According to Food Trust’s 2009 Special Report, “Healthy Food Healthy Coloradoans,” the incidence of diet-related diseases is disproportionately high in lower-income neighborhoods. Coloradoans have a higher incidence of food insecurity compared to the average American household. Tri-County Health Department’s (TCHD) 2008 Community Health Profile found 12-17% of individuals in Adams and Arapahoe counties lack healthcare coverage, and 19-26% are obese. Obesity and diet-related chronic disease can be partly attributed to inadequate fruit and vegetable intake. Access to fresh produce is a concern due to limited personal transportation and lack of retail food stores within walking distance. Convenience stores often do not carry fresh produce, and food pantries have limited cooling systems. Only one-fourth of Colorado adults eat five or more fresh fruits or vegetables per week, according to the Food Trust.
Goal: To promote increased access to fresh produce and health-related programs in the low income population.
Objective 1: Large-scale distribution of donated produce to target population through partnership with a large food bank in a health fair setting, along with food demonstrations to give ideas on how to use donated produce.
Objective 2: Increase awareness of local resources and participation in community programs that work to decrease health disparities on a local level.
Objective 3: Develop a community-based partnership among health-promoting organizations for greater networking and collaboration potential in the future.
The Produce and Health Fair County Collaborative (representing Adams, Arapahoe, Denver, and Jefferson County Health Departments in Colorado) developed the Produce and Health Fairs (PHF) as a unique way to disseminate both health information and fresh fruits and vegetables to the community in an overall effort to decrease obesity and the incidence of diet-related disease. The PHFs were successful at meeting all of the set objectives. Food packages given to participants always included at least four different types of food, and depending on the season, could include nine or more different varieties. Occasionally the food bank would also bring yogurt and bread/tortillas; however, the majority of the donated food was fresh produce.
Over the course of the twelve fairs in 2009, 70,260 pounds of food were distributed to 3,358 households. Assuming three individuals per household, the total number of individuals reached was 10,074. At the local level (Adams and Arapahoe Counties) 1,665 packages of healthy food were distributed. It is estimated that this food reached approximately 4,495 individuals. Agency representatives were encouraged to visit other agencies’ exhibits during the fair. This worked towards building camaraderie and brainstorming how to serve the public more efficiently. Agencies were also asked to fill out an evaluation of the event for improvements in the future. Finally, partnership and networking were forged among the County Collaborative members. Overall morale was high through out the process due to frequent communication and shared encouragement.
This practice seeks to address three public health issues: chronic low fruit and vegetable consumption in the low-income population, local food bank that has a surplus of fresh produce during the summer months that must be distributed quickly, and the disconnect between local health programs and the individuals in need of their services. The low-income population of Adams and Arapahoe counties has a high incidence of chronic disease, increased food insecurity, and many lack proper healthcare. Up to 17% of this population does not have healthcare coverage.
The top two causes of death in 2008 for these counties were cancer and heart disease, according to TCHD’s 2008 Community Health Profile. Poor health outcomes such as cancer, heart disease, diabetes, and obesity can, in part, be attributed to unhealthy diets, which are typically chronically low in fruits and vegetables. There are many factors leading to decreased fruit and vegetable consumption among the low-income population. Financial constraints have been a heavy burden for this population. Based on 2008 Consumer Reports data, food prices were up 5.6% and produce prices were up 6%, while the unemployment rate was on the rise. Access to available fresh produce has also been a barrier, whether due to limited personal transportation or the lack of large retail food stores that are within walking distance. Convenience stores are the main supplier of goods and often do not carry adequate amounts of fresh produce, while local food pantries have limited or no cooling systems to keep produce fresh. This leaves consumers of this demographic group stuck in the middle of an “urban food desert” where they are left with processed food items as their dietary mainstays. Food Bank of the Rockies is heavily involved in the mission to reduce hunger. It distributes almost 25 million pounds of food each year to more than 1,000 hunger relief programs across Denver, Northern Colorado, and Wyoming. During the summer months, the food bank gets inundated with produce and must find ways to distribute this produce quickly to avoid spoilage. Many programs exist to reduce health disparities; however, the target community is not always aware of such programs. Lack of funding for major marketing campaigns prevents these programs from making known the services they offer. A literature review of community health publications was used to ensure that food insecurity and health disparities were real issues of concerns for the target population.
Through this process, it was found that urban food deserts are rampant in many Denver Metro communities. According to the Food Trust, the number of supermarkets found in the lowest-income areas was almost 30% less than the highest-income areas. Studies indicate that fruit and vegetable intake increases up to 32% per additional supermarket in a community. Transportation is another key factor in determining whether a family will have access to nutritious food. The Colorado Health Foundation has found a nutrition gap between communities that have plenty and communities that lack access to basic essentials based on the availability of transportation. Low-income families are six to seven times less likely to have their own car, according to the Food Trust, and in communities where supermarkets are few and far between, this poses a huge challenge to achieving food security. Health disparities were also found through the literature review process. Adams County, with a higher proportion of low-income individuals, has a 26% obesity rate, while the more affluent Douglas County has only a 16% obesity rate (TCHD 2008 Community Health Profile). 26% of Adams County residents do not recall having their cholesterol level checked in the past five years, while only 16% report the same in Douglas County (Colorado Department of Health and Environment Behavioral Risk Factor Surveillance System Statistics). By combining a health fair with food distribution, both the need for incr
Agency Community RolesTCHD Nutrition Division was the coordinator for the PHF County Collaborative, a group consisting of three local health departments and several local hunger-relief agencies. TCHD Nutrition Division was also responsible for planning and implementing six of the 12 health fairs— three in Arapahoe County and three in Adams County. In both counties, this included coordinating which local agencies would be attending as exhibitors, communicating with these exhibitors prior to each event, finding volunteers to help staff the event, procuring food for volunteers after the event, creating and printing demographic cards, helping to set up the site, accounting for traffic and crowd control, acquiring plastic bags to be used for food distribution, packaging donated food, distributing food to participants, administering event evaluations to exhibiting agencies, and cleaning the site after the fair. TCHD Office of Emergency Planning assisted with event set-up and planning for crowd control at the Arapahoe County events.
After the events were completed, TCHD Nutrition Division entered and assessed all demographic data, and sent out event participation totals to agencies that attended. The PHF County Collaborative includes the following organizations: TCHD, Jefferson County Health Department, Denver Health, Food Bank of the Rockies, Operation Frontline, Immaculate Heart of Mary Food Bank, and Colorado State University Extension. Each local health department serves as the “lead” for the event in their county or community and plays an important role in deciding upon the structure of the PHF. They work together to make decisions about dates, times, marketing material, evaluation process, resource exhibit guidelines, solicitation of community agencies to be resource exhibitors, and food distribution logistics. The Collaborative members work to establish an appropriate site for the events, how each event will be run specific to each individual site, volunteer resource management, and coordination of food demonstrations at each event.
Costs and ExpendituresThe implementation and start-up costs of the events depended significantly upon existing agency and community resources in each county. Each local health department was encouraged to utilize existing internal and external resources (e.g., Emergency Planning had event management materials such as tables, parking cones, etc... and the event location had tables, chairs, trashcans, extension cords). Participating community agencies provided staff on an in-kind basis for program planning and implementation.
The primary implementation and start-up costs included: attendee evaluation incentives (about $450.00), event marketing costs such as printing, postage, etc… (about $350.00), one-time cost for event logistic materials such as tents, food insulation blankets, and “caution” tape for crowd control (about $1000.00), and nourishment for event volunteers and community stakeholders/partners. Nourishment for community stakeholders/partners and event volunteers was provided through donations from local grocery stores and pizza restaurants. Each local health department funded their community events in a variety of ways. For the fairs in Adams and Arapahoe counties, TCHD provided the approximate $2,000.00 start-up costs with the knowledge that cost would be less in future years.
Implementation1. The PHF County Collaborative was established at the beginning of 2008 with the purpose of conducting twelve PHFs in four Metro Denver counties. Representatives of the Collaborative included Food Bank of the Rockies, TCHD, Denver Public Health, Jefferson County Department of Public Health and Environment, Immaculate Heart of Mary Food Bank, Adams County Food Distribution, Colorado State University Extension, and Operation Frontline Colorado. This group met three times during the year to plan upcoming fairs and share ideas and resources related to conducting the PHF events in four separate county locations. The Collaborative shared logistical ideas, information about marketing and evaluating events, volunteer management, and agency exhibitor guidelines and strategies. In addition, an evaluation training was conducted with each county to ensure consistent evaluation between the four sites.
2. The PHF Collaborative worked with Food Bank of the Rockies to provide several pallets of fresh produce for distribution at each of the events on dates selected by the group. On the morning of each event, Food Bank of the Rockies dropped off three to four pallets of fresh produce at the event site. Volunteers at the event site arranged the produce (in bags or farmer’s market style) for event attendees to pick up. Each event attendee received two to three bags of a variety of fresh produce at each event.
3. Operation Frontline Colorado and Colorado State University Extension set up a food demonstration exhibit at each event. These food demonstrations featured easy, healthy and inexpensive recipes that could be made with food distributed at each day’s event. Event attendees were provided with food demonstration recipes in English and Spanish.
4. Local community resource agencies were contacted and asked to set up resource exhibits at each PHF event. Event attendees were asked to circulate through the resource exhibit area prior to picking up their package of fresh produce. In the resource exhibit area, they received information about local resources available to assist with food insecurity and self-sufficiency. The planning period took place beginning in January. The collaborative met once in January and once in March. The events took place each Friday in June, July, and August.
The goal of the PHFs is to increase access to healthy food and health services among the low income population to improve diet quality, nutritional status, and overall health. Large-scale distribution of donated produce to target population through partnership with a large food bank in a health fair setting, along with food demonstrations to give ideas on how to use donated produce.It was expected that the County Collaborative, including Food Bank of the Rockies, TCHD, and the two other local health departments would have at least two meetings during the spring to plan and coordinate the twelve upcoming fairs. Each local health department was expected to market and execute their fairs, at a site of their choosing, on their designated Friday of the month during June, July, and August.
Food Bank of the Rockies was expected to communicate what produce was available at least two days prior to the event so the food demonstration teams could develop recipes incorporating those foods. The Food Bank was expected to deliver the food to the appropriate sites within two hours of the fair opening to the public. Each local health department was responsible for dividing up the food to be dispersed to the public and to coordinate the health agency exhibits.Data were collected on pounds of food distributed, number of participants attending the fairs, and demographics of those participants. The food poundage was tracked by Food Bank of the Rockies by weighing food before it left the warehouse for delivery. Participant data were collected by the local health department. For TCHD, demographic cards were used to collect data on age, gender, race/ethnic group, zip code of residence, and use of government services.
Before entering the fair, participants stopped at a welcome table to complete a demographic card. Each adult entering the fair was asked to complete a card (pencils were provided). Before receiving food at the end of the fair, the demographic cards were turned in to a volunteer designated for collecting cards. Food poundage was recorded at the Food Bank of the Rockies warehouse prior to delivering the food at each of the twelve fairs. Demographic cards were completed during each of the six TCHD fairs at the welcome table. They were available in English and Spanish. Participants were required to fill out a card before proceeding through the fair. It was considered their “ticket” for receiving food at the end. Food Bank of the Rockies reported total pounds donated at the conclusion of the summer’s 12 fairs to the County Collaborative members.
Demographic information was collected by the TCHD Nutrition Division and entered into the computer for data analysis. The data collected illustrated that the low-income target population was being reached through the PHF efforts. Since the data showed the target population was being reached, the only modification made was to increase marketing through local services the target population already uses.The PHF successfully distributed fresh produce and other healthy food items to the target population through large-scale efforts. 70,260 pounds of food were distributed during the 12 fairs to 3,358 households, or approximately 10,074 individuals. Coordinating six of those 12 fairs, TCHD reached 1,665 households and approximately 4,495 individuals. Of those individuals attending the TCHD fairs, 1,072 (64%) participated in some type of low-income service program such as TANF, WIC, Food Stamps, Food Banks, Medicare/Medicaid/CHP, Headstart, or free/reduced school meals. 49% of attendees were Hispanic/Latino, 39% Non-Hispanic White, 7% Black/African American, and 5% Other. The distribution of healthy food over twelve fairs was a short term accomplishment. However, the exposure to new foods and the increased knowledge gained by participants through food demonstrations and local health agencies will positively affect the long term health outcome of this population.Increase awareness of local resources and partic
All of the County Collaborative members have expressed interest in continuing to commit to the PHFs. Stakeholder commitment and continued involvement to the fairs is ensured in several ways. Event success is probably the most important determinant to continued stakeholder participation. Since all of the PHFs over the past two years have been well attended, stakeholders see the value in participating, hosting fairs, and/or donating produce. Another important factor is the high level of autonomy stakeholders are given to organize and coordinate their fairs.
Each local health department can tailor their event to meet the needs of their community through marketing, location, agencies invited to participate, data collection, distribution of food, and other logistics. Active participation in the County Collaborative is also an incentive to remain committed. Networking and sharing of ideas with other professionals in the public health setting is a valuable asset to any agency. The feeling of being involved in something innovative and on the forefront of public health is another benefit for stakeholders.
One positive aspect of this practice is its sustainability. There are very few ongoing costs associated with implementation of the practice. Most of the resources that are utilized, including food, tables, and tents, are donated or already owned by the local health department or one of the community partners. The majority of personnel involved in the project are volunteers or labor is donated in-kind by community agencies. The primary costs associated with yearly implementation of this practice involve marketing costs (printing and mailing), evaluation implementation costs (printing participant evaluation forms), and small logistical costs (such as caution tape for crowd control and golf pencils to complete participant evaluation forms). The majority of resources that have or will be purchased can be used in other capacities and in future years. Currently, the PHF County Collaborative has decided to conduct 12 PHFs again during the summer of 2010 at the same locations as 2009. These partners can play a role in helping the Collaborative achieve its stated goals and objectives with the hope of possibly expanding beyond 12 events in four counties in 2011.