The Children’s Healthy Living Program for Remote Underserved Minority Populations in the Pacific Region (CHL) is a partnership among remote Pacific states and other jurisdictions of the US: Alaska, American Samoa, the Commonwealth of the Northern Mariana Islands (CNMI), Guam, Federated States of Micronesia (FSM), Hawai‘i, Republic of Palau, and the Republic of the Marshall Islands (RMI). All jurisdictions have US Land Grant Colleges. CHL is a partnership among land grant colleges and public health partners that share a purpose to build capacity to address health issues through research, training and outreach. Partnership among land grants, components of land grants, and public health and other partners that affect policies, systems and environments that affect health is explicitly called for in the recent USDA Healthy Food Systems, Healthy People (2016) call to action, and the USDA Cooperative Extension Framework for Health and Wellness (Braun et al. 2014).  Partnership is also called for in the new Interagency Committee on Human Nutrition Research (2016).  The goal of the CHL Program collaboration among Pacific Region states/jurisdictions was to build 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. FSM and RMI are in the top three of rates of diabetes in the world (35%, International Diabetes Federation 2013). Diabetes, heart diseases, strokes, cancer and other NCDs 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 causal factor: obesity. Adult 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, http://www.who.int/mediacentre/factsheets/fs311/en).

Data are limited on children of the region. Childhood obesity is an important determinant of adult obesity. Obese children have a higher chance of obesity, premature death and disability in adulthood. Obese children 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 will support and extend the CHL network, training, intervention activities and research programs initiated through CHL, which has demonstrate feasability of the approach. The land grant institutions held stakeholder meetings that resulted in the CHL application.  Land grant colleges in the Pacific have been an organizing mechanism for CHL. This multistate project will continue to be an important mechanism to maintain a stable partnership and coordinated activity.  Without this tool 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.