Regular physical activity can improve the health and quality of life of Americans of all ages, regardless of the presence of a chronic disease or disability. Among adults and older adults, physical activity can lower the risk of early death, coronary heart disease, stroke, high blood pressure, type 2 diabetes, breast and colon cancer, falls, and depression. Among children and adolescents, physical activity can improve bone health, improve cardio-respiratory and muscular fitness, decrease levels of body fat, and reduce symptoms of depression. For people who are inactive, even small increases in physical activity are associated with health benefits.

Personal, social, economic, and environmental factors all play a role in physical activity levels among youth, adults, and older adults. Factors positively associated with adult physical activity include post-secondary education, higher income, enjoyment of exercise, expectation of benefits, belief in ability to exercise (self-efficacy), history of activity in adulthood, social support from peers, family, or spouse, access to and satisfaction with facilities, enjoyable scenery, and safe neighborhoods. Factors negatively associated with adult physical activity include advancing age, low income, lack of time, low motivation, rural residency, perception of great effort needed for exercise, overweight or obesity, perception of poor health, and being disabled. Older adults may have additional factors that keep them from being physically active, including lack of social support, lack of transportation to facilities, fear of injury, and cost of programs (DHHS, 2010)

In addition, strong science exists supporting the health benefits of eating a healthful diet and maintaining a healthy body weight. Diet and body weight are related to health status. Good nutrition is important to the growth and development of children. A healthful diet also helps Americans reduce their risks for many health conditions, including overweight and obesity, malnutrition, iron-deficiency anemia, heart disease, high blood pressure, dyslipidemia (poor lipid profiles), type 2 diabetes, osteoporosis, oral disease, constipation, diverticular disease, and some cancers. Efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, work-sites, healthcare organizations, and communities.

Social factors thought to influence diet include knowledge and attitudes, skills, social support, societal and cultural norms, food and agricultural policies, food assistance program, and economic price systems. The places where people eat appear to influence their diet. For example, foods eaten away from home often have more calories and are of lower nutritional quality than foods prepared at home. Marketing also influences people’s—particularly children’s—food choices (DHHS, 2010).

Over one-half of key informants (community or business leaders, physicians, other health providers, public health representatives and social service providers) ranked nutrition, physical activity and weight as a major issue. They also shared comments such as: ‘’We have populations that are not able to afford fresh produce and barely make enough to cover their food costs for the month. Need to work on properly educating the public on malnutrition and ensuring they know how to access, afford, and utilize healthy foods.’’ Specific populations as risk include African American and Hispanic individuals, as well as individuals experiencing poverty (WNC Health Network-WNCHN, 2018).

Health indicators in our County show the following trend:

• Only 30% of respondents reported obtaining leisure-time physical activity in the past month.  This was an increase from 24% in 2015 (WNC Health Network-WNCHN, 2018).   
• Nearly 13% of adults reported receiving a diagnosis of pre-diabetes, a slight increase from 2015 (WNC Health Network-WNCHN, 2018).   
• Fewer adults reported taking action to control high blood pressure: 93.3% in 2015 vs 92% in 2018 (WNC Health Network-WNCHN, 2018).   

Chronic disease prevention and the related result ''helping Haywood residents live well and live long by promoting physical activity, healthy eating and quality healthcare'' are aligned with the following Healthy NC 2020 Focus Areas/ Objectives. 

Physical Activity and Nutrition/Chronic Disease

• Increase the percentage of high school students who are neither overweight nor obese.
• Increase the percentage of adults who report they consume fruits and vegetables five or more times per day.  
• Increase the percentage of adults getting the recommended amount of physical activity.
• Reduce the cardiovascular disease mortality rate.  
• Decrease the percentage of adults with diabetes.  

How would we experience ''helping Haywood residents live well and live long by promoting physical activity, healthy eating and quality healthcare'' in our community?

Following the completion of the 2018 Haywood County Community Health Assessment (CHA), the Wellness Action Group (WAG) completed ''Getting to Strategies.''  This is a road map for health priority work groups.  The WAG discussed answers to the following questions:

• What are the overall quality of life conditions (results) we want for the people who live in our community?
• What would these conditions (results) look like if we could see them?
• How can we measure these conditions?
• How are we doing on the most important of these measures?
• Who are the partners with a role to play?
• What works to do better?
• What do we propose to do? 

Quality of Life Conditions (results):

• Healthy, active, engaged and happy people who are thriving and working to build better lives and a better community
• We embrace the vibrant potential of this area
• Inclusivity and accessibility for working community members, which helps the whole 
• Programs are available with no strings attached
• Awareness of a healthy diet and sharing information with all
• People are more empowered to live to be healthy; a greater ability to maintain a healthy diet
• Awareness of available opportunities
• Healthier food environment: healthier restaurants and less fast food
• Improved accessibility for healthy diet and food security
• A safe community
• Everyone can access good health 

Clinical Factors

• Medicaid expansion and health care for all
• Focus on prevention of heart disease and diabetes
• More clinical lifestyle change programs, such as Walk with a Doc, including better promotion and referrals 

Health Behaviors

• More accessible and free fitness programs: e.g. Girls on the Run (scholarships available), Active Routes to School and gyms; evening and weekend options available.  These programs may include a revised Healthy Haywood Fitness Challenge and community walking groups.  
• Improved promotion and marketing of existing opportunities and resources
• Improved education about healthy habits: offer nutrition education through social media and educate others about nutrition literacy (reading labels and understanding ingredients)
• People take advantage of programs like Double Up Food Bucks and MANNA produce distribution.
• Culturally appropriate recipe modifications and Meatless Mondays
• Improved education and awareness of nutritious foods, including how to shop and eat cheaply
• Heart disease prevention programs
• Fewer cases of illness and death from preventable chronic disease
• Lower obesity rates, including among children

Social and Economic Factors

• Improved food security; Fruit and veggie access without restriction
  • Existing programs include: Double Up Food Bucks, Haywood Gleaners, SNAP, WIC, Cooperative Extension
• Improved partnering and delivery of food
• Cooking education is available
• Potential pickup and delivery/distribution of restaurant food
• Programs raising funds to support other programs
• Healthier workplaces
• More intergenerational interaction and community support, such as seniors engaged in youth programs
• Less crime
• Better paying and living wage jobs

Physical Environment

• Improved access to recreation and physical activity, including group fitness opportunities
• Plenty of sidewalks and other walkable spaces
• Story walk expansion (involves family, physical activity, literacy). 
• Gardens at all schools and pre-kindergarten; more church gardens 
• Safe, adequate, affordable housing
• Adequate, available, more convenient public transportation

Health Outcomes 

• Less preventable chronic disease
• Less death from preventable chronic disease
• Lower obesity rates/childhood obesity

What information led to the selection of this health issue and related result?

In addition to the above focus areas, the WAG discussed how Haywood County is doing on the most important of these health measures.  This information was also reviewed as part of the prioritization process during the CHA.  The group discussed the percentages of individuals who:

• Are uninsured (adults)
• Have access to ongoing care (adults)
• Meet recommended physical activity levels (adults)
• Have not had any leisure-time activity in the past month (adults)
• Are limited in activities (primarily due to back/neck or mental health/depression problems) (adults)
• Who eat the recommended amounts of fruits and vegetables (adults)
• Use tobacco (cigarettes, smokeless and vaping) (adults)
• Are food insecure (adults)
• Receive free and reduced lunch (children)
• Usually get the support they need (adults)
• Also discussed was the average gross weekly wage, which is far below the state average 

• The 'Haywood's Hope for the Holidays' food distribution reached over 240 families and nearly 800 individuals.  Volunteers distributed 200 resource bags containing over 60 flyers each.  Nearly 170 volunteer hours were recorded (Mountain Projects, Inc., 2020).  
• The Safe Routes to School (SRTS) initiative reported a number of activities, including: 
  • Over 4500 individuals participated in virtual Bike to School Day activities.  This included public and faith-based schools (SRTS, 2020).  
  • North Canton Elementary received 50 helmets, supporting their school bike fleet and 4th and 5th grade students from low-income households.  In addition, Haywood Christian Ministries received 100 helmets for their Christmas bicycle program (SRTS, 2020).  
• Haywood County Government established an employee wellness program in partnership with Haywood Regional Medical Center (HRMC).  Over 180 individuals completed yearly labwork with the program's nurse navigator.  Over 75 individuals with abnormal labs received additional nurse navigation services.  The program also featured nearly 30 educational classes (HRMC, 2020).  
• Haywood Trails, a program of Haywood County Recreation and Parks, led 19 free hikes for community members (HCRP, 2020).