U.S. Department of Health and Human Services (HHS)

ece obesity prevention


Several HHS agencies provide funding, standards, or guidance for ECE:

Administration for Children and Families (ACF):

ACF hosts a range of state and national statistics for child health and wellbeing on their website, and oversees the following key program offices pertaining to ECE:

  • Office of Child Care (OCC) administers the  a multibillion-dollar Federal and State partnership to support access to high-quality ECE for working families  (see CCDF fact sheet). Through the CCDF, the majority of children are served through vouchers that allow the parent to select an ECE provider. Several states use CCDF funds to pay tiered child care subsidy reimbursement for higher-quality care, and some states require providers who receive subsidies to have higher quality ratings. OCC helps states, territories, and tribes administer their CCDF programs through program support, policy guidance, research, and through the Child Care Technical Assistance Network (see CCTAN fact sheet). OCC Regional Program Managers are available in each of the ten HHS administrative regional offices.
  • Administration on Children, Youth and Families (ACYF) supports child development, protects at-risk children, and assists families with adoption of children with special needs. ACYF periodically has funding opportunities that include the ECE setting. In 2012, they released a funding announcement for Early Education and Care Welfare partnerships.
  • Office of Family Assistance (OFA) administers the Temporary Assistance for Needy Families (TANF) program, under which qualifying low-income families can receive funds to help pay for ECE. As much as 30% of TANF funds may be transferred to CCDF. Additionally, TANF monies can be used to provide cash assistance for ECE. A small number of states, such as Mississippi, use TANF funding to require higher-quality care for children.
  • Office of Community Service (OCS) administers the (SSBG, also referred to as Title XX of the Social Security Act). The SSBG allows states, territories, and the District of Columbia to use funds for a number of social services, including ECE.
  • Office of Head Start (OHS) provides comprehensive child development services to economically disadvantaged children and families through the administration of the ; Early Head Start; American Indian-Alaska Native, and Migrant Head Start; and Seasonal Head Start Programs. Funded through grants to local public and private nonprofit and for-profit agencies, all Head Start programs must meet federal performance standards and comply with relevant state ECE licensing and administrative regulations. Head Start programs are subject to the nutrition standards for CACFP or, if located within a public school, the National School Breakfast and Lunch programs. In 2004, OHS launched a pilot of I Am Moving, I Am Learning (IMIL), an intervention designed to prevent and reverse the negative consequences of obesity in Head Start children. Since that time, IMIL has been rolled out nationwide for Head Start programs through a train-the-trainer model, and expansion of IMIL to all of ECE settings began in 2009.  Since 2006, OHS has maintained the Early Childhood Learning and Knowledge Center, a web resource for anyone involved in early childhood education. Head Start’s newest initiative, Healthy Active Living, focuses on eating healthy foods, staying physically active and getting enough rest.

Centers for Disease Control and Prevention (CDC):

CDC supports state and community-level obesity prevention and health promotion efforts, including those targeting the ECE setting, through funding, training, and technical assistance. CDC’s primary support to states and communities for obesity prevention includes:
  • Community Transformation Grant (CTG): Program supports and enables awardees to design and implement community-level programs that prevent chronic diseases such as cancer, diabetes, and heart disease. This program is expected to improve the health of more than 4 out of 10 U.S. citizens—about 130 million Americans.
  • State Public Health Actions to Prevent and Control Diabetes, Heart Disease, Obesity, and Associated Risk Factors and Promote School Health: CDC supports efforts nationwide to reduce the risk factors associated with childhood and adult obesity, diabetes, heart disease and stroke. Federal grants to all 50 states and the District of Columbia help prevent these chronic diseases. Thirty-two states receive extra funds to enhance their program and to reach more people. The program funds the two components with project periods of up to 5 years.

    All states are required to:
    – promote the adoption of food service guidelines/nutrition standards that include sodium, and
    – promote physical activity in schools, ECE and worksites.
    States receiving enhanced funding are required to:
    – provide access to healthy food and beverages and implement nutrition standards where foods and beverages are available;
    – increase physical activity access and outreach and implement physical activity in ECE;
    – increase access to breastfeeding friendly environments

Health Resources and Services Administration (HRSA):

Within HRSA, most ECE-related work is administered by the Maternal and Child Health Bureau (MCHB), which is authorized by Title V of the Social Security Act. MCHB administers the , as well as an array of discretionary Title V grants that can help states enhance and improve their ECE system. For example, since 2003, states, the District of Columbia, and territories have received Early Childhood Comprehensive Systems (ECCS) grants to help states and communities build and integrate early childhood service systems through multi-agency collaboratives. ECCS includes five key components: ECE, access to health care and medical homes, social-emotional development and mental health, parenting education, and family support. The ECCS website provides grantee plans and models, and grantee contact information. MCHB also funds Caring for Our Children: Health and Safety Standards for Early Care and Education (CFOC), the gold standard for health and safety guidelines for ECE, currently in its 3rd edition, along with resource and training centers including the following:

  • Children’s Safety Network — Provides information and technical assistance for maternal and child health agencies and other organizations.
  • National Resource Center for Health and Safety in Child Care and Early Education — Offers national performance standards, resources for parents, a compilation of state regulations, and an annual assessment of how well state regulations meet the national obesity prevention standard components.
  • Healthy Child Care America, Child Care Health Partnership— A collaborative effort of health professionals and ECE providers working to improve the early education and health and safety of children in out-of-home child care. This effort is jointly funded by MCHB and ACF/OCC and administered by the American Academy of Pediatrics (AAP).  AAP also maintains State Chapter Child Care Contacts.

Indian Health Services (IHS):

IHS is the federal health program for American Indians and Alaska Natives. IHS is involved in several efforts to address obesity in ECE including the development of the “My Amazing Body” curriculum, which promotes healthy eating and physical activity, and the provision of trainings on built environment, playground safety, and natural play spaces to promote active play. In conjunction with the First Lady’s Let’s Move! obesity prevention initiative, IHS has disseminated new resources, including an obesity prevention toolkit, to all tribal Head Start and Early Head Start grantees.



  1. Administration for Children and Families. Child Care and Development Fund Grantee Support. Washington, DC: U.S. Department of Health and Human Services; 2010. Available from http://cdf.acf.hhs.gov/cgi-bin/ccdf.cfg/php/enduser/std_alp.php?p_sid=tF5kyQik. Accessed 2010 Dec 10.
  2. FindYouthInfo.gov. Funding Information Center. Available from http://www.afterschool.gov/docs/federalFunding.html. Accessed 2012 Feb 14.
  3.  American Academy of Pediatrics, American Public Health Association, and National Resource Center for Health and Safety in Child Care and Early Education. Preventing Childhood Obesity in Early Care and Education: Selected Standards from Caring for Our Children: National Health and Safety Performance Standards; Guidelines for Early Care and Education Programs, 3rd Edition Elk Grove Village, IL: American Academy of Pediatrics; Washington, DC: American Public Health Association; 2011.

 During any given month, approximately 1.6 million children benefit from CCDF subsidies. CCDF grants, which are matched by states and territories, are primarily used to subsidize ECE for low-income families. States, territories, and tribes can decide how funds are spent and generally determine the following policies for CCDF administration:
  • Health and safety standards required for ECE providers
  • Activities to improve the quality and supply of child care (minimum of 4% of funds plus additional earmarks must be set aside for quality initiatives)
  • Provider payment rates
  • Family eligibility and co-payment requirements
  • Form of distribution of subsidies to parents (vouchers, certificates, contract services, electronic benefit transfers)

In 2013, ACF proposed changes to the CCDF regulations, including changes designed to strengthen health and safety requirements for ECE providers and to reflect current state and local practices to improve the quality of child care with a focus on training in obesity prevention and related standards. A complete description of the proposed changes can be found here.

A link to CCDF officials and program contacts is available here.

The Social Services Block Grant (SSBG), Title XX of the Social Security Act, allows states to have flexibility to determine the types of services provided, eligibility categories, geographic areas covered, and the administration mechanism (e.g., whether the services will be provided by state or local agency staff or through grants or contracts with private organizations). Many states distribute these funds through a community grant process to pass through some of the dollars to local communities and agencies. Each state must submit an annual expenditure plan. A link to state SSBG officials and program contacts is available here. Many SSBG-supported services are designated specifically for children including child day care. ECE services must comply with state and local licensing requirements and may include a comprehensive and coordinated set of appropriate developmental activities for children including, recreation, meals and snacks, transportation, health support services, social service counseling for parents.
Head Start programs. Head Start serves children aged 3 to 5 years, while Early Head Start serves children birth to 3 years. In FY 2009, approximately 904,000 children were served by Head Start programs. In FY 2010, more than $7 billion was appropriated for Head Start, and $709 million supported 650 Early Head Start programs. The majority of funding supports local Head Start programs in states, but funding also supports training and technical assistance; research, demonstration, and evaluation; and program monitoring and review. Six National Centers serve as Head Start’s Training and Technical Assistance System, including the National Center on Health, which is operated by the American Academy of Pediatrics. As of 2013, Head Start preformance standards contained minimal requirements related to obesity prevention, particularly with respect to physical activity. A comparison of the performance standards with the national Caring for Our Children Health and Safety Standards is available here
Established in 1981, MCHBGs provide states with funds for basic public health services to address the needs of children and women. States have broad flexibility to plan and execute the MCHBG but must submit an annual Block Grant request. The MCHBG is not a major source of direct funding for ECE services in most states; however, states may use their funds to foster quality improvement efforts particularly focused on improvements in health and child development. State block grants are usually managed by state health departments, and state MCH plans are publicly available. For more information click here.