Frequently Asked Questions about the STEPS Program

The Steps to a HealthierUS Cooperative Agreement Program (Steps Program) is a national, multilevel program coordinated by the U.S. Department of Health and Human Services (HHS). Administered through the Centers for Disease Control and Prevention (CDC), the program funds states, cities, and tribal entities to implement integrated chronic disease prevention and health promotion efforts focused on reducing the burden of obesity, diabetes, and asthma, as well as addressing physical inactivity, poor nutrition, and tobacco use. Funding supports the following:

• Implementing community, environmental, educational, media, and policy interventions in schools, communities, health care, and workplace settings.
• Establishing an alliance of partnerships and coalitions committed to participating actively in planning, implementation, and evaluation activities.
• Tracking specific progress indicators in conjunction with quantifiable program objectives.

Each of the Steps-funded communities are required to address all of the high priority conditions—obesity, diabetes, asthma—and their underlying causes—physical inactivity, poor nutrition, and tobacco use.

President Bush's HealthierUS Initiative helps Americans take steps to improve personal health and fitness and encourages all Americans to:

• Be physically active every day.
• Eat a nutritious diet.
• Get preventive screenings.
• Make healthy choices.

Steps to a HealthierUS is an HHS initiative that advances President George W. Bush’s HealthierUS goal of helping Americans live longer, better, and healthier lives and envisions a healthy, strong U.S. population supported by a health care system in which diseases are prevented when possible, controlled when necessary, and treated when appropriate. This initiative is a shift in the traditional approach to the health of our citizens, moving us from a disease care system to a health care system.

The centerpiece of the Steps to a HealthierUS Initiative is the Steps Cooperative Agreement Program.  The Steps Program funds communities to implement integrated chronic disease prevention and health promotion activities.

The Steps Program works closely with HHS sister agencies, CDC Divisions, and the public health community to ensure an inclusive Steps Program that incorporates the skills, resources, and input of the public health community at all levels. A representative from each of the divisions of the National Center for Chronic Disease and Health Promotion and from each of the HHS agencies meets regularly with the Steps team to provide and improve technical assistance to the communities, share in decision making, serve as expert consultants, and coordinate similar activities at the national, state, and community levels. For example, CDC worked with the Indian Health Service to provide culturally appropriate technical assistance for implementing and evaluating community-based initiatives in funded tribal consortia.

In addition, a workgroup of representatives from funded communities, national partners, and other public health leadership organizations has been established to ensure collaboration between grantees and key partners; assist in organizing and facilitating approaches to sharing experiences, resources, and results among grantees and existing community and state programs; address priority needs of grantees; and lend expertise and evidence-based resources to assist and enhance the work of the Steps funded communities.

The overarching design of the Steps Program emphasizes

1. Integrating programs at the national, state, and local levels.
2. Maximizing limited resources and connecting categorical programs.
3. Accelerating progress toward important outcomes.
4. Basing programs on sound scientific evidence and practice-based knowledge and lessons.

The Steps Program was created to be an extension of these existing programs and to enhance, expand, and create an integrated approach to address the collective goals of chronic disease prevention. The Steps Program aims to enhance the tremendous efforts already being done at the local, state, and national level—adding connections, building on existing systems, coordinating best practice, and leveraging resources to create an integrated approach to public health promotion and disease prevention. The Steps Program cannot exist without the support and resources established by existing chronic disease programs at CDC, HHS, and within individual communities.

The purpose of the Steps to a HealthierUS Cooperative Agreement Program is to develop an integrated chronic disease prevention and health promotion program in each funded community. Such an integrated program requires working in all sectors of the community and across health challenges. To accomplish this:

• All sectors of the community—public health, education, business, health care systems, community and faith-based organizations, and local government—need to be involved.
• Health challenges—obesity, diabetes, asthma, physical inactivity, poor nutrition, and tobacco use—must be addressed
• All levels of the socioecological model—individual, interpersonal, organizational, environmental, and policy—must work together.

Additionally, the Steps Program is being integrated across levels of government. Steps communities’ action plans must be integrated with state-level strategic plans, particularly those that are federally funded. State programs are integrated with CDC programs and other federal initiatives.

The Steps Program hopes to produce accelerated outcomes in the three health areas—obesity, diabetes, and asthma—beyond that which can be accomplished by addressing any disease, risk factor, sector, or level of the system individually.

Target populations within the Steps communities include Hispanics, Native Americans, African-Americans, Asian American/Pacific Islanders, immigrants, low-income populations, youth, senior citizens, uninsured/underinsured people, and people at high risk for or those who have been diagnosed with obesity, diabetes, and asthma.

• Community-wide campaigns to promote physical activity.
• Diabetes disease management programs.
• Asthma education and awareness programs for schools.
• Multimedia campaigns.
• Training courses for chronic disease health care providers.
• Smoking cessation programs.
• School nutrition plans to promote healthy eating.

To address the burden of obesity, diabetes, and asthma in funded communities, the Steps Program focuses on measurable improvements on 12 outcomes:

• Prevent overweight and obesity.
• Prevent diabetes among populations with pre-diabetes.
• Increase identification of those with diabetes.
• Reduce complications of diabetes.
• Reduce complications of asthma.
• Increase physical activity.
• Improve nutrition.
• Prevent tobacco use and exposure.
• Increase tobacco cessation.
• Increase use of appropriate health care services.
• Improve the quality of care.
• Increase effective self-management of chronic diseases.

• CDC's National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)
• CDC’s Diabetes Public Health Resource
• U.S. Department of Health and Human Services (HHS)
• CDC’s Tobacco Information and Prevention Source (TIPS)
• CDC’s Division of Nutrition and Physical Activity
• CDC’s National Center for Environmental Health: Asthma
• The White House: Healthier US Initiative

Steps activities are designed to build on and coordinate fully with existing programs and resources at the local level. This is accomplished through community consortiums, made up of an alliance of partnerships that participate in planning, implementing, and evaluating activities to ensure coordination of activities and prevent duplicate efforts.

Partners include:

• Local and state health and education departments.
• Key community, health care, voluntary and professional organizations.
• Business, faith-based, and community leaders.