Connecting State to Local: Healthy People

Connecting for the FutureA Gathering of NC Food Councils

Dec. 4-5, 2014

Public Health Challenges

Among the most pressing public health problems in the U.S.

Contributing significantly to each of these problems is

our current food system

Obesity, chronic diseaseEnvironmental Degradation

Economic/Health disparitiesand food insecurity

We Pay for Poor Health• Food is associated with most leading causes of

death – heart disease, cancer, diabetes – Obesity is a contributing factor to each

• Chronic diseases = high costs to communities:– Higher health care expenditures– Higher absenteeism, lower “presenteeism”– Costs for adaptive equipment: stretchers, seating– Opportunity costs – failure to recruit businesses

CDC Framework for Preventing Obesity CDC Framework for Preventing Obesity

Energy Intake Energy Expenditure

Energy Balance

Prevention of Overweight and Obesity Among Children, Adolescents, and Adults

Individual Factors

Behavioral Settings

Social Norms and Values Home and Family

School

Community

Work Site

Healthcare

Genetics

Psychosocial

Other Personal Factors

Food and Beverage Industry

Agriculture

Education

Media

Government

Public Health Systems

Healthcare Industry

Business and Workers

Land Use and Transportation

Leisure and Recreation

Food and Beverage Intake

Physical Activity

Sectors of Influence

Draft – last revised, March 24, 2005

Policy and Systems Change

Intrapersonal

Interpersonal

Community/Institution

Macro Level/Policy

Socioeconomic statusAgeKnowledgeSkillsPerceptions

MotivationPreferencesSelf-efficacyHealth status

Home food availability

Culture

Time constraints

Social support

Store food availability

Store location

Demographics

Social norms

Proximity to farms

Media and advertisements

Zoning Public policy

Food pricingFood safety regulations

Distribution networks

Socio-ecological model

Factors influencing food purchasing behavior:

Created by Beth Hopping

Ramona and friends

Farmers Market Line

Midtown Grocery

Ramona and friends

Farmers Market Line

Midtown Grocery

Comprehensive Plan Complete Streets OrdinanceHealthy Community Zoning

Business incentives Advertising banPublic transit bike rack

Fines for littering Business improvement districtLighting

Policy Behind the Environment

Healthy Eating: Community Garden

Agreements with land owners (public or private)

Policies to specify healthy eating uses, and on-going site maintenance

Strategies for accessibility and safety

Refrigeration and storage for harvested produce

Strategies for distributing produce

Healthy Kids,Healthy Communities

Healthy EatingPromising Strategies

Healthy Eating: Stores

Policy requiring foods that meet healthy eating guidelines

Partnerships with local farmers to provide and deliver affordable, fresh produce

Assistance to store owners to accept WIC and SNAP benefits

Plans for providing other healthy fruit/vegetable options during off-season

Refrigeration and storage for fresh produce in stores

Healthy EatingPromising Strategies

Strategies to Promote the Availability of Affordable Healthy Food and Beverages

1. Increase availability of healthier food and beverage choices in public service venues

2. Improve availability of affordable healthier food and beverage choices in public service venues

3. Improve geographic availability of supermarkets in underserved areas4. Provide incentives to food retailers to locate in and/or offer healthier

food and beverage choices in underserved areas.5. Improve availability of mechanisms for

purchasing foods from farms.6. Provide incentives for the production,

distribution, and procurement of foods from local farms.

Communities should:

Price incentives to subsidize healthier options

Policies requiring state/county/city agencies to restrict low nutrient density foods

Loans and grants for the development, expansion or renovation of fresh food retail establishmentsLoans and grants for the development, expansion or renovation of fresh food retail establishments

Subsidize CSA (Community Supported Agriculture) programs.

Support farm to institution programs

Support EBT use for SNAP at Farmers Markets

Strategy to Encourage Breastfeeding

11. Communities should increase support for breastfeeding. Baby friendly hospital and

worksite policies to support nursing or pumping milk

Strategy to Encourage Communities to Organize for Change

24. Communities should participate in community coalitions or partnerships to address obesity.

Food Policy Councils that include a specific emphasis on healthy food access and market opportunities for

local farmers.

Food is critical to broader community health

• Food contributes to the health of the:– Individual

• Energy and nutrients to sustain life• Pleasure, comfort, creativity, nuturing

– Family• Family meals – many benefits, but we’re losing this

– Community• Critical contributions to the economy from farm to table• Sustains cultural values and traditions• Promotes social interaction and support• Is a part of every celebration!

Sweet Spot

• Increase healthy food access with NC grown crops– Fresh, wholesome, good tasting food– $ stays in the state– Decreases transportation and storage costs– Reduces adverse environmental impact– Creates many opportunities for business expansion

or start-ups to replace current inefficient systems or cross continental shipping

(food hubs, value added processing, distribution, retail)

Leveraging federal food benefit programs

• SNAP (formerly Food Stamps) and WIC bring millions of dollars into the state that benefit NC farmers and retailers as well as recipients

• USDA child nutrition program (school breakfast and lunch)– Breakfast and summer programs significantly underutilized – much

money left on the table– NCDA Farm to School program – unique program

• BUT If you sell or serve it “will they buy it, store it, cook it, and eat it?”

• Food and Nutrition programs created by federal policy- critical coordinated statewide support to assure effective use of nutrition-related resources at the local level; eg)SNAP-Ed

Food safety Policy• Mission is to manage but not eliminate risk.

– Most food outbreaks have been from large farms/processors– Risk is more easily managed on a smaller scale where producers and

distributors are identifiable.

• Liability fears can get in the way of economic opportunities and healthy food access– Salad bars pulled from schools– Rules forbidding food from school gardens in the school cafeteria– GAP certification requirements for farms – important but often

inefficient and expensive– Small business food retailers can’t afford to operate

• Major challenge looming – FSMA – strict federal regulations– Some potential for state level modification/control

Many entrepreneurial opportunities• Food hubs

– Warehouse to aggregate NC grown food, store, light prep, package, and ship out

• Farm to school/hospital/worksite… “institution”• Supply Food banks, pantries, soups kitchens

• Farmers markets– Often increase revenue for neighboring businesses– SNAP (Food Stamps) can be used via EBT (electronic benefits transfer)

• Of the 229 markets in NC << 1% of sales due to EBT• Other states doing much better• Need for a state level effort to provide TA re EBT transactions,

marketing, outreach to SNAP consumers. Partnership developing

• Community supported agriculture/fisheries (CSAs/CSFs)– Don’t forget seafood!

Take Chances,

Make Mistakes, Get Messy!

Ms. Frizzle says…