Quantifying the Well-being of Communities

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By Ellie DeGarmo, B.A., Junior Policy Associate

Can the well-being of a community be measured? Can it be quantified? The Siena College Research Institute (SCRI) developed a way to do both. In May 2017, SCRI conducted a public opinion survey of 1,000 New York State (NYS) residents, as a statewide community.

The survey comprised 80 questions, categorized in groups, addressing six different indicators: community quality; civic engagement; personal and mental health; life chances of young people; economic well-being; and presence of discrimination. Answers were scored on a scale from 0 to 100. The weighted averages of these scores form the Percent of the Possible (POP) score, which quantifies the well-being of a community. While the general POP score provides an overview, a deeper look at the question-level data may provide more useful insights for actionable interventions. SCRI used demographic characteristics such as race, ethnicity, income, gender, and education, to identify subsets within the statewide community.

Answers from several survey questions are important for gauging the ways in which the built environment impacts health. For example, Question 10A, found in the crosstabs data file, asked respondents how much they agree or disagree with the statement, “I do not feel safe to go on walks in my neighborhood at night.” Nearly half (49 percent) of individuals with incomes less than $30K either somewhat agreed or strongly agreed, while only 14 percent of individuals with incomes over $100K somewhat or strongly agreed with this statement. These results have implications beyond that of feelings of safety. Lower-income individuals, who may arrive home from work after dark, are less likely to engage in walking outside as a form of exercise. Lacking the option to engage in physical activity of this kind may increase their risk of developing chronic diseases like heart disease and obesity.

In addition to walkability, access to transportation also impacts health. To this end, survey respondents were asked: “do you have access to a car when you need it?” Individuals in the lowest income bracket were ten times more likely than individuals in the highest income bracket (30 percent versus 3 percent) to respond with “almost never” or “never at all.” This is significant, particularly in rural communities, where public transportation is lacking and long distances are required to receive necessary medical care. A similar disparity is reflected when looking at the breakdown of responses to this question according to race and ethnicity, in which white individuals answered this way 6 percent of the time, whereas African Americans and Hispanics responded this way 27 percent and 33 percent of the time, respectively.

Although these results offer some insight about the well-being of NYS as a state-wide community, a larger sample would generate accurate metrics of well-being in communities of smaller size. SCRI worked with DataHaven on a survey of over 16,000 Connecticut residents in 2015. SCRI hopes to conduct a survey of comparable size in New York, in the future. With a much more robust sample, dynamic and dramatic differences will emerge between smaller geographic areas. This information could inform the implementation of more targeted and tailored health interventions.

Measuring the well-being of a community is an abstract concept and SCRI has developed a set of useful metrics as a baseline against which future progress can be measured. As a part of the work of the New York Academy of Medicine, the Advancing Prevention Project (APP) provides technical assistance and tools for individuals working at local health departments. However, we encourage professionals across various sectors to download SCRI’s booklet and explore their data as a means for improving the lives of individuals in New York State.

Health & the Built Environment: Innovative Approaches

DASHNY Active Communities, Advocacy & Policy, Economic and Community Development, Environment

Photo credit: Buffalo Rising and the Five Points Buffalo NY neighborhood

By Diane Kolack, Policy Associate

This is the second of two posts on health and the built environment. Part one focused on a recent workshop on built environment solutions to obesity, sponsored by the National Academy of Sciences.

We often hear that your zip code is a better predictor of your health than your genetic code. Although this refers broadly to health inequity, the health-promoting quality of a zip code is impacted by the built and social environments. Inaccessible or nonexistent sidewalks and bicycle or walking paths contribute to sedentary behavior, which is a factor in poor health outcomes such as obesity, cardiovascular disease, diabetes, and some types of cancer, according to the CDC. Policies like New York State’s Complete Streets law help frame ‘the healthy choice as the easy choice’ by making it possible for people to safely walk, bike and be physically active in their communities. While these policies offer an opportunity to improve streetscapes and encourage physical activity, there can be time and cost barriers to implementation.

Tactical Urbanism is one solution. The concept comes from the field of urban planning and refers to “lighter, quicker, cheaper” improvements to the built environment. According to the Center for Active Design, when barriers are seemingly high, tactical urbanism approaches can offer affordable, rapid-fire solutions and change the way people think about their streets and public spaces. The Walkable and Livable Communities Institute has created a Pop-Up Intervention Toolkit that provides step by step instructions for local groups interested in tactical urbanism.

The workshop we covered in this first part of this series, Advancing Obesity Solutions Though Investments in the Built Environment, organized by the National Academy of Sciences, brought our attention to the success of “pop-up” interventions in rural Montana, including a roundabout made of hay bales to test out new traffic patterns.  Several communities in New York State are working to improve the quality of the built environment with similarly innovative approaches.

  • Tonawanda, NY set up a temporary mini-roundabout with cones and bumpers at a busy intersection. By removing a 4-way traffic signal and installing a sloped mini-roundabout, they demonstrated how 50mph traffic could safely flow at 15mph.
  • Newburgh, NY was recently awarded an AARP Tactical Urbanism Grant to add flowers, potted plants, and colorful paint to a hazardous intersection to supplement traffic-calming efforts and create more visible crosswalks.
  • Buffalo, NY transformed a large 5-point intersection into a vibrant space by introducing functional street art, temporary traffic-calming designs, pedestrian-friendly elements, and simple green foliage—all in a single day.
  • Geneva, NY recruited local teen artists to design sidewalk murals and games that encourage people to stop in their tracks and take time to play.

New York State’s Health Across All Policies initiative acknowledges that to improve the health of all communities, cross-sector cooperation is necessary. Making lasting change to the built environment requires civic engagement and multi-disciplinary policy approaches. During a recent workshop on built environment solutions to obesity, Rodrigo Reis of Washington University emphasized the importance of cross-sector collaboration in creating policies for healthier built environments through his work in modeling multi-disciplinary approaches to active transportation.

The Advancing Prevention Project (APP) is proud to promote Complete Streets policy initiatives as part of our ongoing support to local health departments’ Prevention Agenda plans and our advocacy for active communities around New York State. To participate in the upcoming technical assistance for Complete Streets, please contact Diane Kolack at the New York Academy of Medicine.

New Report: Local Food on the Public Plate Can Boost Health, Create Jobs

DASHNY Advocacy & Policy, Economic and Community Development, FEATURED ARTICLES, Food Policy, Prevent Chronic Disease Leave a Comment

By Kimberly Libman and Glenda Neff

When you hear “local food,” what do you imagine? Do you think of apple picking every fall at your favorite orchard, rows of sweet corn along a country road, or your favorite stall at the farmers market?

Chances are all of these options come to mind, but you seldom think of farm-fresh foods appearing on plates at local school cafeterias, college dining halls, hospitals and emergency food programs. Traditionally, canned, frozen and processed foods, often purchased out of state, make up the bulk of institutional fare, but it’s not only possible to serve fresh, highly-nutritious foods in New York’s schools, hospitals, and other institutions,  it’s a double-win for public health and our local economy.

The new report, “The Public Plate in New York State: Growing Health, Farms and Jobs with Local Food,” produced by The New York Academy of Medicine (the Academy) and the American Farmland Trust as part of its Farm to Institution New York State (FINYS) initiative,  explains that increasing public spending on fresh or minimally-processed food grown in New York has the potential to positively impact the health of approximately 6 million people eating in public institutions and possibly generate more than 200 million dollars in additional economic output.

Healthier Food Equals a Healthier Economy

It’s important to recognize that institutions across New York, including hospitals, universities, childcare centers, prisons, older adult centers and food pantries, all play a significant role in our health. In addition, these organizations serve food purchased with public dollars – they are collectively referred to as the “public plate.”

From a health perspective, the upside potential of increasing the amount of healthy food on the public plate is tremendous. Poor diet is a leading cause of death and chronic disease.  Increasing the procurement of farm-fresh local foods by these institutions and organizations offers many of New York’s most nutritionally vulnerable residents opportunities to eat in ways that may lower their risks for obesity or developing a host of diseases, such as diabetes and heart disease.

Additionally, the increased income and economic activity associated with spending public plate dollars on food grown in New York may improve the health of rural communities by bringing new jobs and higher incomes to residents. An investment in local food greatly impacts New York farmers and food businesses. According to the Public Plate report, institutions spend more than $957 million annually on food. Allotting 25 percent of that budget to foods grown and raised in New York would generate $208 million in additional economic output. Such an investment in the state’s economy would support jobs on farms, as well as the food processors, distributors and others that do business with them.

As a health promotion strategy, farm to institution procurement stands alone in its ability to address hunger, obesity and chronic disease rates among New Yorkers, while bringing together diverse stakeholders, such as farmers, parents, doctors, educators, cooks and eaters,  while also increasing economic activity.

The State of New York has a unique opportunity to become a national leader in the farm to institution movement by establishing a clear goal of spending at least 25 percent of public funds on food grown on farms in the state—connecting the dots between a healthy food economy and healthy citizens. From young children in childcare programs and schools to older adults receiving meals in adult care centers and visiting food pantries, everyone wins when we support fresh, local food and the farmers who grow it.

How can you help? Speak up at town halls, write and call your legislators, talk to your school board or the administrators of institutions that serve your community and encourage them to seize this opportunity by purchasing at least 25 percent of the foods they serve from farms right here at home, in New York State!

Addressing Obesity through the Built Environment: An Event Recap

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By Ellie DeGarmo, B.A., Junior Policy Associate and Diane Kolack, B.A., Policy Associate

We tuned into a daylong Roundtable on Obesity Solutions Workshop

In an effort to address obesity by exploring potential mechanisms for changing the built environment, the National Academies of Sciences, Engineering, and Medicine (the National Academies) hosted Advancing Obesity Solutions through Investments in the Built Environment: A Workshop on September 12, 2017. The daylong event was a part of the National Academies’ Roundtable on Obesity Solutions, which began in 2014 with the mission of coordinating efforts across sectors to address the obesity epidemic.

The event was broken up into the following three topical sections:

  1. Built Environments, Obesity and Health Overview
    • Rodrigo Reis from Washington University in St. Louis spoke about the importance of cross-sector collaboration in creating policies for healthier built environments. Through computer modeling, his multi-disciplinary team identified eight integrated regional and local interventions that, when combined, encourage walking, cycling, and public transit use, while reducing private motor vehicle use. Reis also suggested that in order to maximize cross-sector engagement, messaging should be crafted effectively. Research shows that this means shifting the conversation from a focus on health to a focus on the sector specific co-benefits (e.g. environmental sustainability and improved safety) that result from changes to the built environment.
    • Karen Glanz of the University of Pennsylvania began by telling the well-known parable of the Blind Men and the Elephant in which each man feels a different part of the elephant, and confidently arrives at a completely different conclusion about the definition of an elephant. Glanz used this analogy to illustrate the limitations of some recent research on obesity and food environments. She cautions that when interventions that focus on just one piece of the puzzle (or the elephant) fail, we need to ask why and consider the bigger picture.
    • Daniel Rodríguez from the University of California, Berkeley emphasized the ways that city planners can improve the built environment through transportation elements and land use policies that benefit the 53 percent of our country’s population living in suburban environments.
  1. Progress in Improving Built Environments – Examples from Communities and Cities
    • Michelle Nance of the Centralina Council of Governments had the goal of making places more walkable. She conducted “walkability audits,” and discovered that a crucial element was increasing safety through simple and understandable measures like expanding sidewalk lighting.
    • Leslie Meehan from the Tennessee Department of Health cited the example of the Middle Tennessee Transportation and Health Study to demonstrate that data collection is an effective way for the transportation and health sectors to work together. In this case, each sector took responsibility for a distinct part of the process: the transportation department funded the study, while public health professionals executed it.
    • Cathy Costakis of Montana State University explained how community reluctance can be a barrier to implementing changes in the built environment. She offered an effective way of mitigating this through temporary modifications (referred to as “pop-up interventions”), allowing residents to “test” measures before permanent changes are made, including temporary road signs and crosswalks, a roundabout made with hay bales, and mini recreational spaces called parklets.
  1. Challenging and Promising Strategies for Achieving Equitably Healthy Environments
    • KaBOOM! CEO James Siegal discussed how his organization builds playgrounds to increase an area’s “playability,” an idea that can be thought of as “the extent to which a city makes it easy for all kids to get balance and active play.” KaBOOM! focuses on health equity by prioritizing their work in the neighborhoods that need it most.
    • Kimi Watkins-Tartt from the Alameda County Public Health Department shared three health-related projects that her department carried out. She attributed the success of each initiative to the county’s broad approach that included policy and systems change, institutional change, and partnerships and community collaboration. The projects included writing a community health and wellness plan, creating healthy and equitable development guidelines, and implementing tobacco and food-related changes in retail environments.
    • Sara Hammerschmidt from the Urban Land Institute (ULI) talked about the work her organization does through providing real estate developers with expertise on using land responsibly and sustainably. For example, ULI lent support to construct Arbor House in the Bronx, New York, a building with 124 units of affordable housing. Arbor House is located in a neighborhood where residents suffer from disproportionately high rates of chronic disease. The development includes a hydroponic rooftop farm for residents with 40 percent of the produce designated for school, hospital, and food market programs. Arbor House’s design also promotes physical activity, from fitness areas located inside and outside the building to prominently placed stairwells.
    • Finally, Shai Lauros, a developer from Local Initiatives Support Coalition (LISC) National discussed the ways in which her organization supports local initiatives by involving local leaders and residents, facilitating cross-sector partnerships, and addressing the physical, social, and economic needs in a community.

The rate of obesity in New York State (NYS) is 25.5 percent. Even though this is more than 10 percent below the national average, addressing obesity is a top priority, and we strongly encourage communities across the state to consider the importance of the built environment in their work to reduce obesity and chronic diseases.

In the second and final part of our series on health and the built environment, we will highlight innovative approaches from communities throughout NYS.

Universal Free Lunch—Feeding Even More Kids

DASHNY Food Policy, Healthy Schools and Childcare, Prevent Chronic Disease Leave a Comment

Image Credit: Wikimedia Commons

By Holly Woodbury, B.A., Center for Health Policy & Programs Intern

The push toward improved healthy food access for children scored another victory earlier this summer. New York City’s new budget allows for universal free lunches for public school children. The City has already made strides for healthy food access for children, like NYC’s Free Summer Meals and Free Breakfast Program at schools, but this recent change in spending will be a gamechanger for lunchtime. Currently, New York’s free and reduced-price lunch program is structured as follows:

  • Free lunch for students who come from families with incomes at or below 130 percent of the poverty level
  • Reduced price lunch for students who come from families with incomes at or below 185 percent of the poverty level
  • Full price lunch for students who come from families with incomes above 185 percent of the poverty level

Children having access to nutritious food throughout the school day is crucial to their overall health and development, but it is even more imperative for their learning. It’s been proven that when children have healthy meals at school, they are more attentive, more energetic, and retain their lessons better.

While free and reduced-price food is vital for many kids, there is the fear of being teased for paying a reduced price. Sometimes, kids face ostracization if their family cannot pay the full price, which may lead to their food being thrown out or kids not eating at all. In addition, some schools shame their students and throw their food away if the fee is not paid on time. Not only does teasing lead to a negative school environment, but throwing uneaten food away contributes to food waste. The way to quell this problem is to implement a universal free school lunch program, which would make lunch available for over one million school children in New York City. Before, it was just a popular idea.

Now it’s been made possible.

President and CEO of the New York State Health Foundation, David Sandman, PhD, announced on Wednesday, June 7th that, thanks to the Foundation, New York City’s budget for 2017-18 has expanded to give all 1.1 million public school children have access to free lunches, along with the already established free breakfast. Sandman said that the expanded budget means “students will have the food they need to be healthy, to learn, and to play.” Numerically, this new budget means that 90 percent of public schools will offer free lunches. In addition to the expanded lunch program, the budget will also help in improving food quality in schools, and aid in program promotion.

Universal free school lunch means that no child will have to face teasing or alienation over the need to have a free lunch. Moreover, this will ensure that no child will be teased. In addition, this new budget expansion will especially help children from low-income communities, which are often disproportionally affected by lack of healthy food access. The implementation of universal free lunch will not only be beneficial for children and help them succeed in class, but will also be a great step for food justice.

New York State’s budget expansion for New York City aligns with the Academy’s work to prevent chronic diseases and promote health equity. The Academy and Designing a Strong and Healthy New York (DASH-NY) applaud New York State’s efforts in building a healthier and more equitable New York City.