process, findings and implications from two health impact assessments: informing farm to school...
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Presenter: Dr. Tia Henderson, Upstream Public HealthTRANSCRIPT
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Dr. Tia Henderson Upstream Public Health Megan Lott Kids’ Safe and Healthful Foods Project
Process, Findings and Implications From Two
Health Impact Assessments
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A structured process that uses scientific data, professional expertise, and
stakeholder input to identify and evaluate public health consequences of
proposals and suggests actions that could be taken to minimize
adverse health impacts and optimize beneficial ones.
Source: “Improving Health in the United States: The Role of Health Impact Assessments” by the National Research Council, September 2011
Slide courtesy of Health Impact Project
What is a Health Impact Assessment?
HIA Addresses Social and Economic Determinants of Health
Slide courtesy of Human Impact Partners
Housing Noise Safety
Air quality Social networks Transportation
Parks and natural space Physical activity
Food environment Diet & Nutrition Public services
Livelihood Water quality
Education Inequities
How might the proposed project, plan, policy
affect
And poten8ally lead to predicted health
outcomes?
• It’s not used to make the case for why a policy, program or project should or should not be proposed.
• It’s not an assessment to understand the impacts of a program or policy following implementation (that’s program evaluation).
• It’s not a community assessments tool, but those can be used during the assessment stage of HIA.
Slide courtesy of the Health Impact Project
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What HIA is NOT…
• Used to determine how well a program is meeting its goals and objectives
• “Evaluation” is a systematic collection and assessment of information in order to provide useful feedback about something
• Increases knowledge about what is working, and what can be improved about a program or project
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What program evaluation does
SCHOOL
School Food Environment
• Wellness policies • Characteristics of school
meal programs
• Competitive foods and drinks availability
• Farm to School programs • Nutrition education • Food promotion • Price of healthy and
unhealthy foods/drinks
CHILDREN
Food and Drink Consumption at School
Body mass index, obesity
Other Influences
• Macro-level environments
• Physical settings
• Social environment
• Individual factors
Focus: School Food Environment
Adapted from: Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: policy and environmental approaches. Annu Rev Public Health. 2008;29:253–272. and Briefel RR, Crepinsek MK, Cabili C, Wilson A, Gleason PM. School food environments and practices affect dietary behaviors of US public school children. J Am Diet Assoc. 2009 Feb;109(2 Suppl):S91–107.
Food and Drink Consumption Everywhere Else
1 in 4 adolescents are overweight or obese in Oregon
7 OR Health Teens Survey, 2009
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Dr. Tia Henderson Upstream Public Health
Health Impact Assessment:Oregon Farm to School and School Garden Policy, HB 2800
What is Farm to School?
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PROCURE
START
HERE
FINISH HERE
RECOMMENDED DAILY AMOUNTS OF FRUITS AND VEGETABLES
Kids - ages 5-12 Teens & Adults - age 13+
Males 2 ! – 5 cups per day 4 ! -6 ! cups per dayFemales 2 ! – 5 cups per day 3 ! – 5 cups per day
If you are active, eat the higher number of cups per day. Visit fruitsandveggiesmatter.gov to learn more.
Healthy, Fit and Ready to Learn
FIND OUT MORE:
www.ode.state.or.us/services/nutrition
More Tomato Fun Grown In Oregon
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PROMOTE
EDUCATE INVOLVE
Why an HIA? HIA Screening
HB 2800 ¡ Considered in legislature in 2011 ¡ Previous history = legislature familiar with
student health benefits via diet & nutrition ¡ Less obvious = potential economics stimulus
for rural communities, food security HIA fill information gap for decision makers
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Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.
World Health Organization
How will HB 2800 affect Oregonians’ health?
HIA Goals
1. Inform Oregon legislative decision process 2. Outline linkages & magnitude of interactions
between the policy and health outcomes 3. Inform agency work plans 4. Inform regional institutional procurement efforts 5. Create model F2SSG state-wide policy HIA
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Decision: Farm to School Bill HB 2800
Introduced $22.6 million Competitive Grant Program ¡ 2-3 Districts every 2 years ¡ $175,000 reimburse
Lunch - 15 cents ¡ $25,000 for food, garden,
agriculture activities
Reimbursement Program § Lunch – 15 cents § Breakfast – 7 cents § NSLP & SBP § $19.6M
Competitive Agriculture, Food Education Grants § ~150 gardens § $3M
Amended $200,000
Scope: Farm to School Bill and Health Determinants
How does the proposed policy
and lead to health outcomes?
Social Capital
Diet and Nutrition
Employment
affect health determinants
Environmental Health
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F2SSG K12 Education
Environmental Health Outcomes
HB 2800 Components & HIA Scope: Health Determinant Pathways Summary
Diet & Nutrition Outcomes
F2SSG K-12 Education Program Outcomes
Social Capital Outcomes
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Reimburse School
Districts
Food, Garden &
Agriculture Education
Grant Program
Policy
Employment Outcomes
Health Outcomes
↑ School districts’ purchase of Oregon food
↑ School menu options
Direct Impacts
↑ Student gardening
↑ Food activities in gardens, classroom & cafeteria
↑ School promotion of new local options
Intermediate Outcomes
Scope: Impacted Populations
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n Students n Teachers n Parents n Low-income youth; racial and
ethnic specific youth n Low-income families n Farming communities
n Farmers n Processors n Distributors n School nutrition service staff n Food industry workers,
agriculture production labor n Farmer/worker families
Assessment Methods
1. Literature review 2. Secondary data analysis 3. Job creation model 4. Community and expert input
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HIA – Collaborative Research
Scoping
Screening
Assessment
Recommendations
Reporting
Monitoring & Evaluation
Communications Workshop
2 Community Forums
Key Informant Interviews
OFSSG Network Survey
2 Advisory Committees
Oregon: Seasonally Adjusted Unemployment Rates by AreaDecember 2010 (Preliminary Estimates)
Unemployment RateLess Than 10%
10% - 14%
Higher Than 14%
Current Conditions: Economics
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Source: OLMIS
Key Economic Findings
¡ $1.75 million = 24 jobs ¡ $19.6 million = 270 jobs ¡ Full and part time
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¡ Effects urban and rural ¡ Effects of policy distributed to
rural counties more than in general economy
¡ “Inspired” purchases
Images courtesy of Truitt Brothers and Happy Harvest Farm
Current Conditions: Food Insecurity
HarneyCounty
LakeCounty
MalheurCounty
KlamathCounty
LaneCounty
GrantCounty
DouglasCounty
BakerCounty
CrookCounty
UmatillaCounty
LinnCounty
WallowaCounty
JacksonCounty
DeschutesCounty
WascoCounty
UnionCountyMorrowCounty
CoosCounty
JeffersonCounty
ClackamasCounty
PolkCounty
CurryCounty
WheelerCounty
JosephineCounty
GilliamCounty
MarionCounty
LincolnCounty
TillamookCounty
ClatsopCounty
ShermanCounty
YamhillCounty
BentonCounty
ColumbiaCounty
WashingtonCounty
MultnomahCounty
Percent of Population 5-17 Years of Age in Families in Poverty, 2008 by Oregon School Districts
Source: US Census Bureau, Small Area Income and Poverty Estimates (SAIPE), 2008.State of Oregon draft school district boundaries.
Estimated number of relevant children 5-17 years of age in poverty who are related to the householder. Data not available/displayed for school districts with less than 10 students. Color classification based on natural breaks.
Institute of Portland Metropolitan Studies, Portland State University, 2010.
LegendNo data
4.1-12.6%
12.7-18.9%
19.0-25.0%
25.1-36.4%
Cities
Reservations
Counties
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Key Diet and Nutrition Findings
¡ ↑ Meal participation from 1-16% ¡ ↓ Food insecurity for families
with children ¡ ↑ Positive behavior, learning,
cognitive development and educational attainment
22 Images courtesy of Megan Kemple
¡ ↑ Promotion and offerings of Oregon fruits and vegetables
Farm to School and School Garden K-12 Education Findings
Child Learning Outcomes, Physical Activity
Child Self-Efficacy – Belief they can accomplish their goals
Child Diet and Nutrition Overweight and Obesity
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HB 2800 IMPACT:
¡ ↑ Child preferences for fruits and veggies
¡ ↑ Child consumption of fruits and veggies
¡ ↑ Physical activity, positive class behaviors
¡ ↓ Overweight and obesity risk
¡ ↑ Knowledge, learning, academic achievement
Image from Samuel Mann
Healthy food exposures can lead to healthier eating…
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Policy Recommendations
To maximize positive job growth and food security impacts: Ø Rec #1 -- Modify language of the bill so that only items “produced”
or “processed” in state are eligible for reimbursement
To maximize child nutrition, food security, and student learning benefits: Ø Rec #2 -- For education grant recipients – prioritize schools serving:
§ Low income § Ethnically/culturally diverse student populations § Food insecure areas
Ø Rec #3 -- For education grant recipients – prioritize schools developing multi-component programs (i.e.; procurement, promotion, & education w/community support)
Policy Impact: Evaluation
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¡ Relevance to legislator’s constituents § Current employment and food
security conditions § Current chronic health conditions
§ Most Policy HIA recommendations included in amended version.
§ In June 2011, a pared-down version of the bill unanimously passed house/senate & was signed into law by governor.
School reimbursement funds of introduced bill could:
§ Create, maintain up to 800 jobs over 5-10 yrs § ↑ Student school meal participation § ↑ Food security for families with children
Food, garden and agricultural grants could:
§ Support child preferences for fruits and vegetables § Shape long-term (+) healthy diet choices affecting: § children’s learning § academic achievement § preventing obesity
Key Assessment Findings You Can Use
Emphasize Linking Classroom and Cafeteria
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START
HERE
FINISH HERE
RECOMMENDED DAILY AMOUNTS OF FRUITS AND VEGETABLES
Kids - ages 5-12 Teens & Adults - age 13+
Males 2 ! – 5 cups per day 4 ! -6 ! cups per dayFemales 2 ! – 5 cups per day 3 ! – 5 cups per day
If you are active, eat the higher number of cups per day. Visit fruitsandveggiesmatter.gov to learn more.
Healthy, Fit and Ready to Learn
FIND OUT MORE:
www.ode.state.or.us/services/nutrition
More Tomato Fun Grown In Oregon
1 2 34 5 6
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Use Messages About Other Benefits of Farm to School
Influence other institutions
Track and share learning
Establish habit Shape student
preferences Model behavior
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Acknowledgments
All members of our advisory committees Sodexo and Ecotrust for use of data All community members who attended a forum or workshop All stakeholders who gave input through interviews All advisors who gave input on the data or report The Northwest Health Foundation and the Human Impact Project Research team members
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