Effectiveness & Maintenance – Multi-Sector Impacts

This indicator includes government investments and incentives that improve food access and promote healthy eating behaviors including the implementation and enforcement of government food procurement policies, plans that incorporate health in key land use, transportation, housing, and other community development decisions, and financial incentives to promote healthy food retail.

Government investments and incentives can help stimulate the development of healthy food retail and improve access to healthy food options particularly among low-income and underserved populations. For example, according to CDC, procurement policies help create healthier food environments, have the potential to drive the reformulation of foods, and impact diverse settings (e.g., employee cafeterias, correctional facilities, schools, child care centers, public hospitals, senior centers, parks). There are several key factors to strong government procurement policies¹:

• “Food procurement policies should be comprehensive and include standards for a variety of food components such as sodium, trans fat, and sugar.”
• “From a purchasing perspective, having such a policy means considering not only the cost and quality of products but also the overall healthfulness of each food purchased. How much sodium does it have? Is it free of industrially produced trans-fat?”
• “As a practical matter, the procurement policy requires seeking healthful foods that will contribute to more nutritious environments and healthful diets.”

Healthy procurement policies include:

• Healthy vending
• Guidelines or nutrition standards for gatherings (conferences, meetings, parties, etc.)
• Guidelines for nutrition standards for cafeterias or lunch rooms
• Menu labeling
• Limiting unhealthy food marketing
• Worksite wellness

Additionally, government investments and incentives that incorporate nutrition and physical activity outcomes in key land use, transportation, housing, and other community development decisions provide opportunities for supporting dietary and physical activity behaviors to benefit SNAP-eligible populations. In this indicator, SNAP-Ed programs can work with other stakeholders/partners to support cities, counties, and municipalities to add opportunities or remove barriers to healthy retail, local food systems, and physical activity in order to benefit SNAP-Ed eligible settings, communities and/or residents. “Upstream” land use decisions by city/county governing bodies, primarily in the built environment, can affect healthy eating and physical activity in low-income communities. Modifications in General Plans could potentially address any factor in the food system continuum for locally grown foods, from producer to consumer. Typically, the local food continuum may include farmers markets, CSAs, farm stands, and nonprofits or businesses that aggregate, process, distribute, and/or store locally produced food. Examples of SNAP-Ed relevant topics that may be included in General Plans include the siting of food stores, restaurants, and schools; home and community gardens; urban farms and forests; parks and green space; sidewalks, bike lanes, traffic calming and road placement; and health impact assessments. In this indicator, barriers and opportunities within the elements of General Plans may include, but are not limited to zoning, neighborhood plans, and development standards; road designs and standards; master plans; project reviews; taxes and fees.^1,2

State requirements may specify how often a General Plan must be updated and the processes to do so. Processes may include visioning, formation of a review committee, analysis of existing conditions, drafting of a policy, review and revision of the proposed policy, adoption by the jurisdiction’s governing body, and implementation. Involvement by SNAP-Ed stakeholders may occur at any stage.

Lastly, several states have focused on providing financial incentives to improve access to healthy food retail. These states provide financial assistance or other type(s) of incentives to attract healthier food retail outlets to underserved areas or to improve healthier food offerings in existing stores.^1,2 Incentives included grants, loans, or tax incentives to assist with costs associated with establishing new food retail outlets, such as land acquisition, building and construction, or feasibility studies. Costs associated with improving healthier food offerings in existing retail outlets may include remodeling, refurbishing equipment, and the purchase of refrigeration to store fresh produce. A few states have enacted legislation that provides other types of incentives, such as technical assistance to small corner stores to assist with purchasing, stocking, or marketing fresh produce, or offers to waive existing zoning requirements to make it easier for grocery stores and supermarkets to locate in underserved areas.

LT13a.	Number and percentage of local, state, territorial, or tribal government agencies/organizations that implement and adhere to healthy food procurement policies including healthy food vending and meeting policies, menu-labeling, and worksite wellness programs.
LT13b.	Number and percentage of local, state, territorial, or tribal government agencies/organizations agencies/organizations that implement and adhere to policies that support healthy lifestyle behaviors in land use, transportation, housing plans, etc.
LT13c.	The total amount of financial incentives (in dollars) provided to support healthy food retail in areas within census tracts where at least 50 percent of residents are SNAP-eligible.
LT13d.	The number of new healthy food retailers within census tracts where at least 50 percent are SNAP-eligible or the number of new healthy food retailers per 10,000 residents located within the three largest underserved census tracts within a local jurisdiction.

The outcomes for this indicator may include, implementation and enforcement of policies related to:

1. Healthy food/local food procurement
2. Financial incentives to expand food availability
3. General Plan implementation and enforcement

Measurement for this indicator focuses on understanding how many government organizations/agencies within a geographic area implement and adhere to the policies.

Recommended Community Strategies and Measurement to Prevent Obesity in the United States, CDC
Of the 24 strategies recommended in this guide, 14 have the potential to assess the impact of the government investments and incentives:

1. Increase availability of healthier food and beverage choices in public service settings – Implementation of nutrition standards in government facilities to reduce the availability of unhealthy options and increase the availability of healthy options. Potential data sources:
   • Office that maintains government-wide policies (e.g., city/county manager’s office, mayor’s office)
   • Department of facilities management
   • Purchasing staff person who manages the food service or vending contract for jurisdiction
   • School district’s administrative office, such as the district school food authority
2. Improve availability of affordable healthier food and beverage choices in public service settings – Reduce the price of healthy food options relative to the price of unhealthy food options. Potential data sources:
   • School district administrative offices
   • Facilities managers and/or parks and recreation staff
   • Local government office that maintains government policies
3. Provide incentives to food retailers to locate in and/or offer healthier food and beverage choices in underserved areas – Provide tax incentives, loans, and grants. Potential data sources:
   • City/county manager’s office
   • Economic development office
   • Chamber of commerce
   • Department of public health
4. Improve availability of mechanisms for purchasing foods from farms
5. Provide incentives for the production, distribution, and procurement of foods from local farms
6. Restrict availability of less healthy foods and beverages in public service settings
7. Institute smaller portion size options in public service settings
8. Limit advertisements of less healthy foods and beverages in public settings
9. Reduce screen time in public service settings
10. Enhance infrastructure supporting bicycling
11. Enhance infrastructure supporting walking
12. Support locating schools within easy walking distance of residential areas
13. Improve access to public transportation
14. Zone for mixed-use development

Information on measurement of these strategies can be found at: https://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

Governments and communities

Additional evaluation tools to measure LT13 can be found in the SNAP-Ed Library.

N/A

¹ChangeLab Solutions. How to Create and Implement Healthy General Plans: A Toolkit for Building Healthy, Vibrant Communities. 2012. Available from http://www.changelabsolutions.org/sites/default/files/Healthy_General_Plans_Toolkit_Updated_20120517_0.pdf.

²Keener D, Goodman K, Lowry A, Zaro S, Kettel Khan L. (2009). Recommended community strategies and measurements to prevent obesity in the United States: Implementation and measurement guide. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. Available from https://www.cdc.gov/obesity/downloads/community_strategies_guide.pdf

ChangeLab Solutions. Understanding Healthy Procurement: Using Government’s Purchasing Power to Increase Access to Healthy Food. 2012.
Available from https://www.changelabsolutions.org/sites/default/files/Understanding%20Healthy%20Procurement%202011_20120717.pdf

ChangeLab Solutions. Healthy Planning Guide. 2009. Available from https://www.changelabsolutions.org/publications/healthy-planning-guide.

ChangeLab Solutions. From Start to Finish. How to Permanently Improve Government Through Health in All Policies. 2015. Available from https://www.changelabsolutions.org/publications/HiAP_Start-to-Finish.