1 Promoting Healthy Public Policy through Community-Based Participatory Research: Case study University of California, Berkeley School of Public Health Team: Meredith Minkler, Professor of Health and Social Behavior Victoria Breckwich Vásquez Charlotte Chang Jenesse Miller Presentation by: Ensiyeh Jamshidi At Community Based participatory Research Center, Tehran University of Medical Sciences.

Community Based participatory Research Center,TUMS 2 Addressing food insecurity in San Francisco’s Bayview Hunters Point: The Literacy for Environmental Justice Partnership Bayview is located in southeastern corner of San Francisco, California, United States-

High rates of obesity and food insecurity Limited or uncertain access to nutritionally safe and adequate foods Supermarket flight(Large and full-service grocery stores moving out to more profitable locations) Transportation barriers Dependency of resident to fast-food outlets or small corner stores with liquor, tobacco, and processed foods heavy in salt, sugar, and fat, and little fresh fruits and vegetables Food insecurity contributes to growing rates of diabetes and obesity – health concerns that rank high in Bayview. Bolen, E. and Hecht, K. Neighborhood Groceries: New Access to Healthy Food in Low Income Communities. California Food Policy Advocates Food Deserts…

Community Based participatory Research Center,TUMS 4 What is food security?

Community Based participatory Research Center,TUMS 5 Food security Access by all people at all times to enough food for an active, healthy life Food security(High food security): no reported indications of food-access problems or limitations. Food security(Marginal food security): one or two reported indications—typically of anxiety over food sufficiency or shortage of food in the house. Little or no indication of changes in diets or food intake. Food Insecurity(Low food security): reports of reduced quality, variety, or desirability of diet. Little or no indication of reduced food intake. Food Insecurity:(Very low food security): Reports of multiple indications of disrupted eating patterns and reduced food intake. United state department of agriculture: Economic Research Service

Community Based participatory Research Center,TUMS Food Insecurity in the U.S in 6 Americans struggle with food insecurity. 2. Low Income people and people of color are more likely to suffer from food insecurity (hunger and obesity). 3. Food insecurity affects 35% of low income households in the US. 4. African American and Latino households face food insecurity and hunger rates three times as high as those of white households. (USDA) 6

Community Based participatory Research Center,TUMS 7 The Partnership Literacy for Environmental Justice (LEJ), Academicians at the San Francisco Department of Public Health, Local high school youth mostly from underserved racial/ ethnic communities and, Paid Literacy for Environmental Justice interns. LEJ partnership funded by health department’s Tobacco Free

Community Based participatory Research Center,TUMS key questions: What was the situation of current access (or lack of access) to healthy foods in the neighborhood? Would local merchants consider making changes to increase their stock of healthy foods? What incentives would encourage stores to become “good neighbors” by offering healthier, fresh foods and reducing alcohol and tobacco advertising while promoting community safety? 8

Community Based participatory Research Center,TUMS 9

Capacity building in youth Training courses: Critical thinking and research skills for understanding the root causes of problems, Identifying contributing factors, Gathering data, Evaluating action-oriented change Developing policy solutions. 10

Community Based participatory Research Center,TUMS 11 framework: Five step Community Action Model (CAM)

Community Based participatory Research Center,TUMS 1.To assess needs and desires of residents in relation to local markets, health and nutrition, behaviors and habits -Youth developed and conducted survey of 130 residents the community. 12

Community Based participatory Research Center,TUMS 2. To Determine how much space in local stores was devoted to processed foods and to tobacco, liquor, and other products. -Youth used store-shelf diagramming 13

Community Based participatory Research Center,TUMS 3.To display the location of corner stores, supermarkets, transportation routes, and relevant community demographics. -Youth conducted in-depth interviews with merchants at five local stores and utilized GIS mapping 14

Community Based participatory Research Center,TUMS 15 Summary of findings: 1.Store-shelf diagramming in 11 corner stores: -40 % of shelf space went to processed foods,26 % to tobacco and alcohol,17 % to sodas and other beverages, 2-5% to fresh fruits and vegetables. 2.GIS mapping: -It take approximately one hour and three bus transfers to get to the closest supermarket. 3. Interviews with merchants and community surveys -Merchants were interested in the possibility of joining a “good neighbor” program if they could receive incentives that would make such changes economically feasible. -Residents were favorable to increasing access to healthy foods and decreasing the availability of alcohol and tobacco advertising at the local stores

Community Based participatory Research Center,TUMS A student at UC Berkeley’s School of Business to conduct a study of the economic feasibility for local stores of increasing their stocking of healthier foods, and of the potential economic incentive mechanisms available through the city and related programs. Related policies in different cities were reviewed to show what’s worked in other communities. 16

Super Save Pilot Partnership December 19, 2003, LEJ Youth Envision launched the opening of the Good Neighbor partnership with Super Save Grocery! Produce Sales: up from 1% to 15% Tobacco/Liquor sales down 10% Overall Sales up about 12% Only allows Tobacco ads behind the counter….up high!

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Surfside Liquor Store

Community Based participatory Research Center,TUMS LE leads the program by providing technical assistance and working with youth who help with taste testing and branding at the pilot store, Super Save Market, which became a “Good Neighbor” This pilot store saw an increase in produce sales from 5% to 15%, and a decrease in alcohol sales from 25 % to 15 % of total sales in the first seven months. 21

Community Based participatory Research Center,TUMS Four years later, these figures remained strong: Produce sales remained up 12 %, alcohol and cigarettes down 10%, and overall profits up 12 %. Other stores were encouraged to become “Good Neighbors.” 22

Community Based participatory Research Center,TUMS 23 Getting to Action: Establishing a Good Neighbor Program (GNP) in the Bayview neighborhood. Four city departments were quickly recruited as program co-sponsors, with the Redevelopment Agency now beginning to provide façade improvements to local stores that agreed to make specific health-promoting changes in their business practices.

The partnership developed detailed memorandums of understanding (MOUs) of The Good Neighbor Incentive Program City entities, including the Mayor’s Office on Economic and Workforce Development, the Department of the Environment, and the Redevelopment Agency, joined the health department in contributing staff and resources to manage and sustain the program, with an eye to possible citywide expansion.

Community Based participatory Research Center,TUMS LEJ joined other stakeholders in helping to promote a state assembly bill that would establish healthy corner store programs statewide 25

Community Based participatory Research Center,TUMS Policy Change Outcomes Successful adoption of the voluntary municipal policy that promotes store conversions in the Bayview neighborhood resulted in 13 stores becoming “Good Neighbors”. Additional funding from The California Endowment. 26

Community Based participatory Research Center,TUMS Policy Change Outcomes On a larger scale, and with the support of the LEJ partnership and other groups, Assembly Bill 2384, supporting the establishment of a statewide “Healthy Food Purchase” pilot program modeled on the GNP and other corner-store conversion programs. The bill was passed and signed into law in 2006, albeit without a budgetary appropriation. 27

Community Based participatory Research Center,TUMS 28 Barriers and Success Factors: Store recruitment and compliance, youth empowerment, Program growth and sustainability. Coming up with innovative models to connect stores with local farmers and then providing produce at prices that local residents can afford and will purchase Turnover among youth members and program staff

Community Based participatory Research Center,TUMS Community Food Project: The Good Neighbor Thank you