Seattle and King County – Letter of Intent W.K.

Kellogg Foundation Food and Fitness Initiative The Pacific Northwest is known for its livable communities, active lifestyles, rich agriculture and technological innovation. Nevertheless, overweight and obesity prevalence are increasing, as they are in the rest of the nation. King County, which encompasses both large urban centers such as Seattle and Bellevue and small rural towns, is home to a number of initiatives that aim to make it easier to eat well and live actively. Efforts are underway to shape our local food system to support sustainable agriculture and provide fresh food to King County residents, especially those in underserved communities. Last year, the King County Board of Health adopted a 10point plan with specific goals for promoting nutrition, increasing physical activity and improving the built environment and land use to reduce overweight and obesity prevalence in our population. With this foundation, we are poised to integrate these activities horizontally across program areas and vertically across socio-ecologic levels. Efforts are also underway to eliminate health disparities among racial, ethnic and low socioeconomic populations. Participating in the Planning Phase of the Food and Fitness Initiative would allow coordination of these broad-based community efforts into an integrated system. The creation of a comprehensive community plan would leverage resources, facilitate partnerships and significantly expand our community’s capacity for change. Our primary goals for this Initiative are to: 1) Help build social environments that encourage healthy eating and physical activity. 2) Develop an integrated regional food system that supports local, sustainable agriculture. 3) Support built environments and land use that promote physical activity and environmental sustainability. 4) Provide healthy, affordable, locally-produced foods, especially to marginalized communities. 5) Reduce socioeconomic disparities in overweight, poor nutrition and physical inactivity. 6) Engage youth and those most impacted by health disparities in program planning, intervention, implementation and policy development. 7) Activate a participatory, community-based process that supports a systems approach to realize the above goals. As a result of our initial planning in response to your invitation, we identified several areas that need attention to reach these goals. Communication and coordination among existing stakeholders needs improvement and new stakeholders (i.e. representatives of the food industry) need to be included. More efforts are needed to assure open space protection; educate elected officials about the connections between local food and public health; increase access to healthy food and physical activity; develop innovative policies; decrease costs of local, sustainably produced food; decrease overweight and health disparities; and assure that regional planning processes include a focus on food systems and agricultural policy. Participants in developing this letter recognize that food systems activists, physical activity proponents and community health promotion advocates have largely operated in separate arenas. They see integrating efforts and making connections between food, activity and community

health as mutually beneficial and the next logical step for expanding the effectiveness of their efforts. Our Community and the Target Area of Focus The Seattle-King County region covers 2000 square miles with approximately 43,000 acres of farmland (approximately 3% of the total area). Farmed acreage declined by 20% between 1997 and 2002, with a corresponding decline in number and size of farms. Positively, the number of farms certified as organic tripled from 7% to 23% between 1995 and 2004 and the number of local farmers’ markets and community supported agriculture programs increased. Sales at county farmers’ markets totaled approximately $10,000,000 in 2005. King County is home to 1.8 million residents. African Americans, Asian/Pacific Islanders and persons of Hispanic/Latino ancestry account for 5.7%, 10.7% and 3.8% of the population, respectively. Our county is home to increasing numbers of immigrants from Mexico, Central America, Eastern Europe, Asia and Africa. Our ethnic diversity is also reflected in the more than 100 languages spoken by families in the Seattle School District. Despite a generally healthy economy, economic disparities present a major challenge. Nearly a quarter of the population lives in households with incomes below 200% of the federal poverty level. Food insecurity affects 10% of households. Disparities in health are also a significant concern. While half of our residents are overweight or obese, low-income people are 1.3 times more likely to be obese than wealthier residents, African Americans are 1.6 times more likely to be obese than whites and residents of suburban south King County are 1.6 times more likely to be obese than residents of urban Seattle. Disparities in physical activity are even more pronounced. Overall, 44% of residents do not meet national activity recommendations. Latinos report having no physical activity at a rate 1.9 times higher than whites, low income people at a rate 2.9 times higher than high income people and residents of suburban south King County at a rate 4 times higher than residents of urban Seattle. We will define two levels of community for the purposes of this proposal. Because food systems by definition include rural areas for food production, we will include the Puget Sound region in our food systems work. This area provides year round agriculture and serves approximately 28 farmers’ markets in the County. Because interventions to promote healthy eating and active living are more effective when concentrated within smaller communities, we will select several communities most affected by disparities. Our planning process will select the specific communities based on health and social indicators, food access, availability of supportive environments for physical activity and community readiness for change. Data from public health and regional planning efforts will help inform this selection. We will likely focus on those with high proportions of low-income residents and people of color in south Seattle and 6 adjacent suburban cities. These communities are already beginning to address physical inactivity and poor nutrition through the REACH and Steps to Health programs (see below). Our History of Collaboration and Resulting Accomplishments Seattle and King County have an extensive history of cross-sectoral collaborations, community building and participatory planning. Several successful coalitions are active in the food and fitness arena and are ready to participate in this Initiative. The shaded examples listed in the table below are mature partnerships with a transparent structure defined through formal operational

procedures, established communications systems and local (as well as national) recognition. These coalitions have emphasized capacity development of their members and integration of member activities. Below these are a few examples of the many partnerships formed for specific collaborative projects. All of these partnerships have established valuable cross-sector and crossinstitution relationships and the trust and good will for moving ahead together. Name REACH 2010 Founded 1999 # Partners 68 • • • Steps to Health 2003 75 • • Activities & Accomplishments assessed current status of diabetes prevention and control efforts among minority communities. implemented diabetes education and chronic disease self-management classes, faith-based education, clinic case coordination and community business activities. programs improved physical activity and nutrition behaviors and disease management self-efficacy. implemented evidence-based strategies that promote the reduction of asthma, diabetes and obesity. supported implementation of new wellness policies in schools through menu changes, increased breakfast participation, walk-to-school activities and a revised physical education curricula. developed evidence-based 10-Point Plan that was adopted as by the King County Board of Health. convenes organizations in King County to plan and implement innovative programs and policies to promote healthy eating, physical activity and healthier built environments. convenes stakeholders to holistically address food systems issues. develops strategy, relationships and infrastructure for an officially recognized council for Seattle/King County. presents annual awards to PE teachers who excel. provides communication, collaboration and networking for organizations working to increase physical activity. conducts walking school bus programs in concert with school breakfast programs for school children. provides education, awareness, training and advocacy for older adult health on a variety of wellness topics. included local food sourcing language in Seattle school nutrition policy.

Overweight Prevention Initiative



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Acting Food 2006 Policy Council for Seattle and King County Physical Activity Coalition Injury Free Coalition for Kids of Seattle Healthy Aging Partnership Farm-to-School Connections Team 2002


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1995 2004

40 62

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• Active Living by Design/Healthy Eating by Design 2003 30 • • •

Grants for Healthy Youth South King County & Seattle Food Committees





developing a strategic plan for furthering farm-toschool connections in King County and beyond. launched Seattle’s Safe Routes to School with connected nutrition program and new start-up checklist. established highly regarded walking audit approach. published TT Minor Elementary food environment map and the online Seattle Green Map with grassroots process. developed and evaluated food and fitness projects; leveraged additional funding to implement wellness policies in schools. coordinates and maximizes emergency food services.

Why our Community is Excited about Participating in the Food and Fitness Initiative This Initiative is precisely what we need to take the next critical steps to fill the gaps in our work, integrate efforts to create systems change and address disparities. While a moderate degree of coordination is occurring across these partnerships, much more is needed to develop an integrated, cross-sectoral approach to food and fitness by linking existing activities and filling gaps. We are enthusiastic about expanding our strong collaborations, implementing best-practices through projects and policies and engaging the political will for systems change. We know that we would learn and grow through our interactions with the Kellogg Foundation and would reciprocate by sharing our experience and knowledge. To further integration, we would a) expand programs linking local producers with restaurants, food retailers, restaurants and school/worksite cafeterias, b) make farmers’ markets more accessible to a wider population, c) create local processing and distribution facilities to increase markets for local food producers, d) acquire data on local barriers to physical activity and healthy food followed by coordination of work within schools, worksites, community centers and neighborhoods to address these barriers, e) expand partnerships that involve youth in gardening activities to create integrated agriculture and garden-based after-school programs such as a community garden-based urban 4-H and Youth Garden Works at Marra Farm, f) link schools, medical providers and families with community-based opportunities for physical activity. We would like to promote system-wide change including creation of a mandate for our Acting Food Policy Council; expanding policies that increase access to local food for low-income populations such as the farmers’ market nutrition programs; ensuring access to safe space for play and physical activity; furthering our current use of health impact assessment efforts to integrate health into land use decisions; and implementing school wellness policies. Our Past and Current Work in Food Systems, Physical Activity and Community Health Our community is currently engaged in programs and policymaking that integrate issues around nutrition, physical activity, built environment and land use to tackle the problem of overweight

and obesity. The King County Overweight Prevention Initiative has demonstrated the political will to address these issues and provides a strong framework to shift from program-based progress to systems-based change. Highlights of our Past and Current Work in Food Systems: Our region has long recognized the importance of a vibrant food system to the health of our community. Our work in this arena has been characterized by citizen activism, collaborative partnerships and a systems approach that addresses both policy and programming. Farmland Preservation & Support for Local Agriculture: As early as 1979, King County citizens took an interest in their local food system by establishing a farmland preservation program in 1979 – one of the first of its kind in the country. The King County Agriculture Commission was established in 1995. The subsequent Farm & Forest Report (1996) identified incentive-based strategies to continue farming in our county as well as the creation of two programs; Washington FarmLink, which links retiring and prospective farmers and the Puget Sound Fresh marketing program, both now operated by the non-profit Cascade Harvest Coalition. Urban-Rural Connections: Additional initiatives to build local markets include Washington State University (WSU) King County Extension’s Farm-to-School Connections Team of educators, parents and other advocates who work to better the nutrition environment in schools and open new markets for local farms and the recent Farmer-Chef Connections meeting, a collaborative between Ecotrust and local organizations. Food Policy: Long-time community efforts to establish a food policy council gained momentum when Seattle hosted the annual Community Food Security Coalition conference and the first national Farm-to-Cafeteria conference (2002). A series of “Growing a Regional Food Economy” forums in 2004 connected a wide range of food system stakeholders and resulted, with leadership from WSU King County Extension, in the establishment of the Acting Food Policy Council for Seattle and King County in 2006. In the same year, the City of Seattle formed an interdepartmental team and partnered with the University of Washington’s Program on the Environment and the Henry Luce Foundation to explore strategies that address inequities in access to local, healthy food and embedded environmental impacts of the local food system. These strategies would leverage current programs including a health promotion initiative, an edible food recovery project, support for emergency food providers, food-related climate protection efforts and the successful P-Patch Program with 70 community gardens across the city, special urban agriculture market gardens for immigrant and low-income populations, youth gardening and nutrition education. Highlights of our Past and Current Work in Physical Activity: Initiatives in King County have prioritized physical activity in both transportation and recreation. The King County Physical Activity Coalition promotes physical activity by shaping policy and programming for youth and families with the greatest need. They spearheaded the “Live Outside the Box” media campaign to reduce children’s screen time. Seattle, King County and Puget Sound Regional Council include walking and cycling as key elements in planning, such as Seattle’s newly commissioned Bike Master Plan. Jurisdictions within King County collaborate on bike trails, bicycle lanes and signed bike routes. Bike to Work/School Day drew 15,000 participants, including 2000 youth, with government, non-profit, club, business and school

support. The Seattle Department of Parks and Recreation has 28 community centers and 10 swimming pools, providing low-cost fitness and recreation activities, after-school and summer programs, meal programs and safe places for all ages to be active. Seattle Public Schools adopted progressive physical activity policies in 2005, with approximately 20 schools involved in Safe Routes to School activities. In 2006, King County began an employee wellness program focusing on nutrition and physical activity. Seattle has a Neighborhood Matching Fund that supports community driven projects including refurbished playgrounds and new food gardens. Many community-based programs in King County focus on promoting lifelong physical activity such as walking, biking, swimming, running and weight conditioning. For example, Children’s Hospital and Regional Medical Center, along with the YMCA of Greater Seattle, promotes lifestyle change for overweight youth and their families through their Strong Kids/Strong Teens program. Active Seattle, an Active Living by Design-funded project, works with five neighborhood health clinics to increase walking and biking through promotion of walking maps, Safe Routes to School and advocates for improving land use for more active living. Highlights of our Past and Current Work in Community Health: Community health approaches in King County are driven by a combination of data and community demand. The efforts to eliminate racial, ethnic and income – related disparities and to promote social justice are a priority for many community health programs in King County. Several such programs are described above (i.e. the Overweight Prevention Initiative, REACH 2010 and Steps to Health). REACH and Steps to Health are broad, population-based initiatives funded by the CDC that include planning and policy/system change efforts. REACH (Racial and Ethnic Approaches to Community Health) is a nationally mandated effort to address health disparities, while Steps to Health is nationally directed to prevent chronic disease (including obesity) with a local focus on addressing health disparities. Other community health initiatives that support active living include collaborations to prevent injuries among children and teens through bike, car and water safety and development of neighborhood walking maps and groups. The county has a well-established network of community health centers that coordinate with community-level programs. For example, Sea Mar Community Health Centers, serving primarily a Spanish speaking clientele and Harborview Medical Center serving all demographic groups, provide safety net services for the indigent. Both are partners in REACH and Steps to Health. Children’s Hospital Obesity Action Team is supporting several community clinics in making system change to improve care and prevention of pediatric overweight. Key Criteria for the Organizations in our Community to Serve as the Convener, Grantee and/or Fiscal Agent A convener, grantee and/or fiscal agent would: be successful at collaboration and committed to a participatory process; have a broad reach in the community; have a proven capacity for managing large multi-year grants with multiple partners and subcontracts; have been part of prior national demonstration projects; be well respected and trusted by policymakers, community members and fellow professionals; and have capacity to conduct training for other partners. We are considering co-conveners with expertise in local food, fitness and community health. In addition, the fiscal agent would have low overhead expenses, a track record of effective budget management of projects of this scope and organizational capacity given its current workload.


Our Community’s Readiness for System Change Much of the prior discussion indicates that King County is ready to make a qualitative jump in addressing food and fitness. Existing coalitions and programs see the need for systems building and policy change to increase the effectiveness of the many individual programs that are already in place. Local elected officials are concerned about obesity and ready to act. Our community has been working together to reduce obesity through the Overweight Prevention Initiative, a 2 year county-wide planning effort that addresses healthy eating, physical fitness and healthy built environments. We need to extend this work to local food systems. We also have engaged cuttingedge researchers at the University of Washington, Washington State University King County Extension, Children’s Hospital and Regional Medical Center and other institutions in the region to identify key questions, assist in program planning and conduct evaluations. Another indication of our community’s readiness is illustrated by the swift response to your invitation. Within two weeks, more than 40 people representing institutions, community based organizations, policymakers, businesses and foundations met to discuss a response. They made it clear that they were at the table to pursue the opportunity to influence policy, integrate activities and take a systematic approach to creating healthy food and built environments, rather than to obtain funds for their organizations’ individual programs. Our Collaborative’s Approach to the Community Action Planning Process To build the partnership, we will develop a governance structure and decision-making process with formal by-laws; conduct leadership development; and establish credibility with elected officials, businesses and community organizations through targeted outreach and implementation of a communication plan. We will build relationships through celebration, joint efforts and team building activities. The partnership will be well-positioned to conduct a participatory process to identify policy priorities and activities to include in the action plan. In order to gain broad input as we develop the plan, we will add partners. However, we recognize that some stakeholders (especially youth, community residents and businesses) may prefer alternative channels for participation rather than attending meetings or joining the partnership. Therefore, we will conduct focus groups and key informant interviews, develop time-limited workgroups and/or advisory committees, conduct community forums and attend meetings of established coalitions and organizations. We will analyze local data on health behaviors, food and fitness-related health outcomes, community assets and food access and availability to target and prioritize interventions. Our local health department has produced innovative assessments of community health issues and has access to a wide range of relevant data including community assets. We will propose an integrated set of cross-sectoral activities based on both evidence-based practice and practice-based evidence through review of peer-reviewed and gray literature, consultation with experts (in the community, academia and the public sector) and web review. We will conduct pilot activities during the planning period to guide selection of interventions for the second phase and to assure that the infrastructure needed to implement phase two is in place. Preparation of the plan will occur in multiple contexts in order to facilitate meaningful involvement of the wide range of stakeholders. The principle locus will be monthly steering committee meetings of the partnership, open to all interested parties. Workgroups will prepare detailed assessments and plans for steering committee review and action. The steering committee


will present proposals at the full partnership meetings for review and approval. Partnership retreats will be scheduled for more in-depth discussions, facilitated by an external moderator. We will use established methods and models such as PRECEDE-PROCEED, the social-ecologic model, the Community Tool Box, From the Ground Up! and community based participatory research (CBPR) methods to guide the planning process and partnership development. We will develop communication mechanisms based on partner preferences that may include a website, extranet, list-serve, email groups, media and a newsletter. Our Approach to Evaluation and the Quality and Availability of Data Evaluation of the planning phase will focus on providing formative and summative feedback on progress of the partnership in developing the characteristics of a successful coalition and preparing the action plan. We will use methods of CBPR and “empowerment evaluation” to assure the collaborative nature of the evaluation. Outcome measures to assess action plan development may include completion of specific, measurable products such as an asset map and needs assessment; prioritized actions for phase two; a community action plan which includes integrated partner activities; systems change strategies and a plan for coordination with other regional planning processes. The evaluation will assess the degree to which the plan takes into account best practices, local conditions and the local political, economic, cultural and ecological environment. A second set of indicators will measure the attainment of characteristics of successful coalitions, (i.e. membership, structure, bylaws, leadership, trainings, enhanced member skills, new collaborative efforts, completion of vision and mission statements, effectiveness, visibility) from the perspectives of members and key stakeholders outside the partnership. This evaluation will primarily use qualitative techniques. We will collect data from participant observation at partnership meetings, in-depth semi-annual interviews with representative members, reports, meeting notes, attendance lists, products and activity logs of partners. Qualitative data may be supplemented with an annual member survey assessing satisfaction with the partnership using tools such as CSAS. A number of our current partners have nationally recognized research and data capabilities including the Center for Public Health Nutrition at the University of Washington (Drewnowski et al), the Epidemiology, Planning and Evaluation Unit of Public Health (Krieger, et al) and the Group Health Community Foundation (Beery & Cheadle, et al). All have extensive experience evaluating coalition-based approaches to community health promotion. Through a collaborative effort, the evaluation team will be selected by the project steering committee. In Summary King County, Washington and its surrounding region is ready and eager to further our efforts to improve our systems of healthy food accessibility; infrastructure and program support of physical activity; and overall efforts to reduce obesity, other chronic conditions and risk factors and health disparities. Our strengths lie in our extensive resources and expertise, tangible political will and our broad base of knowledgeable community partners who will work together and with policy makers to develop and implement policies and programs to further these ends.


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