Recess for Success

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Originally published in The DASH-NY Newsletter April 2012

By Leonardo Blair

A trend in some schools to eliminate recess to meet increasingly demanding academic schedules is being challenged by new research. Children who engage in daily active recess, says the new data, tend to do better in class and are healthier.

Some advocates in New York are also concerned about the level of physical activity students are getting during recess and the effect it can have on obesity rates. “What we are encouraging schools to do is to make recess active but I think the schools are under such demands it makes it real tough,” said Thomas Hohensee, project coordinator at Bassett Healthcare Network in Cooperstown, NY. “If we got many schools ensuring that students are a lot more active during recess, it would have some effect (on obesity rate),” he said.

More than eight in 10 principals reported in The State of Play: A Gallup Survey of Principals on School Recess, that recess has a positive impact on academic achievement and two-thirds of them say students listen better after recess and are more focused in class. And seven-year-old New York City student, Amadin Collette agrees. He shudders to imagine what his school days would be like if he didn’t get to play at recess.

“If you don’t get a lot of energy out you’re gonna be hype [sic] the whole day,” he said. “I would feel tired if there was no recess.” For Amadin, recess is also more than just releasing energy. During play time, “I learn how to not overreact. I can think better about what I can do and make good choices,” he said.

In Recess Rules, Why the undervalued playtime may be America’s best investment for healthy kids and healthy schools, researchers note that recess represented the single largest opportunity for elementary school children between the first and sixth grades to engage in physical activity during the school day. Schools with more than 50 percent minority enrollment and the lowest income levels are also most likely to have fewer minutes of recess or none at all.

A number of organizations have already taken note across the state and are working to ensure that students are active in schools. Healthi Kids, an initiative of the Finger Lakes Health Systems Agency and an advocate of active recess, successfully pushed for the School District in Rochester to put in place a policy which guarantees at least 20 minutes of daily supervised unstructured recess for students. The new policy is currently being piloted at two schools and will go districtwide in the fall.

PLAYWORKS, a national nonprofit organization that supports learning by providing safe, healthy and inclusive play and physical activity to low-income schools at recess and throughout the entire school, began working to address this problem for a few schools in Brooklyn, New York just over a year ago.

“Principals saw recess as a chaotic time,” said Adeola Whitney, executive director of PLAYWORKS Greater Newark/Greater New York. “Students weren’t getting enough physical activity and that chaos was spilling over in the classroom. We mitigate a lot of that chaos by teaching them conflict resolution and getting them to spend more time on play and physical activity,” she said.

In just one year, they have already started seeing positive results. “I was just at PS 11 last month and both principals and teachers spoke about recess as a much more pleasant time for all and much of what the children are learning is carrying over into the classroom,” said Ms. Whitney.

Incentives for Food Retailers Deliver Fresh Food and Create Jobs

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Originally published in The DASH-NY Newsletter September 2012

By Perrin Braun

Inspired by Pennsylvania’s Fresh Food Financing Initiative (FFFI), New York has been taking some bold moves in order to improve both the health and the economy of the state. Since launching in 2004, the FFFI has become a national model for increasing access to fresh foods in underserved communities. The program has provided funding for 88 fresh-food retail projects in 34 Pennsylvania counties. Not only did over half a million people gain improved access to healthy food, but more than 5,023 jobs were also created or preserved as a result of the program. Lesson learned: the investment of a supermarket in an urban setting had a significant impact on food access, employment, and earnings on a county level. You can read more about details of the FFFI impact assessments here.

Encouraged by the success in Pennsylvania, then-Governor David Paterson announced the creation of the New York Healthy Food/Healthy Communities Initiative in 2009, which sought to increase access to healthy food in New York’s underserved communities. The goal of the New York program was two-fold: 1) support the direct development of jobs in these communities, and 2) meet the financing needs of market operators who want to do business in underserved communities, but do not have access to financing through the conventional credit market.

The program grew quickly, thanks to an allocation of $10 million in the state’s budget, which was used to create a revolving loan fund to finance grocery store projects. By 2010, the Healthy Food & Healthy Communities Fund was announced as a public-private partnership after Goldman Sachs Group, Inc committed another $20 million that would be put towards funding for for-profit, nonprofit, or cooperative food markets that are located in underserved areas across New York State.

The results of the program were overwhelmingly positive: since October 2010, more than $6,134,996 million in capital has been deployed through New York’s Healthy Food & Healthy Communities Fund. The investment has created, enhanced, or preserved 67,500 square feet of food retail space serving an estimated 24,000 people. It has also created or preserved 204 full-time equivalent permanent jobs and approximately 132 construction jobs .

John Gage, owner of Conklin Reliable Market, a second generation, family-run market that serves a low-to-moderate income area in Conklin, NY, was the first applicant to be approved for a grant from New York’s Healthy Food & Healthy Communities Fund. Thanks to the funding that he received, Gage used the money to add additional shelves to his fresh produce section, which resulted in a significant increase in the sale of fresh produce.

“Sales are up,” he announced happily. “Produce sales are up 10 percent more.” He pointed out, however, that while the State’s efforts were commendable, a lot more needs to be done to get people to eat healthier. “It’s all about education, not necessarily just providing access,” Gage said.

Aside from the Healthy Food & Healthy Communities Fund, New York State is taking many more proactive steps to increase residents’ access to healthy food. For instance, The New York State Healthy Food / Healthy Communities Initiative is an innovative program administered jointly by Empire State Development and the New York State Department of Agriculture & Markets, which provides capital in the form of grants and loans to support the development of fresh food retailers in underserved urban and rural communities across New York State. The statewide program meets the financing needs of market operators that plan to operate in underserved communities where infrastructure costs and credit needs cannot be filled. Additionally, thanks to the Food Retail Expansion to Support Health (FRESH) Program in NYC, a permanent farmer’s market grant program and financial incentives for food markets to be green and energy efficient have been established. The FRESH Program has been providing zoning and financial incentives to property owners, developers, and grocery store operators in areas underserved by grocery stores since 2009.

Finally, in November 2011, NY Senator Kirsten Gillibrand introduced the “Healthy Food Financing Initiative” to Washington lawmakers. The legislation proposed an ambitious agenda that would significantly bolster efforts in New York and across the country to eliminate food deserts. $32 million was appropriated for fiscal year 2012 to fund food retail outlets in underserved communities in the U.S. This funding is intended to bolster nationwide efforts to remove barriers to access to fresh and healthy foods—especially in low-income communities and communities of color where food deserts are present. It will also help to revitalize communities by establishing healthy food retail and by creating and preserving quality jobs for local residents. Improving access to healthy food can benefit the economy!

When it Comes to Healthy Food Access, Are”Food Deserts” and Food Swamps” Really that Different?

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Originally published in The DASH-NY Newsletter September 2012

by Perrin Braun

The relationship between obesity and access to healthy foods has been complicated by recent studies that suggested food deserts are not an issue. The term “food desert” has been used by the media, economists, and policy-makers to describe communities that have limited access to healthy food outlets. The communities plagued by food deserts are often of color and typically low income. Many policy decisions and interventions—including Michelle Obama’s Let’s Move! campaign—have operated under the premise that addressing food deserts can help curb obesity in these communities. Enhancing the availability of healthy foods is now a national priority, but are we missing the mark if we are not simultaneously addressing the overabundance of unhealthy food in many of these communities?

The USDA currently defines a “food desert” as a “low-income census tract where a substantial number or share of residents has low access to a supermarket or large grocery store.” One of the initial proposals to address the problem of food deserts was to add more food retail options to these neighborhoods. However, simply increasing the number of grocery stores in under-served communities is not a universal solution to decreasing the prevalence of hunger and chronic disease.

John Weidman, the Deputy Executive Director of Food Trust, argued in a recent New York Timesarticle that “not all grocery stores are equal,” meaning that every supermarket doesn’t necessarily stock fresh, affordable, and appealing produce. In fact, a 2006 study in the American Journal of Preventative Medicine found that the quality of the grocery stores in low-income neighborhoods may influence the BMI of residents. These studies give increasing credence to the idea that issues related to access need to be considered in conjunction with quality, pervasiveness of competing foods, and affordability as barriers to creating healthy eating behaviors.

In fact, current research has suggested that although some areas designated as food deserts may contain some healthy food options, they are so flooded with energy-dense, low-cost options that it undermines efforts to make healthy choices. Donald Rose and his colleagues were the first to name this concept “food swamps” in their 2009 study, Deserts in New Orleans? Illustrations of Urban Food Access and Implications for Policy. Several researchers propose that the focus on the food environment in these communities needs to be shifted from what they lack to draining the food swamps of what they have in abundance—namely, high-calorie foods that fuel obesity.

Does the “food swamp” vs. “food desert” debate address the complex economic and health needs of low-income neighborhoods? There is a substantial body of evidence demonstrating the existence of food deserts. At the same time, the latest observation is that low-income neighborhoods contain an overabundance of fast food establishments. So, it appears that food swamps and food deserts are not necessarily mutually exclusive. For example, one can live in a county with no grocery stores for miles around, butplenty of fast food or quick service establishments nearby.

Therefore, it is important to consider both ease of access and lack of access when considering the main drivers of food choice in underserved neighborhoods. A 2009 USDA report notes that access to a supermarket or large grocery store is a problem for only a small percentage of U.S. households. It shows that while 23.5 million people live in areas more than one mile from a supermarket or large grocery store, only 11.5 million of them (or 4.1 percent of the U.S. population) are actually low-income. It has also been argued that you would be hard-pressed to find an urban community that has absolutely no access to fruits and vegetables, but what matters most is how much fresh produce costs in relation to energy-dense fast food options.

Food advertising is also a part of the problem, but determining its true impact will require further assessment. A 2010 study from the Rudd Center demonstrated that fast food marketers have been targeting children across a variety of media and in select restaurants that provide mostly unhealthy side dishes and drinks with kids’ meals. It also noted that children as young as two are viewing more advertisements for fast food than ever before.

So, what does this mean for the “food swamp” vs. “food desert” debate? Increasing access to healthy foods is part of the solution, but it is not a panacea. While it’s necessary to make affordable, nutritious, and appealing food options more readily available, it’s also important to work towards decreasing the prevalence of unhealthy foods. The healthy choice needs to be the easiest choice!

Calorie Labeling

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Originally published in The DASH-NY Newsletter January 2013

by Shara Siegel

New York City pioneered calorie labeling in 2008, with Albany following close after in 2009. These efforts served as a model for the national legislation mandated by the Affordable Care Act. The ACA requires that calorie labels be added to standard items on menus and menu boards of chain restaurants with 20 or more locations doing business under the same name, which would include places like Starbucks, McDonalds, and Cosi, to name a few examples. According to the law, if you want to know specific nutritional information about a brownie, burger, or strawberry banana smoothie at any of these venues, they will have to disclose this in written form upon request. Requests could include anything from total calories and calories from fat to the amounts of fat and saturated fat, cholesterol, sodium, total and complex carbohydrates, sugars, dietary fiber, and protein.

Calorie labeling is intended to help Americans make healthier nutritional choices when presented with information about their choice at the point of consumption. With more people purchasing food outside their homes and the rates of obesity continuing to grow, this intervention is timely and can potentially affect millions of people. A recent NYS DOH effort, “ichoose600,” built upon this idea, encouraging mothers in particular to aim for a target of 600 calories or less when buying meals at fast food restaurants. The campaign saw great results with increased recognition and use of posted calorie labels in chain restaurants in four counties in New York State.

Now, with the ACA, vending machines will also be subject to some regulations designed to make consumers more conscious about their food choices. Vending machines offer easy, convenient, and quick access to food, but they are not typically stocked with the most nutritious items. The ACA requires vending machine operators who own or operate 20 or more vending machines to disclose calorie content for items that are being sold. Reaching for that 3 p.m. candy bar? The new regulations might cause you to think twice! Check the Food and Drug Administration website for more information on the topic, and theFederal Register notice for more details on the requirements.

Community Benefit

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Originally published in The DASH-NY Newsletter January 2013

by Shara Siegel

The Affordable Care Act promotes broad-based community prevention initiatives through changes to the nonprofit hospital community benefit program. The legislated changes to the tax code are premised on the idea that with more Americans receiving health coverage, nonprofit hospitals will provide less uncompensated coverage, or charity care, over time. The provision of charity or uncompensated care was initially the primary means by which nonprofit hospitals could qualify for federal tax-exempt status. Since 1969, or after Medicaid and Medicare drastically reduced the number of uninsured, the IRS has broadened the scope of qualifying activities beyond charity care to include programs that improve the health of the community, public health initiatives, and health promotion.

Some of the ways hospitals have fulfilled these obligations include providing education for health professionals, conducting community health screenings, supporting school-based health initiatives, and undertaking other outreach programs that do not just treat illness, but promote wellness.  The recent community benefit changes in the ACA encourage more hospitals to engage in this kind of work, and pave the way for innovative new community partnerships and community-based interventions.

Effective for tax years beginning after March 23, 2012, hospitals are to collaborate with local stakeholders to develop a Community Health Needs Assessment (CHNA). The assessments are to be conducted every three years, and in between, hospitals must implement strategies to address the identified needs.

Stakeholders across New York have been developing the State Health Improvement Plan: The Prevention Agenda 2013-2017  to help inform hospitals and their community partners about community interventions that have been proven to prevent disease at a population level. The Prevention Agenda (still being finalized) includes a special section on obesity prevention that recommends interventions like defining/innovating business models that support increased use of healthy, locally grown/developed/ minimally processed foods and requiring health insurance contracts to cover obesity and diabetes prevention programs. This will be an important resource both for hospitals developing their community health needs assessments, and for local health departments identifying local priorities. In fact, the Prevention Agenda calls on local health departments and hospitals to identify two or three of the ten Prevention Agenda priorities and to work with community providers, insurers, community based organizations and others to address them. Statewide program and policy initiatives will complement local efforts.

Through the framework of the Prevention Agenda, New York will see new and stronger partnerships between hospitals, local health departments and other community organizations.  When operating in alignment, these entities can best support the health of their entire community.