1

Dr. Tia HendersonUpstream Public Health

The HIA Scoping Process & Stakeholder Engagement:Lessons from the Oregon Farm to School and School Garden Policy HIA

Presentation Overview

Policy descriptionStakeholder engagementScopingLessons 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 gardensPromotional materials on local foods and nutrition

3

Oregon HB 2800Oregon HB 2800

4

Introduced: $22.6 million Economic Development funds

Components:Reimbursement ProgramLunch – 15 centsBreakfast – 7 cents

Competitive Education Grants150 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 process2. Outline linkages & magnitude of

interactions between the policy and health outcomes

3. Inform agency work plans4. Inform regional institutional procurement

efforts5. Create model F2SSG state-wide policy HIA

6

F2SSG HIA Stakeholder Engagement

7

Assessment

Reporting

Evaluation, Monitoring

Recommendations

Screening

Scoping

2 Advisory Committees

Key Informant InterviewsNetwork Survey

2 Community Forums

Communications Workshop

HB 2800 Policy & Health Determinants

How does the proposed policy

and lead to health

outcomes?

Social Capital

Diet and Nutrition

Employment

affect health determinant

s

Environmental Health

8

F2SSG K-12 Education

9

Screening

Scoping

Assessment

Recommendations

Reporting

Monitoring & Evaluation

Stakeholder Input in the Scoping Process

Research Team – 1st draft

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

& Agricult

ure Educati

on Grant Progra

m

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 Impacts Intermediate Outcomes

Committee Scope Prioritization, Part 1

Pathway Criteria:Most directly affected by policyAffect groups most impacted by policyInclude 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 District

s

Policy Health Outcomes

Direct Impacts Intermediate 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 children’s 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 analysisAvailable dataAccessible literatureFeasible to answer without primary data collection

16

Sample Scope Topic Priorities

17

Health Determinant Topic Related Health Outcomes

Employment Ability for job to help workers pay bills e.g. food, healthcare, housing

Food security, chronic diseases

Employment Increase demand for Oregon food products

Community food security

Diet and Nutrition Child learning outcomes, ability to focus

Learning and graduation

F2SSG K-12 Education Child understanding of food and nutrition

Obesity, chronic illness

Diet and Nutrition and F2SSG K-12 Education

Child food preferences Obesity, 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 subscribers21% respondedConfirmed impacted

groupsConfirmed potential

impacts

18

Lesson Learned: Involve Experts of All Kinds

LegislatorsGeneral publicState agency Farm to School

coordinatorsFarm to School Network

membersProducers and processorsChild nutrition service directorsNational and state researchersMembers of policy advocacy

coalition

19

Image From Growing Gardens

Lesson Learned:Stakeholder Involvement in

Scope

20

Helped HIA Research Team…Understand policy

landscapeRevise scopeFind data sourcesUnderstand program

barriers and successesClarify 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 productsDiet & 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” or “processed”

To increase child nutrition, food security, and student learning:# 2 Education Grants – prioritize schools serving:

a. Low income populations orb. Ethnically and culturally diverse student populations orc. Food insecure areas

#3 Education Grants – prioritize schools developing multi-component programs

Procurement Promotion Educationw/Community Support

22

Oregon HB 2800Oregon HB 2800

Recommendations incorporated from HIA:

Modified the eligible items for reimbursement program to “produced” or “processed”

Prioritized low income populations in education grants

Amended: $2 millionGeneral Fund

Component:One Competitive Grant

Program3-4 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 committeesSodexo and Ecotrust for use of dataAll community members who attended a forum or workshopAll stakeholders who gave input through interviewsAll advisors who gave input on the data or reportThe Northwest Health Foundation and the Human Impact ProjectResearch team members 24