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Good afternoon, everyone. This is Julia Schneider, Director of Chronic Disease Prevention at
the Association of State and Territorial Health Officials. I would like to welcome you to
todayís interactive webinar, Salt and Your State: Sodium Reduction through Procurement
Strategies.
For several years ASTHO has been working with state health agencies to improve the nutritional
content of student food and decrease the consumption of sodium. From 2010 to 2013 ASTHO, with support
from CDCís Division for Heart Disease and Stroke Prevention convened a working group
of seven states aimed at building their capacity for sodium reduction efforts and specifically
focused on using government food procurement to improve the nutritional quality of food
for state employees and state program clients. Two of the participating states, Massachusetts
and Arkansas, will present about their sodium reduction efforts during this webinar. In
addition, Washington State will speak about their recently passed executive order to ensure
access to healthy foods in state facilities.
We have an esteemed panel of experts that will be speaking with you today. Following
my introduction all of the speakers will present about the various strategies in their states
to address healthy eating. If you have a question for one of our speakers please post it to
the chat box on your screen at any time during the webinar. These questions will be used
during the Q&A after todayís presentation.
At the conclusion of the webinar you will be directed to an evaluation survey. Please
take a few minutes to inform us about the work you are doing to encourage healthy eating
and reduce sodium consumption and provide us with feedback on todayís webinar. We look
forward to hearing your comments and will follow up with you afterwards. Also, a recording
of this webinar will be posted to our website in the next few days. The site is available
is on the last slide.
Next I would like to introduce Jessica Levings from CDC. Jessicaís comes as a federal contractor
and policy analyst at the Division for Heart Disease and Stroke Prevention and supports
the agencyís sodium reduction initiative. Jessica.
Thank you, Julia, and thank you, everyone for joining the webinar. We do hope the information
thatís provided today will help you with your sodium reduction efforts. We also just
wanted to let you know about a new exciting resource that would also ñ you can also find
helpful, a supplemental issue of the Journal of Public Health Management and Practice has
just published a supplement related to CDCís Sodium Reduction in Communities program work,
and it really covers the methods and the progress and the lessons learned from the first round
of communities. It was published online ahead of print in an open-access publication on
the Journalís website. And for those of you who arenít familiar, the Sodium Reduction
in Communities program was launched by the CDC in 2010 and they worked on the local level
to increase the availability and access to lower sodium foods in settings like schools,
work sites, grocery stores, restaurants, and congregate meal programs for older adults.
If youíre interested in reading the articles in the supplement you can visit the Journal
of Public Health Management and Practice and youíll find it there online. And thank you
again for joining the webinar today.
Great. Thanks, Jessica. Our first speaker is Katie Bishop. Katie is a nutrition policy
associate at Center for Science in the Public Interest, CSPI, a leading health advocacy
organization that specializes in food nutrition and obesity prevention. Katie.
Hello, everyone. So at CSPI I specifically work on providing support and technical assistance
to states and localities that are working on healthy food procurement policies. And
I just wanted to share some of the resources that weíve recently come out with that might
help all of you in your work. And also just to mention, I help people with policies related
to vending, cafeterias, concessions, institutional feeding, and meetings and events.
So one of the new resources is a fact sheet on how to choose nutrition standards for your
state or locality. So this is just a fact sheet that sort of walks through step-by-step
different things that you would want to consider while youíre putting together your nutrition
standards, you know, what types of venues you would want to cover, what nutrients should
be covered in a comprehensive policy, just things to look out for when youíre putting
your policy together.
And then another one of the new resources is a fact sheet that sort of lays out the
different national nutrition standards for vending machines. So you can see how the different
standards compare with each other; you can just read straight across, what do they have
for calorie limitations, what do they set for saturated fat limits, just you can easily
compare them. And then we also highlight different areas that we think might be problem areas.
So if you wanted to use a particular standard you might want to address those areas and
modify the standards a little bit.
And another fact sheet that we have come out with, our tips for successfully implementing
healthy foodservice guidelines. So these are different tips that weíve heard from states
and localities that have been implementing procurement policies that have really worked
for them. So instead of just putting a policy in place, theyíre putting a policy in place
and then using some of these other tactics to really make sure that people are eating
the healthy foods, and the healthy foods just arenít sitting in the vending machines or
sitting in the cafeterias, but people are actually buying them and consuming them.
And then another thing that we have recently put up on the website are 12 different promotional
posters. So these are posters that we want you to be able to take off our website and
use in whatever way works for you. So you could put your departmentís logo on there
or put your stateís logo on there. You could really, you know, brand them to be your own.
And we have ones for foods, for beverages, some directed at children, so you should really
go and check all of those out.
And then also just a quick refresher of some of the other materials that we already have
up on the website. We have model policies, we have a financial impact fact sheet. So
examples from states and localities that have implemented healthy foodservice guidelines
but havenít seen a drop in revenue. And we also have a list of all of the states and
localities that we know have passed healthy food procurement guidelines, and then other
general fact sheets and toolkits. And theyíre not all CSPI policies, but some of them are
just great resources that weíve found from CDC or from the Heart Association that we
think will help people in this work.
And then one other resource that weíll have coming out soon is a healthy meeting toolkit.
So that has guidelines for healthy meetings. Itís a two-tiered system, so thereís a standard
healthy meeting, but then there are also superior healthy meeting guidelines if people want
to go that extra step. Or else you could sort of mix and match for whatever works for your
department or organization. And that comes with a whole comprehensive toolkit, so it
has things like how to talk to a caterer about reducing sodium, how to negotiate with a hotel
about having a healthy meeting there. So there are all sorts of great resources that can
help people to have a healthy meeting.
And finally thereís just my contact information, if people want to reach out, if they have
any questions about these materials or other things that CSPI does.
Great. Thank you so much, Katie. Iím sure everyone has pretty well find that really
helpful. And again, if folks have questions for Katie please put them in the chat and
weíll address them at the end of the webinar.
Next weíre going to move on to our first state presenters, who are from Washington,
and will be presenting about a new executive order that improves access to healthy food
in state facilities. Jessica Todorovich is a Deputy Secretary for the Washington State
Department of Health. She oversees agency administrative operations, including human
resources, risk management, financial services, and information technology. Sheís been with
the department since 2012 and has more than 15 years experience in state service. Jessica
recently received the Governorís Leadership Award in 2010 for her work in labor relations.
Colleen Arceneaux is a healthy eating coordinator for the Washington State Department of Health
Healthy Eating Active Living program. Colleenís roles include working with communities, schools,
worksites, and state partners to help make their eating environments healthier through
policy and environmental changes. Washington.
Thank you. Good morning, everyone. Good morning from the West Coast. This is Colleen Arceneaux
and I will begin our presentation. I will start with giving an overview of the history
of the executive order and how we arrived to this point.
In 2009 and 2010 the American Heart Association and the Childhood Obesity Prevention Coalition
observed cities beginning to consider citywide procurement efforts. They also saw a Massachusetts
executive order signed. In 2010 graduate students from the University of Washington developed
a policy analysis report. The purpose of this was to inform advocacy decisions of the Washington
State Coalition for Childhood Obesity and other interested parties regarding the idea
of creating standards for institutional purchasing food by state government. This report informed
the content of House Bill 1801.
In 2011 House Bill 1801 was introduced; it required each agency to develop and implement
food purchasing policies for food purchased with state funds for meetings and events,
foods served in vending machines for state employees, and foods served in direct custody
of the state. In 2012 House Bill 1801 continued where it left off in the previous legislative
session, but with a few changes. Some of those included food available to state employees
from on-site vendors such as cafeterias and coffee shops was added, and then excluded
from the bill would be the Department of Veterans Affairs, training programs conducted by the
Washington State Patrol, and other criminal justice training programs.
The bill changed from food procurement to food service, and in committee House Bill
1321, as it moved forward was recommended that the governor consider signing this as
an executive order because of interest in worker productivity. This executive order
was signed on October 30, 2013 by Governor Inslee.
We feel that the partnership between public and private organizations was key to arriving
at the executive order. External advocates, such as the American Heart Association and
the Childhood Obesity Prevention Coalition, helped jumpstart the issue and create legitimacy
for it as an idea. Because of that work this work then got prioritized within the State
Department of Health, and the Department of Health was able to secure grant funding to
support a physician dedicated to food procurement. With dedicated staff the Department of Health
was able to form a food procurement workgroup made up of representatives from multiple state
agencies, local public health departments, and other external partners. This workgroup
had been meeting for over a year when the executive order was signed. Workgroup members
developed the state healthy nutrition guidelines and informed the development and content of
an implementation guide. Their participation assisted their agencies and organizations
in understanding and gaining support for this work.
As you saw in the first slide, the framing of our message changed over time. In the first
year of the bill it focused on government efficiency and food procurement. Like many
places, we do have a central contract for state agencies to purchase foods and other
items, but we quickly learn that not all food served in state agencies is purchased through
this contract, particularly not by the owner or operators of cafeterias located on state
property. Because of this, in the second bill the frame was changed from food procurement
to government as a model or early adapter. While this bill was in legislative committee
it was suggested by a committee member that the governor might be interested in signing
this as an executive order because of his interest in employee productivity. The previous
bill focused solely on food procurement or food service, but in the end this executive
order has a much more comprehensive worksite wellness frame with a focus on employee productivity.
Hi, this is Jessica. Welcome this morning. So this bill, as my colleague just mentioned,
does have a very large framework, and we wonít be covering all the pieces of it today, but
it may be of interest to note that it covers things such as insurance benefits and possible
incentives to reduce insurance benefits if you participate in certain wellness activities
in the workplace, and some of that activity that is coupled with the food procurement
that weíre going to talk about today. So what Iím going to take you through ñ what
Iím going to take you through today is just quickly go through the scope of the executive
order and walk through some of the practical aspects of implementing this within state
governments.
So as you can see, this executive order covers Washingtonians. It started out covering Washingtonians
in general, and we really reduced that scope down in the executive order to really focus
on state employees and the custodial populations that we serve. One of the things that was
really important as we got started with this was engaging our state agency partners. So
just like Colleen spoke about our external partners, we also realized pretty early on
we had to engage other state agencies, especially those that have large financial impacts. And
that primarily focused around the custodial populations. There were also unique employee
issues that we had to start thinking about and we will continue to have to think about,
because we have employees, as probably many of you do, in a wide range of activities with
lots of different types of support when it comes to healthy eating. We have people who
donít have sent work sites; we have people who travel more than theyíre anywhere located,
you know, in one spot. So that becomes very difficult to think about.
And then the custodial population, thatís a huge group of people, and certainly they
have rights and expectations that we need to build into this process. Our external partners
helped with that, but also engaging the state agencies in really learning about the ways
in which they interact with their custodial populations was really important pre-work,
and weíre continuing as we implement the executive order focus on that. So really trying
to set the tone of being practical.
The other piece that weíre really interested in, the Governor is very interested in is
the measurable aspects of this, to show a return on investment. So this will actually
ñ the executive order is actually going to be tied into our overall state performance
management program that weíll be reporting on.
One of the things that we talked about was moderation. Youíll notice in our executive
order it talks about providing more options, not taking away options. Particularly for
the custodial population that was really important, as well as for our union partners, in dealing
with labor issues that was really important. We have made a focus on Washington-grown produce
and resources, but weíve also recognized the practicality and budget needs to be balanced
there. One of the things that we talk about in our executive order is really leadership
modeling the behaviors, so not just providing the options, but what weíre calling the ìnudge
factor,î which is also how do we as agencies and leadership model and set an expectation
that folks will do this, but not necessarily have a specific directive in that regard.
And then we talked about building in the ROI.
One of the things that we did learn, some takeaway lessons that Iíd like to share today
that hopefully will help you in your work is really engagement at all levels with state
agencies. On our initial workgroup that Colleen talked about there were a number of agencies
that had staff involved, but as we moved towards the executive order what we realized is the
budget offices in those agencies and the agency leadership had not been engaged, so we did
have to do some backtracking and bring them up to speed on some of the work as they thought
about the budget implications, pieces of that work. So I would really encourage sort of
that full participation and really getting leadership involved initially as opposed to
doing that after the fact.
And then really the ability to acknowledge those unique situations, places where we have,
you know, shift workers or ñ so those would be employees that, you know, donít have a
common work site, that move around in facilities or even between facilities, how do you give
them resources and tools? Very diverse worksites, you know, we have some that have, you know,
cafeterias and those type of opportunities; we also have maintenance sheds out in the
middle of nowhere. So how do we provide some options for all of those people? And then
as I mentioned before, the custodial population.
Finally I thought it would be good to cover kind of what our next steps are going to be.
So at the beginning of the year we are sharing our healthy nutrition guidelines broadly with
the agencies, as well following up with a final implementation guide that will be used
by agencies to help them step through the process; promotional activities, communications,
marketing, those types of things, as well as making sure they understand the components
that they need to provide in order to meet this executive order. And then really starting
to talk about, okay, now that weíve done this in state government how do we explore
that next level of engagement with our, you know, private sector partners and really looking
at where I think the governor would like to go with just to Washingtonians as a whole,
promoting the leadership by example, making ñ the Governor has a real interest in making
sure his cabinet models these behaviors and these activities. And then weíre applying
for grant dollars so that we can do some assessment of this work and show some ROI.
And with that I will turn it over and answer questions at the end. Thank you.
Great. Thank you so much, Jessica and Colleen. We did get a few questions that weíll address
at the end of the call. And as a reminder, please put your questions in the chat box.
Next our presenters from Massachusetts will present about their stateís executive order
for state agency procurement. We have Cynthia Bayerl, who is the Nutrition Coordinator in
the Wellness Unit in the Prevention and Wellness Division at the Massachusetts Department of
Public Health. Cynthia has worked at DPH for over 20 years in a variety of capacities,
including as the first Massachusetts state special needs nutritionist, and in primary
care. Cynthia is the project manager for Executive Order 509, which is establishing nutrition
standards for food purchased and served by state agencies. And Executive Order 509, which
they will talk about, is one of the six Mass in Motion statewide wellness initiatives to
promote healthy weight and improve the health of Massachusetts.
Also presenting from Massachusetts is Margaret Barry, who is the dietician and food service
manager of the Morrison Healthcare Food Services. Margaret has extensive experience in acute
and long-term care foodservice management. We are very excited to be hearing from both
of them. Massachusetts.
Thank you. This is Cynthia and I will be presenting from the state agency policy perspective,
and Margaret has kindly agreed to cover as an implementer of the executive order in a
medium-sized facility.
So our first slide here was actually covered by our introduction, but our Mass ñ this
is part of Mass in Motion, which is one of five components of our obesity prevention
and control initiative. And if people want to know about the other ones Iíd be happy
at a later time, but today weíll concentrate on Executive Order 509.
So basically the executive order you can see is based on not only the epidemic, the concept
that a lot of state dollars, millions of state dollars are used to feed in residential population,
and this initiative gives the opportunity to improve the range of healthy food choices
to promote healthy lifestyles. Next.
So the executive order was signed in 2009 by our governor. It impacts eight state agencies.
Itís the new contracts and itís for any agency that provides foods and beverages on
a regular basis. So if you look at the bottom, the definition of the executive order is services
to clients who are dependent on the state for a package of services, including food
and beverages, and also the exemptions at that time, which I feel quite differently
about at this time, but vending, concessions, and cafeterias were exempted because at that
time, in 2009, it was felt that no state or federal tax dollars was used in these settings;
it was really the employee or the client who was using their funds.
The executive order itself, the language for the nutrition standards is based on the dietary
guidelines. And we actually have 68 state agency boards of commission that do not meet
the criteria, but we encourage them to use our healthy meeting and event guide, which
youíll also find on our website.
So basically this so our target population. Thereís only eight ñ you might say, ìWell,
thereís only eight agencies,î but it actually impacts approximately 1.4 meals and snacks
a year. You can see the range of the agencies, anything from the Department of Children and
Youth, which only has one shelter and it has about 16,000 meals a day, on over to some
of the largest, which is the mental health and the youth services, which have between
them about 6,000 small community programs. Next.
So basically what we did in our baseline is we identified with the ñ we sent our survey
to all 78 boards, agencies and commissions, and we found from their reply was that really
the most challenging component that they were dealing with was sodium reduction, which I
felt was very apropos to this discussion. But they also had other, four other areas
that they focused on, which was how to prepare healthy food, how to increase fiber, how to
improve snacks, and also healthy beverages. When we looked at some of the other key findings,
the high cost of healthy food, mainly the availability and cost of lower-sodium products
was a huge challenge, and then basically the gaps that we found between the largest agencies
that had food services and the 6,000 community homes, there was a huge variability in skill
and training of the staff who buy and prepare the food, and then basically a number ñ most
of the staff in those settings do not know how to ñ they may know how to cook, but not
necessarily healthy.
So basically what we did was strategize is that we had four specific strategies that
we worked on, which was getting internal partners, an interagency group, additional collaborations
and then obviously implementing, monitoring and evaluating. Next. So Iíll speak a little
bit more about that at this point.
Basically the first phase we, like one of our former speakers, we really upfront got
internal partners involved from legal, purchase of service, wellness and policy. We looked
at how this was going to be managed. We identified external and internal champions, with the
highest level being the governor, the mayor, or the commissioner. In our case it was the
governor, but there may be other people that you identify. And the focus was which kind
of vehicle would be used; would it be policy and executive order, the definition of the
language, identifying what some of your baseline is, what your gaps and barriers are, looking
at whoís the impacted agency, and looking at the advisory group. Iíll speak about that
a little bit more. And developing an implementation plan, and once again, the evaluation and monitoring.
And the next stage, which is really pretty key, each of the eight agencies appointed
their official representative of the highest level that dealt with foodservice management,
and they helped us with a variety of tasks, including the baseline survey. They reviewed
and approved the standards and we pretty much used what New York City had. And basically
the main issues, which was really based on food preparation skills and training and then
site visits to try to identify what some of the training and implementation needs would
be. They provided input into the online course, which we have with our academic partner, Framingham
State University, and they provided input on the web-based resources and tools, which
our accessible to you all on our web.
The next thing we found was pretty key was working with state agencies, and this has
been alluded to by a prior speaker. But we basically work with our departmentís own
purchase of service and we also work with our sister agency, which is the Mass. Division
of Operational Services, to embed the executive order nutrition standards into all new contracts.
We collaborated with operational services division on long-term RFPs for food and we
actually have ñ I forgot to put one on, but we have a catering, a bakery, a prime grocer,
and a dairy contract. So those are specific food, although the nutrition language is in
all new contracts. And then weíve done a number of presentations and provided technical
assistance to a variety of groups to pull in more partners to strengthen the collaboration.
Next.
So basically what our challenges were is that the smaller community-based programs, which
I mentioned is about 6,000, the ñ each of these three components I think impacts sodium
and sodium levels, that the staff is less-trained in healthy food preparation, thereís little
or no access to the large food vendors, and I think a former presenter ñ even though
we have the food contracts, the smaller vendors do not necessarily use them for a lot of specific
reasons, and obviously these smaller community homes that house from three to ten clients
have much smaller budgets, and so their capability to buy in large quantity wherever is a problem.
Our monitoring is self-reported and the state contract system at this point in time is more
concentrated on money spent, not necessarily on outcomes, like how ñ was there an increase
in fruit and vegetable or an increase in whole grain, for example. Next.
So lessons learned, we found that a procurement policy is a fantastic opportunity to be an
umbrella over many goals so that you donít have to do each of these initiatives alone
or in a silo. And obviously the ones that weíre most interested in and weíve been
working on for a long time are listed here, including sodium reduction. We really needed
a robust implementation plan between agencies, we really needed to have a very strong food
preparation and procurement training program and a monitoring system. We needed to have
some work with leveraging purchasing power, and Margaret is going to speak about that
in a minute. And we basically, I think, need to have learned include this in a worksite
wellness capacity with vending, catering, and concessions stands and cafeterias, because
in many of our state agencies we learned that even though this language was exempted, that
they are very interested in making progress in these areas. Next.
So some of our initial success stories in a nutshell is that we were actually able to
implement healthy eating language in the public health hospital contract, which was right
before the executive order was signed. Thatís a ten-year contract worth $100 million, and
that included not only options for patients, but employees, so that we did have a component
of worksite wellness. Mental health uses our standards as the house diet for the hospital,
which I think is pretty phenomenal. The Veterans has recently reported that they have reduced
their sodium consumption by about a half by doing things like making soups instead of
canned, having salad bars, and the really nice thing is that these foods are also available
to the employees and visitors in the cafeteria, so this is kind of a spin-off wellness program.
Operational services division has involved me in working with the other agencies in developing
language and adding foods, healthier versions, and the grocer RFP alone is worth $14 million
a year, so weíre talking high-stakes money here. Developmental disabilities agency, over
2,600 of their staff who procure and prepare food have taken our online course. And basically
through the work of the development disabilities we have worked on medium, small programs,
and we have some thoughts on some current and future pending.
And this is where my wonderful colleague, Margaret, will step in and present what sheís
been doing in both a medium and a small agency. Margaret.
Thank you, Cynthia. As the foodservice manager for Morrison Healthcare Food Services, which
is a sector of Compass Group, the largest foodservice management company in the world,
Iíve had an opportunity to work closely with Cynthia in a medium-sized facility, managing
this implementation. Itís been a challenge; I wonít say that it hasnít been, but the
resources that Morrison brings to the table have been a huge help.
One of Compass Groupís sectors, a purchasing sector, a procurement sector, if you will,
Food Buy, has been very helpful in terms of negotiating contracts with food manufacturers,
working with the people that produce the canned foods and so on, in order to provide us at
the operations level with products that are lower in sodium. For instance, we now have
a lower-sodium marinara sauce, which is, as you can well imagine, widely used on our menu.
Our staff have been trained on food safety and health promotion and special diets, and
especially the EO509 nutrition standards. In addition, in the facility we have used
the EO509 fact sheets just to refresh peoplesí memories.
In addition, Iíve had the opportunity to work with a single registered dietician, who
is currently providing technical assistance to residential facilities. Initially that
opportunity came when some of our larger inpatient facilities closed, and those residents were
relocated into community residences, and there was a terrible need for consultation from
a dietician. And so that gentleman got involved in consulting on tube feedings and various
other things, discovered the lack of knowledge in those units, and began providing training
on food safety and menu development and EO509 nutrition standards and reducing sodium in
the diet.
One of the advantages of partnering with a foodservice company is that it eliminates
the need to reinvent the wheel, because as you know, weíre located across the nation,
and the procurement systems that we have in place and the culinary experts that work with
us, the chefs developing recipes and menus and the dieticians all bring resources to
the table.
Cynthia, Iím going to turn it back to you.
Sorry, I didnít realize I was still muted. My children wouldíve loved that.
In our next steps is that we are going to be updating our standards to include the Massachusetts
and the USDA competitive foods and the hot meal standard, because in some of our agencies,
including the Department of Youth Services and in our shelter, they would be following
two sets of standards, so we want to make it seamless. Weíre going to continue our
online course and web resources because we found that that was so vital to our community
programs particularly. And then pending funding, we want to conduct a baseline survey in the
small community programs.
We recently conducted a base ñ second survey last winter in the large agencies, but now
we wanted to conduct one into the small community settings to gauge the influence of our Mass
in Motion community food policies, such as healthy restaurants and the healthy markets
on the foods that are available to these clients. In our findings from the large agencies we
found about 50-percent of the clients eat some type of food outside their residential
home, anything from a cup of coffee or when their family takes them out to dinner on a
weekend, and so we realize that itís really important not only to have healthy food within
the program where they live, but to have it in the neighboring community if we want to
continue.
So thatís our plan for the next step. And I would just really like to acknowledge the
numbers of people who have been involved in this, and you can see the various capacities,
which we have been told has made this move positive, because this was an unfunded mandate.
And so thatís the end of our presentation. We look forward to questions at the end. Thank
you.
Great. Thank you so much, Cynthia and Margaret. We do have a few questions for you that weíll
get to at the end of the presentation.
Our final presenters are from Arkansas and will be discussing the stateís worksite-wellness
program for state employees. Presenting will be Katrina Betancourt, who is the worksite-wellness
section chief for the chronic disease prevention and control branch of the Arkansas Department
of Health. Katrina is the administrator of the Arkansas Healthy Employee Lifestyle program,
a comprehensive worksite wellness program for state employees, and she has created the
Community Healthy Lifestyle Program for worksites throughout the state.
Katrina is also joined by Linda Faulkner, the healthcare systems lead at the Heart Disease
and Stroke Prevention division of the Arkansas Department of Health. And I turn it over to
Arkansas.
Thank you. This is Katrina, and what weíre going to talk about is basically how sodium
impacts Arkansas and our worksites. So Iím just going to give you a brief overview of
what weíre going to discuss. As you mentioned a second ago, there are two worksite-wellness
interventions here in Arkansas, both AHELP and CHELP. And then weíre going to talk about
how sodium is impacting our state currently and the evaluation of nutrition within current
AHELP ñ with our current AHELP participants, and then the nutritional strategies that weíre
using in our worksites.
So this right here is ñ AHELP stands for the Arkansas Healthy Employee Lifestyle Program,
which is based on state employees at their worksites in our agencies, boards, and commissions,
and then our Community Healthy Employee Lifestyle Program, which uses the same model, but itís
for non-governmental worksites, such as private practice or local government or non-profit.
We did have a video to show, but weíre not able to show it, so if you do want to see
the video Iíll be more than happy to show it to you at a later time or send you a link
for that video. But basically AHELP is to create a worksite culture that supports healthy
lifestyle choices for employees, like I said, at stage agencies, and we use that same model
for a CHELP program. It is at the directorís discretion, so we do involve leadership. We
have a web-based tracking system, which is a self-reported data that they can log in
their cardiovascular activity, their fruit and vegetable intake, their other exercises
like flexibility and strengthening, and whether theyíre tobacco-free or not. Then we have
some yearly activities they can log, like if theyíve participated in a marathon, if
theyíve completed the health risk assessment, if they got an annual physician screening.
So thereís a lot of different ways to earn points.
Which brings me to our incentive-based program thatís tied in with this. In 2004 the program
first was piloted, and then by 2005 we actually passed a law for participation in AHELP that
employees could receive up to three days off as an incentive for participating and completing
the challenges. From that, in 2012 we actually completed our CHELP program, which is modeled
off of our AHELP program. And when companies bring this program on part of it is that incentive
base, that they allow up to the three days off as an incentive for participating and
meeting those challenges in physical activity, nutrition, tobacco cessation.
So weíre going to talk a little bit about sodium in Arkansas. Okay, the ñ if you look
at this, based on a 2007 study that was conducted, the average daily sodium intake among adults
in Arkansas was 900 milligrams per day over the recommended intake for the general population
at 1,700 milligrams per day. And these were over at-risk populations, which at-risk includes
African-American adults aged 51 and older or any persons of any age with hypertension,
diabetes, or chronic disease. So Iím just showing you the impact of where Arkansas stands.
Now this was an evaluation that was conducted in 2013, which was recently ñ it was just
done in August. And there was a total of 2,174 Arkansas Department of Health employees reported
health behavior and outcomes through the health risk assessment that we have, and it was between
the years 2010 and 2013. What we found is that there was more female employees actually
participate in this program, which in turn they all ñ there was more that responded
to this evaluation and the health risk assessment than the male counterparts. The racial and
ethnicity distribution of AHELP contributors was submitted for the health risk assessment,
and they were predominantly white, and the majority of the respondents were between the
age of 30 and 50 years.
So hereís some of our findings. Here is a distribution of disease ñ or disease conditions
among employees. So in this figure there was a high blood pressure, high cholesterol, depression,
and arthritis were the most prevalent.
This slide ñ this particular slide is healthy food consumptions of fruit, vegetables, grains,
dairy, and high-quality protein. Participants reported in the range of five to seven times
per week for most employees, which is very, very low considering standards for fruit and
vegetable intake. This really should be ñ say ìdaily,î but this was done for weekly.
And these, again, just a reminder, these are all state employees.
Figure three shows that the consumption of processed meat, fried foods, fats, sweets,
and desserts average one to four times per week for a majority of the employees. Iím
just leaving it up there for a second so you guys have a second to look at it.
All right, so the following are current strategies that weíre using in AHELP and CHELP to kind
of combat these unhealthy lifestyle choices. We currently have a policy that approximately
80-percent of our AHELP agencies and about 60-percent of our CHELP worksites have implemented;
itís a Healthy Choices at Official Events policy. This policy states for at a function,
which means a meeting, reception, conference, meals, breaks, trainings, or other similar
events, at least 50-percent of the food and beverage items served are healthy choices.
This includes events sponsored by the agency or state funded. Even if the food and beverages
are not paid for by agency funds, sodium reduction is identified in food standards within the
policy.
So the next one is promoting the adoption of foodservice guidelines and nutritional
standards, including the reduction or elimination of sodium-rich food and beverages. Weíre
following and have adapted Health and Human Services and General Service Administration
Health and Sustainability Guidelines for Federal Concession and Vending Operations at all of
our worksites, and we have approximately over 300 worksites and just in our state government
we have about 37,000 ñ or sorry, thatís a little bit high ñ 37 ñ no, it is 37,000
employees within the AHELP program. We started our CHELP program in 2012, so currently we
have about 30 worksites, but close to 3,000 employees at those worksites.
The Department of Health also provides technical assistance to DHS for the blind to increase
vendor participation with nutritional standards and guidelines to support the Randolph Sheppard
Act. So currently the Arkansas Department of Health and the Arkansas Department of Human
Services work together to help educate blind vendors, and they actually manage the blind
vendors at their department. And of course we always assess and evaluate and target our
AHELP and CHELP employees to see how we can improve the nutritional standards at each
worksite.
Okay, we did draft an executive order and it is currently under review, but states that
it shall produce, disseminate and implement guidelines for nutritional food and beverages
in compliance with our federal guidelines for concession and vending operations. The
guidelines should be in effect for state employees and their guests at breaks, meetings, conferences,
and other work-related events held on public property. So this is coming from the procurement
side and not just the policy side for employees and what they purchase. In addition, it states
the Arkansas Department of Human Services shall disseminate guidelines, establish minimum
nutritional standards for food and beverages sold at vending facilities on public property.
So for the purposes of this order the term ìpublic propertyî is limited only to those
properties in the executive branch or the state government subject to administration
by our Arkansas Department of Finance and Administration, and this order applies to
all vending and food services that are at our public properties.
And here is my contact information. Like I said earlier, if you guys want any of the
links to our resources or to our website, and we do have that video there as well that
explains about AHELP and CHELP a little bit more in depth.
Great. Thank you so much, and thank you to all of our speakers. We definitely had a number
of questions come in, so Iím going to now switch over to the Q&A portion of the webinar
so that we can get to as many questions as possible. And then our last slide does have
contact information for staff at ASTHO, so if your question didnít get answered and
youíd like to connect with one of the speakers through us, you know, weíre happy to facilitate
that, or many of the speakers have put their contact information up.
Weíve gotten a lot of questions just in terms of staff capacity and the time that staff
take to implement many of these programs, and also funding for these positions. So if
all of you could like briefly address those questions Iíd really appreciate it.
Hi, this is Colleen from Washington and we ñ the funding for my position comes through
our statewide community transformation grant. And we have since also received a Sodium Reduction
in Communities Program, so part of my time is now on that. So most of it is CDC funded
through that.
Great. Arkansas, do you want to answer that?
Iím sorry, I guess I missed the question. Is it concerning funding?
Yes, concerning funding for the program and also funding for your staff time and how much
that takes.
All of our ñ well, Iím not going to say all, but a majority of our work, yes, is done
through work sites. So I am the worksite-wellness section chief, so Iím going to say there
is a lot ñ a high percentage for the nutritional guidelines and standards. Our funding does
come ñ none of it is state revenue; all of it does come from CDC currently.
Great. And Massachusetts, Iím going to drive the question to you as well, and specifically
somebody asked about Cynthiaís time and how itís different when the executive order first
passed versus now.
Well, when the executive order first passed I was on 805 funds, CDC funds. And now my
funding is from the 1305, but due to many emerging and important issues, my capability
to work on this as intensely as I have been will be modified.
Okay. Great. Thank you. And speaking of the 1305 funding, there was also a question that
came in asking how the states are fitting their work into this CDC grant. Does anybody
want to answer that?
Well, with Arkansas it was kind of a natural progression, ëcause we had already started
this work with our healthy options policy, but one of the requirements is to implement,
you know, nutritional standards and guidelines. So we just naturally were able to use the
federal guidelines and start our work with disseminating and educating on the nutritional
standards and guidelines. And weíre hoping to get more involved with the executive order
or hopefully passing some heavier policy to really work with our vendors.
Great. Thank you. Does anyone else want to address that question?
This is Colleen, and here in Washington our work started, and as I just said, is funded
first through the Community Transformation Grant and then through the Sodium Reduction
in Communities Program. So when we wrote our 1305 grant we really focused on really looking
at early childhood, working on nutrition guidelines at that level, because our executive order
really focuses on employees. But now weíre kind of taking a step back and relooking at
it and seeing how we can incorporate it with the executive order and the scope is much
larger than we had originally anticipated. Weíre kind of relooking at it and thinking
how to include pieces of it in 1305. But I think thereís a lot of people who had multiple
funding sources from CDC, you know, weíre trying to make sure that there arenít ñ
that our pieces donít overlap, so.
Great. Thank you. And there was a question about what recommendations do you have for
creating monitoring systems on a food procurement policy for a city contracts. Do any of the
speakers want to address that?
I can say Arkansas is not currently working with city contracts right now, so we donít
have anything to address with that.
Okay. We can follow up with-
There is Washington-
Okay. And many of you have mentioned other resources that you used as you developed your
nutrition guidelines. So there was a question about do the guidelines that you all develop
look similar to any of the major national organization guidelines. So if you just want
to kind of go through some of the federal, national, maybe other state and city examples
that you use, I think that would be helpful to the participants.
Well, Arkansas is really just adapting the federal guidelines to be specifically to our
state, and the ones that weíre using are the Health and Human Services and General
Service Administration Health and Sustainability Guidelines for Federal Concession and Vending
Operation. I apologize for that long-winded, but basically itís all one document. And
I guess the easiest way we ñ I donít know if we can post it or you can literally Google
the Federal Concession and Vending Operations and youíll be able to find that document.
Itís been very valuable to Arkansas with dealing with procurement.
This is Washington. If you-
This is Massachusetts-
Sorry. We use the same guidelines as well, but weíve also looked at the USDAís Smart
Snacks in Schools guidelines for our vending. Seattle & King County Public Health here in
Washington, they had developed guidelines, which ours closely mirror. But when we went
to write our cafeteria and our institutional foodservice guidelines, we rather than ñ
most of the guidelines that are out there are very nutrient-based and our, most of our
smaller institutions and many of our ñ most of our cafeterias and smaller cafes and delis
are run by small businesses and they donít have the ability or capabilities to do nutritional
analysis on their foods. We will have some small resources to help them with this, but
we donít have a lot. So we really ñ those guidelines of ours were written ñ theyíre
food-based, rather than nutrient-based. So we ñ our workgroup worked long and ***
developing those so that they make sense but also support the dietary guidelines for Americans,
which are the basis of all of our guidelines.
In Massachusetts we used ñ with our nutrition standards we used the dietary guidelines,
but we utilized the tool that New York City had presented. And since vending was exempted,
vending is in our 1305, so weíre in the process of comparing existing tools, because we feel
that thereís no need to develop a Massachusetts-specific tool. So weíre looking at obviously the federal
tool, but weíre also looking at the nano-tool because there is a pending state legislation
that would have vending in all state buildings, and if that passes it would be the nano guidelines.
So weíre going through objective process to look at what currently exists that we could
use that we could propose that would be used in vending.
Great. Thank you. So questions for Arkansas. How effective is policy change at the worksite
on employees? Do nutritional behaviors change?
And what weíve found, like I said, our program has been in existence since 2004, and that
evaluation that we did was between 2010 and 2013. There has been, if you compare other
years there has been a positive effect as we see overall the statewide weíre getting,
you know, more obese and other, you know, other chronic conditions are on the rise.
So we have seen a positive effect. Again, itís over time, but weíre still not where
we need to be. And I think thatís why this natural progression of how can we change procurement.
We canít always change behavior of a single individual, but if we at least provide those
healthy options and they can make their own healthy choices. So weíre just providing
support.
Great. And Iím going to ask one final question that I think is really relevant, especially
to the ASTHO audience. Do you have any tips to get buy-in from leadership? And Iím going
to allow that to be kind of a closing comment from all of the states. If you could all address
that and then Iíll have some final comments and weíll finish up.
Well, sorry to speak first, but this is Katrina with Arkansas. And I would say that we have
something in place as it is with our two interventions that we actually address it at the leadership
level to begin with. So in order for these programs to be implemented at those worksites
we have to have a letter of intention basically to be a part of this program. So weíve already
done the groundwork; we work with leadership and get them onboard first before we even
implement this into the program, and weíve found that to be very effective.
This is Colleen in Washington, and we ñ I think through a bit of the work, through our
CTTT leadership team there are a number of leaders from different state agencies that
are there, so theyíve heard about this work, been talking about it a lot. I think the work,
again, from our private partners, as I mentioned, was really integral in kind of getting this
topic on peoplesí radar. And then finally I think our leadership here at the agency,
really working with their peers in the other agencies. So just that worked really closely
with the deputy directors and talked with them a lot about this work and really got
their buy-in and listened to their concerns and we really took their concerns into account
when we wrote ñ not only when the executive order was written, but also when the guidelines
were written. And as well our secretary, he did the same with his peers in the cabinet.
Massachusetts?
I think that we have quite a bit at different levels. I think that our commissioner was
ñ our former commissioner was a wonderful champion; he was a president of ASTHO and
I think a lot of this initiated from his leadership there, on the president of ASTHO and our medical
director being involved in the Sodium Regional Workgroup, obviously his influence on the
governor. And Iíve been told by a procurement deputy here that she really believes that
it was the dedication of the leadership in the state agencies that really started with
the commissioners, but the person that they appointed and the work that they have done,
because it was ñ itís amazing how much progress has been made considering the limited amount
of ñ itís an unfunded mandate and there is a limited amount of technical assistance.
And so it really ñ and the other ones that are directly working with the people in foodservice,
so I think itís really important to have a champion and leaders on all levels to demonstrate
the dedication behind this from the highest level to the people working directly in the
trenches of buying and procuring healthy foods.
Great. Well thank you so much to all of our speakers today. I also wanted to let everyone
know that ASTHO has our own internal healthy foods policy and works very closely with our
vendors to provide healthy foods at all of ASTHO meetings, and our healthy foods policy
is available on our worksite-wellness website for other organizations, state health agencies
and partners to use as a resource. And you can see our resources here on this last slide,
both our sodium reduction website and also our worksite-wellness website.
As I mentioned earlier, you will also be directed to an evaluation at the conclusion of todayís
webinar, and weíd really appreciate it if you took a few minutes to complete the survey,
as it provides us with useful information for upcoming projects. And it also has questions
related to the work that you are doing in your state, and as you may know, we have had
a technical ________ project in the past, and weíre launching a new working group for
states interested in pursuing sodium reduction projects and food procurement work. So you
can use the evaluation to express your interest in participating and we will follow up with
you afterwards.
Again I would like to thank the CDC Division for Heart Disease and Stroke Prevention for
sponsoring this webinar. And I would like to thank our speakers, Katie Bishop, Jessica
Todorovich, Colleen Arceneaux, Cynthia Bayerl, Margaret Barry, and Katrina Betancourt.
A recording of our webinar will be available on our website within the next few days at
the web address on your screen, on our sodium reduction website. And we hope that this webinar
will serve as a resource for you, and please feel free to disseminate the archives. If
you have any follow-up questions about todayís webinar or need help connecting to any of
the speakers please contact our team that is noted on the slide. And otherwise we will
wrap up and we thank you so much for your participation and hope that you enjoy the
rest of your day. Thank you.
[End of Audio]