1. Health Bucks Program Alyson Abrami, MS, RD
Manager, Farmers Market Programs
New York City Department of Health and Mental Hygiene
Physical Activity and Nutrition Program
Farmers Market Federation:
March 4, 2011

2. Physical Activity and Nutrition Program, Bureau of Chronic Disease Prevention and Control, Division of Health Promotion Disease Prevention
Mission: Make it easier for at-risk populations to eat healthier and exercise more
Developed in 2005 to develop and implement programs and policies around physical activity and nutrition
Interventions target areas with highest rates of obesity and other chronic disease, and least access to healthier foods and opportunities for physical activity
Policies and social marketing staged citywide

3. Examples of PAN Programs & Policy Work
Food Retail Initiatives
Calorie Labeling Regulation
Are you Pouring on the Pounds Social Marketing Campaign
Water in school cafeterias
Day Care Regulations
Physical activity in schools and day cares

4. Prevalence of Adult Obesity, NYC (2009)
57% of NYC adults are overweight (34%) or obese (23%)
In some neighborhoods, as many as 70% of adults are overweight or obese

6. District Public Health Offices

7. Increasing Access to Fruits and Vegetables in Food Retail Venues in Target Areas
Corner Stores:
Healthy Bodegas Initiative
Supermarkets:
FRESH Supermarket Initiative
Healthy Supermarkets Program
Mobile Food Vending:
Green Carts
Farmers Markets:
Health Bucks and EBT promotion at farmers markets
Stellar Farmers Markets Nutrition Ed/Cooking Demos

8. Health Bucks Program

9. Initial Concept
Certain areas of the City have less access to healthy foods like fresh produce
We need to support the existence of all types of healthy food retail in these areas, including farmers markets
Farmers may be unwilling to come to poor neighborhoods because of perceived lack of demand
Financial incentives for customers thereby support both supply and demand

10. Program History
2005: Piloted in South Bronx with approximately 3000 Health Bucks
2006: Expanded to all three DPHO areas
2007: EBT incentive added
2008: Funding secured to expand EBT incentive
2010: Over 130,000 Health Bucks distributed to over 160 CBOs and 60 farmers markets

11. How Health Bucks Are Distributed
1: To community groups to incentivize first time visits
Only organizations and sites in DPHO areas can apply for Health Bucks (application avail. online)
given per org based on previous redemption rates and needs
Must be distributed as part of a nutrition education program
In 2010, over 160 orgs distributed ~30,000 Health Bucks

12. How Health Bucks are Distributed
2. As an Incentive for using SNAP Benefits
For every $5 spent in EBT, customer gets a $2 Health Buck (unlimited), representing a 40% increase in purchasing power
Customer approaches market manager, decides how much EBT to spend, receives EBT $ in tokens and corresponding Health Buck coupons
EBT can be used for any non alcoholic food, Health Bucks only for non processed produce

13. How Health Bucks are Distributed
In 2010, ~100,000 Health Bucks were distributed as an EBT incentive at 60 participating markets in all 5 boroughs

14. How Health Bucks are Used
Customers bring their Health Bucks to the market or receive them upon spending EBT at the market
Customers use Health Bucks at individual farm stands to purchase fresh produce (no change given)
Health Bucks can be used at any participating market over the course of the season
Unlike EBT tokens, they expire every year

16. How Farmers Are Reimbursed
Farmers collect Health Bucks and mail them to the Farmers Market Federation for reimbursement
They do this on their own schedule, must be mailed in by mid December
All reimbursement complete by early January

17. How Health Bucks are Promoted & Supported
Promotional materials including maps and posters provided to distributing organizations, markets, and nearby sites offered free of charge
Website updated annually with all materials, downloadable via PDF
Press releases
Mailing sent to all SNAP recipients in DPHO areas
Banners, buttons, and aprons provided to all participating markets promoting EBT incentive
Stimulus funds for mini-grants to markets to ensure they accept EBT (29 markets awarded grants in 2010)
Interns stationed near markets directing people to their location

19. Complimentary Program: Stellar Farmers Markets
Empower Food Stamp (SNAP) eligible New Yorkers to make healthier food choices
Enhance nutrition knowledge and improve skills in purchasing and preparing simple recipes using locally grown, seasonal produce.

20. What does Stellar Farmers Markets Provide
Practical nutrition information
Quick and easy recipe demonstrations, taste sample and recipe handout
Tips and ideas for planning and preparing delicious, healthy meals
Food safety information
Nutrition handouts
Free gift for each participant
2010
Over 1400 workshops
Over 38,000 people reached
People are trying & purchasing new fruits & veggies
Community residents value our work
Participants are incorporating nutrition recommendations into their daily lives

21. Program Administration
Each year Health Bucks are printed in a different color to differentiate between years
Unique serial number identifies each Health Buck to limit fraud and enable tracking
Farmers remit coupons to Farmers Market Federation who trains all farmers and sends them reimbursement checks over the course of the season

22. Health Bucks Distribution and Redemption 2006-2010
Note: includes both EBT and organization distribution data from all three boroughs

23. Health Bucks Distribution and Redemption 2008-2010

24. Health Bucks Incentive Increases EBT Use at Participating Markets (2009)
Data from 2009 indicate that Health Bucks have significantly increased the amount of EBT spent at farmers’ markets. An analysis of Greenmarkets (specific farmers’ markets operated by the non-profit organization GrowNYC), found that markets that offered the Health Bucks incentive did more than twice as much in food stamp business as those that did not. Specifically the 13 Greenmarkets that offered the incentive in 2009 did over $166,000 in EBT sales; $100,000 more than the 11 Greenmarkets that did not.
Results in doubling to tripling of EBT use at participating markets

25. ABT/CDC Evaluation
Health Bucks selected by RWJ/CDC as a promising national practice
CDC funding evaluation conducted by ABT Associates
Multi pronged evaluation effort conducted in 2010 to assess impact and feasibility for national implementation
Results and toolkit should be available soon
90% of 350 customers surveyed in 2009 said they eat more FV because of Health Bucks
Farmers claim to double even triple their income with Health Bucks

26. Thank you!