The Children’s Healthy Living Program for Remote Underserved Minority Populations in the Pacific Region Network (CHLN) Multistate is a partnership among remote Pacific states and other jurisdictions of the US: Alaska, Arizona, American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM), Hawai‘i, Republic of Palau, the Republic of the Marshall Islands (RMI) and West Virginia. All CHLN partners are connected via the US Land Grant College system and an interest in addressing disparities in health that are experienced by ethnic minorities and indigenous populations and those living in rural communities. CHLN partners, inclusive of land grant colleges and public health partners, share a purpose to build capacity to address relevant health issues through research, training and extension. These partnerships aim to affect policies, systems and environments that affect health and are explicitly called for in the 2019 USDA Healthy Food Systems, Healthy People call to action, and the USDA Cooperative Extension Framework for Health and Wellness (Braun et al. 2014).  The goal of the CHLN is to develop social/cultural, physical/built, and political/economic environments that will promote active play and intake of healthy food to prevent young child obesity in the Pacific Region. To do this, CHL engages the community, and focuses on capacity building and sustainable environmental change.

The Pacific region has some of the highest rates of non-communicable disease in the world. The Marshall Islands and Guam are in the top ten for diabetes prevalence in the world (30.5% and 18.7%, respectively, International Diabetes Federation 2019). Diabetes, heart diseases, stroke, cancers and other non-communicable diseases are affecting Pacific peoples at a disproportionate rate compared to other populations, placing a significant burden on their daily functionality, and threatening the national security of these island countries and territories (PIHOA 2010). All of these conditions have a primary common factor: obesity. The number of adults with obesity is among the highest in the world in these countries, especially among women (FSM 58%, RMI 48%, Ng et al 2013). Pacific lifestyles continue to transition from native crops to imported foods, and from active forms of work and play to sedentary ones, as in most of the world (World Health Organization, 2015). These populations face a dual burden of food insecurity and obesity, where estimates of nearly half of children sampled by the CHL research program on Guam were living in households who lacked sufficient food or resources to feed the household (Li et al, 2016). 

Data are limited on children of the region. Obesity in children is an important determinant of obesity in adulthood. CHL has been successful in collecting data on child growth in the region, where 30% of children in the CHL sample suffered from overweight or obesity (Li et al, 2016). Children with obesity have a higher chance of developing obesity, premature death and disability in adulthood. Children with obesity have breathing difficulties, increased risk of fractures, hypertension, early markers of cardiovascular disease, insulin resistance and psychological effects. Contributors to obesity occur across the life course and include both early undernutrition and nutrition excess. Obesity is associated with social and health problems. Prevention is the best long term solution.

This multistate project continues to support and extend the CHL network's training, intervention activities and research programs initiated through CHL, which has demonstrated feasibility of the approach. The land grant institutions held community meetings that resulted in the CHL application.  The community engagement process included over 900 community members that included parents, teachers, and community leaders; who identified the need for environmental interventions that address six key behavioral outcomes that became the six CHL target behaviors (Fialkwoski, 2013). The priorities and intervention strategies remain relevant as evidenced by sustained CHL interventions and partner programs. This multistate project has continued to be an important mechanism that maintains the stable partnership and coordinated activities and has facilitated the expansion to include Arizona and West Virginia partners. These partners bring a wealth of new resources and interventions that can be adapted for our region and CHL interventions can be adapted to inform strategies to promote child health in Arizon and West Virginia communities as well. Without this multistate the group will need to rely on grant opportunities that are now smaller and will likely result in smaller less coordinated subsets of the partners working together.  This project has the potential to model multistates as platforms for coordinated health extension coalitions to facilitate and support broad sector partnership for health.