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All the kids have one.

A sleek 24-oz. water bottle, clear with a black cap and a colorful logo. It’s now a standard accessory among students at every school in Kingsport, Tennessee, thanks to a massive giveaway program.

The goal: Get kids to choose water over sugar-heavy drinks.

“This is the land of Mountain Dew and sweet tea,” says Kandy Childress, executive director of Healthy Kingsport, the nonprofit leading the area’s Live Sugarfreed campaign.

“Here, people drink 2.7 sugary drinks a day, and health experts recommend no more than one per week . The consumption of sugary beverages is the single biggest contributor to obesity and type 2 diabetes , studies have shown.

“The water bottles and Live Sugarfreed program are part of a bigger, long-term attempt to improve health overall.”

In fact, by the time Healthy Kingsport and its supporters handed out more than 17,000 water bottles to the city’s youth, the move to ditch dependence on sugary drinks was well underway throughout the city.

• For months, residents heard the message on TV and through social media.
• Bottled water was delivered, free, to organizations that pledged to reduce or eliminate access to sweetened beverages.
• Workplaces and churches installed water bottle filling stations and stopped stocking their fridges with soda.

That comprehensive effort follows the Healthy Kingsport plan to effect real change using an approach called collective impact.

Designed specifically to tackle complex social issues, the collective impact model has proven to successfully alter ingrained behaviors by presenting small, achievable steps and making them easily accessible to anyone. Soon, the healthier choice (such as drinking water instead of soda) becomes the default choice.

It requires an entire community to work toward the same goal, reinforcing efforts at every turn.

Water, water everywhere

Early indications show the move toward water appears to be working.

• More than 240 organizations made a pledge to either stop providing sugary drinks to employees, discourage consumption, or simply promote water instead.
• All 38 schools in Sullivan County have installed filling stations, and the bottle giveaway helped to make water an easy choice over soda for students.
• At one high school, 1,602 water fill-ups were recorded at one refill station in a single day.

“No matter where someone goes, they find the same approach,” says Healthy Kingsport Advisory Council Chairman Roger Mowen. “If our businesses, schools and places of worship exclude sugary drinks, what is the likelihood that the reduced access will increase the consumption of water? Pretty darn high.

“It’s critically important to get the mass of institutions to agree to the strategy. Then, people will see that things are changing all around them, and that leads to a change in habits.”

Change must happen.

Kingsport, like much of Tennessee, has serious health issues to address.

In Sullivan County:

• 72.9% of adults are obese or overweight
• 25% of adults use tobacco
• 45% of residents have pre-diabetes and
• 15% are already diagnosed with type 2 diabetes.

Getting residents to adopt better lifestyle behaviors is key to turning the tide, so it has become a citywide commitment involving multiple groups and organizations.

“We know that this is not a five-year deal,” says Mowen. “It’s going to take 20-30 years to get us back to health.”

Do something now

In 2010, USA Today ran a story on the 10 unhealthiest cities in the country, and Kingsport ranked high on its list. The news did not go over well in the city, and so the first reaction was to look at the research methods to determine if the conclusion even had merit.

“It’s debatable whether it was accurate, but the damage was done,” says Kingsport Chamber Chief Executive Officer and President Miles Burdine.

“We were labeled. And frankly, we knew that we were unhealthy.”

“So, rather than get angry and pick a fight with the paper, we used it as a call to action.”

Some steps toward change were already taking place. In 2009, the Greater Kingsport Family YMCA had applied for and received a Pioneering Healthier Communities grant from the Robert Wood Johnson Foundation. City leaders and stakeholders traveled to Washington, D.C., to learn how to build a framework of policies and programs to fight obesity.

“It was all about creating an environment tied to making healthy choices,” says Greater Kingsport Family YMCA CEO Charlie Glass.

That might include changing the process for resurfacing roads to always include bicycle lanes or sidewalks, extending the greenway, or enacting city ordinances to restrict smoking.

The main takeaways were:

• To get the entire community involved
• To measure the effectiveness of every program, and
• To have a long-term plan in place.

That training session eventually led to the formation of Healthy Kingsport, now housed in the Kingsport Chamber offices, and a commitment to the collective impact model to get all parts of the community working toward the same goals and reinforcing efforts.

“Healthy Kingsport is the backbone organization and others join us as sponsors and partners to form a collaborative effort,” says Childress.

“That’s how we are able to get out and be effective in the community.

“Our advisory council is made up of members of local organizations, and they help us develop a strategic plan for each of our wellness initiatives. We determine how we will measure progress to do what we say we are going to do. Then we create reinforcing activities that spread through our main channels — businesses, schools, places of worship and at-risk populations.”

Every goal is broken down into steps, forming a path to success that works like a stream of perfectly falling dominos, one achievement leading to the next, from awareness, to calls to action and commitment, to maintenance.

Living Sugarfreed

The Live Sugarfreed campaign framework, for example, looked like this:

• Metric: Increase the number of citizens who have easier access to water.
  • City population: 53,000
  • Goal: 26,481
  • Current reach: 35,945
• Action plan:
  • Educate: Spread a message about the benefits of water and the health consequences of sugary drinks using the Healthy Kingsport website, newspaper articles and social media (13,750,000 impressions)
  • Engage:
    • Get local organizations to take a Live Sugarfreed pledge to promote water and discourage sugary drinks onsite (245 organizations)
    • Offer free water bottle delivery for 3 months to participants
• Sustain: Continue and reinforce efforts.
  • 16 organizations continued water delivery
  • 5 organizations installed water bottle refill stations
  • 38 schools installed water bottle refill stations
  • 17,200 students received a Tritan reusable water bottle, manufactured by hometown business Eastman Chemical Company

Going horizontal

Ultimately, the city of Kingsport marshals multiple forces to spur a grassroots movement toward health. Open communication among interested parties allows effective programs to get greater traction.

They call that “taking a vertical success and making it horizontal” — basically having a system in place to broaden the reach of something that has proven to work.

Taking out tobacco

The city’s tobacco-free campus initiative offers an example of how a single action can spark a movement. It began as a one-man mission to snuff out smoking. Kingsport Chamber’s Burdine saw his mother die as a result of cigarettes, and decided he would do what he could to keep people from lighting up anywhere near him.

He declared the Chamber campus a No Tobacco zone, and placed a permanent sign to that effect outside its building. Then, when he saw someone ignore the sign and light up, he stepped up to enforce the rule.

“I’m a retired Marine, so I don’t avoid conflict,” Burdine says, grinning.

It didn’t take long for smokers to obey the rule. The Chamber, which had declared itself a force for healthier living, stood as proof that the change could occur.

• Kandy Childress at Healthy Kingsport ran with the idea, bringing in other companies to go tobacco-free and creating common signage for those who joined.
• Now, throughout the city, those signs discourage smokers.
• Even more important, any organization that wants to deter smoking among its employees and on its premises can get a Tobacco Cessation toolkit from Healthy Kingsport to guide them on how to do so successfully.

“The movement started here, with Miles as the champion,” says Childress. “He talked to people at the Bank of Tennessee, and they followed his lead. Then more organizations designated themselves as tobacco-free campuses, so the message with the signage and the toolkit is widespread.”

Upping the activity

Of course, getting good habits started early is key, and the schools make physical activity and nutrition an integral part of each student’s day.

• Elementary schools use GoNoodle to give the youngest students regular breaks from sitting at their desk, and all participate in the annual Walk to School Day.
• Middle schools use the SPARK curriculum for physical education, an alternative to traditional gym classes that encourages greater participation.
• Some classrooms have standing desks, bicycle desks, foot movers and other “movement furniture” that allows students to move while working.

“So much of what we do is supported and aligned with other organizations in our community. We encourage our students and families to utilize our city’s wonderful Greenbelt for walking, biking and jogging together,” says Misty Keller of Kingsport’s Coordinated School Health.

“We worked directly with the city in a joint effort to make infrastructure improvements to the Greenbelt and sidewalks around some of our schools so that students who walk would have safer and better access. In turn, we provided bicycle and pedestrian education for students and families.”

Change can also begin in a workplace and extend out to the community.

That was the case when one of the area’s largest employers, Eastman Chemical Company, noted the 34 percent rate of pre-diabetes among their employees.

They wanted to give them and their spouses a path to better health, and connected with the Greater Kingsport Family YMCA to deliver the YMCA Diabetes Prevention Program, with a goal of referring 1,000 people.

The community program, with a CDC-approved curriculum, is for those who are at risk of developing type 2 diabetes and are committed to making lifestyle changes. The program has small groups meet for a total of one year.

“The community told us loud and clear that they need the Y to be a healthy living resource,” says Glass. “We take that approach in all that we do.”

• As participants move through the program and incorporate physical activity, they take advantage of the YMCA’s classes and indoor track.
• They sign up for activity events, many of which take place on the city’s Greenbelt, a 10-mile, paved stretch along scenic Reedy Creek.
• They encourage friends or co-workers to join them in a step-counting competition, or look for restaurants that make healthy options available on their menu.

This is the Kingsport plan.

Every step toward better health connects to another, so that a health-focused community grows and begins to nudge the unhealthier habits aside.

Include everyone

One of the biggest challenges to improving health is reaching at-risk populations outside of school and work.

Healthy Kingsport takes that into consideration in all its efforts.

• The YMCA adjusts fees for those with financial constraints.
• The Kingsport community comes together in numerous ways to offer help to those in need, volunteering time and funds.

Friends in Need, a clinic in town that serves working men and women without health insurance, saw the power of that community spirit when it undertook an outreach program to offer dental care.

In April 2016, the Appalachian Miles for Smiles mobile dental unit launched, housed in a 53-foot, five-bay trailer. In its first nine months it was used to treat 800 patients who had no dental insurance.

“If we bought this on the commercial market it would cost $1 million,” says Friends in Need executive director Bruce Sites.

“We spent less than $150,000. A local architect donated his services. It was designed and constructed with volunteer labor and donations.

“Kingsport has always had that spirit, with people working together to make a real impact.”

Together, one by one

It happens step by step.

• A child learns about healthy eating at school and asks for more fruits and vegetables at home, spurring better family eating habits.
• Someone gives up smoking because fewer places condone it. That first step to feeling better leads them to join the Y.
• There, they join a few friends to sign up for Healthy Kingsport’s annual Walk for Wellness Expo, and enjoy it so much that they convince their co-workers to form a team to counts steps in a 12-week virtual Walk Across Tennessee competition.

It won’t take much to embark on a big challenge: participating in a yearlong effort to rack up the steps to help make Kingsport a Million Mile City.

“All we are doing to improve our health is a marathon, not a sprint,” says Burdine.

“We want to be a million-mile city. We’ll get there. I have no doubt.”

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Photos by Tyler Oxendine.

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