Nine of 10 Minnesotans believe improved health is solely about personal choice. Yet, in the next breath, most can identify something in their communities that makes it hard for them to exercise regularly or pick out the good-for-you foods.

Those responses to a recent survey are the inspiration for a new ad campaign launched Monday by the Center for Prevention at Blue Cross and Blue Shield of Minnesota. The campaign, called “Pulling Together,” seeks to inspire communal efforts toward improving health just as the center’s “Do” ads have encouraged individuals to make midlife changes to their diet and exercise.

Minnesotans have “deeply held perceptions that our health is really about our own personal decisions and willpower,” said Janelle Waldock, director of the Blue Cross prevention center, “but we know — and the science increasingly shows us — that our surroundings really play a big role.”

Among 504 Minnesotans who participated in the center’s recent survey, 52 percent said a lack of safe biking paths and streets was a barrier to healthy exercise. And while 55 percent noted the lack of affordable produce in their communities as a barrier to healthy eating, 64 percent said the problem was the ease and convenience of fast food.

TV ads, billboards and online features will highlight these findings and what communities can do to address them.

Community solutions to personal health aren’t new to Minnesota. Since 2008, the state has been investing millions annually in Statewide Health Improvement Grants that fund everything from promoting healthy snack carts and safe walking routes for schools to establishing farmers markets in low-income communities.

Minnesota is also home to Dan Buettner and the Blue Zones project, an independent health agency that documented measurable weight loss in residents of Albert Lea after spearheading a series of improvements to increase exercise and healthy eating options in the southeast Minnesota community.

“This shift from personal responsibility to environment is absolutely the way to go,” said Buettner, whose organization is now working in Los Angeles and 11 cities in Iowa with plans to expand to Hawaii and Texas. “We’ve beat this notion of personal responsibility for six decades — exercise regularly, eat better — and yet the rate of obesity has continued to skyrocket.”

In Minnesota, two out of three residents are either overweight or obese and are consequently at increased risk of diabetes, heart problems and other physical disorders. Medical expenses related to obesity cost the state around $3 billion per year, according to state Health Department estimates.

More tobacco than fruit

LaTrisha Vetaw said she was raised in poverty in north Minneapolis with poor eating habits and a belief that grape soda constituted a serving of fruit. Over time, she learned better, but it wasn’t easy in a community with only one grocery store amid dozens of fast-food restaurants and convenience stores with cigarettes.

“Ultimately, it is your personal choice,” she said. “But when you walk out of your house and you see 10 corner stores with cigarettes and tobacco everywhere, and you go into the stores and see more tobacco than fresh fruits and vegetables, eventually that’s what you begin to do. It becomes the norm.”

Vetaw now leads Breathe Free North, a grant-funded organization that is seeking to reduce tobacco usage in north Minneapolis and successfully lobbied 35 churches to become smoke-free.

“Churches have ushers who greet you when you come in the morning,” she said. “Some people talked about the ushers smelling like smoke when they reached in to give them a hug.”

Breathe Free North is featured in the new Blue Cross campaign along with organizations seeking to improve bicycling options in Richfield and increase the availability of healthy produce to families and college students in Morris.

Given that 91 percent of survey respondents believe health is a matter of personal choice, Waldock expects some resistance to the “Pulling Together” ads, in contrast to the broad popularity of the “Do” campaign and its real-life transformation stories.

Some might worry that the new ads are pushing for government funding and programs to solve personal health woes, but Waldock said real change in a community requires the involvement of schools, neighborhoods, businesses and government leaders.

In some communities, for example, businesses have volunteered to help by reducing access of flavored cigarettes that are popular with youth, or creating check-out aisles only for healthy snack purchases.

“People will make their own decisions,” Waldock said, “but they’re not able to do that if they don’t even have any choices.”