Roundtable on Obesity Solutions 10th Anniversary: Looking Back, Moving Forward: Proceedings of a Symposium (2025)
Chapter: 4 Catalyzing Action Across Multiple Sectors
4
Catalyzing Action Across Multiple Sectors
In this symposium session, Stephanie A. Navarro Silvera, Montclair State University, moderated a discussion among panelists about how the roundtable facilitates cross-sector collaboration. Silvera began by describing how being a member of the roundtable has affected both her work and her personal experiences. Professionally, she said, the insights she gained have shaped her approach to addressing obesity in her work, and the use of multidisciplinary perspectives broadened her understanding of the factors contributing to obesity and the strategies needed to address the needs of people with obesity.
She noted that she was choosing her words intentionally; the roundtable should not be aimed at addressing obesity, but at addressing the needs of people who are living with obesity. These experiences on the roundtable influenced her research and advocacy efforts and allowed her to integrate concepts of stigma and bias into her work on structural inequities. Moreover, said Silvera, the connections made with other professionals and experts on the roundtable have been invaluable in providing ongoing support and staying updated with developments in the field. For example, this year Silvera attended a meeting about racism in the food system hosted by one roundtable member, and another about health equity in communities hosted by a panelist at this symposium.
On a more personal note, she said, participation in the roundtable has encouraged her to push past her own experiences with stigma and bias to seek assistance in her weight journey. Silvera said that she has struggled with her weight and body image since her teenage years and spent most of her teens and early adulthood feeling that if she were “just thin enough,”
she would be pretty. She eventually found a workout routine that helped her focus on feeling good, but it was interrupted by the COVID-19 pandemic; this left her spiraling with stress eating and no outlet for exercise. She was invited to join the roundtable and through conversations about research, practice, and lived experience, “something clicked in a way that it never had in the past.”
She made the choice to try a GLP-1 drug. Silvera said that the drug has helped her to not focus on food and to eat when she is hungry and stop when she is full; this shift has “been life changing.” However, she has also experienced stigma related to her use of the drug. She recalled a gastroenterologist who she was seeing for an unrelated issue commenting that she should not be on the medication and she “probably just needed to eat less rice.” There is a lot to unpack in this story in terms of racism, stigma, and bias, said Silvera, and she is glad to be part of a group that is tackling that in a meaningful way. The work that has been done and continues to be done by bringing together groups of individuals from diverse fields is vitally important to address all of the issues connected to obesity, she said. Silvera asked panelists a series of questions about their own experiences on the roundtable.
THE ROLE OF FINANCIAL INSTITUTIONS
Silvera began the panel discussion by asking Jennifer Fassbender, Reinvestment Fund, to talk about the role of financial institutions in addressing the drivers of health. Fassbender said that Reinvestment Fund, a community development financial institution (CDFI), may not seem like a traditional partner of the roundtable; such a partnership began in 2017 when Reinvestment Fund participated in a workshop on the built environment. Neighborhoods are not all created equal, said Fassbender, and community development has a distinct role in helping to alleviate some of these inequities. CDFIs are mission-aligned nonprofits that finance projects that traditional banks may not, and they touch communities across the country. Fassbender works on issues related to social determinants of health at Reinvestment Fund, leading the National Invest Health Initiative. This initiative works in 50 small to midsized cities across the country, as well as a four-city cohort in New Jersey, on building healthier and more equitable communities. Driving more equitable investment and connecting resources in communities are important aspects of addressing the drivers of health, said Fassbender, so it is a natural fit for Reinvestment Fund to work with the roundtable.
THE ROLE OF COMMUNITY-FACING ORGANIZATIONS
Silvera asked Katie Adamson, YMCA of the USA (the Y), about the role of the Y on addressing social determinants of health. Adamson focused on one specific initiative of the Y—an effort to get health care systems to understand that they need to invest in health factors that influence health outcomes. This effort starts by educating the Y’s chief executive officers (CEOs) and staff about the fact that 80 percent of health outcomes occur outside the doctor’s office and are influenced by upstream, community-level factors. In addition, health care systems and payers need to be educated about how upstream factors will improve health outcomes and ultimately help their bottom line. The work that the Y does every day will help build healthier communities and reduce costs for health care systems and payers, said Adamson.
The Y is the leading provider of child care and afterschool programs in the United States, supporting parents so they can work and get health benefits. The Y’s summer camps fill the child care gap during the summer. The Y nourishes 3 million children through the U.S. Department of Agriculture (USDA) feeding programs; it provided 61 million meals last year. The Y is the largest provider of evidence-based health interventions and injury prevention interventions. The Y has youth employment programs that helped 55,000 kids get their first jobs last year. Sixty Ys provide shelter, with 15,000 beds available. Through these services, said Adamson, community-based organizations (CBOs) are essential actors in the health care system.
THE ROLE OF HEALTH CARE ORGANIZATIONS
We know that population health approaches support a broad array of obesity prevention and management interventions, said Silvera. She asked Allison Gertel-Rosenberg, Nemours Children’s Health, how traditional health care organizations can integrate population health approaches into their work. Gertel-Rosenberg replied that Nemours Children’s Health, a large pediatric health system, is working to reshape the definition of health and to shift health care systems away from a focus on sickness and toward a focus on health. Eighty-five percent of health outcomes happen outside of the clinic walls, she said, so it is critical to work synergistically with partners outside the health system. With children in particular, Gertel-Rosenberg said that there are opportunities to shift the trajectory of their life by acting early. Creating a healthy generation of kids will make the next generation of adults and parents healthier as well.
MULTISECTOR PARTNERSHIPS
Silvera asked panelists to comment on the role that multisector partnerships can play in addressing obesity. “We are caring for so many of the same kids, families, and communities,” said Gertel-Rosenberg. If organizations can work across sectors and put those communities at the center, these collaborations can change systems with each organization doing what it does best, ultimately benefiting the communities. Fassbender replied that there are three core benefits to multisector collaboration and partnerships. One is what Gertel-Rosenberg said—working together to effectively use each organization’s strengths so they can do what they do best. A second benefit is the ability to increase the power of each organization’s effort through an aligned vision with shared priorities. Third, said Fassbender, multisector collaborations have a diversity of thinking and perspectives that can create more innovative solutions. Adamson said that it is hard for any one organization to be able to understand every sector that is at play in efforts to address obesity; necessary sectors include transportation, education, agriculture, health, and banking. We cannot put the pieces of the puzzle together without each other, she said, and it is too complicated for one entity to understand every sector.
Silvera asked Fassbender and Adamson to talk about the collaboration between Reinvestment Fund and the Y. Fassbender said that while the Y has the structures in place to improve the social determinants of health in communities, the collaboration that engaged the Y leadership with Reinvestment Fund on the issue of community development and facility renovation opportunities bridges the capital gap between a facility’s potential and the actual implementation of a set of integrated social needs. Adamson explained that the model of the Y is that volunteers raise money through capital campaigns to build a Y in their community. In a resource-poor community, this can be a challenge. Reinvestment Fund, and other CDFIs, can offer Ys access to affordable, responsible loan capital and help build assets in low-income communities that meet their needs to thrive; the Y then sustains jobs and stabilizes the community with resource-rich facilities. The collaboration was intended to share capital strategies and tools that CDFIs use to partner with facility developers to advance Y projects to improve facilities.
It is critical that the structure of a community Y is driven by the community’s needs, said Adamson. For example, a Y in West Louisville, Kentucky, secured almost $30 million to build a mixed-use facility that includes a bank, a community health center, a mental health center, child care, and a rehabilitation facility. Collectively, Ys have been able to secure over $1 billion to build about 100 facilities in low-income communities, she said.
Financial institutions can also partner with health care organizations to develop strategies for community building and health through neighborhood investment. Nemours Children’s Health, said Gertel-Rosenberg, has been in the process of thinking about how its role as a community employer and anchor can improve health outcomes and the well-being of the children and families in the community. As an employer, there are opportunities to make a difference through, for example, paying a living wage and making good purchasing decisions. The environment has a significant effect on the health and well-being of children, so it is critical that Nemours identify aspects of the environment that it can improve. There are opportunities to learn from organizations like Reinvestment Fund and other anchor organizations that have been doing this work for many years in many communities, said Gertel-Rosenberg.
Fassbender said that partnerships and collaborations create an opportunity to identify and build on existing strengths and capacities, rather than creating new ones. For example, she said, CDFIs have the expertise to advise health systems and other organizations on capital solutions and provide the financing for community development projects as a trusted resource, while meeting partners where they are on the capital access continuum to layer grant and loan capital sources to get programs and projects off the ground. It is essential to continue dialogues across sectors and between collaborating partners. If the goal is to build healthier, more equitable, thriving communities, this work needs to be underpinned in equity, partnership, and capacity building, said Fassbender. Organizations can collaborate to support each other and use their diverse perspectives and areas of expertise.
PARTNERSHIPS BETWEEN HEALTH CARE AND COMMUNITY ORGANIZATIONS
Opportunities for health care and community organizations to collaborate abound, said Silvera. She asked Adamson and Gertel-Rosenberg to talk about the work they have done together and how it has reshaped their approaches to working with children, families, and communities. Adamson said that the first step to working together was using each other’s language and understanding the other’s value proposition. CBOs need to be able to explain their value to health care organizations. For example, the Y works with public and private payers to encourage them to see how offering community services that help children and families will lead to better health outcomes. Payers want to reduce costs, said Adamson, so if an organization can show that a community service like transportation or child care will reduce costs, payers will listen. Health care providers also want high approval ratings, or star ratings. Partnering with a popular community organization like the Y can help improve these ratings, she said.
One challenge, said Adamson, is that CBOs can have a hard time understanding electronic medical records and how to get health care payers to pay for services. However, this is changing in part because of incentives in the health care system that encourage partnerships with CBOs to provide services. Gertel-Rosenberg agreed that language is key to successful partnerships; organizations often have shared goals but use different language to talk about them. Bridging this gap is a huge opportunity to advance the work, she said. It is often necessary to change one’s language to talk to professionals in other fields and to create an understanding of shared values, opportunities, and goals.
THE FUTURE OF MULTISECTOR COLLABORATIONS
Silvera closed by asking panelists to briefly describe the future of multisector collaborations in addressing deeply entrenched health issues like obesity. Fassbender replied that it is critical for different sectors to understand where they reside in the broader ecosystem and to be impact minded; that is, to position their work so that it is directed at shared goals. Adamson said that the Y is focused on creating multisector collaborations to address the mental health crisis. Mental health is linked to a number of chronic diseases, including obesity, and the Y is committed to working with partners across sectors to build and promote community health and resilience. Gertel-Rosenberg said that the future holds an opportunity to innovate on the playbook of the shared work that has already happened. This is a chance, she said, to examine what has worked and what needs to be done differently to get to the outcomes that are needed.
