Plenary VI Sodium: Actions and Insights from National Forum Members and Stakeholders Delaware State Efforts on Procurement (ASTHO) - Karyl Rattay, MD, MS FAAP, FACPM, Director of the Delaware Division of Public Health National Salt Reduction Initiative - Elizabeth Leonard, MPH, Project Coordinator, New York City Department of Health and Mental Hygiene American Heart Association - Emily Ann Miller, MPH, RD, National Program Lead, Sodium Reduction Initiative

Plenary VI Sodium: Actions and Insights from National Forum Members and Stakeholders Delaware State Efforts on Procurement (ASTHO) - Karyl Rattay, MD, MS FAAP, FACPM, Director of the Delaware Division of Public Health

Healthy Food Procurement in Delaware

Munch Better at Delaware State Parks  February 2010: Delaware DPH awarded American Recovery and Reinvestment Act funding -State Supplemental Funding for Healthy Communities -Implement at least one high- impact policy, environment or system change over a 2 year project period related to nutrition, physical activity, or tobacco  Division of Public Health, Division of Parks and Recreation, and Nemours Health & Prevention Services partnered to implement a healthy food policy for Division-owned vending, camp stores, and concessions in the Delaware state park system

Munch Better at Delaware State Parks GO-Have the most nutrients for the calories consumed and can be eaten “almost anytime”. They include fresh fruits and vegetables, whole grains, lean meats, poultry, fish, beans, low-fat or fat-free milk and are low in sodium. SLOW-Have added sugar, fat or salt that makes them higher in calories and less nutritious. They include fruits canned in syrup or vegetables with butter, flavored milks, and tuna packed in oil. These are considered “sometimes” foods. WHOA- “Whoa” foods are the highest in sugar, fat and salt and are the least healthy – such as candy bars and sugary sodas.

Munch Better at Delaware State Parks  Year 1: –At least 40% GO –35% SLOW –No more than 25% WHOA  Year 2: –At least 40% GO –45% SLOW –No more than 15% WHOA  Reality 75% GO and SLOW; no more than 25% WHOA  Competitive pricing instituted  Kick-off June 11, 2010 at Killens Pond Water Park –Fun day with free entrance, games, DJ, and taste testing –Survey results: An overwhelming majority (N= 100, 95.2%) responded that they would buy the healthy foods they tasted at Killens Pond Water Park in the future

Munch Better at Delaware State Parks An evaluation conducted after year 2 showed:  Attendance was down in 2011 by 7% 100,000 less people; 1.5 million visits in 2010 to 1.4 million visits in 2011  Food and beverage revenue was up which could be attributed to better staff monitoring and new product offerings  Increase in GO and SLOW options sold in concessions  All the parks were in compliance this year except one  Water was a top seller both years  Beverage companies improved their performance the second year-- product line and service improved

Munch Better in the First State  May 20, 2010 Governor Markell’s Executive Order #19: Established a Council on Health Promotion and Disease Prevention  “In carrying out its charge, the Council shall endeavor to ensure that the State, as an employer, set the standard for workplace health promotion and disease prevention, including healthy foods in vending machines, physical activity opportunities, and health promotion benefits to state employees and their families.”

Munch Better in the First State  Delaware Health and Social Services piloted healthy vending at 3 locations (one per county)  Pilot lasted October 26, 2011 – April 25, 2012  75% GO or SLOW products  Conducted consumer engagement activities—taste testing, surveys, education and outreach  Partners: Division of Public Health, “Delawell” the state’s employee health program, Nemours Health & Prevention Services, Canteen, Division for the Visually Impaired, and Business Enterprise Program

Munch Better in the First State  The Randolph-Sheppard Act is a federal law which mandates a priority to blind persons to operate vending facilities on Federal property  This naturally partnered us with Delaware’s Business Enterprise Program  Operators within this program act as independent, self-employed managers of snack bars, cafeterias, and in our case – vending machines  Very difficult relationship for all parties to navigate  Compensation for potential losses was provided  Early lessons learned –Understand this hits home – operators’ monthly incomes are dependent on machine revenue –Include operators early in the process, explain thoroughly, receive buy-in and understanding, commitment from leadership

Evaluation  Evaluation focus on assessing process and outcomes in order to understand whether and how the pilot is fully implemented and the impact of the pilot program on the vendors and employees  Understanding PROCESS change –Product/food supply chain issues –Increasing & maintaining the number of healthy items in a machine  Understanding BEHAVIOR change –Consumer engagement –Consumers purchasing healthier products

Process Evaluation - Monitoring Holloway Adams

Evaluation Net Gain/ Loss in Gross Sales

The Beverage Story  We saw a change in purchasing behavior away from WHOA beverages during the pilot compared to the same time period in the prior year –In New Castle we saw sales of WHOA beverages drop from 46% of the units sold to 30% –In Kent County the units dropped from 75% to 38%  Overall units sold increased from 346 to 410 in New Castle County and from 285 to 335 in Kent County

ASTHO Salt and Your State Initiative  Learned from other states and about CDC Food procurement guidelines.  Developed Healthy Meeting Guidelines for DPH.  Developed healthy food procurement in the Department of Corrections.  Built upon Million Hearts momentum.

Take Aways  Buy-in from leadership is critically important  Understand the realities of your opposition  Find your champions  Seize opportunities  Share best practices  Success should be defined in terms of a public health win –“Win” may be defined as positive process and behavior changes –Success may look different in different sites  Recognize your successes and your partners  Be persistent