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This year marks the 20th anniversary of the San Diego County Childhood Obesity Initiative (COI), a regional a public-private partnership launched in 2006 by the San Diego County Board of Supervisors and the County of San Diego Health and Human Services Agency (HHSA) to address childhood obesity through coordinated, cross-sector action. For two decades, HHSA’s Chronic Disease and Health Equity Unit has provided sustained funding, contractual oversight and support, and strategic leadership for COI. COI is implemented by the UC San Diego Center for Community Health (CCH) in partnership with organizations across the region.

COI is a collaborative network of more than 400 San Diego County partners representing healthcare systems, schools and after-school programs, early childhood providers, community and faith-based organizations, local government, business, and philanthropy. 

Together, these partners work to align policies, environments, and community strategies that support healthy eating, active living, and overall well-being for children and families. COI reflects a long-term public investment in prevention and coordination across sectors, rather than a single program or intervention.

The effort began in 2004, when the San Diego County Board of Supervisors voted unanimously to support development of a countywide plan to address rising childhood obesity rates. That decision established a collaborative framework that continues to guide prevention work today. COI has relied on backbone organizations since it began to coordinate partners and support shared strategy. Community Health Improvement Partners served in this role from 2006 to 2019, helping to build early regional alignment and collaboration. In 2019, CCH assumed the backbone role and continues to implement COI in close partnership with the HHSA and regional partners.

Over time, this sustained cross-sector collaboration has supported a wide range of policy, systems, and environmental strategies across San Diego County. Notably, COI has also helped attract additional resources to support prevention efforts across San Diego County. In the past five years, COI has contributed to leveraging more than $20 million in additional funding for prevention and community-based strategies led by local partners. Through regranting and aligned investments, resources have supported locally driven efforts to increase access to healthy foods, safe opportunities for physical activity, and supportive environments for children and families across diverse communities.

The examples below reflect only a portion of the work advanced through COI partnerships and workgroups over the years and are not intended to represent a comprehensive list. Efforts have included advancing healthy food and beverage policies; supporting local food procurement, urban agriculture, and community gardens; promoting Safe Routes to School and Healthy Places and joint use agreements; strengthening and implementing school wellness policies; supporting workplace and community-based physical activity initiatives; and advancing lactation accommodation and breastfeeding-friendly environments across settings. Together, these efforts illustrate how sustained County of San Diego investment and regional partnership have helped shape conditions that support healthier choices in schools, neighborhoods, workplaces, and community settings throughout the region. 

In addition to place-based policy and environmental work, COI partners have played a leadership role in advancing broader food and nutrition policy efforts through advocacy, coordination, and cross-sector alignment. Through its network, COI has helped support regional engagement in initiatives to advance nutrition security such as Food4All, Más Fresco Plus, CalFresh Fruit and Vegetable EBT statewide pilot, and Pandemic-EBT. While these initiatives involved multiple agencies and stakeholders, COI served as a platform for partnership, shared learning, and community-informed advocacy that helped shape policy discussions and implementation at the local and state levels. COI has also emerged as a model for cross-sector efforts, with staff and partners regularly invited to present at conferences and convenings and to meet with organizations interested in forming or strengthening their own coalitions, sharing lessons learned from San Diego County’s coordinated approach.

HHSA continues to play a central role in guiding COI through backbone funding, staff leadership, and participation in workgroups and advisory bodies. HHSA staff serve in leadership roles across multiple domains, and in 2022 HHSA supported the creation of a Community Council to ensure that residents and community leaders play a lead role in shaping priorities and strategies moving forward. This continued emphasis on shared leadership reflects COI’s evolution toward more community-informed prevention approaches.

As San Diego County marks COI’s 20-year milestone in 2026, partners and local leaders are reflecting on the role sustained public investment and cross-sector collaboration have played in shaping prevention efforts across the region. County leaders and community partners are now looking to continued coordination and investment as critical to maintain progress and supporting healthier environments for children and families throughout San Diego County.

To learn more about the Childhood Obesity Initiative or to participate in a workgroup, visit San Diego County Childhood Obesity Initiative - COI - Get Involved