Lieutenant Governor’s Challenge:

Abstract

The Lieutenant Governor’s Challenge 2.0, Wellness Award Initiative, is an opportunity for everyone to drive change and to elevate the well-being, productivity, and prosperity among communities in Delaware. The 2.0 reference is rooted in the mission of former Lieutenant Governor, and now Governor, John Carney to address physical activity and fitness levels of youth and adults. The Lieutenant Governor’s Challenge 2.0 presents the opportunity to unite the entire state in an ongoing effort to create an overall healthier population. Mobilizing communities to get healthier, promote better health outcomes, and lower health care costs are the goals of this statewide initiative.

Community recognition is a powerful tool to applaud and inspire individuals and organizations that implement health promotion and disease prevention programs. To reduce the burden of chronic disease in Delaware, the Lieutenant Governor’s Challenge 2.0 honors individuals, programs, organizations, and institutions who are implementing policy, systems, and environmental change initiatives to improve the health and well-being of their respective communities. This article highlights the Lieutenant Governor’s Challenge Wellness Award Initiative and discusses the importance of policy, systems, and environmental change strategies in chronic disease prevention. This is more than a recognition program for health and wellness. It is a statewide effort to influence, advance, and sustain systemic change in emotional well-being, healthy living, chronic disease management and prevention, and mother and child health. This effort achieves health equity through approaches that center community voice.

Background

According to the Centers for Disease Control and Prevention (CDC), chronic and mental health diseases contribute to the leading causes of death and disability in the United States, and to the country’s $4.1 trillion in annual health care spending.¹ Common chronic diseases include heart disease and stroke, cancer, diabetes, and obesity.¹ Chronic disease can lead to a decreased quality of life and a shortened life expectancy.

Within the Delaware Department of Health and Social Services, Division of Public Health (DPH), Delaware Health Statistics Center indicates that chronic diseases account for three of the top five leading causes of death among Delawareans.² In 2021, cardiovascular diseases and cancers accounted for 39% of all deaths in Delaware.² High blood pressure and high cholesterol are major risk factors for cardiovascular diseases.³ In 2021, 36% of Delaware adults reported having high blood pressure and 38% reported having high cholesterol.⁴

Diabetes is associated with higher risk of heart disease, stroke, and other serious health conditions.⁵ In 2022, 14% of adults in Delaware reported having been diagnosed with diabetes, and 14% reported having been diagnosed with pre-diabetes.⁶ As diabetes becomes more prevalent with age, 19% of adults ages 55 to 64 had diabetes, and 24% of adults ages 65 and older had diabetes.⁶

Obesity and excess weight are associated with an increased risk of developing other chronic diseases and premature death compared to those of normal weight. In 2022, 37.9% of Delaware adults were obese and another 33.9% were overweight.⁶ In 2021, 18.7% of Delaware adults with obesity and 12.6% of Delaware adults who are overweight had diabetes, compared to 3.5% of Delaware adults of normal weight.⁴

From 2017-2021, the Black infant mortality rate in Delaware was still more than three times the White infant mortality rate. Delaware’s White infant mortality rate was 3.4 deaths per 1,000 live births, which was lower than the national White infant mortality rate.⁷ From 2017-2021, the Delaware Black infant mortality rate was 11.0 deaths per 1,000 live births, which was higher than the national Black infant mortality rate of 10.3 deaths per 1,000 live births.^7,8 Risk factors such as obesity, pre-eclampsia, and high blood pressure are on the rise in women of reproductive age.⁹

Chronic disease can be prevented, delayed, and managed through simple lifestyle changes. Many chronic diseases are caused by common risk behaviors such as tobacco use, unhealthy diet, physical inactivity, and excessive alcohol use.¹⁰ Remaining tobacco-free, meeting the recommended levels of physical activity, and maintaining a healthy diet play a large role in preventing obesity and other chronic diseases.

The factors contributing to chronic disease are complex. Chronic disease and an individual’s ability to make healthy decisions are influenced by distinct factors such as genetics and lifestyles choices, and the social and economic context in which one lives, works, and plays. Differences in social determinants of health can limit a community’s availability and accessibility of opportunities to engage in a healthy lifestyle and contribute to disparities in chronic disease prevalence among racial, ethnic, and socioeconomic groups.¹¹ Policy, systems, and environmental change approaches are used to address health disparities and achieve equitable health outcomes by making healthy choices available and accessible to all.¹²

Community recognition is a powerful tool to applaud and inspire individuals and organizations implementing health promotion and disease prevention programs.¹³ Recognizing community champions not only honors and shows appreciation for those doing important work, but also creates an example for other partners to follow. Honoring community partners and programming also provides opportunity to highlight and explain community issues and needs.¹³

To reduce the burden of chronic disease in Delaware, during his tenure as Lt. Governor (2001-2009), Governor John Carney established The Lieutenant Governor’s Challenge, a wellness award program aimed at inspiring individuals to take the first steps toward leading healthier lifestyles. The program focused on increasing physical activity and fitness levels of Delawareans. In 2018, Lt. Governor Bethany Hall-Long launched the Lt. Governor’s Challenge 2.0, which builds upon the work and achievements of Governor Carney. The Lt. Governor’s Challenge 2.0 expands the focus with a more holistic approach to health and emphasizes the importance of policy, systems, and environmental change initiatives in addressing community health needs.

The Lt. Governor’s Challenge

The mission of the Lt. Governor’s Challenge is to improve the quality of life of all Delawareans.¹⁴ The program honors individuals, organizations, and institutions that inspire others by making healthy choices the easiest choices for their communities, ultimately helping elevate the well-being, productivity, and prosperity of the state of Delaware. The goal is to recognize organizations or individuals who are going above and beyond to advance health and well-being in one of four areas of focus: emotional well-being, healthy living, chronic disease management and prevention, and maternal and child health.¹⁴

More than just a recognition program for health and wellness initiatives, the Lt. Governor’s Challenge is an opportunity for applicants to demonstrate that they are drivers of change among family, neighborhoods, workplaces, faith organizations and institutions, communities, or schools. By sharing nominee’s stories and outcomes, they are motivated to continue to grow their initiatives and encourage other Delawareans to do the same.¹⁴

The Lt. Governor’s Challenge focuses on the power of community when it comes to encouraging and implementing changes that can improve quality of life for Delawareans. It was designed to mobilize and inspire individuals to act on their health and well-being. The program motivates, supports, and recognizes groups, individuals, and communities that work together to make the healthy choice the easiest choice for their members.¹⁵

By engaging businesses, local organizations, and individuals to be change-makers for health in their communities, the Lt. Governor’s Challenge spotlights and applauds those implementing solutions to create environments that support and sustain overall good health in the state.¹⁶

A PSE Approach

The Lt. Governor’s Challenge honors those who go above and beyond in implementing policy, systems, and environmental change (PSE) strategies. An individual’s ability to make healthy choices is heavily influenced by the systems and environment in which one lives, works, and plays. PSE approaches are sustainable changes used to address health disparities and the social determinants of health. PSE changes go beyond health education and programming and seek to enable communities to choose a healthy lifestyle.¹⁷ PSE approaches are designed to drive sustainable, multi-level change by making healthy choices available and accessible.¹⁸ Rather than focusing on individual health education, PSE changes are strategic and deliberate ways of addressing public health issues to ensure that healthy choices are practical, available, and accessible (Table 1).¹⁹

Table 1. Program vs. PSE Change¹⁷.

Programming	PSE Change
Often one-time event Individual level Short term Non-sustaining Additive	Ongoing effort Population and community level Long term Sustaining Foundational

Policy, systems, and environmental change strategies in chronic disease prevention can be achieved through many approaches.

Policy

A formal written statement of position, decision, or course of action at the legislative or organizational level such as laws, ordinances, resolutions, mandates, regulations, or guidelines.¹⁹ Examples of policy approaches include:

• School or worksite wellness policies

• Legislation mandating physical fitness assessments in schools

• Tax on unhealthy foods

• Establishing smoke-free zones and policies.

Systems

Rules, procedures, and processes of an organization, involving the infrastructure of an organization or institution.¹⁹ Systems-level approaches can include:

• Development of a workplace wellness committee

• Updating intake forms and referral systems

• Training school teachers on childhood obesity prevention.

Environmental Change

Changes made to the physical, social, or economic environment in which people live, work, and play.^17,18 Examples of environmental change strategies include:

• Building and maintaining sidewalks and crosswalks to ensure pedestrian and bicycle safety

• Constructing and caring for community gardens

• Stocking vending machines with only healthy food and drink options

• Placing tobacco-free signage in frequented community spaces.

An individual’s ability to make healthy choices is dependent on the availability and accessibility of healthy choices in their everyday environments. PSE strategies create long-term, sustainable change that make the healthy choice the easiest choice.¹⁷

Nomination Process

Individuals are encouraged to nominate themselves, another individual, or a group that exemplifies the promotion and practice of healthier living. The Challenge looks for nominees who go above and beyond what is regularly expected of them in their efforts to create a healthier state and who drive results through policy, system, and environmental changes in one of four areas of focus¹⁴:

Emotional Well-being

Initiatives promote and support emotional health through stress reduction, encouraging positive behaviors, emotional support groups, or similar opportunities.

Healthy Living

Initiatives foster environments for learning and lifestyle behavior changes related to healthier eating and drinking, exercise, weight control or obesity prevention, and avoidance or reduction of unhealthy habits such as tobacco use or excessive use of alcohol.

Chronic Disease Management and Prevention

Initiatives promote and offer access to health screenings, cultivate understanding of chronic diseases and how to live with them, and create an environment to support a higher quality of life for individuals living with a chronic disease.

Maternal and Child Health

Initiatives offer such opportunities as a breastfeeding policy, an environment supportive of breastfeeding mothers, and access to early childcare, which support the formation of a physically and emotionally healthy relationship between a mother and child in the early years of development.

Potential nominators are provided with resources and support as they navigate the nomination process, including step-by-step guidance and educational resources on PSE change, effective prevention strategies, and health and well-being programming.

Selection and Awards

To be considered, an initiative must adopt or enhance policies, systems, or the physical environment aimed at improving physical, behavioral, and/or mental health. All initiatives must address short-term and long-term goals that will ultimately impact the health and wellness of Delawareans. In addition, each initiative must perform well in the following criteria categories¹⁴:

• Sustainability: The initiative should provide ongoing opportunity for healthier living, instead of being a one-time activity.

• Reach: The initiative should seek to demonstrate improvements in the capacity to address the health needs of a community or a target population.

• Outcome/Impact: The initiative should demonstrate improved access and/or increased opportunities for improving behavioral and physical health in the state.

The review committee is made up of impartial judges from state government, nonprofits, and community leaders who have high expertise in PSE strategies.¹⁴

The Lt. Governor’s Challenge honors two categories of awards and both categories of champions exemplify the Challenge’s mission to encourage healthy lifestyles. Recipients of the Delaware Wellness Hero Award show the highest degree and most comprehensive PSE changes to address their specific public health issues, while winners of the Delaware Health Leader Award are applauded for taking significant steps to improve the overall health of their community.¹⁶

Winners of the Lt. Governor’s Challenge Wellness Awards are honored at a prestigious award ceremony. At the ceremony, winners accept their awards, network with other community champions, and spend time with the Lieutenant Governor.

Hall of Fame

Dozens of individuals and organizations have been honored since the inception of the Lt. Governor’s Challenge. Tables 2 and 3 illustrate honorees and their programs from 2023 and 2022, collectively. Table 4 outlines the list of honorees from 2019 to 2021. Honorees have developed, implemented, and evaluated programs that motivate long-term behavioral changes, leading to measurable impact on the well-being of individuals and their communities. For more information on the Lieutenant Governor’s Challenge and Hall of Fame honorees, visit 2024 Lt. Governor’s Challenge (ltgovernorschallenge.org).

Table 2. 2023 Winners of the Lt. Governor’s Challenge, Delaware¹⁴.

Erin Ridout, Delaware Coalition Against Domestic Violence	Implementing statewide services to address domestic violence as a health issue and to integrate domestic violence and health services.
The University of Delaware’s Institute for Excellence in Early Childhood	Creating a health and wellness program supporting family childcare educators that improves mental health and physical wellness, as well as providing social support to reduce stress and lower risk of chronic disease.
Providence Creek Academy Charter School	Creating a program that provides alternative therapeutic methods, such as art and farm therapy, to students experiencing loss and grief.
Nemours Children’s Health	Creating the First Oral Feed Initiative for parents of infants with congenital heart defects, which provides education and fosters important early feeding experiences.
The Sussex County Health Coalition	Improving physical health by providing grants for libraries to conduct exercise classes, and to provide access to community health workers who offered health and wellness coaching.
Face the Facts Delaware	Providing resource and support to those who have lost loved ones to overdose or substance use disorder.
Charity Crossing	Incorporating physical activity into volunteer and community service activities.

Table 3. 2022 Winners of the Lt. Governor’s Challenge, Delaware¹⁴.

Kim Blanch	Created a program to educate Beebe Healthcare staff on trauma and how it affects physical health over a person’s lifetime.
Hope Lutheran Early Education Center	Created a cooking class for children to broaden their food preferences and to include healthier choices by teaching about foods, why they are healthy, and how to grow the food from seed to harvest.
Delaware State University Wesley College of Health and Behavioral Sciences	Developed a survey to screen for food insecurity and mental health impacts within their student population.
Kuehne Company	Created a “Wellness Wednesdays” program to improve the physical, emotional, and financial health of their staff.
The Eco Team at George S. Welch Elementary School	Created an education program to expand on environmental literacy and knowledge, including lessons on recycling and composting as well as more frequent outdoor classes.
Community Education Building	Worked with a network of partners to provide a healthy ecosystem for students, children, and families in Delaware.
Schell Brothers Homebuilders	Improved physical health by sponsoring exercise classes, having an on-site personal trainer, and building a gym for employees and their families.
Erika Cook	Developed programs, including life-enrichment classes and wellness screenings, to combat social isolation and depression for residents at Selbyville’s Bayside community.

Table 4. 2019 -2021 Winners of the Lt. Governor’s Challenge, Delaware¹⁴.

Brandywine Counseling & Community Services	Hank’s Hope
Delaware Libraries	Department of Services for Children, Youth and Their Families
Healthy Foods for Healthy Kids	Incyte Corporation
Hispanic American Association of Delaware	The Breastfeeding Coalition of Delaware
Reach Riverside Development Corporation	Newark Charter School
Rose Simon	Sexual Offense Support (University of Delaware)
Seaford School District Behavioral Health Team	Colonial District 1st Elementary Wellness Center – Eisenberg Elementary School
Compassionate Schools Team	Bling Vendors Committee: Healthy Vending Initiative
Department of Health and Social Services	Delaware Technical Community College: Mindfulness Summit
Delaware Department of Correction	Perdue (Delaware Fit Biz)
ChristianaCare	IMPACT Delaware Tobacco Prevention Coalition
Polytech School District	Children in Nature
Delaware Council on Farm and Food Policy	Khayree Bey

Conclusion

The Lieutenant Governor’s Challenge Wellness Award Program leverages community recognition as a tool to honor individuals and organizations who have gone above and beyond to improve the health and well-being of their community, and to inspire others to do the same. Utilizing a PSE approach drives sustainable, long-term behavior change by making healthy choices the easiest choices. The Lt. Governor’s Challenge continues to recognize those who are driving this change, and ultimately helping elevate the well-being, productivity, and prosperity of the state of Delaware.