Process, Findings and Implications from Two Health Impact Assessments: Informing Farm to School Policy, Programs and Research - presentation 1

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Dr. Tia Henderson, Upstream Public Health

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Process, Findings and Implications from Two Health Impact Assessments: Informing Farm to School Policy, Programs and Research - presentation 1

  1. 1. Process, Findings andImplicationsFrom TwoHealth Impact Assessments  Dr. Tia HendersonUpstream Public HealthMegan LottKids’ Safe and Healthful Foods Project 1
  2. 2. What is a Health Impact Assessment? 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 Project2
  3. 3. HIA Addresses Social and Economic Determinants of HealthHow  might  the  proposed     affect  project,  plan,  policy   Housing Noise Safety Air quality Social networks Transportation Parks and natural space Physical activity Food environment Diet & Nutrition Public services     And  poten8ally  lead  to Livelihood Water quality   predicted health   Education outcomes?   InequitiesSlide courtesy of Human Impact Partners
  4. 4. What HIA is NOT… •  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 Project4
  5. 5. What program evaluation does •  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 project5
  6. 6. Focus: School Food Environment SCHOOL CHILDREN School Food Environment Food and Drink Consumption at Body mass •  Wellness policies School index, obesity •  Characteristics of school meal programs Food and Drink Consumption Everywhere Else •  Competitive foods and drinks availability Other Influences •  Farm to School programs •  Macro-level environments •  Nutrition education •  Physical settings •  Food promotion •  Social environment •  Price of healthy and unhealthy foods/drinks •  Individual factorsAdapted from: Story M, Kaphingst KM, Robinson-O’Brien R, Glanz K. Creating healthy food and eating environments: policy andenvironmental approaches. Annu Rev Public Health. 2008;29:253–272. and Briefel RR, Crepinsek MK, Cabili C, Wilson A, GleasonPM. School food environments and practices affect dietary behaviors of US public school children. J Am Diet Assoc. 2009 Feb;109(2Suppl):S91–107.
  7. 7. 1 in 4 adolescents are overweight or obese in Oregon 7 OR Health Teens Survey, 2009
  8. 8. Health ImpactAssessment:
Oregon Farm to School andSchool Garden Policy, HB 2800 Dr. Tia Henderson Upstream Public Health 1
  9. 9. What is Farm to School? FIND OUT MORE: www.ode.state.or.us/ R ECOMMENDED D AILY A MOUNTS OF F RUITS AND V EGETABLES services/nutrition Kids - ages 5-12 Teens & Adults - age 13+ Males 2 ½ – 5 cups per day 4 ½ -6 ½ cups per day Females 2 ½ – 5 cups per day 3 ½ – 5 cups per day If you are active, eat the higher number of cups per day. Visit fruitsandveggiesmatter.gov to learn more. More Tomato Fun Grown In OregonPROCURE PROMOTE 1 START HERE 4 1 2 3 4 5 6 6 5EDUCATE Healthy, Fit and INVOLVE Ready to Learn 9
  10. 10. Why an HIA? HIA ScreeningHB 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 securityHIA fill information gap for decision makers 10
  11. 11. How will HB 2800 affect Oregonians’ health?Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity. World Health Organization 11
  12. 12. HIA Goals1.  Inform Oregon legislative decision process2.  Outline linkages & magnitude of interactions between the policy and health outcomes3.  Inform agency work plans4.  Inform regional institutional procurement efforts5.  Create model F2SSG state-wide policy HIA 12
  13. 13. Decision: Farm to School Bill HB 2800Introduced $22.6 million Amended $200,000 Reimbursement Program Competitive Grant Program § Lunch – 15 cents ¡ 2-3 Districts every 2 years § Breakfast – 7 cents ¡  $175,000 reimburse § NSLP & SBP Lunch - 15 cents § $19.6M ¡  $25,000 for food, garden, agriculture activities Competitive Agriculture, Food Education Grants § ~150 gardens § $3M
  14. 14. Scope: Farm to School Bill and Health DeterminantsHow does the proposedpolicy affect health determinants Employment Diet and Nutrition F2SSG K12 Education Environmental Health Social Capital and lead to health outcomes? 14
  15. 15. HB 2800 Components & HIA Scope:Health Determinant Pathways Summary Policy Direct Impacts Intermediate Outcomes Health Outcomes ↑  School districts’ Employment Outcomes purchase of Oregon food Reimburse Environmental Health ↑ School menu School Outcomes Districts options Diet & Nutrition Outcomes ↑  School promotion of Food, new local optionsGarden & F2SSG K-12 EducationAgriculture ↑ Food activities in Program OutcomesEducation gardens, classroom & Grant cafeteria Social Capital Outcomes Program ↑ Student gardening 15
  16. 16. Scope: Impacted Populationsn  Students n  Farmersn  Teachers n  Processorsn  Parents n  Distributorsn  Low-income youth; racial and n  School nutrition service staff ethnic specific youth n  Food industry workers,n  Low-income families agriculture production laborn  Farming communities n  Farmer/worker families 16
  17. 17. Assessment Methods1. Literature review2. Secondary data analysis3. Job creation model4. Community and expert input 17
  18. 18. HIA – Collaborative Research Screening 2 Advisory Committees Scoping Key Informant Interviews Assessment OFSSG Network Survey Recommendations 2 Community Forums Reporting Communications Workshop Monitoring & Evaluation18
  19. 19. Current Conditions: EconomicsOregon: Seasonally Adjusted Unemployment Rates by Area December 2010 (Preliminary Estimates) Unemployment Rate Less Than 10% 10% - 14% Higher Than 14% Source: OLMIS 19
  20. 20. Key Economic Findings ¡  $1.75 million = 24 jobs ¡  Effects urban and rural ¡  $19.6 million = 270 jobs ¡  Effects of policy distributed to ¡  Full and part time rural counties more than in general economy ¡  “Inspired” purchasesImages courtesy of Truitt Brothersand Happy Harvest Farm 20
  21. 21. Current Conditions: Food InsecuritySource: US Census Bureau,Small Area Income and Percent of Population 5-17 Years of Age in FamiliesPoverty Estimates (SAIPE), 2008.State of Oregon draft schooldistrict boundaries.Estimated number of relevant in Poverty, 2008 by Oregon School Districtschildren 5-17 years of age inpoverty who are related to thehouseholder. Data notavailable/displayed for school ClatsopCountydistricts with less than 10 ColumbiaCountystudents. Color classificationbased on natural breaks. MultnomahCountyInstitute of Portland MetropolitanStudies, Portland State UmatillaCounty WallowaCountyUniversity, 2010. WashingtonCounty ShermanCounty TillamookCounty MorrowCounty GilliamCounty UnionCountyLegend YamhillCounty ClackamasCounty WascoCounty No data PolkCounty 4.1-12.6% MarionCounty 12.7-18.9% WheelerCounty BakerCounty LincolnCounty JeffersonCounty 19.0-25.0% BentonCounty LinnCounty GrantCounty 25.1-36.4% Cities Reservations CrookCounty LaneCounty Counties DeschutesCounty DouglasCounty CoosCounty MalheurCounty HarneyCounty LakeCounty KlamathCounty CurryCounty 21 JacksonCounty JosephineCounty
  22. 22. Key Diet and Nutrition Findings¡  ↑ Promotion and offerings of Oregon ¡  ↑ Meal participation from 1-16% fruits and vegetables ¡  ↓ Food insecurity for families with children ¡  ↑ Positive behavior, learning, cognitive development and educational attainment Images courtesy of Megan Kemple 22
  23. 23. Farm to School and School Garden K-12 Education FindingsChild Learning Outcomes, HB 2800 IMPACT: Physical Activity ¡  ↑ Child preferences for fruitsChild Self-Efficacy – Belief they and veggies can accomplish their goalsChild Diet and Nutrition ¡  ↑ Child consumption of fruitsOverweight and Obesity and veggies ¡  ↑ Physical activity, positive class behaviors ¡  ↓ Overweight and obesity risk ¡  ↑ Knowledge, learning, academic achievement Image from Samuel Mann 23
  24. 24. Healthy food exposurescan lead to healthier eating… 24
  25. 25. Policy RecommendationsTo 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 reimbursementTo 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)
  26. 26. Policy Impact: Evaluation¡ 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. 26
  27. 27. Key Assessment Findings You Can UseSchool 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 childrenFood, 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
  28. 28. Emphasize Linking Classroom and CafeteriaFIND OUT MORE: www.ode.state.or.us/ R ECOMMENDED D AILY A MOUNTS OF F RUITS AND V EGETABLESservices/nutrition Kids - ages 5-12 Teens & Adults - age 13+ Males 2 ½ – 5 cups per day 4 ½ -6 ½ cups per day Females 2 ½ – 5 cups per day 3 ½ – 5 cups per day If you are active, eat the higher number of cups per day. Visit fruitsandveggiesmatter.gov to learn more.More Tomato Fun Grown In Oregon 1STARTHERE 4 1 2 3 4 5 6 6 5 Healthy, Fit and Ready to Learn 28
  29. 29. Use Messages About Other Benefits of Farm to SchoolInfluence other institutionsTrack and share learningEstablish habitShape student preferencesModel behavior 29
  30. 30. AcknowledgmentsAll members of our advisory committeesSodexo and Ecotrust for use of dataAll community members who attended a forum or workshopAll stakeholders who gave input through interviewsAll advisors who gave input on the data or reportThe Northwest Health Foundation and the Human Impact ProjectResearch team members 30

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