letter of intent (to kellogg) 8-16-06

8/14/2019 Letter of Intent (to Kellogg) 8-16-06

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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 andtechnological 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 suchas Seattle and Bellevue and small rural towns, is home to a number of initiatives that aim tomake it easier to eat well and live actively. Efforts are underway to shape our local food systemto support sustainable agriculture and provide fresh food to King County residents, especiallythose in underserved communities. Last year, the King County Board of Health adopted a 10-point plan with specific goals for promoting nutrition, increasing physical activity and improvingthe built environment and land use to reduce overweight and obesity prevalence in ourpopulation. With this foundation, we are poised to integrate these activities horizontally acrossprogram areas and vertically across socio-ecologic levels. Efforts are also underway to eliminatehealth disparities among racial, ethnic and low socioeconomic populations.

Participating in the Planning Phase of the Food and Fitness Initiative would allow coordinationof these broad-based community efforts into an integrated system. The creation of acomprehensive community plan would leverage resources, facilitate partnerships andsignificantly expand our communitys 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 environmentalsustainability.

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 torealize the above goals.

As a result of our initial planning in response to your invitation, we identified several areas thatneed attention to reach these goals. Communication and coordination among existingstakeholders 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 electedofficials about the connections between local food and public health; increase access to healthyfood and physical activity; develop innovative policies; decrease costs of local, sustainablyproduced food; decrease overweight and health disparities; and assure that regional planningprocesses include a focus on food systems and agricultural policy.

Participants in developing this letter recognize that food systems activists, physical activityproponents and community health promotion advocates have largely operated in separate arenas.They see integrating efforts and making connections between food, activity and community

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health as mutually beneficial and the next logical step for expanding the effectiveness of theirefforts.

Our Community and the Target Area of Focus

The Seattle-King County region covers 2000 square miles with approximately 43,000 acres offarmland (approximately 3% of the total area). Farmed acreage declined by 20% between 1997and 2002, with a corresponding decline in number and size of farms. Positively, the number offarms certified as organic tripled from 7% to 23% between 1995 and 2004 and the number oflocal farmers markets and community supported agriculture programs increased. Sales at countyfarmers markets totaled approximately $10,000,000 in 2005.

King County is home to 1.8 million residents. African Americans, Asian/Pacific Islanders andpersons 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, CentralAmerica, Eastern Europe, Asia and Africa. Our ethnic diversity is also reflected in the more than100 languages spoken by families in the Seattle School District.

Despite a generally healthy economy, economic disparities present a major challenge. Nearly aquarter of the population lives in households with incomes below 200% of the federal povertylevel. Food insecurity affects 10% of households. Disparities in health are also a significantconcern. While half of our residents are overweight or obese, low-income people are 1.3 timesmore likely to be obese than wealthier residents, African Americans are 1.6 times more likely tobe obese than whites and residents of suburban south King County are 1.6 times more likely tobe obese than residents of urban Seattle. Disparities in physical activity are even morepronounced. Overall, 44% of residents do not meet national activity recommendations. Latinosreport having no physical activity at a rate 1.9 times higher than whites, low income people at arate 2.9 times higher than high income people and residents of suburban south King County at arate 4 times higher than residents of urban Seattle.

We will define two levels of community for the purposes of this proposal. Because food systemsby definition include rural areas for food production, we will include the Puget Sound region inour food systems work. This area provides year round agriculture and serves approximately 28farmers markets in the County. Because interventions to promote healthy eating and activeliving are more effective when concentrated within smaller communities, we will select severalcommunities most affected by disparities. Our planning process will select the specificcommunities based on health and social indicators, food access, availability of supportiveenvironments for physical activity and community readiness for change. Data from public healthand regional planning efforts will help inform this selection. We will likely focus on those withhigh 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 poornutrition 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, communitybuilding and participatory planning. Several successful coalitions are active in the food andfitness arena and are ready to participate in this Initiative. The shaded examples listed in the tablebelow are mature partnerships with a transparent structure defined through formal operational

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procedures, established communications systems and local (as well as national) recognition.These coalitions have emphasized capacity development of their members and integration ofmember activities. Below these are a few examples of the many partnerships formed for specificcollaborative projects. All of these partnerships have established valuable cross-sector and cross-institution relationships and the trust and good will for moving ahead together.

Name Founded # Partners Activities & Accomplishments

REACH 2010 1999 68 assessed current status of diabetes prevention and

control efforts among minority communities.

implemented diabetes education and chronic disease

self-management classes, faith-based education, cliniccase coordination and community business activities.

programs improved physical activity and nutrition

behaviors and disease management self-efficacy.

Steps to Health 2003 75 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 breakfastparticipation, walk-to-school activities and a revisedphysical education curricula.

OverweightPreventionInitiative

2004 75 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 topromote healthy eating, physical activity and healthierbuilt environments.

Acting FoodPolicy Council forSeattle and KingCounty

2006 15 convenes stakeholders to holistically address food

systems issues.

develops strategy, relationships and infrastructure for

an officially recognized council for Seattle/KingCounty.

Physical ActivityCoalition

2002 30 presents annual awards to PE teachers who excel.

provides communication, collaboration and networkin

for organizations working to increase physical activity

Injury Free

Coalition for Kidsof Seattle

2004 3 conducts walking school bus programs in concert with

school breakfast programs for school children.

Healthy AgingPartnership

1995 40 provides education, awareness, training and advocacy

for older adult health on a variety of wellness topics.

Farm-to-SchoolConnectionsTeam

2004 62 included local food sourcing language in Seattle schoo

nutrition policy.

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developing a strategic plan for furthering farm-to-

school connections in King County and beyond.

Active Living byDesign/HealthyEating by Design

2003 30 launched Seattles Safe Routes to School with

connected nutrition program and new start-upchecklist.

established highly regarded walking audit approach.

published TT Minor Elementary food environment ma

and the online Seattle Green Map with grassrootsprocess.

Grants forHealthy Youth

2003 4 developed and evaluated food and fitness projects;

leveraged additional funding to implement wellnesspolicies in schools.

South KingCounty & SeattleFood Committees

1984 46 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 ofcoordination is occurring across these partnerships, much more is needed to develop anintegrated, cross-sectoral approach to food and fitness by linking existing activities and fillinggaps. We are enthusiastic about expanding our strong collaborations, implementing best-practicesthrough projects and policies and engaging the political will for systems change. We know thatwe would learn and grow through our interactions with the Kellogg Foundation and wouldreciprocate 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 moreaccessible to a wider population, c) create local processing and distribution facilities to increasemarkets for local food producers, d) acquire data on local barriers to physical activity and healthyfood followed by coordination of work within schools, worksites, community centers andneighborhoods to address these barriers, e) expand partnerships that involve youth in gardeningactivities to create integrated agriculture and garden-based after-school programs such as acommunity 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-incomepopulations such as the farmers market nutrition programs; ensuring access to safe space forplay and physical activity; furthering our current use of health impact assessment efforts tointegrate 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 aroundnutrition, physical activity, built environment and land use to tackle the problem of overweight

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and obesity. The King County Overweight Prevention Initiative has demonstrated the politicalwill to address these issues and provides a strong framework to shift from program-basedprogress 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 ourcommunity. Our work in this arena has been characterized by citizen activism, collaborativepartnerships and a systems approach that addresses both policy and programming.

Farmland Preservation & Support for Local Agriculture: As early as 1979, King County citizenstook an interest in their local food system by establishing a farmland preservation program in1979 one of the first of its kind in the country. The King County Agriculture Commission wasestablished in 1995. The subsequent Farm & Forest Report (1996) identified incentive-basedstrategies to continue farming in our county as well as the creation of two programs; WashingtonFarmLink, which links retiring and prospective farmers and the Puget Sound Fresh marketingprogram, both now operated by the non-profit Cascade Harvest Coalition.

Urban-Rural Connections: Additional initiatives to build local markets include Washington StateUniversity (WSU) King County Extensions Farm-to-School Connections Team of educators,parents and other advocates who work to better the nutrition environment in schools and opennew markets for local farms and the recent Farmer-Chef Connections meeting, a collaborativebetween Ecotrust and local organizations.

Food Policy: Long-time community efforts to establish a food policy council gained momentumwhen Seattle hosted the annual Community Food Security Coalition conference and the firstnational Farm-to-Cafeteria conference (2002). A series of Growing a Regional Food Economyforums in 2004 connected a wide range of food system stakeholders and resulted, with leadershipfrom 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 aninterdepartmental team and partnered with the University of Washingtons Program on theEnvironment and the Henry Luce Foundation to explore strategies that address inequities inaccess to local, healthy food and embedded environmental impacts of the local food system.These strategies would leverage current programs including a health promotion initiative, anedible food recovery project, support for emergency food providers, food-related climateprotection efforts and the successful P-Patch Program with 70 community gardens across thecity, special urban agriculture market gardens for immigrant and low-income populations, youthgardening 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 andprogramming for youth and families with the greatest need. They spearheaded the Live Outsidethe Box media campaign to reduce childrens screen time. Seattle, King County and PugetSound Regional Council include walking and cycling as key elements in planning, such asSeattles newly commissioned Bike Master Plan. Jurisdictions within King County collaborateon bike trails, bicycle lanes and signed bike routes. Bike to Work/School Day drew 15,000participants, including 2000 youth, with government, non-profit, club, business and school

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support. The Seattle Department of Parks and Recreation has 28 community centers and 10swimming pools, providing low-cost fitness and recreation activities, after-school and summerprograms, meal programs and safe places for all ages to be active. Seattle Public Schools adoptedprogressive physical activity policies in 2005, with approximately 20 schools involved in SafeRoutes 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 supportscommunity driven projects including refurbished playgrounds and new food gardens. Manycommunity-based programs in King County focus on promoting lifelong physical activity suchas walking, biking, swimming, running and weight conditioning. For example, ChildrensHospital and Regional Medical Center, along with the YMCA of Greater Seattle, promoteslifestyle change for overweight youth and their families through their Strong Kids/Strong Teensprogram. Active Seattle, an Active Living by Design-funded project, works with fiveneighborhood 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 andcommunity demand. The efforts to eliminate racial, ethnic and income related disparities and topromote 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, REACH2010 and Steps to Health). REACH and Steps to Health are broad, population-based initiativesfunded by the CDC that include planning and policy/system change efforts. REACH (Racial andEthnic Approaches to Community Health) is a nationally mandated effort to address healthdisparities, while Steps to Health is nationally directed to prevent chronic disease (includingobesity) with a local focus on addressing health disparities. Other community health initiativesthat support active living include collaborations to prevent injuries among children and teensthrough 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 withcommunity-level programs. For example, Sea Mar Community Health Centers, serving primarilya 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.Childrens Hospital Obesity Action Team is supporting several community clinics in makingsystem 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 aparticipatory process; have a broad reach in the community; have a proven capacity formanaging large multi-year grants with multiple partners and subcontracts; have been part of priornational demonstration projects; be well respected and trusted by policymakers, communitymembers and fellow professionals; and have capacity to conduct training for other partners. Weare considering co-conveners with expertise in local food, fitness and community health. Inaddition, the fiscal agent would have low overhead expenses, a track record of effective budgetmanagement of projects of this scope and organizational capacity given its current workload.

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Our Communitys Readiness for System Change

Much of the prior discussion indicates that King County is ready to make a qualitative jump inaddressing food and fitness. Existing coalitions and programs see the need for systems buildingand policy change to increase the effectiveness of the many individual programs that are alreadyin 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 yearcounty-wide planning effort that addresses healthy eating, physical fitness and healthy builtenvironments. We need to extend this work to local food systems. We also have engaged cutting-edge researchers at the University of Washington, Washington State University King CountyExtension, Childrens Hospital and Regional Medical Center and other institutions in the regionto identify key questions, assist in program planning and conduct evaluations.

Another indication of our communitys readiness is illustrated by the swift response to yourinvitation. Within two weeks, more than 40 people representing institutions, community basedorganizations, policymakers, businesses and foundations met to discuss a response. They made itclear 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 toobtain funds for their organizations individual programs.

Our Collaboratives Approach to the Community Action Planning Process

To build the partnership, we will develop a governance structure and decision-making processwith formal by-laws; conduct leadership development; and establish credibility with electedofficials, businesses and community organizations through targeted outreach and implementationof a communication plan. We will build relationships through celebration, joint efforts and teambuilding activities. The partnership will be well-positioned to conduct a participatory process toidentify policy priorities and activities to include in the action plan. In order to gain broad inputas we develop the plan, we will add partners. However, we recognize that some stakeholders(especially youth, community residents and businesses) may prefer alternative channels forparticipation rather than attending meetings or joining the partnership. Therefore, we willconduct focus groups and key informant interviews, develop time-limited workgroups and/oradvisory committees, conduct community forums and attend meetings of established coalitionsand organizations. We will analyze local data on health behaviors, food and fitness-related healthoutcomes, community assets and food access and availability to target and prioritizeinterventions. Our local health department has produced innovative assessments of communityhealth 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-basedpractice 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 forthe 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 meaningfulinvolvement of the wide range of stakeholders. The principle locus will be monthly steeringcommittee meetings of the partnership, open to all interested parties. Workgroups will preparedetailed assessments and plans for steering committee review and action. The steering committee

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will present proposals at the full partnership meetings for review and approval. Partnershipretreats 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-ecologicmodel, the Community Tool Box, From the Ground Up! and community based participatoryresearch (CBPR) methods to guide the planning process and partnership development. We willdevelop 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 onprogress of the partnership in developing the characteristics of a successful coalition andpreparing the action plan. We will use methods of CBPR and empowerment evaluationtoassure 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 changestrategies and a plan for coordination with other regional planning processes. The evaluation willassess the degree to which the plan takes into account best practices, local conditions and thelocal 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, newcollaborative efforts, completion of vision and mission statements, effectiveness, visibility) fromthe perspectives of members and key stakeholders outside the partnership.

This evaluation will primarily use qualitative techniques. We will collect data from participantobservation 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 withthe partnership using tools such as CSAS.

A number of our current partners have nationally recognized research and data capabilitiesincluding the Center for Public Health Nutrition at the University of Washington (Drewnowski etal), the Epidemiology, Planning and Evaluation Unit of Public Health (Krieger, et al) and theGroup Health Community Foundation (Beery & Cheadle, et al). All have extensive experienceevaluating coalition-based approaches to community health promotion. Through a collaborativeeffort, the evaluation team will be selected by the project steering committee.

In SummaryKing County, Washington and its surrounding region is ready and eager to further our efforts toimprove our systems of healthy food accessibility; infrastructure and program support ofphysical activity; and overall efforts to reduce obesity, other chronic conditions and risk factorsand health disparities. Our strengths lie in our extensive resources and expertise, tangiblepolitical will and our broad base of knowledgeable community partners who will work togetherand with policy makers to develop and implement policies and programs to further these ends.

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letter of intent (to kellogg) 8-16-06

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