Toward sustainable public health programs : a case study of local physical activity approaches

As a tool for public health, sport and physical activity programs are challenged with sustainability after the initial resources and impetus that created them have subsided. Financial stability is important, but social and political support and consistent effort toward an agreed vision will also factor into whether a program will be sustainable. Program sustainability can be better understood when it is integrated with the phases of the program process, including formulation, implementation, and evaluation. Starting in 2008, the Texas Governor’s Advisory Council on Physical Fitness (GACPF) offered grants to local mayor’s fitness councils to tailor their own physical activity programs as a tool to combat obesity. In this work, I examine three community programs in Texas to illustrate what elements of sustainability were realized, and what achievements and challenges were experienced in the program process. This case study also serves as an opportunity to understand how sport and other physical activities are perceived in public health settings. Using a critical framework to draw out the assumptions and taken-for-granted knowledge of these public health programs, I employ a mixture of qualitative methods to determine what issues stood out in each community and what were common across all cases. I made site visits to each community and interviewed 42 people for this study, including members of the GACPF, members of the local mayor’s fitness councils, and residents in each community. The results reveal a significant drop-off in stakeholder involvement beyond program formulation. This drop-off largely explains why these programs were constrained in what could be implemented, went unevaluated, and had limited prospects for sustainability. The data also indicate that new approaches are needed for promoting greater levels of participation in sport and physical activity. Instead of emphasizing benefits of physical health or appearance, program leaders in public health should focus on the hedonic feeling and sense of community that can lead to more holistic health. The results reveal that it is unrealistic to contend that the challenges of sustaining a public health program can be completely eliminated. Nonetheless, an appreciation for those difficulties increases the possibility that they can be mitigated, and the public health program can be carried out as intended and sustained.