MiM_Apr2016

The Evolution of Mass in Motion
One State’s Response to a National Epidemic
Prepared by
U N D E R S T A N D I N G B O S T O N
APRIL 2016

Design: Kate Canfield, Canfield Design
Cover Photo: hartcreations, iStock
© 2016 by the Boston Foundation. All rights reserved.
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U N D E R S T A N D I N G B O S T O N
One State’s Response to a National Epidemic
Authors
Allison F. Bauer, Senior Director, Health and Wellness, The Boston Foundation
Pamela Hung, Program Associate, Health and Wellness, The Boston Foundation
Megan F. Toohey, Graduate MSW Intern, Health and Wellness, The Boston Foundation
Editor
Barbara Hindley, Senior Director of Publications and Marketing, The Boston Foundation

2 | T h e B o s t o n F o u n d a t i o n : A n U n d e r s t a n d i n g B o s t o n R e p o r t

T h e E v o l u t i o n o f M a s s i n M o t i o n | 3
Contents
Preface. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
CHAPTER ONE A National Epidemic with Local Impact. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
CHAPTER TWO The Mass in Motion Response. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7
Healthy Eating and Active Living Through Mass in Motion
The Municipal Wellness and Leadership Program
CHAPTER THREE Community Profiles. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Springfield
Dorchester
Healthy Hampshire (Amherst, Belchertown, Northampton and Williamsburg)
CHAPTER FOUR Sustainable Policy Systems and Systemic Change. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Going Forward: the Future of Mass in Motion
Endnotes. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19

4 | T h e B o s t o n F o u n d a t i o n : A n U n d e r s t a n d i n g B o s t o n R e p o r t4 | T h e B o s t o n F o u n d a t i o n : A n U n d e r s t a n d i n g B o s t o n R e p o r t
Preface
In the spring of 2007, the Boston Foundation published a report titled The Boston Paradox: Lots of Health Care,
Not Enough Health, the first comprehensive overview of health and health care in Boston.
With stunning statistics, The Boston Paradox drew our attention to the growing crisis of preventable chronic
disease in our city and the accompanying, unsustainable rise in health care costs. The report demonstrated that
Massachusetts, in spite of being the first state to have near-universal health care coverage and some of the best
medical facilities in the world, was highly vulnerable to the insidious effects of a poor diet, inadequate exercise
and unhealthy weight.
It also showed that low-income people of color were disproportionately affected by the lack of access to
opportunities for exercise and healthy foods. And it presented a chart revealing a complete spending mismatch
between government resources going to health care and those supporting key determinants of health.
The Boston Paradox was a wake up call for the Boston Foundation and for the Network for Excellence in Health
Innovation (NEHI), which researched and wrote the report.
The Boston Foundation had been focusing the vast majority of its grant dollars in the health sector on access
to medical care since its founding in 1915. But, as a result of the 2007 report, we swiftly shifted our focus
and began to support programs promoting health and wellness. In partnership with NEHI, we founded the
Healthy People/Healthy Economy Initiative, which tracks the determinants of health and is working to make
Massachusetts a national leader in health and wellness.
We also shifted our grant making to emphasize health and wellness. One of our earliest investments was in
Mass in Motion. We were “there at the beginning” in 2009 and since then have made grants totaling more than
$600,000. A public-private partnership administered by the Massachusetts Department of Public Health, Mass
in Motion is a statewide movement that works with municipalities, schools, child-care centers and businesses
to promote opportunities for healthy eating and active living.
We are proud to publish this report on Mass in Motion, which I believe is one of the most effective, statewide
health and wellness efforts in the nation and should be lifted up for recognition.
As a community foundation, the Boston Foundation is committed to promoting policies that support healthy
choices at the local, neighborhood level. Mass in Motion does exactly that. Its success proves that when a
government program is well-designed and based on a public-private partnership model, it can adapt to
changing administrations and funding sources, while truly partnering with local communities to create
a healthy environment for change.
Paul S. Grogan
President and CEO
The Boston Foundation

CHAPTER ONE
A National Epidemic with Local Impact
Soaring rates of overweight and obesity at the end of the
20th century took the nation by surprise. For decades,
the rates had been quite steady, but beginning in the
1980s and for the next 25 years, obesity rates more than
doubled among adults (from 15% to 34%) and more than
tripled among children and adolescents (from 5% to
17%).1
With overweight and obesity directly associated
with increased risk of type 2 diabetes, heart disease,
some forms of cancer and a variety of other illnesses,
evidence quickly mounted that the United States was
facing a national health crisis.2
This rising tide of obesity
captured media attention in the early 2000s, as more
and more research began to suggest that the current
generation of children may be the first to have a shorter
lifespan than their parents.3
By 2007, the nation was 30
years into an unprecedented rise in rates of overweight
and obesity among residents of every income, educa-
tional attainment level and racial-ethnic group.4
Massachusetts was no exception to this national health
crisis, as local data reflected the same skyrocketing
obesity rates and rising health care costs as those found
in other parts of the country. While Massachusetts’
obesity rates were lower than the national average
in 2007, a steady upward trend was cause for serious
concern. Between 1990 and 2007, overweight and
obesity increased 47% in Massachusetts, compared to
a national average increase of 40%.5
More than half of
Massachusetts residents were overweight, 20% were
classified as obese, and almost a third of middle and
high school students were overweight or obese.6
Significant racial and ethnic disparities made the trends
even more alarming, as 33% of black residents and 28%
of Hispanic residents, compared to 20% of white resi-
dents, were obese in 2005.7
Between 2003 and 2007, black
and Hispanic adults in Massachusetts were 60% and
50% more likely to be obese than white adults, respec-
tively.8
This represented both a moral and a practical
crisis, as both groups were expected to play an increas-
ingly important role in the state’s economy. Addressing
these health disparities was imperative to ensuring the
productivity and competitiveness of the state’s economy,
as well as the quality of life for the Commonwealth’s
people of color. Obesity rates among adults also differed
by education level, with a rate of 31% among those
without a high school diploma, compared to 14% among
those with at least a four-year college degree.9
These disparities, alongside a rapidly aging workforce,
meant that the cost of health care to families, employers
and the state would rise. Obesity was estimated to
increase health care costs by 25% to 100% compared to
the costs for people of normal weight, making obesity-
related health conditions and care the primary driver of
the Commonwealth’s increased health care costs.10
Total
medical costs directly attributable to obesity in Massa-
chusetts in 2009 exceeded $3.5 billion, not to mention the
indirect costs associated with lost productivity, workers
compensation and expenses related to reduced quality
of life due to stress or depression.11
Finite resources and
increasing expenses related to rising obesity rates threat-
ened the Commonwealth’s ability to invest in the crucial
determinants of health that keep people healthy in the
first place, such as education, housing and public safety.
FIGURE 1
Obesity Trends in Massachusetts
and in the United States
MA Obesity US Obesity
0
5%
10%
15%
20%
25%
30%
20152010200520001995
Source: CDC National Vital Statistics data 1996-2014, as viewed at America's
Health Rankings, www.americashealthrankings.org

Reducing obesity rates would allow Massachusetts to
invest precious resources in public health and disease
prevention as well as other determinants of health.
As is the case today, in addition to the determinants that
affect health outcomes broadly, many factors contribute
specifically to unhealthy diets and inactivity, which lead
directly to overweight and obesity. A considerable body
of scientific analysis continues to demonstrate that an
individual’s ability to make healthy choices depends on
the choices available. Yet, societal trends and community
environments are limiting the choices available to
many when it comes to diet and physical activity. The
dominance of highly processed foods and the lack of
healthy foods in many schools and workplaces make
a healthy diet difficult to sustain. Streets designed
for cars and not for pedestrians and bicyclists make
an active lifestyle difficult to achieve. Increased time
in front of computer and TV screens and declines in
school physical education and recess options similarly
limit opportunities to choose physical activity. Many
of these factors disproportionately affect low-income
and minority communities, who also lack safe walking
and bike paths, spend more time commuting, and are
surrounded by an overabundance of inexpensive fast
food restaurants with high-calorie, high-fat foods in
their neighborhoods.12
These barriers effectively stack
the deck against the ability of individuals, families and
entire neighborhoods to make healthy choices.

With the growing body of evidence demonstrating the
rising tide of obesity, leaders in state government in
Massachusetts knew they had to respond. Addition-
ally, the burden of overweight and obesity began
emerging as a concern in regional dialogues about
community needs in general. In 2007, John Auerbach,
then the Massachusetts Commissioner of Public Health,
convened an Obesity Task Force of some 30 key public
and private stakeholders to recommend strategies to:
1) decrease the number and percentage of both adults
and children who are overweight and obese; and 2)
decrease the prevalence of chronic disease associated
with unhealthy eating and lack of physical activity.
The recommendations were released in a 2008 report
commissioned by former Governor Deval Patrick
outlining the state’s overweight and obesity crisis, titled
“Mass in Motion: A Call to Action.” The recommenda-
tions included measures such as crafting legislation
related to nutrition and physical activity, implementing
regulations requiring calorie postings in chain restau-
rants, the promotion of “safe routes to school” programs
that would increase physical activity for children, a
focus on worksite wellness programs, and a Municipal
Wellness and Leadership Grant program.
The Municipal Wellness and Leadership Grant program,
the most prominent component of Mass in Motion, was
made possible through a combination of state funding
and a strong wave of philanthropic support. Blue Cross
Blue Shield of Massachusetts, the Blue Cross Blue Shield
of Massachusetts Foundation, the Boston Foundation,
the Harvard Pilgrim Health Care Foundation, the Tufts
Health Plan Foundation, and The MetroWest Commu-
nity Health Care Foundation understood the importance
of addressing rising rates of overweight and obesity in
the communities they served and supported Mass in
Motion as its initial funders.
As the first statewide health initiative supported by
virtually all of Massachusetts’ major health-funding
foundations as well as a health plan, Mass in Motion
demonstrated the strength of public-private partnership
to focus on policy, systems and environmental change to
create healthier communities.
The official launch of Mass in Motion came in January
of 2009, followed shortly by a request for responses
for two-year grants to create sustained approaches
for active living and healthy eating at the municipal
level. After a review process involving leaders from
the Departments of Public Health, Transportation,
Conservation and Recreation, as well as funding part-
ners, 10 grants totaling $1.2 million were awarded to 12
communities in May of 2009. The communities—Everett,
Fall River, Fitchburg, Gloucester, New Bedford, Revere,
Springfield, Tri-Town (Lee, Lenox and Stockbridge),
Weymouth and Worchester—were joined by Franklin,
Brockton, Northborough and Dorchester within a year
to become the 16 Mass in Motion “legacy communities.”
Healthy Eating and Active Living
Through Mass in Motion
Any effort to address poor nutrition and low levels of
physical activity, the two primary contributing factors
to excess weight gain, suggest obvious solutions: eat
healthier foods and move more. However, putting
these recommendations into practice within supportive
cultural and physical environments is highly complex.
The Institute of Medicine contends that, “it is unreason-
able to expect that people will change their behavior
easily when so many forces in the social, cultural, and
physical environment conspire against such change.”13
Reducing overweight and obesity across a lifespan
requires community-level, municipal-wide support of
healthy behaviors through policy, systems and environ-
mental changes. Mass in Motion embodies this approach
through its statewide campaign and its practice of
making grants that directly support communities to
do the work. The theory of change is that this compre-
hensive effort supports local communities in a broad
range of activities to improve community health and
reduce chronic disease. Through healthy policies, Mass
in Motion creates healthy environments, which lead to
healthier behaviors. And healthier behaviors result in
healthier people.
CHAPTER TWO
The Mass in Motion Response

Mass in Motion operates on a number of levels. On
a policy level, it promotes healthy eating options by
setting nutrition standards for competitive food and
beverages sold in public schools. These standards
were established in Massachusetts in 2010, two years
before the U.S. Department of Agriculture set federal
standards.14
This put Massachusetts on the leading edge
of policy change in this arena. Additionally, Massachu-
setts requires BMI screenings in schools in the 1st, 4th,
7th and 10th grades to measure student health and to
target and strengthen initiatives that are successfully
reducing overweight and obesity. On a systems and
environmental level, Mass in Motion created “Working
on Wellness,” a program that helps employers imple-
ment worksite wellness programs, and “MA Children at
Play,” a childhood obesity prevention program focused
on improving nutrition and physical activity practices in
child care settings.
The Municipal Wellness and
Leadership Program
By far the most well-funded and most visible compo-
nent of Mass in Motion is the Municipal Wellness and
Leadership Program, which uses three community
strategies to create conditions that support and
reinforce healthy behaviors at home, at work, and
in communities.15
1. Healthy Eating
By increasing the availability of healthy foods, such as
fruits and vegetables, and decreasing the availability of
unhealthy foods, Mass in Motion communities encour-
age healthy eating through community gardens, healthy
options at neighborhood markets and restaurants,
improved school nutrition and the offering of SNAP
(Supplemental Nutrition Assistance Program) benefits
at farmers markets.
2. Active Living
With the knowledge that community members are
more active when there are safe, accessible places
that offer opportunities for physical activity, Mass in
Motion communities are designing and establishing
safe routes to walk and bike to school, improving parks
and playgrounds and opening community facilities for
recreational use and physical activity programming.
3. Designing Healthy Communities
Mass in Motion promotes healthy communities through
“Complete Street” policies that encourage designed
and built environments to include more opportunities
for healthy living. These policies make roads safe and
enjoyable for everyone and include features such as bike
lanes, clean, wide sidewalks, easy-to-follow signage
FIGURE 2
The Mass in Motion framework for healthy community change
HEALTHY
POLICIES
HEALTHY
ENVIRONMENT
HEALTHY
BEHAVIORS
HEALTHY
PEOPLE
Promoting healthy eating habits is a primary focus of Mass in Motion.

As Mass in Motion began to influence healthy commu-
nity change, it caught the attention of other stakeholder
groups that understood the importance of promoting
healthy eating and active living on the municipal level.
In 2012, Partners HealthCare joined the group of philan-
thropic partners that were funding Mass in Motion, and
the Centers for Disease Control (CDC) awarded Mass in
Motion two Community Transformation Grants (CTG).
These additional sources of funding enabled Mass in
Motion to nearly double its impact to 33 programs
covering 52 cities and towns, including Chelsea, Lynn,
Salem and other communities.
However, in 2014, the CTG program was eliminated by
Congress two years earlier than anticipated. The DPH
responded to this reduction by revisiting the initiative
and the allocation of its resources. At the same time,
statewide and local stakeholders, including philan-
thropy partners that were concerned that a sudden
funding reduction would threaten Mass in Motion’s
progress, developed a budgetary campaign and lobbied
and safe crosswalks. Mass in Motion also uses Health
Impact Assessments to evaluate the connection between
community policies and health, and the preservation or
development of recreational space.
Massachusetts Department of Public Health (DPH)
staff on the state level work collaboratively with local
Mass in Motion coordinators to develop and implement
healthy eating, active living agendas that meet the needs
of each community. Community partnerships, including
municipal partnerships, conduct needs assessments to
define and prioritize possible areas of improvement.
This process enables communities to address the root
causes of health concerns through sustainable improve-
ments by guiding them through the development of a
detailed community action plan.16
The DPH leverages its expertise by providing additional
resources to support communities, including ongoing
trainings, technical assistance, community visits and
the dissemination of information. Critical trainings in
the early stages of Mass in Motion addressed the role of
sustainable partnerships, community health assessments
and group evaluation in creating healthy municipalities.
Mass in Motion Communities (in blue)

the Massachusetts State Legislature to dedicate funding
for the preservation of the initiative. The combination
of these efforts resulted in enough state, federal and
private resources to maintain Mass in Motion.
With funding secured, DPH went through a competitive
procurement process which provided an opportunity
to revisit funding guidelines. To ensure that Mass in
Motion activities would impact the largest number of
residents, DPH instituted a population requirement
of 35,000 for the Municipal Wellness and Leadership
grants. This requirement led to several regional
applications, where communities with populations
less than 35,000 joined together to meet eligibility
criteria. These new requirements encouraged greater
collaboration and set goals for reaching even more
people. While 22 programs were awarded funding
from DPH, five programs are directly funded through
private philanthropic dollars. Currently, there are 27
programs covering more than 60 cities and towns across
the Commonwealth, six of which are multi-municipal
collaborations.

Springfield
Springfield, one of the 16 “legacy” Mass in Motion
communities, is a city in western Massachusetts that sits
on the eastern bank of the Connecticut River. As of the
2010 Census, the city’s population was 153,060.17
Metro-
politan Springfield is one of two metropolitan areas in
Massachusetts (the other being Greater Boston), and has
an estimated population of 698,903 as of 2009.18
Springfield has one of the highest obesity rates in the
state with 41.8% of students overweight or obese,
compared to the state average of 32.3%.19
And because
roughly 20% of public schools in Springfield are Level
4 schools (underperforming), students have reduced
physical activity time during school hours in order to
extend classroom learning time.20
Springfield also has
a high rate of violence, at 1,048 per 100,000 persons,
compared to the state average of 404 per 100,000
persons.21
Knowing that Springfield residents were experiencing
more health inequities when compared to residents
statewide, city leaders were determined to work with
Mass in Motion in order to improve the health of their
community. In 2009, Springfield was awarded a Mass in
Motion grant to fund a coordinator housed in the city’s
Department of Health and Human Services.
Springfield’s Mass in Motion Coordinator has the
crucial role of coordinating the city’s various wellness
initiatives. As the convener of the Springfield Wellness
Leadership Council, which is made up of stakeholders
in municipal government (Springfield Housing Author-
ity, Springfield Planning & Economic Development,
Department of Public Works), schools (Springfield
Public Schools, Springfield College, American Interna-
tional College), and health (Bay State Health and Mercy
Medical Center), the Coordinator also works with the
Live Well Springfield Coalition and the Springfield
Food Policy Council. Given that Springfield is a city of
neighborhoods with diverse cultures, the Coordinator
has the challenge of promoting communication and
collaboration among the various healthy eating and
active living efforts.
For example, to get kids moving, Springfield Mass in
Motion organized an open gym program in conjunction
with the Springfield Parks Department. The program,
which began in 2010, gives kids a safe place to be
active at night with other kids in the community. With
the assistance of Mass in Motion, a Springfield City
Councilor and the Springfield Youth Violence Task Force
were connected with the Parks Department to organize
a community use agreement with schools and imple-
ment the program. Mass in Motion also helped to secure
funding from Health New England, which supports
staff to run the evening gym program, working with
some 175 students in open gyms in four schools three
to five nights a week. Donated sneakers are also distrib-
uted to the students participating in the open gyms. The
majority of kids who were surveyed about their open
gym experience noted that the program helped them
stay out of trouble and that if it weren’t for the program,
they would most likely be at home watching television
or playing video games.22
CHAPTER THREE
Community Profiles
Students from Coburn Elementary School in West Springfield map their
routes from home to school for the Safe Routes to School Program.

Dorchester
Dorchester, Boston’s largest neighborhood, is also one
of its most diverse. As of 2000, 92,000 people lived in
Dorchester—and the makeup of the population was 36%
black, 32% white, 11% Latino, and 11% Asian. Long-time
residents mingle with newer immigrants from Ireland,
Vietnam and Cape Verde. The nation’s first Vietnamese
Community Center is located in Fields Corner, which
is the heart of the Vietnamese community in Boston.
Dorchester is also home to the first community health
center in the United States—the Columbia Point Health
Center. It was opened in December of 1965 and at that
time served mostly the massive Columbia Point Public
Housing complex adjoining it. It was renamed the
Geiger-Gibson Community Health Center in 1990 in
honor of its founders.25
According to the Boston Public Health Commission’s
annual “Health of Boston” report, in 2008, lower-income
Boston residents (living in households with incomes
of $25,000 or less) reported higher rates of asthma,
diabetes, heart disease, high blood pressure and obesity
when compared to higher-income residents. The report
Another program in Springfield that promotes physical
activity and community safety is the Safe Routes to
Schools (SRTS) program. SRTS began at Brightwood
Elementary School in 2010-2011 in the city’s North End
neighborhood as the “Walking School Bus” program.
Partnering with the Baystate Brightwood Health
Center/Centro de Salud and the C3 (Counter Criminal
Continuum) collaborative, Brightwood Elementary
worked with parents and staff to organize a program
where students walked to school in a group with adult
volunteers. Although the North End neighborhood has
one of the highest crime rates in Springfield, community
members wanted to send messages of “safety in
numbers” and “more community visibility outside
computes to less crime.”23
The Walking School Bus not
only got students moving, but may have increased
attendance as Brightwood Elementary School students
who participated in the program had higher attendance
rates than students who did not participate in the
program.
Mass in Motion was able to scale the Brightwood model
across more Springfield schools through connection to
SRTS funding from the state. Just five years after the first
Walking School Bus program began, SRTS is now in 10
schools. The Brightwood Walking School Bus is a story
about how “a grassroots initiative can turn itself into a
community movement through the work of champions
who are looking to make their community a safer
place for children to walk and bicycle to school,” said
Samantha Fonseca-Moreira, then a Massachusetts SRTS
Statewide Coordinator.24
The open gym and SRTS programs demonstrate
the ways in which Springfield is becoming a more
physically active and safer place through healthy
environment change. And through municipal level
coordination made possible by Mass in Motion support,
these programs have been expanded to engage and
serve more residents. By connecting stakeholders with
shared goals of increasing active living in Springfield
and assisting with accessing other funding sources,
Mass in Motion has proven to be transformative for the
community of Springfield.
Wayfinding signs in Dorchester promote active transit.

also showed that Roxbury, North Dorchester and South
Dorchester were three of the five neighborhoods with
the highest annual heart disease hospitalization rate.
Obesity disproportionately affected black adults: 32% of
black adults were obese in 2008, compared to just 17%
of whites.26
In 2009, a higher percentage of black and
Latino high school students were overweight compared
to white students.27
Roxbury, Dorchester, and Mattapan,
another neighborhood with a high concentration of
low-income residents, are also home to more fast food
restaurants per capita than all other Boston neighbor-
hoods combined.28
These geographic and environmental
realities clearly have an impact on disparate health
outcomes.29
Since 2007, the W.K. Kellogg Foundation has funded
Food & Fitness community partnerships as part of its
Food & Community initiative across the United States
to improve access to healthy, affordable, local food
and opportunities for physical activity in low-income
communities. The work of the partnerships is focused
on transforming conditions for children and families
through homegrown solutions like starting networks
of farmers markets, creating locally-owned food enter-
prises, supporting aggregation and distribution facilities
in working with locally sourced products, implementing
policies that promote locally-sourced school lunches,
and creating safe open spaces for physical activity.
Boston was one of six communities to be awarded
grants from the Kellogg Foundation and in the spring
and summer of 2008 developed a survey to assess food
and fitness behaviors of Bostonians in five neighbor-
hoods: Dorchester, East Boston, Jamaica Plan, Mattapan
and Roxbury. Following administration and analysis of
the survey data, the Boston Collaborative of Food and
Fitness (BCFF) decided to concentrate its work in Matta-
pan and East Boston. As a result, the Boston Foundation
began working with Mass in Motion in Dorchester to
help advance similar goals. The organizations attending
the first planning meeting, held in October of 2010,
included Bowdoin Street Health Center, Trustees of the
Reservation, Sportsmen’s Tennis and Enrichment Center,
Codman Square Health Center, Victory Programs,
Dorchester’s Farm to Family Program
Bowdoin Street Health Center’s Farm to Family (F2F) Community Supported Agriculture (CSA) Program is
a unique, workplace-based community-supported effort that recruits employees and members of Boston’s
Beth Israel Deaconess Medical Center and Longwood Medical Area to purchase a weekly farm box share.
In exchange for their investment, F2F participants receive 16 weeks of locally grown, farm-fresh produce,
conveniently delivered to their job site or to a designated pick-up location.
In addition to paying for the cost of their own farm share, participants are encouraged to donate a nominal
amount of money to support the purchase of subsidized boxes for low-income families in Dorchester.
In 2015, F2F partnered with Ward’s Berry Farm, which is located 25 miles south of Boston in Sharon, to
provide full-priced and subsidized farm box shares for participants. The cost of a box share was $360 (16
weeks at $22.50/week), while the cost of the standard farm box plus sponsorship option was $440, which
included a $5 weekly donation. Nearly 65 percent of the shareholders donated to the sponsorship of a
subsidized box.
Overall, the program generated $43,652.50, of which $42,472.50 went directly to Ward’s Berry Farm for full-
share payments and subsidized box sponsorships. While the season was divided into two month sessions
(summer and fall), subsidized families were given the option to participate on a monthly basis. Participants
receiving a subsidized box share paid $30 per month for produce valued at $90. A family participating
for the entire season spent just $120 on produce valued at $360. Overall, produce valued at $9,000 was
distributed to 38 subsidized families.

Greater Four Corners Action Coalition, Project Right,
YMCA of Greater Boston, and others.
Under the leadership of Sportsmen’s Tennis and Enrich-
ment Center, Dorchester Mass in Motion identified
goals and worked toward a number of policy, systems
and environmental changes. Among the long term goals
was the creation of a Healthy Dot Loop, a continuous
walking pathway easily accessible to all Dorchester
residents that would include parks, shopping centers,
schoolyards, access to public transit, opportunities
for physical activity (fields, courts, indoor pools);
and increasing places to purchase or grow nutritious
and affordable food (supermarkets, farmers markets,
community gardens).
The Dorchester Community Action Plan identified
a nutrition goal of increasing healthy options and
decreasing non-healthy options being sold and
provided to community members by changing the food
environment. Through the leadership of the Bowdoin
Street Health Center, Codman Square Health Center,
Boston Natural Areas Network and ReVision Urban
Farm, which is an initiative of Victory Programs,
the number and use of farmers markets increased,
medical providers provided prescriptions for fruit
and vegetables at markets, and “Healthy Dot” stick-
ers were designated for foods at local corner stores.
Additionally, the number of community garden plots
increased dramatically.30
The physical activity goal of
the community action plan was to increase walking
by Dorchester residents by identifying existing assets,
increasing the usability of existing walking areas and
paths and increasing walk-friendly areas. Through a
public-private partnership with Citizens Bank, a series
of walkability audits were performed by WalkBoston,
a Mass in Motion technical assistance provider, to
assess the distances from one place to another, create
and place permanent wayfinding signage throughout
Dorchester, and increase awareness and use of available
walking and biking routes throughout the community.31
Leadership of Dorchester’s Mass in Motion has
shifted to Bowdoin Street Health Center which now
employs the new Mass in Motion Coordinator, and the
commitment to both healthy food access and increased
opportunities for physical activity remain strong. Also,
increased attention is being paid to biking through
work with the Dorchester Bike Coalition and Bowdoin
Bike School.
Healthy Hampshire (Amherst, Belchertown,
Northampton and, Williamsburg)
Just north of Springfield lies Hampshire County, part of
the “Pioneer Valley” region known for its access to the
Connecticut River and the many colleges in the area.
Healthy Hampshire is a Mass in Motion initiative that
brings together four municipalities within Hampshire
County: Amherst, Belchertown, Northampton and
Williamsburg. Despite making up about one-half of
the county’s population, with a combined population
of about 83,000, these municipalities experience the
kinds of challenges that are common to many rural,
small communities.32
This includes a lack of access to
healthy foods, crumbling infrastructure, tight budget,
and a limited municipal capacity to focus on policy and
systems change. The obesity rate in these communities
in 2013 was about 18% and more than 50% of adults
were overweight in 2009.33
In Hampshire County
overall, less than half of the zip codes had access to a
healthy food outlet in 2011 and only about one in five
low-income people who were eligible for SNAP benefits
were utilizing them.34
Despite efforts in the broader region to build a healthier
food system and more walkable and ”bikeable”
communities, many neighborhoods were being left out of
these efforts. Specifically, Healthy Hampshire has found
that under-resourced, low-income residents do not have
full access to resources such as grocery stores and parks.
Healthy Hampshire focuses on these disparities, intention-
ally using a health equity lens to think about community
needs, including plans to connect low-income residents to
new and existing healthy living resources.
The Healthy Hampshire collaborative became a Mass in
Motion community in 2011 when they received funding
through the CDC’s Community Transformation Grant
program. Originally seated at the Hampshire Council
of Governments, Healthy Hampshire shifted fiscal and
administrative oversight to the Northampton Office
of Planning and Sustainability with new funding in
2012. This move further aligned the collaborative’s
priorities with the city’s existing work and brought
more partners to the table by encouraging planning
departments in the other three municipalities to join the
effort. The city subcontracts with the Collaborative for
Educational Services for overall project management
and coordination, as well as staffing for the healthy food
and physical activity strategies. Healthy Hampshire is
guided by a steering committee of municipal representa-
tives from each community and the local hospital,

Cooley Dickinson. Each individual community also has
a committee to engage its own public works, health,
planning, economic development, public health and
conservation departments.
Because Healthy Hampshire is a collaborative of
four municipalities, the initiative is able to target
strategies at both the individual and regional levels.
At the regional level, the communities have been most
successful in working together on food access strate-
gies, as these tend to be the most universal. The Healthy
Hampshire Markets Program was one of the first strate-
gies identified by the collaborative, targeting corner
and neighborhood convenience stores to stock and
promote healthier options. Knowing that many of their
municipalities’ seniors and students rely on these stores
for household food and snacks, Healthy Hampshire
provides stores with nutritional expertise, promotional
materials and connections to local wholesale farmers,
as well as their published guidebook, “Be a Healthy
Market: A Toolkit for Storeowners.”35
Healthy Hampshire also works to make the healthy
options available at farmers markets more accessible
to low-income residents by ensuring that the markets
have the technology to accept SNAP benefits, as well as
through promoting a regional SNAP incentive program
that doubles the value of SNAP benefits at the farmers
market. Healthy Hampshire coordinated this program
with Community Involved in Sustaining Agriculture
(CISA) for the 2015 market season, including distribut-
ing posters and fact sheets to clearly communicate the
program to the community in more than 50 locations
in English and Spanish. This “SNAP & Save” program
resulted in a 56% increase in SNAP redemptions at the
Amherst Farmers Market.36
The physical activity and built environment work
has been more localized, but Healthy Hampshire has
recently begun a regional effort to develop a complete
streets design manual adapted to their unique geogra-
phy. This process has brought together planners from
many of the communities to examine walkability, bike-
ability and way-finding signage, as well as integrating
these plans into broader community plans and policies.
In Belchertown, there have been several initiatives
to bring the community together around Route 202,
the town’s primary corridor that connects a school
complex, senior center, library, policy department and
the Eastern Hampshire District Courthouse. Healthy
Hampshire has conducted walk audits, bike audits, a
focus group and surveys as the start of a town-wide
process to determine the future of this corridor and
its surroundings, which include an old state hospital
development and acres of pristine farmland located in
the heart of the community.
Mass in Motion funding has enabled these four
municipalities to “shine a light on obstacles that
otherwise would remain invisible,” bringing municipal
and community leaders together to address the region’s
healthy living priorities.37
The simple convening power
of Healthy Hampshire has stakeholders coalescing
around healthy design principles to develop a common
vision that connects individual projects. However, the
collaboration between multiple municipalities also
comes with challenges. Each community has a different
local capacity to support regional priorities and are
located far enough apart geographically that it is hard
to get everyone in a room together, making unified
regional work challenging. Healthy Hampshire provides
the capacity and persistence to mobilize these multi-
sector partnerships for policy and system changes.
Mass in Motion support has also enabled Healthy
Hampshire to access additional resources by expanding
their geographic reach to 14 Hampshire and Hampden
County communities. This, along with small grants
from Cooley Dickinson Hospital, allows Healthy
Hampshire to partner with Hilltown Community
Health Center to develop clinical and community
prevention strategies targeting people at risk for devel-
oping diabetes, heart disease and stroke.
Healthy Hampshire’s work continues to uncover and
highlight large underserved sections of each commu-
nity, further uniting these previously siloed groups in
their collective commitment to work towards equity.
According to Sarah Bankert, a Healthy Hampshire
Coordinator, “We are making progress in all four major
communities in Hampshire County, changing the way
our municipalities prioritize healthy living.”38
Northampton residents take a walk on the New Haven-Northampton
Canal trail.

Mass in Motion has succeeded in seeding a culture
shift toward healthy eating and active living across the
Commonwealth. As the original 2008 report recommen-
dations outlined, Mass in Motion spurs communities
to create healthy food access and promote safe, active
environments.
The number of community partners engaged in Mass in
Motion efforts has increased over time, creating a snow-
ball effect of forward momentum. Currently, there are 27
programs with support totaling $1,350,000. The nearly
$9 million distributed between 2009-2016 to more than
60 cities and towns has resulted in real policy, systems
and environmental change.
Mass in Motion communities have recorded 63 policies
passed—or in the process of being passed—related to
complete streets, transportation plans, zoning and/or
healthy community design. Among these policies, 23
were complete streets policies, in step with the August
2014 Massachusetts Department of Transportation
(MassDOT) launch of a $12.5 million Complete Streets
Pilot Project to help fund these projects.39
The active
transit movement around complete streets is making
streets safer and more inviting for walking, running and
biking, which is an example of how municipal policy
change can lead to change on a larger scale.
The state has also recorded almost 350 sites that are
either in the process of implementing—or have already
implemented—healthy food access policies and/or
practices through Mass in Motion. These sites, which
are targeted in low-income areas with less access to
fresh produce, include grocery stores, restaurants, food
pantries, farmers markets, school and public access to
fresh drinking water. These efforts in increasing access
to healthy food have touched more than 55% of the
local population, reaching more than 744,427 people
both in and outside of the Mass in Motion communities.
In addition, more than 170 sites have been engaged
through Mass in Motion to provide increased opportuni-
ties for physical activity in local communities through
community use agreements with schools and commu-
nity centers, safer parks and playgrounds, improved
roads and trails and creation of transportation hubs.
CHAPTER FOUR
Sustainable Policy Systems and Systemic Change
Mass in Motion has also encouraged greater collabora-
tion within and across communities. A total of 595
partners have been documented to be participating in
efforts around Mass in Motion. These include stakehold-
ers representing municipal departments, school districts,
health centers, regional planning groups, religious
organizations, private sector businesses, neighborhood
associations and more. While many of these partners
began their work with Mass in Motion by participating
in a single program area, 64% now collaborate across
multiple program areas, leading to a more sustainable,
multisector partnership network. Mass in Motion has
also inspired collaborations with sister agencies in state
government, with DPH working closely with MassDOT,
the Department of Housing and Economic Development
and the Executive Office of Energy and Environmental
Affairs on initiatives such as the Healthy Transportation
Compact and the Food Policy Council.
The “Healthy Options” program labels healthy foods in grocery and
corner stores in an effort to make diets healthier.

Going Forward:
The Future of Mass in Motion
The obesity epidemic did not happen overnight and
will not be solved overnight. It will take time to reverse
the trend and create environments that truly support
healthy lifestyles. This shift will only come through
deliberate and focused efforts to create health-focused
policy and healthy environments. Only then will resi-
dents be able to choose the healthy behaviors that will
lead to improved health outcomes. This is where Mass
in Motion can make the difference.
The Mass in Motion approach establishes long-term
healthy community change by institutionalizing local
policy and shifting municipal priorities, protocols
and budgets. Staff capacity is a crucial part of both
implementing these policies and building lasting part-
nerships. For example, if positions similar to the Mass
in Motion coordinator role were permanently funded in
municipal budget allocations, cities and towns would
be better equipped to create environments that promote
health and well-being for its residents.
Somerville pioneered this new way of doing business
by hiring and fully funding a “Shape Up Somerville”
coordinator as municipal staff through the city budget.
However, this leaves 350 cities and towns in the
Commonwealth that have not yet made such an invest-
ment and need continued support for their Mass in
Motion efforts.
Mass in Motion continues to demonstrate significant
change in communities across the Commonwealth.
With strong support from philanthropic and private
partners, this innovative program plays a vital role in
ensuring the health and well-being of Massachusetts
residents. Support for Mass in Motion and its efforts
around coordinating healthy eating and active living,
designing healthy communities, convening key commu-
nity stakeholders and leveraging funding will enable
Massachusetts to truly reverse the obesity trend.
As this report has demonstrated, we cannot understate
the high impact Mass in Motion has had in promoting
the health of the Commonwealth’s residents through
policy, systems and environmental change. Because of
Mass in Motion, Massachusetts is on the path toward
healthier habits and healthier residents. But we are not
there yet. Mass in Motion needs more state financial
support to advance and institutionalize this progress in
obesity prevention—an issue that has spanned across
time, communities and administrations.
FIGURE 3
Mass in Motion Partnership Content Areas
Communities identified a total of 595 partners that they collaborate with for
MiM-related work.
Note: Many partners work in more than one content area.
Mass in Motion Partnership Content Areas
100
200
300
400
500
JointUseAgreements
Zoning
SafeRoutestoSchool
CompleteStreetsPolicies
Bike/Ped/TransportationPlans
SafeEnvironment
BuiltEnvironment
HealthyRetail/FoodAccess

Chapter 1
1. Cynthia Ogden, et al., “Prevalence and Trends in
Overweight Among US Children and Adolescents,
1999-2000,” Journal of the American Medical
Association 288, no. 14 (2002): 1729-30.; Cynthia
Ogden, et al., “Prevalence of High Body Mass Index in
US Children and Adolescents, 2007-2008,” Journal of the
American Medical Association 303, no. 3 (2010): 245-247.
2. RAND Corporation, “Preventing Obesity and Its
Consequences: Highlights of RAND Health Research”
(2011), 1, http://www.rand.org/content/dam/rand/
pubs/research_briefs/2011/RAND_RB9508.pdf.
3. S. Jay Olshansky, et al., “A Potential Decline in Life
Expectancy in the United States in the 21st Century,”
New England Journal of Medicine 352, no. 11 (2005):
1138-1145.
4. The Boston Foundation, “Healthy People/Healthy
Economy: A Five-Year Review and Five Priorities for
the Future,” (2015), 8, https://www.tbf.org/~/media/
TBFOrg/Files/Reports/HPHE2015Final2.pdf.
5. Massachusetts Department of Public Health, “Mass in
Motion: A Call to Action: Addressing the Public Health
Crisis of Overweight and Obesity in Massachusetts,”
(2008), 2, http://www.mass.gov/eohhs/docs/dph/
mass-in-motion/action-plan.pdf.
6. The Boston Foundation and New England Health Care
Institute (NEHI), “The Boston Paradox: Lots of Health
Care, Not Enough Health: Indicators of Health, Health
Care, and Competitiveness in Greater Boston,” (2007),
13, http://www.tbf.org/tbf/56/hphe/~/media/
BBCC5400440E4D14A8ADCE51D3F45CDC.pdf.;
Massachusetts Department of Public Health, “Mass in
Motion: A Call to Action,” (2008), 2-5.
7. The Boston Foundation and NEHI, “The Boston
Paradox,” (2007), 13.
Motion: A Call to Action,” (2008), 1.
9. Ibid., 3.
10. RAND Corporation, “Preventing Obesity and Its
Consequences,” (2011), 1.
Endnotes
11. Justin Trogdon, et al., “State- and Payer-Specific
Estimates of Annual Medical Expenditures
Attributable to Obesity,” Obesity 20, no. 1 (January
2012): 214-220.
Motion: A Call to Action,” (2008), 1.; Sarah Booth, et
al., “Environmental and Societal Factors Affect Food
Choice and Physical Activity: Rationale, Influences,
and Leverage Points,” Nutrition Reviews 59, no. 3
(2001): 21-26.
Chapter 2
13. Institute of Medicine, Promoting health: Intervention
strategies from social and behavioral research, eds. Brian
D. Smedley and S. Leonard Syme (Washington, DC:
National Academy Press, 2000), 4.
14. “Snack Foods and Beverages in Massachusetts
Schools.” The Pew Charitable Trusts and the Robert
Wood Johnson Foundation. January 2015. http://
www.pewtrusts.org/~/media/assets/2015/01/
state-fact-sheets/kshf_appendix_massachusetts_
v4.pdf?la=en
15. Massachusetts Department of Public Health, “Mass
in Motion Community Overview,” (2015), 4-5, http://
d3dmubwaxeg5i9.cloudfront.net/wp-content/
uploads/2015/09/MiM-Highlights-2015-web.pdf.;
Massachusetts Department of Public Health, “Mass in
Motion Municipal Wellness & Leadership Program,”
Mass in Motion, 2016, http://www.mass.gov/eohhs/
gov/departments/dph/programs/community-
health/mass-in-motion/community/municipal-
program/.
16. Centers for Disease Control and Prevention,
“Community Health Assessment aNd Group
Evaluation (CHANGE): Building a Foundation of
Knowledge to Prioritize Community Needs,” CDC’s
Healthy Communities Program, October 25, 2013,
http://www.cdc.gov/nccdphp/dch/programs/
healthycommunitiesprogram/tools/change.htm.

Chapter 3
17. U.S. Census Bureau, “Population and Housing
Occupancy Status: 2010 – State – County Subdivision,
2010 Census Redistricting Data (Public Law
94-171) Summary File,” (2010), http://factfinder2.
census.gov/faces/tableservices/jsf/pages/
productview.xhtml?pid=DEC_10_PL_GCTPL2.
ST16&prodType=table.
18. Ibid.
19. Massachusetts Department of Public Health, “The
Status of Childhood Weight in Massachusetts,
2009-2011,” (December 2012), http://www.mass.
gov/eohhs/docs/dph/com-health/school/status-
childhood-obesity-2011.pdf.
20. Massachusetts Executive Office of Education, “Level 4
Schools in Massachusetts,” (December 2015), http://
www.mass.gov/edu/docs/ese/accountability/
turnaround/level-4-schools-list.pdf.
21. Brittany Peters, “Violent Crime in Massachusetts:
a 25-Year Retrospective,” Massachusetts Executive
Office of Public Safety and Security, (February
2014), http://archives.lib.state.ma.us/bitstream/
handle/2452/207516/ocn870869699.pdf?sequence=1.
22. “Mass in Motion Stories from the Field: Opening the
Doors of Springfield Gyms for Safe Areas to be Active,
(August 2011), http://www.mass.gov/eohhs/docs/
dph/mass-in-motion/ss-mim-springfield-gyms.pdf.
23. “Walking School Bus Program Helps Move a
Neighborhood Forward in Springfield, Mass,” (July
2013), http://www.saferoutesinfo.org/about-us/
newsroom/our-newsletter/article/walking-school-
bus-program-helps-move-neighborhood-forward-.
24. Ibid.
25. Paul Halloran, “Geiger Gibson pioneer health center
celebrates 50,” Dorchester Reporter, (October 14, 2015),
http://www.dotnews.com/columns/2015/geiger-
gibson-pioneer-health-center-celebrates-50.
26. Boston Public Health Commission, “Health of
Boston,” (2010), http://www.bphc.org/healthdata/
health-of-boston-report/Documents/HOB-2010/
Health%20of%20Boston%202010%20Full%20Report_
Rev16Nov10.pdf.
27. Centers for Disease Control and Prevention, High
School Youth Risk Behavior Survey Data website,
1991-2013, http://nccd.cdc.gov/youthonline/.
28. Boston Public Health Commission, “Health of
Boston,” (2010), http://www.bphc.org/healthdata/
health-of-boston-report/Documents/HOB-2010/
Health%20of%20Boston%202010%20Full%20Report_
Rev16Nov10.pdf.
29. Allison F. Bauer, “Disparities in Food Access and
in Opportunities for Physical Activity,” (September
2011), http://www.gih.org/files/FileDownloads/
Disparities_FoodAccess_PhysicalActivity_TBF_
September_2011.pdf.
30. Sarah Shemkus,” Urban Farming Takes Root,”
The Boston Globe, (June 21, 2014), https://www.
bostonglobe.com/business/2014/06/21/urban-
farming-takes-root/IoeiZucFBdu2b9HRWYZIVO/
story.html; Zanna Ollove, “Changing Dorchester, one
garden at a time,” Exhale, http://www.exhalelifestyle.
com/2011-3-4/DorchesterGarden.html.
31. Mass Nonprofit News, “New Grants Program Awards
$125K to Four Urban Nonprofits,” (November
14, 2013), http://www.massnonprofit.org/news.
php?artid=3475&catid=12.
32. United States Census Bureau, “QuickFacts,” (2014),
http://www.census.gov/quickfacts/table/PST045215
/2501504825,2546330,2501501325,25015.
33. Healthy Hampshire, “Mass in Motion 2013
Community Report,” (2013), 1, http://www.mass.
gov/eohhs/docs/dph/mass-in-motion/community-
reports/2013/hampshire.pdf.; Western Mass Center
for Healthy Communities, “Cooley Dickinson Hospital
Community Health Assessment,” (January 2011), 57,
http://www.cooley-dickinson.org/Resource.ashx?sn=
CDHHealthAssessmentReportSept2012.
34. Western Mass Center for Healthy Communities,“
Cooley Dickinson Hospital Community Health
Assessment,” (January 2011), 53.
35. Healthy Hampshire, “Be a Healthy Market: A Toolkit
for Storeowners,” (n.d.).
36. Collaborative for Educational Services, “Mass in
Motion Focus: Amherst, MA,” (2016), 1.
37. Editorial staff, “Healthy Hampshire Shines
Welcome Light on Challenges,” Daily Hampshire
Gazette, (March 19, 2015).
38. Healthy Hampshire, “Mass in Motion 2013
Community Report,” (2013), 1.
Chapter 4
39. Massachusetts Department of Transportation,
“Announcing New Complete Streets Funding
Program,” http://www.massdot.state.ma.us/
Portals/8/docs/CompleteStreets/flyer.pdf.

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