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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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6 5

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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