking groups or other physical activity programs, the DOHMH‟s goal
of reducing the impact of obesity will fail.


ORGANIZATION MISSION STATEMENT

The New York City Department of Health and Mental Hygiene (DOHMH) is one of the
oldest health departments in the nation. The DOHMH stands out among local health
departments in its level of commitment to, and its activities in chronic disease prevention
and control. Recent domestic and internationally progressive initiatives include the
introduction of regulations that ban trans fats and that require calorie labeling in NYC
restaurants.

The DOHMH is also involved in active living through addressing opportunities for daily
physical activity through environmental change. Initiatives include both Take the Stairs
Campaign, as well as Active Design Guidelines, which were launched in January 2010
(www.nyc.gov/adg). Additionally the District Public Health Offices of DOHMH, focus
agency resources in the three poorest communities in New York City, and seek to reduce
the gaps in health between these and other NYC neighborhoods.

PROJECT DESCRIPTION

Goals and Objectives

Short 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.


 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%.

Methodology
The walking group pilot program will target female participants ages 34-54, and will take
place from April 1st – October 31st 2012 for a six-month duration. In Year 1, the pilot
program will first commence in East Harlem due to the great demand, turnout and
feedback received from surveyed participants attending Shape-Up classes within this
neighborhood. 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 and
the percentage of those who lower their BMI, and blood pressure. In year 2 (2013), after
determining the program‟s success through thorough evaluation, walking groups will
then be replicated in Central Brooklyn. In year 3 (2014), if the program continues to
show growth and success, walking group programs will be implemented throughout all of


NYC‟s high-needs communities, which include Central Harlem, North and Central
Brooklyn and the South Bronx.

Sessions:
Walking group sessions will be held 3 days a week: Monday/Wednesday/Friday from
9:00am – 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, and
another 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 loyalty
program which will include incentives to attend the walking groups. On an individuals
first time attending a walking group, they will receive a T-shirt, which will also act as
free 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 group
leaders, 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 and
interns. Student volunteers will be trained and certified in CPR and first aid to become
walking group leaders. Student interns can work as monitoring and evaluation
coordinators, focus group leaders and facilitators for academic credit. Through the use of
student volunteers, we also expand community ties, and intergenerational activity. If
student volunteers are determined to not be feasible due to liability issues, we will then
hire certified trainers at $100 an hour.


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 can
Organization Name: provide in
Email: partnering with
Phone: the DOH
CHALK at New Stephanie Pitsirilos-Boquin Focuses on health care CHALK focuses on Would be able to
York- chalk@nyp.org including hospitals, mental physical activity offer funding
Presbyterian 212-305-2771 health, and medical research programs, particularly on assistance, interns,
Hospital This organization receives group fitness classes, and exercise
Columbia funding through government recreational sports and supplies (jump
University grants family fitness ropes, balls,
Medical Center pedometers).

Northern Maria Guevara Focuses on human services Currently does not focus Would be able to
Manhattan Nmpp_chwp@yahoo.com in Manhattan. This on physical activity offer space
Perinatal 212-289-8800 organization focuses on programming but are including indoor
Partnership, Inc. ages thirteen and up, in low- interesting in and outdoor space.
income communities. They implementing physical
currently receive funding activity programming.
from government grants
Fort Tryon Park Nancy Bruning Fort Tryon Park Trust is a Focuses on physical Would like to have
Trust 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.


Randall’s Island Laurence Vargas Focuses on recreation and The physical activity Would be able to
Sports Laurence.vargas@parks.nyc.go sports in Manhattan, Bronx, programming focuses on offer outdoor space
Foundation 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 to
SOM/Little Perry.sheffield@mssm.edu Manhattan, Bronx, groups, recreational offer funding
Sisters of the 212-241-2265 Brooklyn, and Staten Island. sports, and after school assistance
Assumption 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 grants
FC 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 interns
Partnerships for Carlos Martinez Focuses on recreation and Focuses on physical Would be able to
Parks-Catalyst Carlos.Martinez@cityparksfou sports, youth development, activity programs offer funding
Program 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.


TIMELINE

PROJECT DURATION

Table 2: Timeline for East Harlem Walking Group Pilot Program

Timeline Narrative
Donor prospecting will take place from June – August of 2011. Once a list of funding
candidates is compiled, grant proposals outlining the pilot program will be sent out to
donors from September – December of 2011. Training instructors and personnel as well
as community outreach should run from January through April of 2012. The goal is to
begin the pilot program in East Harlem on April 1st of 2012 until October 31st of the same
year, totaling 6 months. Evaluation and monitoring will occur throughout the entire pilot
program (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 analyzed
effectively. If the pilot program is successful, we recommend that the program be
replicated in Central Brooklyn in 2013. In Year 3 (2014), the program will be
implemented in all of NYC‟s high-needs communities, which includes East and Central
Harlem, North and Central Brooklyn, and the South Bronx.


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 A

TYPE OF QTY AMOUNT REASON FOR EXPENSE
EXPENSE
EQUIPMENT $5,860
Safety:
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 participant
Incentives:
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
supermarkets
PERSONNEL --
Certified instructor 1 -- In accordance with best practices, all personnel will be providing their services
M&E coordinators 2 -- pro bono
Focus group leader 1 --
Creative designer 1 --
TRAVEL $1,560
Instructor RT MTA 1 metro card $390 In accordance with best practices, all personnel will receive reimbursement for
M&E RT MTA 2 metro cards $780 their MTA subway expenditures; Assumes $5 round-trip, 3x/week over 26 weeks
FG leader RT MTA 1 metro card $390
MARKETING/ $20,000
COMM
Creative -- -- 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; Print
Online Social Media -- -- advertising, using the creative, must be carried out to drive awareness of the
Print Advertising $20,000 walking groups and spur participation
TOTAL $27,420
We will ask for $30,000 per borough for the 6 month program


Budget: Walking Group Pilot Program
East Harlem
April - October
Mon/Wed/Fri
9AM - 10AM

Table 4: Budget with Paid Staff and Trainers

SCENARIO B

TYPE OF QTY AMOUNT REASON FOR EXPENSE
EXPENSE
EQUIPMENT $5,860
Safety:
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 participant
Incentives:
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 supermarkets
PERSONNEL $7,800
Certified instructor 1 $7,800 In the event a volunteer certified instructor cannot conduct the walking
M&E coordinators 2 -- groups, a certified instructor will require payment; this figure assumes a
Focus group leader 1 -- high of $100/hour, 3x/week over 26 weeks
Creative designer 1 --
TRAVEL $1,560
Instructor RT MTA 1 metro card $390 In accordance with best practices, all personnel will receive
M&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 weeks
MARKETING/COMM $20,000
Creative (logo/messaging) -- -- Assumes creative will be provided pro bono; Social media (Facebook,
Online Social Media -- -- Twitter, YouTube, targeted blogs), will be absorbed by the nonprofit
Print Advertising $20,000 staff or intern; Print advertising, using the creative, must be carried out to
drive awareness of the walking groups and spur participation
TOTAL $35,220
We will ask for $40,000 per borough for the 6 month long program


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 people
benefits 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

Calculation

Numerator Number of survey respondents who are aware of walking groups and can identify
at least one benefit – multiplied by 100

Denominator Total number of respondents (Goal is minimum of 1,800 over six-month period)


Consultancy Proposal to NYC DOHMH

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