Presenter: Dr. Tia Henderson, Upstream Public Health

1. Process, Findings and
Implications
From Two
Health Impact Assessments
Dr. Tia Henderson
Upstream Public Health
Megan Lott
Kids’ Safe and Healthful Foods Project
1

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 Project
2

3. HIA Addresses Social and Economic
Determinants of Health
How
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?
Inequities
Slide courtesy of Human Impact Partners

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 Project
4

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 project
5

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 factors
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.

7. 1 in 4 adolescents are overweight or obese in
Oregon
7 OR Health Teens Survey, 2009

8. Health Impact
Assessment:
Oregon Farm to School and
School Garden Policy, HB 2800
Dr. Tia Henderson
Upstream Public Health
1

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 Oregon
PROCURE PROMOTE
1
START
HERE 4
1 2 3
4 5 6 6 5
EDUCATE Healthy, Fit and INVOLVE
Ready to Learn
9

10. 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
10

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. 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
12

13. Decision: Farm to School Bill HB 2800
Introduced $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. Scope: Farm to School Bill and
Health Determinants
How does the proposed
policy affect health
determinants
Employment
Diet and Nutrition
F2SSG K12 Education
Environmental Health
Social Capital
and lead to
health outcomes?
14

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 options
Garden & F2SSG K-12 Education
Agriculture ↑ Food activities in Program Outcomes
Education gardens, classroom &
Grant
cafeteria Social Capital Outcomes
Program
↑ Student gardening
15

16. Scope: Impacted Populations
n Students n Farmers
n Teachers n Processors
n Parents n Distributors
n Low-income youth; racial and n School nutrition service staff
ethnic specific youth n Food industry workers,
n Low-income families agriculture production labor
n Farming communities n Farmer/worker families
16

17. Assessment Methods
1. Literature review
2. Secondary data analysis
3. Job creation model
4. Community and expert input
17

18. HIA – Collaborative Research
Screening 2 Advisory Committees
Scoping Key Informant Interviews
Assessment OFSSG Network Survey
Recommendations
2 Community Forums
Reporting
Communications Workshop
Monitoring & Evaluation
18

19. Current Conditions: Economics
Oregon: Seasonally Adjusted Unemployment Rates by Area
December 2010 (Preliminary Estimates)
Unemployment Rate
Less Than 10%
10% - 14%
Higher Than 14%
Source: OLMIS
19

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” purchases
Images courtesy of Truitt Brothers
and Happy Harvest Farm 20

21. Current Conditions: Food Insecurity
Source: US Census Bureau,
Small Area Income and
Percent of Population 5-17 Years of Age in Families
Poverty Estimates (SAIPE), 2008.
State of Oregon draft school
district boundaries.
Estimated number of relevant
in Poverty, 2008 by Oregon School Districts
children 5-17 years of age in
poverty who are related to the
householder. Data not
available/displayed for school ClatsopCounty
districts with less than 10 ColumbiaCounty
students. Color classification
based on natural breaks.
MultnomahCounty
Institute of Portland Metropolitan
Studies, Portland State UmatillaCounty WallowaCounty
University, 2010.
WashingtonCounty ShermanCounty
TillamookCounty
MorrowCounty
GilliamCounty
UnionCounty
Legend 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. 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. Farm to School and School Garden K-12
Education Findings
Child Learning Outcomes, HB 2800 IMPACT:
Physical Activity
¡ ↑ Child preferences for fruits
Child Self-Efficacy – Belief they and veggies
can accomplish their goals
Child Diet and Nutrition ¡ ↑ Child consumption of fruits
Overweight and Obesity and veggies
¡ ↑ Physical activity, positive
class behaviors
¡ ↓ Overweight and obesity risk
¡ ↑ Knowledge, learning,
academic achievement
Image from Samuel Mann 23

24. Healthy food exposures
can lead to healthier eating…
24

25. 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)

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. Key Assessment Findings You Can Use
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

28. Emphasize Linking Classroom and Cafeteria
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 Oregon
1
START
HERE 4
1 2 3
4 5 6 6 5
Healthy, Fit and
Ready to Learn
28

29. Use Messages About Other Benefits of
Farm to School
Influence other
institutions
Track and share
learning
Establish habit
Shape student
preferences
Model behavior
29

30. 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
30