How Hartford Is Eating

H O W H A RT F O R D I S E AT I N G :
A 2013 REPORT ON NUTRITION IN HARTFORD D E V E L O P E D B Y T H E C O N N E C T I C U T F O RU M
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It
Introduction
This report, which aims to provide an overview of the current state of nutrition in Hartford, was undertaken at the request of the Connecticut Forum as a follow-up on issues raised at its May 2012 Our Fragile Earth forum. The goals were to provide an initial assessment of nutrition challenges in Hartford and to map pivotal resources and stakeholders, identify issues needing attention, and provide recommendations for next steps. As a result of this preliminary investigation, it is clear that, as with most socially challenging issues regarding Hartford residents quality of life, the picture is complex. Like school outcomes, employment, access to health care, family stability, and public safety, nutrition in Hartford is a field that presents daunting obstacles. Food insecurity and child obesity rates are very high; access to healthy, high quality, affordable food is problematical; while access to fast and processed food is not. There are great unmet opportunities to raise awareness about how to obtain healthy food and to educate about healthy eating and improve cooking skills. The Hartford Public Schools, which provide more meals to more people than any other entity in the city, have in recent years significantly improved the quality of what they offer from a nutritional perspective; yet there is room for improvement in terms of enrolling more students in programs such as the federally funded School Breakfast Program. On the other hand, it is encouraging to report that outstanding and highly sophisticated community and technical resources are now being deployed to address these issues. Research for this report consisted of a series of one-on-one conversations with leading figures active in the field, a small group meeting with several leaders and representatives of the Connecticut Forum, and extensive background research into food security, food policy, and nutritional programs at the local, state and national levels. Concluding recommendations highlight some specific actions that community leaders from the public, private, and social sectors can take that will have a major impact on the overall nutritional wellbeing of the community. The Chief among them will be to leverage the know-how and efforts of the strong and effective organizations and institutions already in place, by ensuring their work is supported by adequate resources and effective policies, in order to set in motion a dedicated strategy to achieve sustained improvements in the nutritional well-being and overall health of Hartford residents.
1|Page For more information, contact The Connecticut Forum at 860-509-0909 ext.12 or Timothy Cole, Ph.D. at tim@westwindconsulting.net / 860-874-7134
I.
Assessment
Among nutrition-related issues in Hartford, two immediately stand out: the high level of food insecurity and the high rate of obesity, especially among children. Neither is surprising, insofar as there are well documented correlations with the poverty rate for both of them. Hartford is now the third poorest city in the nation, among communities over 50,000 in population. 1 To understand nutrition issues in Hartford, they must be seen in this context. Therefore, some definitions and a few statistical facts about the city of Hartford relative to Hartford County and to the state of Connecticut are included in the following discussion. Food Security: According to the US Department of Agriculture, food security means that households have access at all times to enough food for an active, healthy life for all household members. For measuring purposes, food insecurity means that households were food insecure at least some time during the year. Very low food security means that the food intake of one or more household members was reduced and their eating patterns were disrupted at times during the year because the household lacked money and other resources for food.2 Feeding Americas 2010 Map the Meal Gap studies3 reveal that 13.7% of the residents of Hartford County should be counted as food insecure. Of these, 52% had household incomes below 185% of the federal poverty guidelines, the threshold for Supplemental Nutritional Assistance Program (SNAP formerly known as food stamps) eligibility. 48% of those counted as food insecure were above the threshold and therefore not eligible, despite their difficulties. While the study does not state what proportion of the 13.7% are residents of the city of Hartford, considering what else is known from other sources, such as the US Census, about the differences between the city and the county, it is reasonable to infer it is a high number. When considering the 185% cut-off point it should be noted that in a high cost of living state like Connecticut, the federal poverty guidelines, which are set nationally, seriously underestimate the number of financially distressed households. These are the 2013 guidelines for the 48 contiguous continental states plus the District of Columbia:
1 2
http://www.city-data.com/top2/c3.html http://www.ers.usda.gov/publications/err-economic-research-report/err141.aspx 3 http://feedingamerica.org/hunger-in-america/hunger-studies/map-the-meal-gap.aspx - Note that Map the Meal Gap studies do not provide data below the county level, hence the need to develop inferences about Hartford based on what else is known about the socio-economic conditions of the community.
Persons in family/household 1 2 3 4 5 6 7 8 Poverty guideline $11,490 $15,510 $19,530 $23,550 $27,570 $31,590 $35,610 $39,630
185% $21,256.50 $28,693.50 $36,130.50 $43,567.50 $51,004.50 $58,441.50 $65,878.50 $73,315.50
Using these guidelines as the standard of measurement, according to the 2010 Census 32.9% of residents in the city of Hartford are living below the poverty level, while the median household income in the city is $29,107.4 44.5% of children under the age of 18 are living in poverty.5 With an average household size of 2.52, Hartford has many families with incomes well below the approximately $36,000 SNAP eligibility cut-off for households with 3 members, even if they are technically above the poverty guideline. In consequence, although approximately 41,000 residents of Hartford are estimated to be living in poverty by the restrictive federal guidelines, of which approximately 14,325 are children under 18, clearly many more are living in severe financial distress well above that cutoff point. Knowing that a very high percentage of Hartford residents is living well below the 185% threshold for SNAP and other federal subsidized nutrition programs, it is therefore reasonable to conclude that they represent a substantial share of the 121,660 food-insecure people estimated in the Map the Gap study. This is corroborated by End Hunger Connecticut!s CT Hunger Map, which reports that almost 50,000 people received monthly SNAP benefits in Hartford , by information from the Hartford Public Schools that 76.7% of the 24,000 children in the Hartford Public Schools participate in the Free/Reduced Price Meals (FRPM) program; and by the recently released University of Connecticut College of Agriculture and Natural Resources 2012 study of food insecurity in Connecticut by towns. According to the UConn study, Hartford tops the list of the states 169 towns in terms of residents risk of being food insecure. 6
4
http://quickfacts.census.gov/qfd/states/09/0937000.html. It should be noted that the methodology behind the federal poverty guidelines is seriously dated, based on lifestyles and living patterns that were normal in 1963 when they were first introduced. For political reasons, the methodology remains in place unchanged. However, the Census has developed a Supplemental Poverty Measure which more accurately reveals the true extent of financial distress the poverty guidelines were designed originally to capture. The SPM has not yet been recognized as a more credible alternative by policy makers. 5 http://factfinder2.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src=bkmk 6 http://www.endhungerct.org/ct-hunger-map#group8; May 1, 2013 email communication from Brunella Ibarrola, HPS Nutrition Support Manager; http://zwickcenter.uconn.edu/CFS/documents/2012foodsecurity1_10_13.pdf
Obesity: After food insecurity, obesity has been identified as a factor that impacts a very significant number of Hartford residents, especially children. Obesity has been trending rapidly upward nationally and statewide as a threat to health and well-being for several decades, but its impact in Hartford is even more marked. In 2009 it was reported that approximately 40% of Hartford children were at risk or obese, compared to approximately 25% statewide. 7 In 2012, the UConn Center for Public Health and Health Policy completed a study for the City of Hartford Department of Families, Children, Youth and Recreation entitled Child Weight Surveillance in Preschool in Hartford, Connecticut.8 The study reported Thirty-seven percent of the [preschool] children were classied as overweight or obese, with 17% classied as overweight and 20% as obese. This is compared to the CDC normal distribution of weight classication targets that would classify 10% as overweight and 5% as obese.The prevalence of overweight and obesity was twice as high as the CDC guidelines for age and gender specic BMI (Body Mass Index). It is difficult to overstate the severity of the threat posed by obesity to Hartford residents individually and as a community. The Connecticut General Assemblys Commission on Childrens 2009 fact sheet highlights a number of salient points, among them the following: Obesity is the second-leading cause of preventable death in the United States, after smoking. More than half (59%) of Connecticut adults are obese or overweight (2005-2007 data). One in four (26%) Connecticut high school students is obese (12.3%) or overweight (13.3%) (2007 Youth Risk Behavior Survey). Adolescents who are overweight have an estimated 80% chance of being obese as adults. Overweight children are at risk for serious physical, social and mental health problems, both during their youth and as adults: including Type 2 diabetes, asthma, cardiovascular disease, shortened life expectancy, behavioral problems, depression and poor selfesteem. In one year, obesity-related health problems in Connecticut added $856 million in adult medical expenditures, including $665 million in Medicaid and Medicare costs.9
7 8
http://www.hispanichealth.com/hhc/files/download/12 http://publichealth.uconn.edu/images/reports/HartfordObesityReport_web.pdf 9 http://www.cga.ct.gov/coc/PDFs/obesity/obesity_factsheet_012909.pdf
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It Notably, in light of the full-court press behind current efforts to improve educational outcomes in Hartford, it has also been established that there is a negative correlation between obesity and school achievement.10 It is also clear from the research that there is a strong correlation between high Free/Reduced Price Meals program eligibility rates and likelihood of obesity high rates as shown in the following table taken from a presentation11 by Department of Public Health Commissioner Jewel Mullen at a November 2012 Forum on Childhood Obesity held at the Legislative Office Building.
Not Overweight or Obese % of students eligible for FRPL Program < 25% 25 - 49% 50 - 74% >= 75% N 3351 928 587 649 % 73.86 66.67 58.64 56.43
Overweight N 638 232 168 226 % 14.06 16.67 16.78 19.65 N 548 232 246 275
Obese % 12.08 16.67 24.58 23.91
The same study also showed strong correlations between ethnicity and obesity, with Black and Hispanic youth at a strikingly higher risk of obesity than their non-Hispanic white peers: In Hartford, where non-Hispanic whites comprise just 16.8% of the population, this correlation is clearly of signal importance.
Not Overweight or Obese N

Total
Overweight OR Obese N 2565 1334 384 688 % 31.8 26.8 40.8 43.3
% 68.3 73.2 59.2 56.7
5515 3641 557
NH White* NH Black*
Hispanic 901 *NH denotes Non-Hispanic.
II.
Resources
Supply: Obtaining healthy food can be difficult for vulnerable populations in Hartford for a variety of reasons, some more obvious than others. Affordability is an obvious factor; however
10 11
http://www.ctfightobesity.org/key-facts http://www.ct.gov/dph/lib/dph/hems/nutrition/obesity_report_2012_every_smile_counts_survey.pdf
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It accessibility and convenience pose severe obstacles for families with limited transportation and/or childcare options. A national study published in 2012 by The Reinvestment Fund, in collaboration with the Opportunity Finance Network and with support from the US Treasury CDFI Funds Capacity Building Initiative, entitled Searching for Markets: The Geography of Inequitable Access to Healthy & Affordable Food in the United States12 reported that Hartford ranks 8th from the bottom among cities of between 100,000 and 250,000 in terms of ready access to full service grocery stores. In the reports terminology, Hartford is an LSA (Limited Supermarket Access) area, which means one where the residents must travel significantly farther to reach a supermarket than the comparatively acceptable distance traveled by residents in well-served areas. TRF defines comparatively acceptable as the distance that residents of well -served areas (block group with incomes greater than 120% of the areas median income) travel to the nearest supermarket. From the perspective of the reports authors, this is significant because when we look at availability (consistency in access), variety (diversity of products) and price, supermarkets consistently have shown in various research studies to be the most reliable source of access to healthy foods. Unfortunately, unhealthy options fast food outlets including both big name franchises and somewhat less visible corner convenience stores are in many parts of the community more readily accessible than venues that offer healthy food, including large and medium sized grocery stores and especially farmers markets, which are seasonal and typically open only a few hours a week. There is also an extensive network of emergency food providers, including both food pantries and soup kitchens, in many cases operated by churches and faith-based organizations. Many Hartford residents supplement the food they obtain through SNAP, FRPM, and similar programs by making use of these resources; especially later in the month when benefits may be exhausted. In 2012, Foodshare, with its fleet of mobile delivery trucks, and its network of food pantries and soup kitchens, served on average well over 30,000 individuals and families per month. Because not all emergency food providers are in the Foodshare network, the number of those dependent on such resources may easily exceed 35,000 per month. With respect to the healthfulness of the food offered, particularly by soup kitchens, providers frequently serve up what is familiar and filling, which is not necessarily what is most beneficial from a nutritional perspective.
12
http://www.trfund.com/resource/downloads/policypubs/SearchingForMarketsFullReport.pdf. An interactive site allowing for detailed research of study results is available here: http://www.trfund.com/TRF-LSA-widget.html
Significant Assets: Hartford benefits from the presence and activities of several prominent organizations variously engaged in the production and distribution of healthy food, in food policy and research, and in program development and evaluation. Generally, these organizations are outstanding in terms of the quality and comprehensiveness of their work, their creativity, and dedication. Atypically among social service organizations, there appears to be relatively little turf-consciousness or determination to stick to business-as-usual-becausethats-how-we-have-always-done-it. However, they are also typically hampered by resource constraints and/or systemic and institutional inertia with respect to their ability to take their best efforts to scale. Leading organizations include: 1) Foodshare The regional food bank serving Hartford and Tolland counties. The agency is committed to distributing as much produce as possible through its network of partner agencies and its own fleet of mobile delivery vehicles. Both the volume and proportion of fresh produce has been increasing noticeably. In 2011, Foodshare distributed almost 2,000,000 lbs. of produce to Hartford sites alone. In 2012, the amount of produce went up 13% to approximately 2,225,000 lbs.
2011
Hartford Sites Partner Agencies: Mobile Foodshare: Total: # receiving Produce 100 of 113 18 of 18 118 of 131 = 90% Produce Lbs. 863,142 1,094,562 1,957,704 Total Lbs. % Produce 23.2% 77.2% 38.1%
2012
# receiving Produce 98 of 107 19 of 19 117 of 126 = 93% Produce Lbs. 1,059,568 1,165,649 2,225,217 Total Lbs. % Produce 29.0% 77.4% 43.1%
3,718,443 1,417,426 5,135,869
3,651,700 1,506,585 5,158,285

13
In an interview, Foodshare President and CEO Gloria McAdam shared the following, beginning with her basic concern that more and better emergency food distribution is not the point and giveaways are not the solution.13 Historically, the emergency food distribution system emerged in the 1980s in response to Reaganomics, when funding for many basic human needs programs was eliminated. Increasing SNAP outreach is an important step to reducing dependence on the emergency food system. Healthy food: access and affordability appear to be bigger issues than awareness
http://site.foodshare.org/site/PageServer?pagename=programs_movement
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It o It is a misperception that low income people in Hartford do not choose healthy food when it is available and affordable. o Healthy food is not a fringe issue rather it is one that has growing resonance among consumers broadly. There is widespread interest in nutrition and cooking education. Models of neighborhood- and community-based health and hunger coalitions are emerging. There is a generational not socio-economic/class bias toward processed food among younger people, which suggests there is a need /opportunity for broad-based education. Funders are paying increasing attention to continued reliance on emergency food distribution and looking for systemic solutions to hunger and food insecurity. In this context the Freshplace demonstration project is especially noteworthy. Freshplace is a collaborative initiative in which, besides Foodshare,14 the Chrysalis Center,15 the Junior League of Hartford16, and UConns Department of Allied Health Sciences17 are participating. The objective is to transform a neighborhood-based food pantry from a long-term food supply into a portal to self-sufficiency through case management. It is based on the premise that with more and better knowledge behavior changes. With an integrated evaluation component to provide ongoing tracking and analysis, the initial results look promising. 2) Hartford Food System HFSs involvement in the Hartford food security and nutrition a rena is multi-faceted and multi-dimensional. Historically, there are few community based food security or local agricultural initiatives in Connecticut, in the development of which HFS has not played a crucial role. It currently serves as the convener of the City of Hartfords Advisory Commission on Food Policy, represents Hartford and food policy advocates on the Connecticut Food Policy Council, operates the Grow Hartford urban agriculture project and the North End Farmers Market, coordinates the Hartford Farmers Markets consortium, and directs, with technical assistance from UConns Department of Allied Health Sciences, the Healthy Food Retailer Initiative to promote the sale of healthy food through neighborhood small and medium sized retailers. Most recently, in January 2012 HFS launched the North Hartford Community Kitchen as a pilot program, the goal of which is to promote the importance of healthy eating, to give participants hands-on cooking skills and experience
14 15
http://site.foodshare.org/site/PageServer?pagename=programs_independence_model_wraparound http://www.chrysaliscenterct.org/programs-services/community-connections/freshplace 16 http://www.jlhartford.org/?nd=freshplace 17 http:// foodandhealthequity.blogspot.com
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It needed to supplement the healthy eating messages, and to reinforce for our residents that it is possible to advocate for better food and to eat well on a limited budget. 18 In the course of several conversations, HFS Executive Director Martha Page highlighted a diverse array of issues that require either more detailed research or action by policy makers. These included: Mapping mid-sized markets and franchises to develop a more comprehensive picture of where Hartford residents shop and where there may be missed opportunity to improve access to affordable healthy food. Investigating what children and youth in Hartford actually eat, including especially snacking and their own, independent purchasing behavior Drilling deeper into nutrition-related health symptoms and deficiencies. Some, like obesity, diabetes, and heart disease are well documented. Less clear however, due to insufficient data, are the reasons why. A number of disparate factors should be taken into consideration: o Greater risk of food insecurity o Limited access to healthy food outlets o Inadequate services to address food insecurity o Limited availability of transportation o Inadequate SNAP enrollment outreach and delays in application processing o Too few farmers markets with limited opening times o Need for education in healthy cooking skills o WIC caseload backlog Addressing the special challenges faced by Hartfords African American community due to the lack of an organization comparable to Hispanic Health Council to lead on nutrition issues, develop targeted culturally competent programs, and compile comprehensive reliable data. In this connection HFSs involvement in the new Community Solutions project in the Northeast neighborhood may provide an opportunity.19 Strengthening the engagement of Hartford Public Schools in promoting healthy nutrition in Hartford. 3) Hispanic Health Council Since its founding in 1978, HHC has been actively involved in health issues affecting Latino communities in Hartford through an integrated approach involving community-based research initiatives, research-informed direct programming, and policy and advocacy work. Community dialogues and focus groups are important tools the
18 19
http://www.hartfordfood.org/programs/community-kitchen/ http://www.slideshare.net/Cmtysolutions/healthy-northeast-initiative-presentation-13227577
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It organization uses both to learn from the communities it serves and to develop and administer programs that serve them. While its activities address a broader array of healthrelated needs, with respect to nutrition HHC has a clear focus on education for children and adults, including notably breastfeeding. Although funding was recently shifted to the Community Health Centers Association of Connecticut, the agency historically has provided culturally competent bi-lingual support for SNAP outreach, using a mix of media strategies, including a series of comic books and videos modeled on fotonovellas, which are popular in Latino communities. In a similar vein, HHCs Family Nutrition Program has created a series of comic books and coloring books in English and Spanish, along with a very successful Muppet-style puppet show to educate school-children about good vs. bad nutrition.20 Recognizing that the health needs of Latino communities are broadly shared by other ethnic groups in Hartford, HHCs Latino Policy Institute also focuses on the needs of the underrepresented African American community. It has published a series of fact sheets on a range of health issues that speak directly to black people in Hartford.21 In recent conversations HHCs Director of Research and Service Initiatives Grace Damio highlighted the following examples of the organizations current activities and points of concentration: Community-based Systems Research Combining advocacy, assessment through community engagement, intervention, evaluation with a specific interest in understanding social determinants designed to provide feedback on intervention models and approaches, with the ultimate goal of system change Community Health Workers A peer-based model involving deployment of specially trained culturally competent counselors(Promotoras) and midwives (Comadronas) to promote and assist with health and nutrition needs such as breast feeding, prenatal care, and chronic disease management Breast Feeding An important point of emphasis because of its connection with later health and socialization issues such as obesity, diabetes, asthma, and school performance for children and its positive impacts for mothers. 4) UConn Department of Allied Health Sciences The Department is actively involved in a number of community-university collaborative projects that bear on nutrition in Hartford. These include as noted above the Freshplace demonstration project currently being piloted
20 21
http://www.hispanichealth.com/hhc/nutritioneducation http://www.hispanichealth.com/hhc/publications
10 | P a g e For more information, contact The Connecticut Forum at 860-509-0909 ext.12 or Timothy Cole, Ph.D. at tim@westwindconsulting.net / 860-874-7134
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It by Chrysalis Center with support from Foodshare and the Junior League, and the Hartford Food Systems Food Retailer project, among others. Such projects illustrated the Departments broader interest in nutrition-related health conditions prevalent in low income communities, such as obesity, diabetes, and heart disease. Nationally networked, the Department has the ability to draw on experience and research developed elsewhere to the benefit of local efforts to improve nutrition outcomes. In conversation, Katie Martin advocated strongly for a targeted initiative to strengthen the relationships among advocates, service providers, researchers and policy makers, an idea which will be taken up in more detail in the recommendations section of the report. 5) Hartford Childhood Wellness Alliance Based at the Connecticut Childrens Medical Center, HCWA is a working collaboration involving more than 35 partners. The membership includes advocacy groups, health care centers and practitioners, researchers in public health and the social sciences, as well as community organizations, schools, early childhood education and daycare centers, Hartford-based businesses, and local and regional government. The Alliances efforts are aimed at preventing and decreasing childhood obesity in Hartford and improving the overall health of the communitys children and families. By design it seeks to provide a structure through which organizations can join forces in the common interest of creating healthy environments for children and families, and to foster the coordination and integration of efforts in the community to prevent childhood obesity. The Alliance is currently working with its partners to develop appropriate and consistent messaging and marketing strategies to reach diverse audiences with information about healthy eating, exercise, and reducing obesity. 6) Other Resources There are a number of other organizations, agencies and networks that play significant roles with respect to nutrition in Hartford. Important examples include: City of Hartford Health and Human Services / WIC Program The program provides nutritional assessment and education, referrals to health care and social services, breastfeeding education and support and nutritious foods to supplement diets. Connecticut Coalition against Childhood Obesity Formed to combat the epidemic of childhood obesity and the urgent need to address its connection to Connecticuts educational achievement gap, the Coalition stresses that the connections between better health and better academic achievement make action against childhood obesity an education as well as health imperative. Connecticut Food System Alliance A newly reinvigorated alliance of food security organizations and institutions from around the state, including among its members New
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It Havens CitySeed, Bridgeports Wholesome Wave, the Hartford Food System, CT NOFA, UConn, Yale, and others. End Hunger Connecticut! A statewide organization whose mission is to eliminate hunger in the state through legislative and administrative advocacy, outreach and public education.
III.
Municipal Initiatives
Under the leadership of Mayor Segarra, the City of Hartford has begun to play a more engaged role in addressing nutrition and food security issues in the community. The Mayor has convened the Childhood Obesity Task Force, charged with developing a set of actionable recommendations in response to the Child Weight Surveillance in Preschool report mentioned above. The Task Force goals and objectives include the development of a matrix of what has been done/is being done on this front in Hartford, and providing information on the nutrition and physical activity environment within the city to major stakeholders and policymakers. It is expected that the task force will report out its recommendations to the Mayor by August 2013. Hartford Advisory Commission on Food Policy The 12-member Commission, which is charged with making recommendations to the City through the Mayor, on matters of food policy, is comprised of representatives of a wide range of stakeholders, along with representatives of the community at large. The Hartford Food System serves as the convener. In its just completed and not yet formally released 2013 annual report,22 the Commission put forward a comprehensive and expansive series of recommendations to improve food security in Hartford, with ancillary community economic development benefits: 1) Ensure Hartford Maximizes Use of the Federal Child Nutrition Programs The Commission recommends the City support efforts to increase and maximize participation in these programs that provide healthy meals to Hartford children while also bringing additional federal funds into the City. This is largely in response to the fact that despite marked progress in recent years, the School Breakfast, At-Risk Afterschool Snacks, and Summer Nutrition Programs continue to be undersubscribed relative to the numbers of eligible students. 2) Improve Nutrition Standards for Licensed Child Care Facilities The Commission recommends that the Hartford Department of Health and Human Services revise its
22
When formally released, the report will be available on the Hartford Food System website http://www.hartfordfood.org
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It guidelines for licensed day care facilities regarding meals and snacks for children to emphasize fruits, vegetables, and whole grains. This is based on the observations that in Hartford, approximately 73% of three to five year-old children participate in centeror school-based child care; and offering healthy meals and snacks, and nutrition education at childcare centers is a great opportunity to prevent childhood obesity. 3) Plant More School Gardens in the City The Commission recommends that all of Hartford public schools consider planting a school garden. Noting that school gardens are a great way to teach urban youth about how food is grown and provide students with the skills to harvest and prepare healthy foods at home, and that growing food also helps impart children with a sense of responsibility, environmental stewardship, and community, the report urges the City and Hartford Public Schools to consider incorporating gardening into a classroom curriculum for teaching lessons about health, nutrition, and the environment. 4) Implement Zoning Ordinances Supporting Urban Agriculture & Healthy Food Choices First, the Commission encourages the City of Hartford to take action to update current codes to permit urban agriculture to occur in more sections of the City. This is based on the recognition that municipal zoning ordinances, originally written to e nsure the health, safety and welfare of residents by regulating land use, may present barriers to urban agriculture; while gardening and farming in urban areas improve health and combat food insecurity by making fresh produce more accessible; promote environmental sustainability and create more green spaces; revitalize neighborhoods and support economic vitality; and build stronger communities. Secondly, the Commission recommends that the City research model Healthy Food Zone ordinances and draft strategically written municipal codes that would create healthy food environments in Hartford neighborhoods, with the intent that zoning ordinances () be implemented to ban fast-food restaurants from being established in certain areas of urban centers or () require that retailers carry a baseline inventory of perishable and nonperishable food, which would both encourage healthier grocery inventories in corner stores and deter criminal activities. 5) Develop a Compost Pick-Up Program The Commission recommends that the City encourages residents to compost in safe and effective ways, by establishing a composting campaign to promote the practice. In addition, [it] recommend[s] that the City help make use of excess compost by developing a pick-up program that would transport collected compost for use off-site. Such a program would enhance efforts to develop urban agriculture in Hartford, along with removing valuable organic material from the stream of waste that is costly to dispose of.
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It 6) Tax Incentives and Economic Benefits for Healthy Food Businesses Because food production and food retailing account for a very significant portion of Hartfords economic activity, to encourage the development of healthy food production and increased access to healthy food in the City, the commission recommends that incentives for healthy food production and sale be explored and implemented. 7) Respond to Results of Grocery Store Price Survey Based on preliminary results of a recent study by researchers at the University of Connecticut to examine the accessibility, affordability and quality of healthy food sold at grocery stores in a two mile radius of Hartford, it appears that while there are no significant differences in availability and price between Hartford and suburban stores, () the quality differs significantly. There are also significant differences between small, medium and large stores on all variables. Improving the quality of food, and store appearance in Hartford stores will improve healthy food access. Therefore the Commission recommends that the City consider 1) provid[ing] tax breaks or credits for store infrastructure improvements, such as internal and external lighting, improvements for parking lots, and refrigeration for produce to make existing stores more appealing and safe; and 2) creat[ing] liaisons between local farmers and small and medium-sized groceries to improve the quality and availability of fresh produce. This could be between community gardens, farmers markets or regional farmers to sell their produce in local markets. 8) Support Development of Hartford Food Hub Building on the growing interest in locally grown food for both health and sustainability reasons, the Commission recommends that Hartford take this opportunity to support small farmers by working with community organizations to explore developing a food hub. A food hub is a centrally located facility offering production, aggregation, distribution, and marketing services to small and mid-sized food producers. The City has taken a step in this direction by providing a small Community Development Block Grant award to the Hartford Food System to investigate the possibility. 9) Evaluate and Improve Disaster Preparedness Impacting Hartfords Food Supply Noting that grocery stores, food pantries, shelters, and institutional and residential food storage were all impacted by the recent severe storms, along with critical communications, the Commission recommends that the City undertake an evaluation of food system readiness for a disaster and report its findings to the community.
IV.
Recommendations, Next Steps and Conclusions
As a result of the investigations described here, two basic statements may be made: 1) Food security and obesity issues in Hartford are as severe as in virtually any other community in Connecticut or in the United States. 2) Extraordinary and very high quality resources are already being deployed at the local, regional, and state level in response to these challenges. High quality research is available. Impressive quantities of healthy food are being distributed. At the grassroots level, residents are supporting and making use of farmers markets and volunteering at soup kitchens and food pantries. There is an extensive network of community gardens throughout the city. Activists in local nonprofits and neighborhood organizations continue to explore opportunities to increase the supply and distribution of healthy, locally grown food. The primary takeaway then is that the foremost needs are 1) to continue to build public awareness of the magnitude and nature of the problems; 2) to raise the profile of the issues in the public arena and among leading stakeholders and policy makers; and 3) most especially to support and strengthen efforts already underway through enhanced coordination and targeted investment of resources where they are most lacking and can make the most difference. When asked in interviews what they would most like to see happen as a result of this investigation and actions it might eventually set in motion, respondents repeatedly emphasized the need for greater and deeper coordination of efforts. Players and stakeholders need to be more and better informed about each others activities, resources, strengths and weaknesses, learnings and aspirations; and to the extent possible they need to be able to work more effectively together to achieve optimal results at the level required to significantly reduce food insecurity and promote healthier nutrition and lifestyles for Hartford residents and their children.
Recommendations:
These insights point then to the primary recommendation to emerge from this investigation: A high profile, coordinated campaign should be undertaken, with the objective of achieving agreed upon measurable reductions in the levels of childhood obesity and food insecurity by 2018 and with the full and committed support of o The Citys political leadership and key agencies o The Hartford Public Schools and Board of Education o Leading healthcare, nonprofit and educational institutions o The philanthropic sector o Neighborhood and faith-based community organizations, and o The local retail and corporate business communities. 15 | P a g e For more information, contact The Connecticut Forum at 860-509-0909 ext.12 or Timothy Cole, Ph.D. at tim@westwindconsulting.net / 860-874-7134
A Collective Impact approach is the most promising model for launching and carrying through such a campaign. The model allows for the effective engagement and deployment of a wide range of diverse resources for optimum impact. It is inherently flexible and adaptable to changing circumstances and learnings acquired underway, especially when supported by a developmental evaluation component that allows the initiatives leaders and stakeholders to learn as they go. 23 The HACFP recommendations cited above should be fully implemented.
Next Steps:
1) Steering Committee In the near term, efforts should be focused on convening a Steering Committee charged with laying the groundwork for such a campaign. It is noteworthy that many of the obvious people and/or organizations who should be invited to join the Committee are already members of, or represented on, the Hartford Advisory Commission for Food Policy and the Hartford Childhood Wellness Alliance. A primary task for the Committee will be to create an operational platform to coordinate campaign activities going forward in order to achieve collective impact. It will be up to the Committee to determine where the platform will be located and how it will be configured. 2) Stakeholder Conference Practically speaking, to start moving in the direction recommended here, a small stakeholder conference should be held to review the issues and consider options for action. The objective should be to agree on near-term goals, form workgroups, and identify potential partners and resources that can facilitate and support implementation. To get to this point some preliminary tasks need to be addressed either because they are prerequisites or because they are time-sensitive. Important examples include: Compile list of community partners with active or potential involvement in addressing food insecurity and nutrition-related health issues in Hartford o Public and government agencies
23
Extensive resources about the Collective Impact model can be found online: http://www.ssireview.org/articles/entry/collective_impact http://www.fsg.org/KnowledgeExchange/FSGApproach/CollectiveImpact.aspx http://www.fsg.org/OurApproach/WhatIsCollectiveImpact.aspx; http://www.fsg.org/Portals/0/Uploads/Documents/PDF/Embracing_Emergence.pdf
Food Insecurity and Obesity: How Hartford is Eating and What Can Be Done About It o Healthcare and academic institutions o Community-based nonprofits o Faith community o Social organizations o Business and trade organizations Initiate contacts with local funders to identify potential sources of start up and capacity building support for the early stages of the campaign. Coordinate with the City on its follow up on the recommendations put forward by the HACFP and on the potential development of a community Food Action Plan. Coordinate with the City on the implementation of the recommendations of the Obesity Task Force now at work. Coordinate with the Hartford Childhood Wellness Alliance on its effort to develop and launch an effective public outreach marketing initiative.
3) Communications Strategy Ultimately, to make real headway in reducing food insecurity, obesity, and other nutritionrelated health impacts, a tremendous amount of public awareness among virtually all constituencies needs to be fostered. To this end, planners should look to develop and implement a high impact communications strategy along the following lines: The strategy should be designed to achieve three primary objectives: o Build public awareness of food insecurity, obesity, and other nutrition-related health deficiencies in low-income communities like Hartford o Educate the public about: A) The structure, operations, economics, and frailties and deficiencies of the food system itself how food is produced, marketed, and distributed; the environmental impacts of the system; and the quality of what is consumed with respect to health outcomes for different segments of the population. B) The fact Hartford is a node within a more complex regional food system in which people, businesses, and institutions outside the city also participate. o Inform the public about positive initiatives and practices currently in place locally and best practices developed elsewhere that could be adopted or brought to scale locally The strategy must be able to speak to diverse audiences in ways that allow for differences in age, educational attainment, cultural background, and social positioning.
Conclusion
For the Campaign to succeed, there will have to be buy-in at the highest level by people such as the Mayor, the Superintendent of Schools, the CEOs of the local healthcare institutions, the Hartford Foundation for Public Giving, the United Way, the MetroHartford Alliance, and their peers in other key larger and smaller organizations in Hartford. Such buy-in is essential, because the campaign will require targeted resources that are beyond what the current key players in the field can provide, if genuine impact is to be achieved. In sum, at this stage the most important actions that might follow from this investigation should be aimed at bringing greater coherence and coordination to work already underway, ranging from community volunteers operating food pantries, to activists working on the development of organic greenhouses, to school-based nutritionists developing healthier menus, to researchers mapping the retail food supply chain that feeds the city, to advocates who are dedicated to the notion that people in Hartford should be able to eat well and be healthy. Accomplish this, and making Hartford a healthier place, with fewer people suffering from hunger, will prove to be doable.

How Hartford Is Eating

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How Hartford Is Eating

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H O W H A RT F O R D I S E AT I N G :

A 2013 REPORT ON NUTRITION IN HARTFORD D E V E L O P E D B Y T H E C O N N E C T I C U T F O RU M

185% $21,256.50 $28,693.50 $36,130.50 $43,567.50 $51,004.50 $58,441.50 $65,878.50 $73,315.50

http://www.hispanichealth.com/hhc/files/download/12 http://publichealth.uconn.edu/images/reports/HartfordObesityReport_web.pdf 9 http://www.cga.ct.gov/coc/PDFs/obesity/obesity_factsheet_012909.pdf

Obese % 12.08 16.67 24.58 23.91

Not Overweight or Obese N

% 68.3 73.2 59.2 56.7

5515 3641 557

Hispanic 901 *NH denotes Non-Hispanic.

3,718,443 1,417,426 5,135,869

3,651,700 1,506,585 5,158,285

http://site.foodshare.org/site/PageServer?pagename=programs_independence_model_wraparound http://www.chrysaliscenterct.org/programs-services/community-connections/freshplace 16 http://www.jlhartford.org/?nd=freshplace 17 http:// foodandhealthequity.blogspot.com

Recommendations, Next Steps and Conclusions

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