1. From Pamphlets to Playgrounds: Why Public Health Officials are Concerned about Greenways and Trailways Ann Stahlheber, M.S., R.D., L.D. Creating Healthy Communities

2. Today’s Objectives 1.The relationship between the built environment and human behavior. 2. The impact that the built environment has on health and chronic disease. 3. Review some intervention strategies in our communities.

3. The Built Environment man-made surroundings that provide the setting for human activity, ranging in scale from personal shelter to neighborhoods to the large-scale civic surroundings.

4. Fact: The choices we make are shaped by the choices we have

5. Sooo….What kind of choices do we have?

6. Nutrition Environment Local grocery stores/supermarkets Corner stores/gas stations Farmers’ Markets Restaurants (dine in and fast food) Food assistance programs School/Institution foodservice Gardens, community/home/school

7. Fact: On average, there are 4 times as many supermarkets in predominantly white neighborhoods as there are in predominantly Black or Latino neighborhoods This correlates to less optimal nutrition intake

8. Avg. Dist. (Miles) Cuyahoga1.4 Suburbs1.3 Cleveland1.6

9. Avg. Dist. (Miles) Cuyahoga0.5 Suburbs0.7 Cleveland0.4

10. Food Balance Score Cuyahoga2.5 Suburbs2.0 Cleveland4.5

11. Households Without Vehicles

12. Physical Activity Environment Parks Playgrounds Safe walking/biking paths/lanes Public Transportation Recreation facilities (pools, tennis, basketball courts) School/institution facilities/activities Community programs for physical activity

13. Fact: Fewer recreation facilities, parks, and playgrounds exist in higher need communities This correlates to less physical activity

14. Fact: Where we live, work, play and pray impacts our health The Built Environment and Health

15. Health Impacts in Cuyahoga County

16. Heart Disease is leading cause of death in the U.S. Cleveland: 395 per 100,000 Suburbs: 289 per 100,000

17. Cancer death rates higher among blacks… Second leading cause of death in the U.S. Cleveland: 261 per 100,000 Suburbs: 205 per 100,000

18. Hough 64.0 Lyndhurst 88.5

20. In a survey of East Cleveland residents: More than half of those surveyed do their grocery shopping outside of East Cleveland

21. Almost all East Cleveland residents surveyed (in the city’s Master Plan survey) expressed the need for improving youth programs

22. Strategies to improve the built environment

23. Overall – health department Focus on systems, policy and environmental changes Enhancing our infrastructure to address social determinants of health Healthy Land Use policies Looking at Health Impact Assessment Connecting the dots between the natural environment, the built environment, and human health

24. Policy change Healthy Land Use Policies –Partnership with CCPC for creating healthy municipal plans –Partnership Cleveland Cuyahoga Food Policy Coalition –Garden Zoning, ordinances to promote/support gardening –Transportation plans Nutrition/Physical Activity specific policies –Healthy vending policy within schools/institutions –Comprehensive nutrition policies –Policy to support increased physical activity in schools

25. Environmental/Systems Change Nutrition –Community gardens Build new gardens Build systems to support and sustain the gardens –Enhance farmers markets EBT programs Resources for promotion, signage Food safety assistance –Promote alternative access points Community Supported Agriculture Healthy Corner Stores –School Nutrition Interventions Farm to School School gardens Community Supported Agriculture

26. Environment/Systems Change Physical Activity –Build Playgrounds Create systems for maintenance –Safe Routes to School Infrastructure and education to create safe routes for kids Increases walking and biking to school –School Physical Activity Interventions Trainings for teachers, principals, to Promote Playtime/outdoor time in School Recess in School –Brownfield reutilization Greenspace, gardens, playgrounds –Develop Walking Clubs Clevelanders in Motion

27. East Cleveland Creating Healthy Communities Program Cuyahoga County Board of Health Partners –Ohio State University Extension –County Planning Commission Reduce the leading causes of death by developing environmental, systems, and policy changes that promote healthy behaviors

28. East Cleveland Health and Development Committee Three focus areas 1.Gardening and Nutrition 2.Physical Activity 3.Environmental Redevelopment Focus on upstream social determinants of health to make East Cleveland a healthy place to live

29. Improving Food Access in East Cleveland Quality of Life Survey (E.C. Master Plan) –Over 50% of residents reported that they grocery shop outside of E.C. (before Tops moved out) Community Food Assessment of 2008 –E.C.’s score is 4.5 (any score over 1.0 puts residents at higher risk for obesity) –7 th worst in the county (county average 2.5) Health and Development surveys –Most were unhappy with grocery store options in E.C. –Solutions included adding a grocery store, community gardens, and improving the Coit Road Market

30. Priorities identified Assist to develop community gardens Assist Coit Road Market with EBT program Explore the possibilities for a new grocery store with County Dept of Development Promote additional programs (City Fresh, other Huron programs, School Nutrition programs etc)

31. Gardening and Nutrition committee Community Gardens - Policy Coit Road Farmers’ Market City Fresh East Cleveland School nutrition programming

32. Vacant lot at Coit Road Farmer’s Market – Feb ’07

35. Composting workshop at E.C. Grows

36. Community Gardening Currently 8 community gardens in East Cleveland 6 gardens in 2009 3 gardens in 2008 1 garden in 2007

37. Community Gardening impacts Nutrition Increase fruit and vegetable consumption Children who participate in gardening are more likely to eat more vegetables than their peers Improved nutritional content of produce 95% of community gardens share their produce with neighbors, shut-ins, food pantries, etc. to spread the healthy harvest In Cuyahoga County, community gardeners consume more than the 5 a Day recommended

38. Coit Road Market Electronic Benefits Transfer program – infrastructure grant provided in 2008 (fall) More promotions for EBT conducted in 2009 Sales for EBT for 2009 = $2500 Also accept WIC and Senior Farmer’s Market voucher programs

39. Huron/School Nutrition Programs City Fresh East Cleveland –Started in 2007 (90% staff) –2009 (90% community residents) –Average of 35 shares per week Schools –ODE Fruit and Veggie grant recipient –Consideration for Farm to School –Consideration for Community Supported Agriculture (coordinate for families)

40. Questions?

41. Developed land 1948

42. Developed land 2008