A Discussion with Joseph A. Curtatone, Mayor of Somerville, MA

By Max Leiserson


Joseph Curtatone is currently serving his fourth-term as mayor of Somerville, MA. During his tenure, Somerville has become nationally-renowned for its Shape Up Somerville program, an initiative aimed at reducing the prevalence of obesity within the city. In addition, Mayor Curtatone’s leadership in Somerville earned him the (now former) presidency of the Massachusetts Mayor’s Association, and has won praise from the Boston Globe Magazine which claimed Somerville to be “the best-run city in Massachusetts.”

Could you briefly explain what Shape Up Somerville is?

In a nutshell, it’s a community-based environmental program in partnership with the [Tufts University] Friedman School of Nutrition to reverse the trend of childhood obesity in Somerville’s public schools which was later expanded across the city.

When did the program begin and what were major dates of its expansion?

I came into office in 2004. In 2002, there was a mapping program to evaluate the trend of childhood obesity in Somerville’s public schools. In 2004, Dr. Christine Economos [from the Friedman School] met with me and informed me that 46% of our 1st-3rd graders were obese or at risk for becoming obese. From there, we really launched the program: a myriad of initiatives to really affect how children ate, how they acted, how they played. I would say parallel to that, we immediately started to apply the tenets of Shape Up Somerville–eating smart and playing hard–to all our decision-making processes throughout the city.

You mentioned how Shape Up Somerville is closely linked to the environment. When I was researching the program, I was really struck by how a lot of the initiatives are similar to those seen in energy demand-side management programs. Do you think that the campaign to reduce obesity and the campaign to reduce energy consumption are linked?

I do. When I speak around the country, one of my opening questions to the crowd is “how many people think childhood obesity is the problem?” And some raise their hands. But it’s not the problem, it’s a consequence. Failure on transportation planning, land-use planning, school food policy, health policy; they all collide, and have consequences for our health and social well-being. Childhood obesity is a consequence of failed policy, as is this community’s elevated levels of respiratory illness and heart disease. I preach that connectivity, and I think it’s important to realize that [many policy decisions are influence one another].

Why has Shape Up Somerville been so effective in Somerville, and why has it garnered so much national attention?

It’s been very effective in Somerville because we’ve seen [childhood obesity] for what it is. It is not a technical problem. By that I mean, no single change in health regulations, such as banning trans fats, and no single proclamation by the mayor will fix the problem. This is an adaptive challenge, and therefore we have a community-based approach. You need the community to be engaged to reverse the trend of childhood obesity. There are so many policy failures that have resulted in the current situation that one technical fix will not suffice. You need to engage people’s hearts and minds, elevate their social consciousness on this issue, and give the work to the community. I’ve really stepped back and let them run with it. I’ve tried to be their cheerleader at times and support the work by the broad-based coalition of stakeholders across the city.

So it’s as much an attitude change as it is policy change?

Well that’s huge. We need to see [childhood obesity] for what it is. We’re not putting people on a diet here; we’re asking people to really think about how they live, and to align their values with the goals of healthy living.

You’ve had a chance to speak with many other municipal executives as the former President of the Massachusetts Mayors’ Association. Do you believe it’s possible for other similar-sized municipalities to adopt the same programs and achieve similar results?

Absolutely. Whether you’re Somerville, New York City, or a small town like Groton, there’s no limit to what we can accomplish. We just have to recognize that [childhood obesity] is a consequence and an adaptive challenge. It’s not just a technical problem, like you need to lose five pounds. It’s much more complicated than that, so it will take the will, and the work, of an entire community to resolve it.

Looking at the broader role of government in health policy, it seems that the federal government is under significant pressure to pass large and broad legislation addressing health issues. However, it seems that Shape Up Somerville has taken a gradual approach, adding new programs as it has progressed. So, I was wondering if you could comment on what you think government’s responsibility is in helping individuals make healthy choices or adopt a healthy lifestyle?

That’s a good question. What we are not trying to do here as a government institution is tell you how to act, how to live, or to tell you that you need to go on a diet. We believe that it is our responsibility to enact good policy that helps you make good choices, and the healthy choice should always be the easy choice. We’ve seen past government policies make the healthy choice very difficult, and we’ve seen the consequences both on our health and our social well-being. So my job as mayor is to make sure we guide good policymaking that improves your quality of life. At the same time, I submit that there are no authoritative solutions to the challenge of reversing the trends of childhood obesity. The government should play a role in terms of ramping up the energy and putting the onus on the community to take on the challenge. But, again, it cannot be just one piece of legislation. In a community-based approach, we are really aligning and energizing people’s values to what needs to be done to reverse the trend of childhood obesity. Government plays the role of supporting that, and the work is much more meaningful and more sustainable over time [as a result].

What do you believe the role of federal government is in terms of health care policy? Is it restricted to providing financial backing and national campaigns to help states and localities?

The federal government has different roles. They have a legislative role to play, where they should guide us and stop conduct in particular industries that adds to the prevalence of childhood obesity. Also, the federal government should give states and municipalities the support we need to do the work. The support can be from the rhetorical power of the White House, or the monetary strength of the federal government; both are really important.

Do you believe that the federal government overextended its jurisdiction with the passage of the health care overhaul?

No, I don’t think it’s a question of overextending its reach. I think we need to understand the history of [health care policy in the U.S.]. Health care is still a maturing issue, and we’ve seen incremental change over time, from Medicare to prescription drug assistance. Over time, there were incremental changes because the issue had to mature in the mindset of the federal government before they could take it on. I think the [federal government] has found its place over time.

On a personal level, does the issue of healthy living have a particular resonance for you?

Yes it does, on a few fronts. I’ve tried to live my life by those tenets of eating smart, playing hard, living well. I take them to heart, and try to lead by example with my wife and our children. We try to keep them active, to provide everything in moderation and in balance, and give them the opportunities to make good choices. Also, I grew up in the city, next to a highway, and I’ve seen firsthand how a lack of good policy had a consequence on my life. We talked about respiratory illness earlier; I’m in that category, I suffer from one due to the gradual accumulation of particulates in the air near where I grew up. That’s provided personal motivation on my part, and I always thought that people in the urban core, especially in this community, were sold short by our elected officials, starting midcentury and up until the last 20-25 years.

Was the issue of healthy living then part of your motivation to run for public office in 2004?

My decision was not motivated in particular by childhood obesity. However, I have always thought that when you’re in this position you have the opportunity to repaint the canvas of the community, and unwind policy decisions of the past. I feel that my job is not to pass a balanced budget, or have a good bond rating, but to contribute to and support a community so you would want to live and raise your family here. And such a community is one that is very healthy, with a high quality of life.

Shape Up Somerville began by targeting 1st-3rd graders, but you’ve expanded it. Could you explain some of the different challenges of targeting obesity on a community-level compared to targeting it in a specific age group in public schools?

We [enacted the] two programs simultaneously when we learned of the need to do so across the community. With the 1st-3rd graders, you have a much more controlled environment for a finite period of time, so you know you’re going to be able to affect the majority of a certain population. You’re able to get them actively engaged by doing things such as selecting the Vegetable of the Month, selecting menus, or working with teachers and parents. [With the 1st-3rd graders], we had a set population, and we knew where they were going to be nine months out of the year. Now, it’s a much greater community-based process affecting a diverse and dynamic city in this urban landscape we call Somerville, where there are 52 different languages in our neighborhoods and schools, so it’s a much broader challenge.

How do you measure success in combatting obesity on a community-level?

Jamie Corliss, Director of Shape-Up Somerville:
What you see here is an evaluation by the Institute of Community Health on physical activity levels, and if you flip through it, you’ll see who we are impacting. As the mayor said, we’ve been trying to broaden [Shape Up Somerville]to a community-wide approach. We are working to target our lower income and immigrant populations as well. What you’ll see is a trend is significant increases in both moderate physical activity for both children (middle school and high school) and adults. In the adult category, we’re on par with state averages, which is unusual considering our demographics compared to the state, and also in the adult category we are meeting Healthy People 2010 benchmarks, which again is very impressive. And, for the children, we are making increases over time, which is, as the mayor mentioned, a long-term effort.

Is sustaining the progress you’ve achieved so far a major concern of yours?

It’s a focus, and I believe it will be sustained because we recognize [obesity] for what it is: an adaptive challenge. We want to have a continuum of engagement with our community to keep making progress on this challenge. In that way, we will have sustainability, so no matter who the mayor is down the road, there will be a particular expectation and value-base in the community so the challenge will continue to be met.

You’ve mentioned a few times that there is no technical solution, or single policy, that will reverse the rise of obesity. Could you comment on what you believe the role of technical solutions, such as banning trans fats in restaurants, is in combatting obesity?

I believe all those reforms are important, but no one of those reforms will solve the problem. An adaptive challenge is one where the solution is not known, and you will really need to motivate people’s hearts and minds to take that on. A technical problem is one where there is a technical solution, so implementing the solution would just be the end of the story. The battle against tobacco certainly wasn’t a technical problem, and neither is the battle to reverse the trend of childhood obesity. But I would submit that in order to take on these adaptive challenges, there are a number of important technical reforms we need to implement. In order to make progress, you have to illustrate to your constituency how past policies, failed policies, do not meet the values [of the community]. That’s the way it was with tobacco, and that’s what it is with childhood obesity.

We ran an article in the Fall 2009 issue of TuftScope about the benefits and costs of implementing a soda tax. Do you support a tax on soda? Do you believe it would have a disproportionate affect on lower income individuals?

I support [a tax on soda], though it will not solve all the problems of childhood obesity. I believe the funds obtained through the tax should be used to support the fight against childhood obesity, and support communities who want to take on these challenges. I think it’s important. We’ve taken proceeds from taxes on cigarettes and tobacco settlements to support health initiatives in the past. And no, I don’t think it will affect lower income individuals inequitably. If it does change their behavior so they drink less soda, I think that’s a good thing. Certainly the food and beverage industry is targeting those populations. When you can buy a 24-ounce bottle of soda and you can’t buy a bottle of water of the same size, and when a bottle of water costs more than a bottle of soda, I think that’s unfairly targeting those populations. What they’re doing is they’re using social economic disparity to make the unhealthy choice the easy choice, and we have to reverse that. So [a soda tax] would help balance the field in my opinion, though I still think the proceeds should be used to address other health issues.

What initiatives does Shape Up Somerville have in the works? What isn’t in the works?

The sky is the limit. We really pride ourselves on letting the data show us where we need to go with our program, and help us determine what we can do to adapt. We are looking to put extra emphasis on the racial and ethnic minority populations in our community and the transient populations in our schools and how we can impact their decision-making in a positive way. There’s also a host of other programs that we’re already expanding upon.

Jamie Corliss:
That’s right, so a couple of other projects coming up are winter farmer’s market. There’s been a lot of buzz around that in the media and in the community, so folks are really excited. Boston isn’t launching there’s for another two years, so we’re really the only game in town starting this year. [Also], a mobile produce cart, which is one of the ways people are increasing access, particularly to lower income populations. In our Mystic housing development, there’s an area that the city has identified as a food desert, and one of our solutions is to [use the mobile produce cart] to bring food into the community. The mayor is also looking at healthy vending for city buildings, which is another common strategy to make the healthy choice the easy choice.

Could you comment on how Tufts students could get involved in the program and help make a difference?

Well, first of all, we wouldn’t be where we are today without Tufts University. President Larry Bacow, the best college president in the country, and Dr. Christine Economos from the Friedman School of Nutrition are the ones who got Shape Up Somerville going. To that end, there are limitless opportunities and a need to get the Tufts students involved. We would love that. It can be anywhere from working and volunteering in our recreation programs to helping us in our outreach to the ethnic minority population in our city and our schools. Just talking and writing about Shape Up Somerville, doing any type of policy analysis, or challenging us to broaden our range in Shape Up Somerville. There’s a wealth of knowledge in the students at Tufts, and we pride ourselves on our partnership with academia. We want the great base of knowledge and activism that the university has, and [we know] that if we don’t leverage this knowledge, we won’t succeed. So come on down and get involved!

Do you think that there’s a need for a Shape Up Somerville type program at Tufts itself?

Well, the President does have the President’s Marathon Challenge, which I’m going to run again. I’ve run it twice to support Shape Up Somerville and the Friedman School of Nutrition, but yes, I do think that maybe we should launch an on-campus challenge.

Subject: Public Health, Healthcare Policy
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