SAG members met first to become familiar with the REACH 2010 model of change. The model's most novel features were emphasis on the changes in "change" agents and changes in local policies that were posited to contribute to changes in behaviors such as physical activity and nutrition. The "targeted activities" that drive the model would thus have to consist not only of the health education programs with which all partners were familiar and comfortable but with new capacity-building activities and advocacy interventions that at first seemed somewhat threatening or exotic. SAG minutes and participant observation data show that most SAG members, including organizational leaders, had never appeared before a city council or other elected body (17).

Our community partners were highly skilled at delivering health promotion and education, but they had much less experience dealing with broader policy issues that were not part of traditional health promotion culture. These issues included, for example, the physical environment of the community and whether it supported walking or bicycle-riding or other forms of exercise, the availability of low-fat, low-sugar foods in grocery stores, the food products available in school vending machines, and the use of candy for school fundraising.

As each SAG began to identify and prioritize policy issues in its community, sustaining the distinction between programs and policies was the most challenging aspect of developing a policy agenda. For instance, in initial discussions about changing food choices, some SAG members suggested a health fair. Others, more cognizant of the policy issues, wanted to go straight to market owners or managers and attempt to influence their decisions on which food products to stock and promote and how food products were displayed.

As the policy focus became clearer, the SAGs prioritized and selected issues to be addressed over the following one to three years. Community A divided its policy goals into short- and long-term goals. The short-term goal was defined as increasing opportunities and places for physical activity, and the long-term goals were defined as making an impact on the county's long-range parks and recreation planning and resource allocation. Community B selected the following policy goals: 1) develop more parks and recreation areas, 2) work with grocery stores to offer and promote more healthful foods, and 3) work with schools to emphasize health curricula and to change the use of candy and other junk food in the fundraising and reward structure.

Health came to be seen among SAG members as an array of policy issues that extend well beyond the purview of the experts in the county health department, the community health center, or school nurses. SAG members realized that they needed to reach a number of change agents that included elected officials, business people, members of the faith community, and educational leaders. They also needed to bring this broader vision to other health professionals.

Identifying and then recruiting new SAG members was a critical step in promoting a policy agenda. Convincing some of them that health should be one of their issues was a major achievement in recruiting and retaining them as SAG members (18). These new recruits included the following (some in Community A, others in Community B): a chamber of commerce executive director, county interfaith council director, city manager, parks and recreation department director, public works department director, planning and zoning director, hospital administrator, school superintendent, town librarian, newspaper editor, and police officer.

Once issues were identified and prioritized, the SAGs formed subgroups to develop action plans for each major issue. Community A decided to make the SAG indispensable to the county's long-range development planning effort by volunteering to serve on the planning committee, offering the SAG's own recommendations for open space, parks and recreation, and walking/bicycle paths development, and offering data gathered by its university partner.

Community A also adopted a short-term action plan that designated a three-month period for mounting a series of health promotion activities that would culminate in a presentation to the city council, stressing the need for reallocating (not increasing, at this time) parks and recreation resources to promote physical activity among the entire community, and attending to neighborhood safety, including lighting, sidewalks, and animal control. The SAG in Community A contracted with a consultant to design a compelling fact sheet that would be used in its presentation to the city council and other policy-making bodies.

In Community B, the SAG initiated an annual community forum designed to educate policy makers, advocate for policy change, and hold elected officials accountable for their support, or lack thereof, of policies to promote health. The forum was designed so that representatives of the SAG and other community groups could first present their activities and policy agendas to public officials who were invited to attend. After the community presentations, elected and appointed officials were invited to respond, and then the forum was opened to discussion.

The promotores in this community's SAG mobilized their constituents to advocate for new parks in one of the small towns near the border and in an unincorporated area of the county that provided few public services to its residents. These promotores had been leading the community walking groups and nutrition classes that were one component of Border Health ¡SI!. Now they and members of these groups went before the county board of supervisors to advocate for parks in their neighborhoods.

The SAG in Community B also worked with the schools component of Border Health ¡SI! to promote changes in the curriculum and the use of junk foods. While the schools component of Border Health ¡SI! worked with the School Health Index and the school health teams, the SAG also kept in close contact with the school superintendent and individual principals to promote change and monitor progress.

Of the many lessons learned from the SAGs, the following are among the most salient:

The experience of the SAGs and the results of their advocacy have been reported to the community in a variety of ways. Foremost has been the publication of numerous articles in local newspapers — made possible, no doubt, by SAG membership of newspaper editors or reporters in each community. Presentations at conferences, including the U.S.-Mexico Border Health Association, Arizona Public Health Association, CDC Diabetes Translation Conference, and others provided a mechanism for dissemination of lessons learned to other border communities throughout the region. SAG activities are also reported regularly to the Community Action Board (CAB) of the Southwest Center for Community Health Promotion. The CAB is, in effect, a super-SAG for all communities involved in Border Health ¡SI! and other border community health interventions of the Mel and Enid Zuckerman Arizona College of Public Health.