Minnesota Sugar-Sweetened Beverage Reduction Initiative

PSE Change Real-World Example – Step 6: Implement
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PSE Change Example

Problem: At the time of this initiative, the obesity rate had doubled, with almost two-thirds of Minnesota adults overweight or obese.1 Although many factors influence rates of obesity and overweight, sugary drinks play a significant role. 

1Minnesota Department of Health (n.d.). MN Public Health Data Access Portal: Obesity in Minnesota. Retrieved from https://apps.health.state.mn.us/mndata/obesity_basic#byyear 

PSE Change Solution: In tackling this issue, the Minnesota Comprehensive Cancer Control Program (CCCP) and the Public Health Law Center engaged partners working on community-level obesity prevention strategies. They took multiple steps, including conducting an environmental scan of federal strategies and existing policies related to healthier drink choices; identifying a sustainable funding stream; building awareness via local public health grantees; providing technical assistance to hospitals and health systems; and evaluating their impact. By the end of 2015, 35 hospitals had pledged to or had implemented PSE changes to reduce or phase out the sale of sugary drinks. 

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Problem 

Since 1980, the adult obesity rate has doubled and now almost two-thirds of Minnesota adults are overweight or obese (Minnesota Department of Health, n.d.). Although many factors influence rates of obesity and overweight, sugary drinks play a significant role. 

PSE Change Solution 

Encourage health care organizations to take a key leadership role in creating healthier communities through modeling policies, such as the phase-out of sugar-sweetened beverages. 

Actions/Results 

The steps taken as part of this successful PSE change effort were: 

  1. Engaged Key Partners: Key partners in this PSE change effort were the Minnesota Comprehensive Cancer Control Program (CCCP) and the Public Health Law Center. These partners worked with the Minnesota Office of Statewide Health Improvement Initiatives, along with local grantees receiving funding to work on obesity prevention strategies at the community level (Step 1: Engage). A Minnesota non-profit previously started the Commons Health Hospital Challenge and was responsible for the elimination of sugary beverages in multiple hospitals in Northeast Minnesota. When the state CCCP approached them about expanding their work to other parts of the state, they were eager to join in (Step 1: Engage). 

  2. Scanned the Environment and Assessed the Data: The Department of Health’s environmental scan considered strategies of the Centers for Disease Control and Prevention and the National Academy of Medicine. It reviewed the influence in the state of the federal Healthy Hunger-Free Kids Act of 2010, as well as existing policies related to healthier drink choices in hospitals (Step 2: Scan). Minnesota also reviewed data about obesity rates in the United States and in Minnesota, the link between obesity and cancer risk and the association between the high consumption of sugar-sweetened beverages and obesity (Step 3: Assess). 

  3. Reviewed Feasibility of Intervention: When considering financial resources, Minnesota determined a cost-effective way to proceed: it funded the Public Health Law Center to develop materials and offer technical assistance to the local public health grantees (Step 4: Review). 

  4. Built Awareness: Local public health grantees throughout the state were working to reduce obesity through policies and systems change. The CCCP and Public Health Law Center offered these grantees on-site technical assistance to build awareness and engage with their local hospitals and health care systems on healthy beverage policies. The Minnesota Hospital Association promoted the policy to member hospitals through multiple unique educational vehicles, such as conferences and training videos (Step 5: Promote). 

  5. Executed Strategies: Each hospital and health system had unique challenges in adopting and implementing a policy to eliminate or reduce sugar-sweetened beverages. As a result, technical assistance was provided to address those challenges. The process of planning and holding a Healthy Healthcare Summit strengthened the commitment of those in the implementation stage and inspired commitments from others still exploring a policy to reduce or eliminate sugar-sweetened beverages. At the Summit, all participants celebrated the announcement, a day earlier, of the decision to remove a fast food restaurant from the lobby of a major Minneapolis hospital (Step 6: Implement). 

  6. Conducted an Evaluation: As part of its evaluation, the partners were able to report that by the end of 2015, 35 hospitals in Minnesota had pledged to or had implemented PSE changes to reduce or phase out the sale of sugary drinks (Step 7: Evaluate). 

Success Factors and Key Questions Addressed 

Was enough awareness about the PSE change established to ensure successful and seamless implementation? If so, how did you generate awareness? 

A toolkit about sugar-sweetened beverages, healthy beverage programs and health system partnerships was developed and is available in hard copy and on the web. This toolkit addresses challenges to implementing healthy beverage policies, such as questions about vending contracts, impact on food service revenues and building organizational support. 

Were stakeholders committed and engaged? 

The initiative intentionally sought out key leaders who were in a position to influence the organization and who had a commitment to champion the policy and build broader buy-in and support across the organization. 

How were sufficient resources secured to ensure successful implementation and sustainability of the PSE change? 

One outcome of the Healthy Healthcare Summit was the creation of a Hospital Food and Beverage Learning Group that has sustained the successes and continues to expand the reach of this work. 

Related Resources 

Learn more about Minnesota’s Sugar-Sweetened Beverage Reduction Initiative or download the toolkit and resources from the Public Health Law Center. You can also learn more about PSE change in hospitals from CDC’s Toolkit for Creating Healthy Hospital Environments: Making Healthier Food, Beverage and Physical Activity Choices and learn more about the link between obesity and cancer from CDC’s Annual Report to the Nation on the Status of Cancer and Minnesota Department of Health’s webpage addressing sugary beverages. 

REFERENCES 

Minnesota Department of Health (n.d.). MN Public Health Data Access Portal: Obesity in Minnesota. Retrieved from https://apps.health.state.mn.us/mndata/obesity_basic#byyear 

Resources to Support Similar Evidence-Based Initiatives 

What Works for Health 

Strategies to Reduce Sugar-Sweetened Beverage 

Evidence-Based Cancer Control Programs  

 SIPsmartER 

The Community Guide  

Obesity: Multicomponent Interventions to Increase Availability of Healthier Foods and Beverages in Schools 

Obesity: Meal or Fruit and Vegetable Snack Interventions to Increase Healthier Foods and Beverages Provided by Schools 

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