Public Health Issue:
The public health issue targeted by this intervention pertains to the social determinants of health and the barriers coinciding with access to healthy food. Individuals living in low-income and low access areas experience disproportional positive health outcomes simply because of their zip code. In Adams County, the City of Thornton is an underserved community with increased lack of access to healthy foods and fresh produce. The population of Thornton estimates at 132,310. The major racial and ethnic groups present identify as:
● Non-Hispanic White (57.6%)
● Hispanic or Latino (33.5%)
● African American (1.8%)
● Asian (4.85%)
Of the population, 8.48% are living below 100% of the federal poverty level and 25.36% are living below 200% of the federal poverty level. The limited access to basic resources has significantly affected the health outcomes of this community's residents. With the presence of food deserts in Thornton, 25.81% of people have limited access to food, which is a higher percentage than the surrounding Adams County and State of Colorado.
Prior to implementation of the Markets, there was only one farmers market in Thornton, which ran once a year for three days during the Fall Harvest Days and did not accept SNAP. The Markets are a unique approach developed to address broader social determinants of health through a whole person health lens. The Markets are combatting the stigmas surrounding the social determinants by utilizing data and resources that are committed to targeting a population that encounters significant barriers around health and well-being. The Markets strive to position these resources in locations that are accessible, safe and highlight community connection.
Social stigmas around farmers markets have a history of being less culturally relevant in that they are more prevalent in affluent communities. The Markets Steering Committee wanted to create an inclusive space for all residents no matter their age, health or socioeconomic status by connecting with other local organizations committed to health equity. The success of market expansion from one to two markets is due to the implementation of a Collective Impact Strategy, the process of creating impactful change based on the commitment of groups of partners to agree on a common agenda for solving a specific problem. By supporting equitable access to food systems through implementation of federal nutrition assistance programs, farmers markets can work towards abolishing the stigma around food insecurity.
The target population for the Markets are those relying on federal nutrition programs, SNAP and/or WIC, for nutrition assistance as well as older adults and children. Federal nutrition benefits oftentimes still do not provide enough support for most families, so providing opportunities for leveraging these benefits with funding for produce voucher incentives, provides and immense amount of support for individuals and the households they are feeding. Colorado has one of the highest eligible but not enrolled rates for WIC and SNAP in the U.S, only further exacerbating the food insecurity issue. Among Adams County community residents, only about half of qualifying individuals receive benefits for these programs due to various barriers, including fear of providing personal information required for enrollment and lack of education involved with receiving these services. With Thornton's high rates of individuals living below the federal poverty level, some families in high need are on these programs, with many more being vulnerable to figuring out where to spend their limited incomes.
What percentage did you reach?
The Markets founding partners recognized these health needs and met to establish a course of action towards combating the disparities around food access and connections to additional useful health resources in their community. An exact percentage from program participation as it relates to the total population is not calculated, but participants from target audiences continue to grow every year. Since inception, the Markets have served a total of 784 WIC clients and 343 SNAP clients showing the increased opportunity of residents to use their benefits. The inclusion of vendors that assist residents with WIC and SNAP applications and providing a farmer that accepts both WIC and SNAP/Double Up Food Bucks benefits, is a significant aspect of the Markets that is not typically found within farmers markets throughout the Denver-metro area.
What has been done in the past to address the problem?
For TCHD and our partners, the common practice for individuals experiencing food insecurity has been referral to federal nutrition programs (WIC, SNAP, and Summer Food Service Program), local food banks and community gardens. There are 27 active food banks in Adams County and four are located in Thornton. Additionally, TCHD runs two community gardens with one located in Thornton. Prior to this partnership, partners including TCHD have referred to and co-located certain services such as a WIC collaboration with the food banks, schools, and community gardens.
Why is the current/proposed practice better?
The Markets are not your typical farmers market. The Markets stand out from other markets because our goal is to be an integrated health hub within underserved communities, serving as a gathering place for residents to access affordable, culturally relevant and healthy food, food and health education, and preventative health services all in one location. The current practice is a model of innovation through partnership, ongoing discovery, health equity, and measurable capacity. The cross-sector partnership makes this model particularly effective as each partner brings resources and their unique perspectives to serve the residents of Thornton and surrounding areas.
Is current practice innovative? How so/explain?
By building a foundation as a community hub, this innovative approach has enhanced the traditional farmers market to be responsive to community needs around health and health equity. The vision of the current practice is to inspire, nurture and support healthy communities with a mission of building a marketplace that offers affordable, fresh food and a variety of health resources. In its first year, the Market took place at the Anythink Huron Street Library to target specific communities in Adams County distressed by low living wage, limited access to healthy foods and higher rates of chronic disease. Once a week, the Market provided fresh produce; health education screenings, dental screenings and resources; federally funded Supplemental Nutrition Assistance Program (SNAP) including Double-Up Food Bucks and Special Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits; literary resources and local transportation vouchers in a farmer's market environment. The program was replicated in its second year by expanding to a second location, with both Markets occurring in the 2020 season.
The presence of COVID-19 did require further innovation to the Markets model as there were a number of guidelines for hosting an outdoor community event that needed to be implemented. Hosting a socially distant farmers market required creative planning and organizing. In order to keep our participants and our staff safe, we utilized the parking lot space of the libraries to encourage social distancing between vendors. The layout of the Markets was one loop that required participants to enter through a starting point and flow through the market in one direction. The check-in point is where participants completed a survey in order to learn if they qualified to receive a program benefit to purchase fresh produce. There were also masks, gloves and hand sanitizer available to all participants in order to be compliant with state regulations.
Is it new to the field of public health?
While health issues related to food access are not new to the field of public health, the larger breadth of addressing social determinants of health is still a new challenge when helping under-resourced families make decisions about which health issues to address first. Food insecure children are at higher risk of experiencing developmental delays and long term chronic disease outcomes, while older adults over age 60 are also at much greater risk of poor health outcomes, such as increased risk of heart disease, when they are food insecure. This year marks the completion of a third season of the Healthy Farmer's Markets. By offering a farmers market during the week from 9am - 1pm, we have seen increased participation for older adults and parents of young children who need additional access to fresh food and additional health resources.
Is it a creative use of existing tool or practice?
Food insecure geographic data from Community Commons drove the strategy behind selecting the City of Thornton as the location of the Markets. Enhancing the concept of a farmers market to additionally meet other health-related needs, such as medical screening, dental screening, grocery shopping skills and a wide variety of health related resources, is how the Markets go above and beyond to establish healthy opportunities for the communities we serve. With COVID-19 restrictions, instead of offering health resources directly on site, the Steering Committee had a webpage created for the Markets. This webpage linked our market participants to healthy eating and healthy living resources throughout the community, by displaying posters with a QR code for the web page at the Markets check-in tent in order to limit social gathering.
What tool or practice did you use in an original way to create your practice?
The Community Commons vulnerable population's footprint is a mapping tool that is able to identify the location of needs within a community, in order for an agency to intervene with strategic action towards reducing health disparities. The high prevalence of chronic disease and low living wages is how we identified the City of Thornton as the hosting grounds for the Markets in order to provide fresh produce that was not available before in a predominantly low-income area. Through use of the vulnerable population's footprint, TCHD has been able to view the social determinants of health as a synergistic framework for the Markets in order to address economic stability, education, health services, built environment and social and community context.
GIS mapping capabilities has been another tool to enhance the effectiveness of the practice. This season, the Markets were able to track participation and collect real-time data in order to measure capacity and the reach of marketing strategies. In addition, GIS kept track of dollars spent for the two different funding mechanisms that provided produce vouchers to Thornton and non-Thornton residents at both market locations. The data collected were presented in real-time throughout the market season through use of an interactive data dashboard. Markets staff were able to measure impact each week, but could also break down the collected data by market location and even further by attendees' age. This data dashboard also helped us to track dollars spent as well as dollars remaining each week to utilize all funding available for fresh produce for participants. Dollars from each funding category, WIC, SNAP and older adults, had to be tracked separately for reporting purposes as each category had an allotted subtotal.
Link to data dashboard: https://tchdgis.maps.arcgis.com/apps/opsdashboard/index.html#/4d111f70071a48b7a3a35ff0ceb1a8f1
Is the current practice evidence-based?
While the current practice is not evidence-based, it is evidence-informed, particularly regarding the use of the Collective Impact Model of partnership to align efforts to meet the common goal of addressing an important social determinant of health. This year, the Markets incorporated GIS tracking technology in order to track participant information in real-time. By collecting these data points, we were able to see the reach of our communications strategies to shape those throughout the season to target different audiences as well as track the different funding streams. Each week, we were able to learn about our participant audience, where they were traveling to us from and how they were hearing about the markets. These data help facilitate a formal evaluation for the program in order to improve our Markets each year and establish an evidence-supported, replicable model through the development of a Healthy Farmer's Markets toolkit.