Delivering Community Benefit:
Healthy food playbook

From school gardens to farmers markets, community investments pay off

Orange Center Elementary teaching garden

From school gardens to farmers markets, community investments pay off

Orlando Health - Florida
Collaborative efforts focus on healthy food access in underserved communities across Central Florida including school teaching gardens and farmers markets.

Takeaways

  • A region-wide community health needs assessment (CHNA) identified poverty, access to healthy food, and obesity as persistent problems across central Florida.
    • Significant areas have low, poor, or no access to healthy retail food outlets, based on Modified Retail Food Environment Index scores.
    • Twenty-five percent of adults are obese and 10 percent have diagnosed diabetes.
  • Orlando Health’s community benefit strategy around increasing access to healthy food is a means to prevent obesity and reduce health care costs for diet-related health conditions.
  • Through partnership and community grants, Orlando Health funds multi-faceted programs: 
    • Healthy Teaching Garden: With support from Orlando Health’s Arnold Palmer Hospital for Children, 345 students at Orange Center Elementary learn about the importance of healthy eating and physical activity via a teaching garden. With the garden, healthy lifestyle lessons are incorporated into reading, writing, art, science, math, and other curricula. There is also a STEM (science, technology, engineering, math) component to the garden.  
    • Second Harvest Food Bank of Central Florida: The Orlando Health Community Grant Program supported multiple projects, including expanded refrigeration and healthy meals for at-risk populations.
    • Goldsboro Farmers Market: Increases healthy food access and creates business opportunities for residents to sell homegrown food.
       
Hospital
  • Hospital Size: Medium (158 beds)
  • Hospital Type: Private, nonprofit children’s hospital
  • Geographic Area: Metro/urban 
  • System Network: Orlando Health
  • Network/system/hospital coverage:  Central Florida
     
Demographics
  • Race
    • Asian: 5.6% 
    • Black: 22.2%
    • White: 69%
    • Identify with more than two racial groups: 2.5%
  • Ethnicity
    • Hispanic: 30%
    • Non-Hispanic: 70%
       
Community
  • CHNA Region: Orange County
  • Population: 1.3 million (Orange County)
     
Health indicators
  • Adult Obesity: 25% 
  • Poverty: 18.2%
     
“There is a lack of healthy options and it is hard to make healthy choices when you are surrounded by unhealthy options.”

- Stephanie Carrington, Orange Center Elementary STEM coordinator

Orange County, Florida, home to Arnold Palmer Hospital for Children, has a growing and increasingly diverse population. The county experienced a 40 percent population increase between 2000 and 2014. Children under age 14 make up the largest portion of the county’s population (19 percent). Nearly 20 percent of children live below the federal poverty level and 61 percent qualify for free or reduced lunch. 

Orange County residents face significant health and economic challenges related to food. Obesity is an issue across the age spectrum, and many areas have limited access to healthy foods. Across Orange County, there are multiple areas designated as food deserts that overlap with areas having high numbers of residents who receive Supplemental Nutrition Assistance Program (SNAP) benefits. The majority of census tracts across the region also reported low fruit and vegetable expenditures.

Orlando Health collects biometric data (height, weight, body mass index) at both the annual planting and harvest events and plans to analyze this data to assess changes over time (Orlando Health).
Orlando Health volunteers check students' health metrics, part of a healthy eating and cooking education program at Orange Center Elementary School in Florida  (Orlando Health)

Community health needs assessment: Priorities and process

  • Food and diet-related disease priorities: obesity, diabetes, heart disease, access to quality and nutritious food
  • Participation by food-related organizations: Second Harvest Food Bank of Central Florida
  • How/why did food issues emerge as priority area? 
    • Primary data (community conversations, stakeholder interviews, and consumer surveys) and secondary data revealed food insecurity, specifically access to nutritious foods, as an issue. 
  • Key community indicators (for Orange County):
    • Upward trend of high school students with body mass index (BMI) greater than the 95th percentile.
    • Increasing rate of diabetes hospitalizations for children 12 to 18 years old.
    • Twenty-five percent of adults are obese and 10 percent have diagnosed diabetes.
    • Presence of multiple food deserts, which overlap with areas where a high number of SNAP beneficiaries live.
    • A significant portion of the county has a Modified Retail Food Environment Index score indicating low, poor, or no access to healthy retail food outlets.
    • All census tracts across the region reported low expenditures for fruits and vegetables.

Full Assessment: Central Florida Community Benefit Collaboration 2016 Community Health Needs Assessment 
 

Assessing health needs — and how to meet them

Community health needs assessment process

Orlando Health conducted its CHNA as part of the Central Florida Community Benefit Collaboration. Established in 2016,  this effort brought together three health systems and the health departments of Lake, Osceola, Orange, and Seminole counties. The report combines a regional perspective with county-level views and supports comprehensive planning efforts across health departments and hospitals. 

The collaboration’s participants identified organizations and stakeholders to take part in the CHNA process, looking for both a diverse set of perspectives and for far-reaching presence in the region. Second Harvest Food Bank of Central Florida, which works with more than 500 organizations across Central Florida, met those criteria. In addition to its food bank, it runs a culinary job training program, SNAP and Women, Infants, and Children (WIC) Food and Nutrition Service benefit enrollment services, and disaster relief programs. With its broad presence and first-hand knowledge of community food needs and resources, Second Harvest made valuable contributions to the assessment process.

 

Orlando Health staff members volunteer at Orange Center Elementary School’s Healthy Living Garden

Orlando Health staff members volunteer at Orange Center Elementary School’s Healthy Living Garden

 

Greens growing in the healthy teaching garden

Orlando Health staff members volunteer at Orange Center Elementary School’s Healthy Living Garden

Healthy Teaching Garden

Orange Center Elementary School’s garden creates an interactive venue for students to see up close and learn how plants grow a while implementing good food choices. Hospital team members dedicate time to delivering health and nutrition education and to planning and carrying out planting and harvest days (Orlando Health).

The 2016 assessment identified poverty among its key “areas of concern.” Across secondary and primary data review (including a consumer survey, provider survey, stakeholder in-depth interviews, and community conversations) healthy food access and affordability stood out as significant health issues. For Orange County specifically, obesity, heart disease, diabetes, food insecurity, and access to care were identified as key health themes. 

Orlando Health’s CHNA and community benefit efforts are conducted through the community benefit department, which falls under external affairs and community relations. Lainie Fox Ackerman, director of community benefit, oversees the CHNA process and the community benefit activities of the system’s nine wholly-owned or affiliated hospitals.

Individual hospitals undertake community benefit activities that align with the system’s identified priority health needs and address the needs of the specific populations they serve.  Primary prevention of obesity, the focus of Arnold Palmer Hospital for Children, aligns with Orlando Health’s system-wide focus on access to care issues and connects back to the understanding that influencing children’s behaviors will help them grow into healthy adults.

Investing in solutions

Implementation strategy

Orlando Health’s community benefit strategy combines financial support and direct team member participation. The health system’s community grant program supports multiple initiatives designed to increase access to healthy food. Team members take part directly in project related activities (nutrition education) and through involvement in collective efforts to address health and hunger issues for highly vulnerable populations. 

Ongoing work

Orlando Health is continually exploring how to best support healthy food access for vulnerable populations in the communities it serves.  Orlando Health is strongly committed to continued support of the Orange Center healthy teaching garden. Through its participation in LIFT, the hospital hopes to increase community involvement in the garden, supporting the growth of connections and relationships among the neighborhoods diverse residents.

Orlando Health recognizes the need for tailored approaches to address unique health needs within high-risk populations and  is also supporting  new programs that do so:

  • Libby’s Pink Ribbon Garden: This garden serves breast cancer patients and survivors. The garden operates on a give-one-get-one model with breast cancer survivors growing organic vegetables that they can harvest for themselves and for distribution to low-income and under- or uninsured breast cancer patients.  In fall of 2017, they will launch a pilot to study the impact of a plant-based diet for breast cancer patients. 
  • Seniors First: Orlando Health awarded a $15,000 grant to fund Senior’s First, a meals on wheels program for high-risk seniors. The grant will support 30 days of meals (an estimated 2,000 total meals) to seniors who have recently been discharged from a hospital or have recently lost a caregiver.

Orlando Health is also supporting a new farmers market, in collaboration with the City of Orlando and Orlando City Soccer Club, located adjacent to the LIFT Orlando footprint. As a system, Orlando Health intends to further address food security and healthy food access issues through the implementation of food insecurity screenings and food donations and distribution.

Orlando Health staff members volunteer at Orange Center Elementary School’s Healthy Living Garden
Orlando Health's commitment to the garden and promoting children’s health links back to its mission to promote community health and well-being...and end the cycle of intergenerational poverty in the West Lakes community (Orlando Health).

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