In the previous article on the Prescription for Activity (PfA) Task Force, we walked you through the various elements that make up the Task Force’s systems-change map and showed you how they will work collaboratively to build toward the Ultimate Outcome by 2035. In this article, the final piece of our three-part series on the PfA Task Force, we discuss the transition from mapping out a plan to actually implementing the strategies involved in mobilizing healthcare to help more Americans achieve physical-activity guidelines, leading to better health outcomes and reductions in health disparities.

Organizational Structure

To start taking key next steps to drive the implementation of the early outcomes on the systems-change map, the PfA Task Force first focused on developing an organizational structure that would optimize the talents and insights of all involved. The consensus among Task Force participants was that what is needed to steward the implementation of the systems-change map is a collective impact–style structure—broadly led and broadly held with accountability shared across a group of leaders. Imagine a hub-and-spoke model rather than one that is hierarchical.

A 16-member Leadership Council was formed in the fall of 2017 and will be setting the direction for the ongoing work of the Task Force. From that Leadership Council, a five-member Executive Committee was formed:

• Jenny Bogard, M.P.H., Director, Healthcare Strategies, Alliance for a Healthier Generation
• Cedric X. Bryant, Ph.D., F.A.C.S.M., Chief Science Officer, American Council on Exercise
• Erik Eaker, M.H.A., Director, Population Health Initiatives, Humana
• Laurie P. Whitsel, Ph.D., Director of Policy Research, American Heart Association
• Jennifer L. Wiltz, M.D., M.P.H., Senior Medical Officer, US Public Health Service and CDC Center for Chronic Disease Prevention and Health Promotion

The Executive Committee will make the major strategic decisions. Subgroups organized around specific tasks (e.g., fundraising and budgeting) will report back to the Executive Committee. 

Finally, Rachele Pojednic, Ph.D., assistant professor of nutrition at Simmons College and a former research fellow at the Institute of Lifestyle Medicine at Harvard Medical School, began working as Interim Executive Director of the PfA Task Force in January 2018. Dr. Pojednic reports directly to the Executive Committee.

In February 2018, the Leadership Council held its first in-person meeting in Austin, Texas, to jumpstart the shift to implementation.

Key Next Steps

The PfA Task Force crafted a systems-change map that represents more than 15 years of coordinated multisector work. The Task Force is now turning its attention to implementation. It is rapidly building the foundation for a large, diverse collaborative of local, state and national stakeholders to work across sectors and follow the systems-change map. As the Task Force makes this transition from theory to implementation, early tactical action items include the following. These items also represent opportunities for external funders to support the ongoing work of the PfA Task Force.

• Building a nationwide implementation initiative with a diverse leadership council, backbone support “entity” and “captains” for each of the major areas of work depicted as chains on the systems-change map. The backbone entity will coordinate, communicate, facilitate, measure and evaluate the work specified in the systems-change map through its Ultimate Outcome date of 2035.
• Identifying and recruiting individuals to serve in the leadership, support, coordination and implementation functions in that unfolding initiative. This will likely be a relatively small group of volunteers at the outset. Over time, it will become a virtual army of coordinated, accountable stakeholders—local, state and national—that have answered the Call to Action outlined in the PfA Task Force’s White Paper (see pages 12–13). That Call to Action is addressed to:
  • Leaders in healthcare delivery, infrastructure, policy, payment and support
  • Leaders in public health, health advocacy, disease prevention, health communications and health investment
  • Trusted influencers and practitioners in communities nationwide, communities where health and well-being already are deeply linked to the healthcare experience
• Developing a brand identity for the initiative, a message platform, a communications strategy and an awareness-building campaign so more stakeholders become convinced that all share responsibility for leveraging the healthcare system’s full potential to be a primary agent for increasing physical-activity levels. That is a precursor to a much larger, broadly coordinated, multiyear health-communications effort to systematically reframe the way people perceive physical activity.
• Crafting written materials detailing the work and vision of the PfA Task Force. This includes the already published White Paper, as well as a series of articles for peer-reviewed publications, journals and other media outlets describing the creation of the PfA Task Force, detailing the systems-change map developed at the PfA retreats and clarifying the PfA Task Force’s Call to Action to various sector and stakeholders.
• Constructing a process by which stakeholders across healthcare and in communities nationwide can answer the Call to Action, become formally involved with the initiative to implement the systems-change map, align with others working in that area, understand what they might do or already are doing that supports preconditions on the systems-change map, and provide or find resources to be part of the broad coordinating effort advancing the work.
• Recruiting the critical stakeholders and gathering the funding and human capital necessary to begin pursuing the most urgent preconditions on the systems-change map

It is this last bullet that served as the focus of the Leadership Committee’s meeting in early February and for its immediate efforts. The idea was to identify how they might secure some “small wins” that would serve as catalysts for the ongoing work.

For example, Spark 3 on the systems-change map involves assembling a comprehensive, living inventory of relevant work that supports preconditions on the systems-change map, and making that inventory known, widely accessible and searchable to inform decisions about where resources are being invested. Logical early action to complete this task might include establishing criteria for inclusion in an “ecosystem map” along with chain-specific vetting for value and relevance; identifying resources and requirements to execute, including technology, user interface, data collection, and monetary and human capital; coordinating work through a credible process owner; and building a database with a web-based user interface.

Spark 2, meanwhile, involves compiling the available evidence and filling gaps with new research as needed on the efficaciousness of physical activity–based behavior-change interventions and their cost-effectiveness. Logical early action to complete this task might include conducting a thorough review of the research to date pertaining to the overall efficacy and cost-effectiveness of physical activity–based behavior-change interventions and developing a plan to identify and close research gaps and make the outcome of this assessment widely available.

Spark 4 involves recruiting enthusiastic local and/or state leaders to test the function and feasibility of a locally led, locally sourced policy-, systems-, and environmental-change approach to increasing physical-activity levels in communities. They can also find where this type of work has already been done and what models can be replicated.

Moving beyond the Sparks, the first two outcomes of the Care Delivery Chain involve recruiting and supporting health systems in pilot projects to make assessment, monitoring and counseling on physical activity a routine part of clinical care, utilizing Physical Activity as a Vital Sign (PAVS). The implementation of the early outcomes of the Education & Training Chain involves partnering with key stakeholders to develop needed competencies around physical activity for the education and training of health professionals.

In Conclusion

Clearly, there is a lot of work to be done, especially considering that the Ultimate Outcome depicted on the systems-change map includes the target year of 2035. The beauty of the process used to create this map is that it offers a logically built, step-by-step approach to achieving the long-term objectives of the Task Force. Stated simply, the idea is to start along the left edge of the map—the Sparks—and then move to the early outcomes of each of the seven Chains. As momentum builds and more and more stakeholders join forces, we will hopefully see the process outlined on the map unfold in a way that gets more people active in every community, demographic and age group in America.