6/24/2013

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Nancy Aycock, Center TRT

Center for Health Promotion and Disease Prevention

University of North Carolina at Chapel Hill

and

Sabrina Baronberg, MPH

Director

Food Access and Community Health

New York City Department of Health

and Mental Hygiene

Health Bucks New York City

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What We Will Cover ….

• Housekeeping

• Overview of Center TRT

• Overview of Health Bucks

• Public Health Impact of

Health Bucks

• How Health Bucks works

• Q and A

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Housekeeping…

• If you are calling in on a phone line – turn

your computer volume all the way down.

• Please save questions for the end of the

presentation

• All participant lines are muted

• Technical difficulties – please use the chat

box

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Center for Training and Research Translation

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Center TRT – Web-Based Training

• Nutrition and Health Module

– Nutrition 101

– Policy and Environmental Supports for Healthy Eating

• Physical Activity and Health Module

• Intervention Specific Modules

– Nutrition and Physical Activity Self Assessment in Child Care

(NAP SACC)

– A New Leaf… Choices for Healthy Living

• RE-AIM (program planning and evaluation framework) – revised

training coming late 2013

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Center TRT – Intervention Translation

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What are Health Bucks?

• Health Bucks are $2 coupons

• Can only be used to purchase fruits and vegetables at farmers’ markets participating in the program

• Offer a financial incentive for residents of low-income neighborhoods and food stamp users to increase their consumption of fresh, locally grown produce

• Add to income of local farmers

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Health Bucks

Core Elements

• Farmers’ markets participation in the program

• Distribution system for incentives (HB coupons)

• Tracking system for monitoring coupon use

• System for redeeming coupons from farmers

• Mechanism to reimburse farmers for their coupons

• Means to promote incentives to ensure high use and redemption rates

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Potential for Public Health Impact

Reach

Health Bucks began in 2005 as a pilot. 2012 market season was 8th year of operation. Center TRT review of Health Bucks was based on 2010 evaluation data.

2005 Total HB Distribution

2010 Total HB Distribution

2005 HB Redemption Rate

2010 HB Redemption Rate

3,000 138,930 25% 83%

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Potential for Public Health Impact

Effectiveness

•HB redemption rate has increased every year.

•HB has increased EBT use at farmers’ markets.

•HB incentives provided to SNAP users are effective in increasing EBT sales at farmers’ markets

•Number of farmers’ markets willing to locate in low-income neighborhoods has increased

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Potential for Public Health Impact

Adoption, Implementation, and Maintenance

• Farmers’ markets participating = 60

Started with 5

• Farmers participating = 81

Started with 15

• Farmers revenues = Ave. $2,800

Started at $200

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Health Bucks: Incentivizing healthy food purchases

at NYC Farmers Markets

Sabrina Baronberg Director, Food Access and Community Health Programs

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Polling Questions

1. Do you have a farmers market incentive program in your City/Area?

2. If so, is it linked to EBT spending?

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Obesity is Epidemic in NYC • FV Consumption Lowest in Areas with Highest Rates of Obesity

• Obesity and FV consumption worst in Low Income Areas

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Access to Fresh Produce Varies Widely By Neighborhood

• In 2005, few farmers markets were located in low income areas ( ≈ 1/3)

• Health Bucks provided the income and customer stability markets needed to venture into new areas

• Now more than half of all farmers markets in the city are in low income areas and 91% accept EBT

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Health Bucks Program History

• 2005: Piloted in South Bronx with approximately 3000 Health Bucks

• 2006: Expanded to all three DPHO areas

• 2007: EBT incentive added

• 2008: Funding secured to expand EBT incentive

• 2010: Over 130,000 Health Bucks distributed to over 160 CBOs and 60 farmers markets

• 2012: Sufficient funding received to expand initiative to all

farmers markets in the City

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How are Health Bucks Funded?

• Pilot with <10 markets : NYC DOHMH

• Expansion to all DPHOs: NYC DOHMH

• EBT Incentive to DPHO markets: HRA

• EBT Incentive at all markets: HRA, DOHMH

• CBO and other: OTF, CPPW, DOHMH

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How Do Health Bucks Work?

• 2005-2007, Health Bucks only given to CBOs to support nutrition programming

• In 2007, Health Bucks expanded to include incentive for EBT use (for every $5 spent in EBT, get a $2 Health Buck, unlimited

• Now approx 20% of Health Bucks given to CBOs, remainder as EBT incentive

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2012 Season Overview

• Over 213,000 Health Bucks or $426,000.00

was distributed in all 5 boroughs to:

– 119 farmers’ markets with EBT

– 192 organizations

– 20 Stellar Farmers’ Markets

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Markets Accepting Health Bucks (2005-2012)

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Health Bucks Redemption Rates

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Effects of Health Bucks are Numerous

Health Bucks

Drives shoppers to

markets

Helps farmers site and be

profitable in low-income

areas

Sustains regional

agriculture

Encourages EBT spending on healthful

items

Supports community

based nutrition programs

Increases access

(affordability, etc) of

healthy foods

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Health Bucks Increase SNAP Sales

at NYC Farmers' Markets

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Case in Point First Year of Expansion

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Farmers Market Programs Video

• http://www.youtube.com/watch?v=7BVjczr6e6U

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What We’ve Learned Over the Years…

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Knowledge Still a Major Barrier 27

Promoting SNAP Use (not just at market) is Critical

Why is it important?

• SNAP sales at markets that accept Health Bucks more than double

• EBT use at markets increases each year

• Community organizations still report not knowing markets accept EBT

Best Practices:

• Post signage – at market and nearby

• Train your EBT operators

• Partner with local organizations

• Track sales

• How else do you promote EBT acceptance at your markets?

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Try Farmers’ Market Walking Tours “Seeing the freshness of the produce has made me want to eat healthier.”

• Organizations that have applied to

receive Health Bucks can go on farmers’ market walking tours with Health Department staff

• Curriculum covers information about the benefits of eating seasonal, local produce and spending SNAP benefits (EBT) at markets

• Each tour completes an activity such as farmers’ market bingo

• In 2012, 514 community residents went on 56 walking tours

• And spent 839 Health Bucks or $1,678.00

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Walking Tour Feedback

• “It made me aware of the many farmers’ markets, why it is important and less expensive to use and support these markets.”

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Cross Promotion and Programming Works

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https://www.facebook.com/EatingHealthyNYC

Specifically… • Use similar branding and colors for all food retail

programs • Cross promote them at other sites (day cares,

schools, senior centers, CBOs, etc) • Ensure coupons have VOID banners • Use a different color every year and make

expiration dates clear • Talk about “how” to get them, not “what” they

are • Support farmers markets to decrease other

barriers, like cooking skills

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Stellar Farmers’ Markets • Provides free, bilingual nutrition and cooking classes at farmers’ markets • Participants learn how to select, store and prepare farm-fresh produce while

living on a limited income. • All participants receive nutrition and recipe handouts, taste samples of the

featured recipe, and Health Buck coupons and/or free cooking equipment.

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CBOs Need Support to Increase

Redemption Rates Distribution:

• Health Bucks should be stored in a locked drawer, cabinet or room when

not at market.

• Encourage customers to maximize their food stamp dollars by spending

in $5 increments.

• Health Bucks should be given out at the time of EBT swipe

• Distribute Health Bucks in order of serial numbers to make tracking

easier.

Promotion:

• Post Health Bucks promotional materials at the

market manager table or tent; including banners,

aprons and buttons

• Distribute the farmers’ market maps with Health Bucks

• Local organizations and groups can schedule

a farmers’ market walking tour

CBO Best Practices:

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Tracking and Accountability Are KEY: (use bar codes!)

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Health Bucks Successes

• Replicated across the country

• Recognized as a best practice by RWJ, CDC, and TRT

• CDC 2013 State Indicator Report on Fruits and Vegetables

• Fund for Public Health in NYC donation/purchase portal (http://www.fphny.org/whatsnew/healthbucks)

• All NYC markets searchable on nyc.gov/health/farmersmarkets

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What’s Next?

• Investigating electronic mechanism for Health Buck distribution

• Policy goal to support automatic incentive for FV purchases by EBT users

• Monitoring national incentive programs to consider replication in supermarkets

• Supporting all markets to ensure they have capacity to accept EBT

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Comments/Questions?

Sabrina Baronberg

Director, Food Access and Community Health

NYC Dept of Health

42-09 28th St, 9th Floor

Long Island City, NY

347-396-4307

sbaronbe@health.nyc.gov

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