1. Connecting State to Local: Healthy People Connecting for the Future A Gathering of NC Food Councils Dec. 4-5, 2014

2. Public Health Challenges Among the most pressing public health problems in the U.S. Contributing significantly to each of these problems is our current food system Obesity, chronic disease Environmental Degradation Economic/Health disparities and food insecurity

3. We Pay for Poor Health Food is associated with most leading causes of death – heart disease, cancer, diabetes – Obesity is a contributing factor to each Chronic diseases = high costs to communities: – Higher health care expenditures – Higher absenteeism, lower “presenteeism” – Costs for adaptive equipment: stretchers, seating – Opportunity costs – failure to recruit businesses

4. CDC Framework for Preventing Obesity Energy Intake Energy Expenditure Energy Balance Prevention of Overweight and Obesity Among Children, Adolescents, and Adults Individual Factors Behavioral Settings Social Norms and Values  Home and Family  School  Community  Work Site  Healthcare  Genetics  Psychosocial  Other Personal Factors  Food and Beverage Industry  Agriculture  Education  Media  Government  Public Health Systems  Healthcare Industry  Business and Workers  Land Use and Transportation  Leisure and Recreation Food and Beverage Intake Physical Activity Sectors of Influence Draft – last revised, March 24, 2005 Policy and Systems Change

5. Intrapersonal Interpersonal Community/I nstitution Macro Level/Policy Socioeconomic status Age Knowledge Skills Perceptions Motivation Preferences Self-efficacy Health status Home food availability Culture Time constraints Social support Store food availability Store location Demographics Social norms Proximity to farms Media and advertisements ZoningPublic policy Food pricingFood safety regulations Distribution networks Socio-ecological model Factors influencing food purchasing behavior: Created by Beth Hopping

7. Ramona and friends

8. Farmers Market Line Midtown Grocery Ramona and friends

9. Farmers Market Line Midtown Grocery Comprehensive Plan Complete Streets Ordinance Healthy Community Zoning Business incentives Advertising ban Public transit bike rack Fines for littering Business improvement district Lighting Policy Behind the Environment

10. Healthy Eating: Community Garden  Agreements with land owners (public or private)  Policies to specify healthy eating uses, and on-going site maintenance  Strategies for accessibility and safety  Refrigeration and storage for harvested produce  Strategies for distributing produce Healthy Kids,Healthy Communities Healthy Eating Promising Strategies

11. Healthy Eating: Stores  Policy requiring foods that meet healthy eating guidelines  Partnerships with local farmers to provide and deliver affordable, fresh produce  Assistance to store owners to accept WIC and SNAP benefits  Plans for providing other healthy fruit/vegetable options during off- season  Refrigeration and storage for fresh produce in stores Healthy Eating Promising Strategies

12. Strategies to Promote the Availability of Affordable Healthy Food and Beverages 1.Increase availability of healthier food and beverage choices in public service venues 2.Improve availability of affordable healthier food and beverage choices in public service venues 3.Improve geographic availability of supermarkets in underserved areas 4.Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas. 5.Improve availability of mechanisms for purchasing foods from farms. 6.Provide incentives for the production, distribution, and procurement of foods from local farms. Communities should: Price incentives to subsidize healthier options Policies requiring state/county/city agencies to restrict low nutrient density foods Loans and grants for the development, expansion or renovation of fresh food retail establishments Subsidize CSA (Community Supported Agriculture) programs. Support farm to institution programs Support EBT use for SNAP at Farmers Markets

13. Strategy to Encourage Breastfeeding 11.Communities should increase support for breastfeeding. Baby friendly hospital and worksite policies to support nursing or pumping milk

14. Strategy to Encourage Communities to Organize for Change 24.Communities should participate in community coalitions or partnerships to address obesity. Food Policy Councils that include a specific emphasis on healthy food access and market opportunities for local farmers.

15. Food is critical to broader community health Food contributes to the health of the: –Individual Energy and nutrients to sustain life Pleasure, comfort, creativity, nuturing –Family Family meals – many benefits, but we’re losing this –Community Critical contributions to the economy from farm to table Sustains cultural values and traditions Promotes social interaction and support Is a part of every celebration!

16. Sweet Spot Increase healthy food access with NC grown crops – Fresh, wholesome, good tasting food – $ stays in the state – Decreases transportation and storage costs – Reduces adverse environmental impact – Creates many opportunities for business expansion or start-ups to replace current inefficient systems or cross continental shipping (food hubs, value added processing, distribution, retail)

17. Leveraging federal food benefit programs SNAP (formerly Food Stamps) and WIC bring millions of dollars into the state that benefit NC farmers and retailers as well as recipients USDA child nutrition program (school breakfast and lunch) – Breakfast and summer programs significantly underutilized – much money left on the table – NCDA Farm to School program – unique program BUT If you sell or serve it “will they buy it, store it, cook it, and eat it?” Food and Nutrition programs created by federal policy- critical coordinated statewide support to assure effective use of nutrition-related resources at the local level; eg)SNAP-Ed

18. Food safety Policy Mission is to manage but not eliminate risk. – Most food outbreaks have been from large farms/processors – Risk is more easily managed on a smaller scale where producers and distributors are identifiable. Liability fears can get in the way of economic opportunities and healthy food access – Salad bars pulled from schools – Rules forbidding food from school gardens in the school cafeteria – GAP certification requirements for farms – important but often inefficient and expensive – Small business food retailers can’t afford to operate Major challenge looming – FSMA – strict federal regulations – Some potential for state level modification/control

19. Many entrepreneurial opportunities Food hubs – Warehouse to aggregate NC grown food, store, light prep, package, and ship out Farm to school/hospital/worksite… “institution” Supply Food banks, pantries, soups kitchens Farmers markets – Often increase revenue for neighboring businesses – SNAP (Food Stamps) can be used via EBT (electronic benefits transfer) Of the 229 markets in NC << 1% of sales due to EBT Other states doing much better Need for a state level effort to provide TA re EBT transactions, marketing, outreach to SNAP consumers. Partnership developing Community supported agriculture/fisheries (CSAs/CSFs) – Don’t forget seafood!

20. Take Chances, Make Mistakes, Get Messy! Ms. Frizzle says…