This is an audio recording of a telephone interview recorded in September 2010.

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1 Sound Advice This is an audio recording of a telephone interview recorded in September Marsha Raulerson, MD, FAAP, has been a pediatrician in Brewton, Ala., for more than 30 years. She is a member of the Committee on Federal Government Affairs for the American Academy of Pediatrics. Q: Dr. Raulerson, what role does the community play in creating a healthy lifestyle for people? Dr. Raulerson: Well, I think that times have changed very much since we've become so aware of the obesity epidemic in children. Used to be, we thought it was a family responsibility and an individual responsibility, what children eat and how active they are. But more and more as we look into the problems of our young children, we realized that the entire community has to provide an environment for the child, so that the child can make healthy choices, so that the child has access to healthy foods, and also so that the child has access to activities and ways to keep physically active. They can't do it by themselves. Q: Can you tell us a little bit about what you did in Alabama? Dr. Raulerson: We have a project that s part of Be Our Voice. We thought it was going to be a small project, what can we do to tackle the obesity epidemic in rural Alabama where I live. We got together a group of stakeholders. It included people from the community, from the medical field, from public health, from the school system, and we began to talk about what we need to do to change the way our children eat and how physically active they are. And what we discovered very quickly was, this is not going to be an overnight project. So we have a 10-year goal. Our 10-year goal is that children 10 years from now in Escambia County, Alabama, which is Brewton and East Brewton, Atmore and Flomaton, four towns, that the children in our community in 10 years will choose to be physically active and choose to eat healthy. And we want to do as many things as we can as a community to make that possible. Q: What are some of the things that you've done? Dr. Raulerson: I can tell you a little bit about Brewton.I think Brewton is one of the best places for young families to live. I have to give credit to our mayor and our city councilmen, because they have worked very hard over the last few years to improve the parks in our area, to create new walking paths and bike paths, and even a place where children can roller skate if they want to, or use skate boards. The problem that we found when we began meeting and talking about it, was that families don't access these things. They're there for them, but you can go by on a weekend day and there's nobody there. So we began talking about how do you encourage families to take advantage of what's already there.

2 Q: Have you developed some good ideas to do that? Dr. Raulerson: Well, and this is something that I've learned in working with this project, is that you have to listen to the people who come together. We meet once a month on a Tuesday afternoon from 5:00 to 6:00. We limit it to one hour because our community leaders don t have a lot of extra time, they re already busy professional people. So we meet one hour a month. One of the first things that we became interested in was using some of our community parks to start community gardens. Our first garden had its groundbreaking last month. Unfortunately, it rained so hard that we couldn't start our planting. So the planting is going to start this Saturday coming up. It s led by a group called RSVP, they're retired citizens who volunteer their time. What we found is that families are so busy that they don't have time to do things with their children. So we have a group of retired citizens that are pairing with children to plant the community garden. Children can have a mentor, who is retired and who will work with them, teach them about gardening. And we ll have our first gardens planted this Saturday. Since it s the anniversary of Sept. 11, we also have invited our police, our firemen, our rescue squad, our ambulance service, and we re going to dedicate it to the remembrance of Sept. 11. It will be done at a place called Fort Crawford. Fort Crawford was a large park that became overgrown and not used and vandalized. The community decided they wanted to renovate the park, and so they took a huge section of it and made it into a community garden. Q: That s great. What advice do you have for people who are interested in making similar changes in their communities? How can they get started? Dr. Raulerson: I think that you cannot as a leader have any preconceived notions about what you want. You have to truly listen to the people who volunteer their time. When we meet I m amazed, there s usually 20 to 30 people there, and they all have ideas, and you listen to them. And you support them and the things that you want to do. You don't make old friends in a hurry. You work with your community, you work with the people who are already doing things. One of the things that came out of our once-a-month meeting was an idea to support a community center. We have a middle school in Brewton that will be closing in a year because they re building a brand new middle school. This is a middle school that s been there for many years. In fact, it was the old black high school before integration. It s a historic monument. And the community wants to take this building when it s vacated and use the playground area. There s a tennis court and a swimming pool and a basketball court and a beautiful kitchen inside. They want to develop this into a community center, where children can come to play after school, not necessarily team sports, but just to a safe place to play, where there s adult supervision. They want to use the kitchen in the old middle school to teach people how to cook healthy, and use this center to have a healthier community by involving children and adults in activities after school and on the weekends.

3 And I never dreamed that this would be part of our project, but like I said, we re talking about 10-year change. And this is a big one and I ve supported them as much as I can. In fact, I have here on my desk a petition to the mayor and the city commission asking them to write a letter of support for developing this new community center. Well, we cannot open it until after the middle school moves, and that will be a year from now. It s going to take a lot of planning to bring the building up to a good condition for a community center, and to redo the playground. Also, several years ago, one of the science teachers at the school developed a community garden there. It s kind of been neglected for a few years, but it was our very first community garden, and we want to revise that community garden. It s in a very highly populated area in our town. Many children who live in that area do not have access to playgrounds, because they re such a distance away. Q: Doctor, what environmental factors have the biggest impact on the health and fitness of residents? Dr. Raulerson: I think for my community, having safe places where children can go and play and where families can go. And not only having safe places, but also places where there s adult supervision. In so many of the families in my community, both parents work, and children get out of school at 3:00, and they re unsupervised from 3:00 to often 5:00 or 6:00. And when they re unsupervised, they tend to do a couple of things. They tend to go home and watch TV, text message, play video games, and stay inside. In fact, the parents may even tell them, You can t go out, you have to stay inside. So they re not doing things that are physically active. We have places for them to go, but we ve not in the past had the kind of supervision in the community. When I was growing up, we were not afraid to go out and play ball in the street, ride our bikes for six or eight blocks from our house, or even ride to the library, which was a mile or more away. But today, there is a perception on the part of parents that it s not safe for their children to be out on the street. I m not sure that s true. I think they re safer than they realize, but parents encourage children not to go outside. By having all of these facilities available, one of the things that we found is that there needs to be supervision by adults. And it can t be the parents because they re working, they re going to the grocery store, they re fixing dinner. So we have a group of retired citizens that have volunteered their time to try to be out there, to be with the children, and see that they can do things like work in the community garden, or walk home safely from school instead of riding a school bus six blocks. And so that s one of the things that we re building on is to increase the perception that this is a safe place to go, this is a safe place to play. There are adults around who care and will watch your children. Q: What advice do you give parents who are in that situation, where either they re working or they don t feel it s safe for their children to be outside playing? What can they do, both in their own family and then at the larger community level? Dr. Raulerson: One of the things that I have suggested is that they buddy with other adults in their neighborhood. If Thursday is your day off, on Thursday after school, you supervise other

4 children other than your own. We have a beautiful playground, it s called Rainbow Dragon Playground, it was named by one of our elementary school students. They have a splash pad there, they have lots of playground equipment, and it s one of the busiest playgrounds in town. What I've recommended is that when you take your child, don t take just your child, ask your neighbor, Can I take your two children today? Be a help to your neighbors. That s really catching on. Families are working together to try to supervise children and to take turns. Q: There s been a lot of talk about improving the quality of school lunches. Has that happened in most places? What can parents and school officials do to improve the lunches at their school? Dr. Raulerson: Well, we talk about this just about every time we meet. One of the things that happened in Alabama a couple of years ago was all the deep-fat fryers were taken out of public schools in our state. And I think that was a good step in the right direction. Also all the vending machines were taken out of the elementary schools. That was a statewide policy that has impacted our local communities. But I think also that parents can support the school board in offering healthier choices at lunch. A lot of times people say, Well, the children won t eat salad, or They won t eat steamed broccoli. If the parents support the school board in trying to make these changes, then children will try new foods. And we also are trying to tie that healthier nutrition into the restaurants in our community. At Rainbow Dragon Playground, there s a small restaurant where people who were playing golf there or children at the splash pads can eat. And I ve worked with the owner of the restaurant all summer and we were trying to find things that you could offer that would be healthier for the children. We had to laugh a lot about that. One day we had carrot sticks and celery sticks, and we only had one person who chose that. But we did find that they liked watermelon, and that instead of cookies, cake, pie, ice cream, that you could give them a bowl of watermelon and the children would eat that. It s kind of a slow change about what children choose. And we have to encourage our families to learn how to cook nutritious things at home and offer nutritious snacks. And we ve also talked about changing the way we as adults eat so that we re better role models for our children. For instance, we had a community meeting of adults who have the quality assurance for our department of human resources. One of the members of our committee was responsible for the lunch that day, and she said, I knew that Dr. Marsha was coming, so we have a healthy lunch. And she prepared a dessert that was very low in calories, and she had whole wheat bread that had only 80 calories in two pieces. And it was an adult meeting, but we felt that if you start with adults learning to make wiser choices, then this will also impact the children. Q: How can parents be advocates not only for their own children, but for their larger community?

5 Dr. Raulerson: Well, there are a lot of community activities where people eat. One of the things that we southerners do is when we get together, we eat. So when we have our meeting every month to talk about Healthy Community, Healthy Children, Be Our Voice, we always have a healthy snack. We either have some type of fruit or small servings of nuts at our meetings. We ve also talked about things like church suppers, offering things at church suppers that are more nutritious for the children. And when we have snacks at school to celebrate something special and the parents volunteer to bring snacks, or even when the football players get together for breakfast on the day of the game or after practice, that the things that we offer are more nutritious. For instance, the day cares in our area are starting to serve water. Instead of giving the kids juice for snacks, they re giving them water. That s been pretty universal among our child care centers. I think a step in the right direction. And the parents are the ones who impact these activities, not the children. Q: Doctor, is there anything else you d like to add? Dr. Raulerson: Well, I want to talk a little bit about Rome not being built in a day. You can't say, Okay, we re going to have a community garden, or We're going to change what the restaurant serves, or We're going to change school lunches. You have to look at the entire environment for the child: where the child lives, where they go to school, where they play. And you have to impact all of those things so that the child has an opportunity to make healthy choices. And then you have to tie this somehow to long-range planning for your community. We have something in Escambia County called the Coalition for a Healthier Escambia County. It s been meeting for over 15 years. It s been responsible for such things as fluoridation in all our water systems, changing a section of our highway where there were many accidents so that it became four lanes. We ve increased dental access by building a clinic at our health department that provides dental services for adults and children. We have worked on things like child care centers and Head Start programs, and we ve been working on these things for 15 years. So we decided that we need a home for our projects, Healthy Community, Healthy Children. So we have tied that to our old friend, the Coalition for a Healthy Escambia County. And it has become one of their goals to work on the community to make it a healthier place for kids to live. And then I have to also say that our school nurses come to all of our meetings, and they re trying to work with children at school. They do BMIs (body mass indexes) in our schools now on all the children, and they talk with the children about healthy choices. And the nurses are trying to be role models in their school and talk about nutrition at school and physical activity at school.

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