Policies to Prevent Childhood Obesity: Evidenced-Based Initiatives in Baltimore City

1. Ox Policies to Prevent Childhood Obesity: Evidenced-Based Initiatives in Baltimore City Oxiris Barbot, MD Commissioner of Health

2. Overview • Two major foci for the prevention/treatment of childhood obesity: • Increasing physical activity • Decreasing caloric consumption • Guidance from Key Evidenced-Based Policy Recommendation Documents • Community focus • School focus

3. Healthy Baltimore 2015 • Health policy agenda for action • Tells us where we can impact disease, disability, and death • 10 priority areas with measures of success • Focus on promoting health equity • Three-prong approach: • Policy • Promoting access to quality care • Maximizing community engagement

4. Healthy Baltimore 2015 Priority Areas • Promote access to quality health care for all • Be tobacco free • Redesign communities to prevent obesity • Promote heart health • Stop the spread of HIV and other sexually transmitted infections • Recognize and treat mental health care needs • Reduce drug use and alcohol abuse • Encourage early detection of cancer • Promote healthy children and adolescents • Create health promoting neighborhoods

5. Strategy: Promote Physical Activity at Community Level • Promote neighborhood access to outdoor recreational facilities, and outdoor activities such as bicycling and walking. • Communities should zone for public transit access and mixed-use development, and enhance physical and traffic safety to promote physical activity. • Participate in community coalitions and partnerships to address obesity.

6. CROSS AGENCY HEALTH TASKFORCE (CAHT) • Using a health in all policies approach to redesign communities to prevent obesity. • Goal: Increase safe spaces for physical activity • Examples: • Libraries: Launching exercise classes. • Rec & Parks: Easier/cheaper to get permits to host programs in parks. • Baltimore Development Corporation: Work with farmer’s markets to increase healthy food access. • Strategy - participating in community coalitions and partnerships to address obesity

7. CAHTCollaborative Efforts • DGS & Rec/Parks: New 7-acre park with multi-purpose playing fields, walking path, basketball court, playground, pool renovation/splash pad. • Rec & Parks: Ball fields and walking paths to be constructed in vacant lots through partnership with Ripken Foundation • Planning: Incorporating more walking-friendly communities as part of the development review process. • DPW: Community wide clean-up, information on proper trash disposal and recycling for the community, sweep of the community to identify dump sites and major sanitation issues

8. Health Impact Assessment • Recommendations for Westside Redevelopment • Looking at ways to enhance traffic/public safety to encourage people to use public transportation and outdoor spaces was a focus of the Lexington Market Area Health Impact Assessment. • Strategy - communities zoning for public transit access and mixed-use development, and enhance physical and traffic safety to promote physical activity.

9. Strategy: Promote Nutritional Changes at Community Level • Enact policy to affect the cost of healthier foods/beverages relative to less healthy options. • Increase supermarkets to underserved areas and offer incentives to local retailers to offer healthier foods/beverages. • Increase access to gardens/greenhouses and promote gardening activities. • Increase healthier food/beverage choices in public service venues. • Ban advertising of less healthy foods/beverages during children’s television programs.

10. VIRTUAL SUPERMARKET PROGRAM • Improving Healthy Food Access • An online grocery ordering and delivery system that brings food to neighborhoods with low-vehicle ownership and inadequate access to healthy and affordable foods • 6 Sites: 2 libraries, 3 senior/disabled housing buildings, 1 public housing facility. • Strategy - increasing supermarkets to underserved areas and offering incentives to local retailers to offer healthier foods/drinks.

11. Additional Examples: Baltimore City • Healthy Vending - Pilot program • increasing healthier food/beverage choices in public service venues. • Baltimore Bucks helps people stretch their WIC benefits when purchasing healthy foods. • affect the cost of healthier foods/beverages relative to less healthy options. • Great Kids Farm - partnered with local schools to educate and give hands-on experiences to children. • increasing access to gardens/greenhouses and promote gardening activities.

12. Strategy: Promote Nutritional Changes in Schools • Apply nutritional standards to all foods sold within local government facilities or on public school campuses. • Ban sugar-sweetened beverages from childcare facilities.

13. BALTIMORE CITY PUBLIC SCHOOLS • City Schools’ menus meet the new USDA criteria for school meals • Increased the amount and variety of produce and whole grains offered and reduced sodium levels  • City Schools offers universal breakfast (free to all students), lunch, afterschool snack, supper, Saturday and summer meals, as well as the fresh fruits and vegetable program. • More than 84% of students are eligible for Free or Reduced price meals. • applying nutritional standards to all foods sold within local government facilities or on public school campuses.

14. BALTIMORE CITY PUBLIC SCHOOLS • 89 schools participating in the Fresh Fruits and Vegetable (FFVP) program in 2012-2013.  • Started with 8 schools in the 2008-9 school year and has increased to 89 schools participating in 2012-13.  • In April 2012, seven of these schools received the first-ever delivery of Great Kids Farm produce purchased for a City Schools meal program: bite-size carrots with leaves.  • 13,000 students from 131 schools went to the Great Kids Farm for the experiential learning activities, Career and Technology Education (CTE) programs and curricular resources between June 2011 and March 2012.

15. BALTIMORE CITY PUBLIC SCHOOLS • Salad Bars: Currently have 13 schools operating salad bars during lunch • 102  schools slated to receive salad bars as a result of the 2012 Free and Reduced Price Meals campaign. • For the 2012-13 school year, produce offered has included sorrel from Great Kids Farms, in addition to: romaine lettuce, spinach, cucumbers, carrots, tomatoes broccoli, celery, strawberries, oranges. • The purchase of salad bars have been supported through external partners, such as HBO’s Let's Move: Salad Bars to Schools, Legg Mason and Action for Healthy Kids.

16. Baltimore City Takes Action • Multi-dimensional approach based on evidenced-based recommendations: • Physical Activity: CAHT Safe Space policy, incorporate safe space zoning in policy recommendations • Nutrition: Virtual Supermarket Program, Healthy foods in schools, WIC incentives to purchase healthy foods • Policy Agenda: Core indicators in Healthy Baltimore 2015 • Ongoing efforts continue to look for innovative evidenced-based programs/interventions

17. Thank You www.baltimorehealth.org