1 Dr. Tia Henderson Upstream Public Health The HIA Scoping Process & Stakeholder Engagement: Lessons from the Oregon Farm to School and School Garden Policy HIA

Presentation Overview Policy description Stakeholder engagement Scoping Lessons learned 2

What is Farm to School? Programs include at least one: Procure local foods (local = produced or processed in Oregon) Education that includes foods, agriculture, or nutrition, usually in gardens Promotional materials on local foods and nutrition 3

Oregon HB Introduced: $22.6 million Economic Development funds Components: Reimbursement Program Lunch – 15 cents Breakfast – 7 cents Competitive Education Grants 150 gardens

5 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 6

F2SSG HIA Stakeholder Engagement 7 Assessment Reporting Evaluation, Monitoring Recommendations Screening Scoping 2 Advisory CommitteesKey Informant Interviews Network Survey 2 Community ForumsCommunications Workshop

HB 2800 Policy & Health Determinants How does the proposed policy and lead to health outcomes? Social Capital Diet and Nutrition Employment affect health determinants Environmental Health 8 F2SSG K-12 Education

9 Screening Scoping Assessment Recommendations Reporting Monitoring & Evaluation Stakeholder Input in the Scoping Process Research Team – 1 st draft Interviews – vetted, revised Advisory Committees – expanded, revised, prioritized Survey – Oregon F2SSG Network confirmed, finalized

Committee Edits to Rough Scope 10

Research Team Condense Scope 11

Reimburse School Districts Food, Garden & Agriculture Education Grant Program Student gardening Food activities in gardens, classroom & cafeteria School promotion of new local options Environmental Health Outcomes F2SSG K-12 Education Program Outcomes HB 2800 Components & HIA Scope: Health Determinant Pathways Summary School districts purchase of Oregon food School menu options Employment Outcomes Social Capital Outcomes Diet & Nutrition Outcomes 12 Policy Health Outcomes Direct ImpactsIntermediate Outcomes

Committee Scope Prioritization, Part 1 Pathway Criteria: Most directly affected by policy Affect groups most impacted by policy Include vulnerable populations affected by policy 13 Health Outcomes Intermediate Outcomes Diet & Nutrition Outcomes 1 F2SSG K-12 Education Program Outcomes 2 Employment Outcomes 2 Social Capital Outcomes 4 Environmental Health Outcomes 3

School district purchase of Oregon food Youth consumption of fat, sodium, sugar Youth consumption of fruits and vegetables Youth diet and nutrition Youth educational attainment Youth cognitive development Youth learning outcomes Positive behaviors Risk of chronic conditions Overweight and obesity Food, Garden & Agriculture Grant Program School promotion of new options Youth participation in National meal programs Nutrition service staff knowledge & skills about local food School menu options Food Insecurity Reimburse School Districts Policy Health Outcomes Direct ImpactsIntermediate Outcomes Sample Diet and Nutrition Pathway

Scope Example of Research Topics: How will the Policy reimbursement impact diet and nutrition? 15 Could increase school staff skills in using Oregon food sources. Could change school menus to offer new options. Could increase the # of meals bought at school. How will this impact health? New menu options could increase fruit and vegetable consumption and decrease intake of salt, fat & sugar Nutrition helps kids focus, improve their learning outcomes and lead to graduating. Nutrition can help kids sleep better. Nutrition influences childrens cognitive development and behavior. Diet can influence child overweight or obese and risk of chronic diseases (i.e. diabetes, cardiovascular disease, diet- related cancer) Impacted Populations Students eating school meals Low-income youth in the Free and Reduced meal program (includes vulnerable populations i.e. Latino, African American; Native American; Asian American) School staff

Committee Scope Prioritization, Part 2 Criteria: Add most value to analysis Available data Accessible literature Feasible to answer without primary data collection 16

Sample Scope Topic Priorities 17 Health DeterminantTopicRelated Health Outcomes EmploymentAbility for job to help workers pay bills e.g. food, healthcare, housing Food security, chronic diseases EmploymentIncrease demand for Oregon food products Community food security Diet and NutritionChild learning outcomes, ability to focus Learning and graduation F2SSG K-12 EducationChild understanding of food and nutrition Obesity, chronic illness Diet and Nutrition and F2SSG K-12 Education Child food preferencesObesity, chronic illness

Verified Scope F2SSG Network Survey Questions: How strongly do you think each group will be affected? Did we miss anyone? How much chance will the policy result in the following impacts? Did we miss any impacts? Sent to 141 subscribers 21% responded Confirmed impacted groups Confirmed potential impacts 18

Lesson Learned: Involve Experts of All Kinds Legislators General public State agency Farm to School coordinators Farm to School Network members Producers and processors Child nutrition service directors National and state researchers Members of policy advocacy coalition 19 Image From Growing Gardens

Lesson Learned: Stakeholder Involvement in Scope 20 Helped HIA Research Team… Understand policy landscape Revise scope Find data sources Understand program barriers and successes Clarify issues, nuances going forward to Assessment Set a good foundation for Recommendations

Key Findings 21 Image courtesy of Truitt Brothers Economic: $19.6 million = 270 jobs in 2 years Purchase of Oregon products Diet & Nutrition Meal participation Food security for families with children Child preferences for fruits and veggies Child consumption of fruits and veggies F2SSG Education: Child healthy eating behaviors Knowledge, learning, academic achievement potential

HIA Policy Recommendations To increase positive job growth and food security: #1 Modify the eligible items for reimbursement program to produced orprocessed To increase child nutrition, food security, and student learning: # 2 Education Grants – prioritize schools serving: a.Low income populations or b.Ethnically and culturally diverse student populations or c.Food insecure areas #3 Education Grants – prioritize schools developing multi-component programs ProcurementPromotionEducation w/Community Support 22

Oregon HB 2800 Recommendations incorporated from HIA: Modified the eligible items for reimbursement program to produced orprocessed Prioritized low income populations in education grants Amended: $2 million General Fund Component: One Competitive Grant Program 3-4 Districts $1.75 million reimburse Lunch - 15 cents $0.25 million for food, garden, agriculture activities 23

Acknowledgments – Thank You 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 24