Union County Healthy Department
It Takes a Village: Creating Access to Healthy Foods through the Development of a Local Farmers Market in a Rural Community
The Union County Health Department, located just northwest of Columbus, Ohio, serves primarily a rural community of around 53,000 residents. Union County's poverty rate is around 7.7%, and 11% of residents do not have health insurance. Despite the percentage of residents with no health insurance, and a poverty rate of 11%, Union County residents' average life expectancy is on par with national averages (~76 years for men and ~80 years for women). Based on the County Health Rankings in Ohio, Union County ranks fourth in overall health indicators. Data from the 2015 Union County Community Health Assessment (CHA) indicates the county still exhibits a high number of risk factors that lead to cancer, stroke, heart disease, and other poor health outcomes for residents. Risk factors like overweight/obesity (68%), high blood pressure (28%), high cholesterol (34%), and lack of fruit and vegetable consumption (only 8% of residents eat 5 or more servings of fruits and vegetables daily), along with unhealthy lifestyle choices and lack of access for some residents to healthy foods, are all major contributors to the morbidity and mortality rates within the county.
To combat these risk factors, reduce morbidity and mortality, and improve health outcomes, the Union County Health Department's Creating Healthy Communities program (UCHD-CHC) has been working closely with community partners and coalitions to identify priority communities and advance and develop projects to address the underlying policy, systems, and environmental changes needed within them to improve residents' health in the areas of healthy eating, tobacco prevention, and physical activity. One area of concern noted upon review of Community Health Assessment data was the low consumption of fruits and vegetables by Union County residents. Further investigation led to the discovery of a food desert within one of the priority communities, the Village of Richwood, selected by the coalition. The only grocery store available to residents in the Village for miles had shut down in a community of 2,300 residents, where 21% of families live below the poverty level. This lack of access and lack of consumption of fruits and vegetables, coupled with a high level of poverty, prompted discussions with community stake holders on the best way to address the issue. The result of these discussions was the novel development of a farmers market that was supported and held at the Village's local library. Through partnership with the Richwood-North Union Library, the UCHD-CHC program, the Union County Farmers Market, and several other local community coalition partners, the groundwork for the market was established. A market committee was formed in early 2015, a Market Manager position was posted and hired, and beginning June 2015, the Richwood Farmers Market was introduced to the Village. Vendors were secured through the Market Manager, and communications were sent to the public. The market was supported as a satellite operation through the Union County Farmers Market, a larger, tenured market, with the capacity to support and guide the Richwood location during its first season. The market continues to operate as a satellite under the Union County Farmers Market, and also partners with its Richwood library host to provide a variety of educational activities and events for children and adults, often times focused on nutrition, food preparation, and other health-related topics. The creation of a new farmers market required support from Village residents, as well as logistical and programmatic guidance from an established market located in the same county before the market could be established. The development of the market also required a strong relationship with its host site, and collaboration on how best to serve and engage the community through both healthy food access, and education. Now, after completing its second successful season, averaging 11 vendors per market around 100 customers per market day, the market has met all of its previously mentioned objectives, and continues to develop new strategies to create sustainability and increase both its customer and vendor base to continue to bring healthy food access to the Village. The success of the Richwood Farmers Market can be attributed to the guidance and collaboration with an existing county market, as well as the unique integration and partnership with the local Village library, which has helped weave the market into the fabric of the community. As the market seasons progress, the long-term impact will be measured by awareness of the market in the community, greater food access for the community, as well as decreased prevalence of chronic diseases and the risk factors that lead to said diseases, and increased fruit and vegetable consumption by residents.
www.uchd.net & www.facebook.com/richwoodfarmersmarket/
The Union County Health Department's Creating Healthy Communities (UCHD-CHC) program, which began in 2015 with funding from the Ohio Department of Health, works to address public health issues in the areas of healthy eating, active living, and tobacco-free living through the development and implementation of policy, systems, and environmental changes. In order to address these issues, the UCHD-CHC program analyzes local health data, works closely with a designated coalition, and partners with local stakeholders and organizations to evaluate, prioritize, and direct projects that will combat health disparities in Union County. The UCHD-CHC program analyzed local Community Health Assessment data, and though Union County ranked fourth in overall health indicators, the county still exhibited a high number of risk factors that lead to cancer, stroke, heart disease, and other poor health outcomes for residents. Risk factors like overweight/obesity (68%), high blood pressure (28%), high cholesterol (34%), and lack of fruit and vegetable consumption (only 8% of residents eat 5 or more servings of fruits and vegetables daily), along with unhealthy lifestyle choices and lack of access for some residents to healthy foods, were all contributors to the morbidity and mortality rates within the county.
Through review of the aforementioned data, three priority communities were identified as targets for intervention: Union County, the City of Marysville, and the Village of Richwood. Each priority community has its own unique characteristics as well as varying rates of risk factors for chronic diseases and access to healthy foods, active living, and tobacco-free living. One primary area of concern noted upon review of Community Health Assessment data was the low consumption of fruits and vegetables by Union County residents. Further investigation led to the discovery of a food desert within one of the priority communities, the Village of Richwood. The only grocery store available to residents in the Village for miles had shut down in a community of 2,300 residents, where 21% of families live below the poverty level. This lack of access and lack of consumption of fruits and vegetables, coupled with a high level of poverty, prompted discussions with community stake holders, community organizations, and coalition members on the best strategy to address the issue.
Upon meeting with coalition members, representatives from local community organizations, and community stakeholders, it was decided that an intervention designed to provide affordable, healthy food access for Village residents was a priority need. One partnering organization, the Richwood-North Union Library, proposed the efficacy of establishing a farmers market to meet that need. Several representatives assisting with the project responded to this idea, and stated that there had been a small farmers market in the area years ago, but due to lack of long-term planning and building sustainability, the market failed. The team decided to take another look at building a farmers market, but this time, utilizing evidence-based practices. For this, the team consulted the Guide to Community Preventive Services and Center for Disease Control and Prevention's Recommended Community Strategies and Measurements to Prevent Obesity in the United States (Strategy 5: Improve Availability of Mechanisms for Purchasing Foods from Farms), as well as the USDA's Farmers Market Development Manual to facilitate the development of the market. The team adhered to the guidelines to ensure the use of best practices to help build a successful and sustainable market for the community, but they also utilized the creative concept of a partnership between the host site (the Richwood-North Union Library) and the Richwood Farmers Market. The library and market coordinated to ensure that the library would offer both children's activities as well as programming around nutrition and healthy eating for adults and families during many of the markets. This partnership and co-programming helped establish a strong customer base and higher visibility to residents as the library is a well-traveled hub within the community, and now also a source of healthy food access and education for community members. The team also built the market with a combined business and public health model in mind. This model would look at not only the Return on Investment (ROI) of the health of the community, but also the ROI of the market as a business institution. Utilizing both concepts has allowed the market to better develop a comprehensive sustainability plan, as well as better serve the Richwood community's needs.
The overall reach of the Richwood Farmers Market over the past two years has been strong. During the market's first two years of operation, there was an increase from seven vendors per market day in 2015 to eleven vendors per market day in 2016, and around 100 customers visit the open-air market per week (weather permitting). In reviewing availability of the market to all Union County residents, as a suggested measurement by the Centers for Disease Control and Prevention, the Richwood Market had 26 total annual farmer days at farmers markets per 10,000 residents in 2015, increasing to around 44 annual farmer days at farmers markets per 10,000 residents in 2016; an increase in 18 annual farmer days at farmers markets per 10,000 residents in just two seasons. In surveying customers during the 2016 market season, it was found that 53% of Richwood residents who shop at the Richwood Farmers Market indicated eating more fruits and vegetables on weeks that they shopped at the market. The UCHD-CHC program and partnering organizations continue to annually review the Richwood Farmers Market to measure its overall impact on residents' access to healthy foods, success, and sustainability. New measures will be added and assessed as needed.
Nutrition, Physical Activity, and Obesity
The UCHD-CHC program is the focal point of all the Union County Creating Healthy Communities activities. Historically, the Union County Health Department has pioneered projects that have addressed prevention programming and risk factor reduction for chronic diseases, and has been a leader in the community in working towards reducing and preventing the burden of disease for residents. Since receiving the Creating Healthy Communities grant in 2015, the Union County Health Department has been able to expand on its existing successes and further its efforts to improve the health of Union County residents. This success, however, would not be possible without existing coalitions and partnerships, as well as new partnerships that work alongside the UCHD-CHC program.
Since 2006, the Union County Health Department has worked with a multitude of local partners, to include businesses, schools, healthcare, and other agencies, under the Union County Wellness Consortium (UCWC). The UCWC was formed to bring agencies and organizations together to address health issues in the community, and has been an anchor for many projects and programs in Union County. Currently, the UCWC is the home base for reviewing projects, disseminating information on the progress of the projects, and identifying new focus areas as well as partners for projects and programs. The Union County Health Department also works with smaller coalitions and teams in priority communities. Some of these teams consist of interested citizens, members of local councils, businesses, and community organizations, and are brought about to address one project focus area.
When planning for the development of the Richwood Farmers Market, the UCHD-CHC and its partners established objectives to reach the goal of building out the market as part of the overall Creating Healthy Communities annual work plan for 2015. The first objective was to establish a formal committee to assist in the development of the market. This committee would be made up of Richwood organizations, residents, potential market vendors, and stakeholders, and would serve as the foundation for the market as it came to fruition. The committee ended up forming with representation from the Richwood-North Union Library, a couple local residents who had experience as market vendors, a representative from the Richwood Bank, the local School District, and the local Civic Center. Once our committee was established, it was tasked with following through on the following objectives and activities to complete the goal of developing the market:
1. Survey the Richwood community for feedback on the development of a farmers market in the Village.
2. Develop market guidelines and organization and hire a Market Manager.
3. Gather information of local growers/vendors and survey them for interest in market participation.
4. Work with the Union County Farmers Market to align under one market with multiple satellite locations.
5. Implement the Richwood Farmers Market at the Richwood-North Union Library.
6. Review opportunities for the library and market to collaborate during market days to encourage attendance.
7. Create a marketing campaign and promote to the community.
8. Complete an evaluation of the market to measure community use, access, and overall success.
9. Develop a sustainability plan with market committee and Union County Farmers Market Board.
10. Provide continuous technical assistance to ensure market success, expand market reach through programs like the Supplemental Nutrition Assistance Program (SNAP), and improve community access to healthy fruits and vegetables.
Throughout the year, the UCHD-CHC program and committee worked on each of the objectives, and successfully completed each by the end of 2015. The committee used community feedback to establish a time and day of the week for the market, and organized market guidelines utilizing the USDA's Farmers Market Manual and existing Union County Farmers Market procedures to outline the daily operations of the market. Once the market concept and guidelines were established, an advertisement for a Market Manager went out. After interviewing several candidates, the committee decided on a Market Manager, paid for by funds from the UCHD-CHC program, and then collaborated with the Market Manager to build a vendor base through interest surveys and general outreach. At the same time, the Richwood-North Union Library Director and UCHD-CHC Coordinator worked closely with Union County Farmers Market Board members to establish a partnership and designate the Richwood Market as a satellite location under the existing county-wide market. Once partnership with the Union County Farmers Market was finalized, a date was set to launch the market, and a schedule was developed between the library and market to provide educational activities for children and families. Each partner involved in the development of the market also worked to help advertise the grand opening to bolster attendance. Since the launch of the market, there has been continuous involvement from partners, which has helped continue to promote the market throughout the community and maintain a local focus of interest. The Market Manager and UCHD-CHC Coordinator worked closely to develop reporting tools to track market attendance by both vendors and customers, and also implemented dot surveying and paper and digital market surveys to gather feedback on the market.
At the end of the first market season, members of the committee and market board met to review the collected data and create a sustainability plan. These plans included expansion of access for individuals using the Supplemental Nutrition Assistance Program and the Women Infants and Children Farmers Market Nutrition Program, and also addressed market funding through community and business sponsorship opportunities. The Union County Farmers Market Board also agreed to use some of their annual funds to continue to support the market.
The Richwood Farmers Market continued in to its second season starting in 2016, and due to planning and evaluation, saw even greater success during the 2016 season. The market continues to improve every year due to involvement from a variety of community partners, the Market Board, the Richwood committee, and the UCHD-CHC program. The Richwood Market looks to continue to grow its vendor and customer base, and aims to improve reach and impact each year. General costs associated with the development and implementation of the Richwood Market in 2015, are listed below.
2015 Richwood Farmers Market Costs:
Market Manager Contract: $2,500.00
Advertising and Printing: $3,000.00
Signage and Market Manager Equipment: $1,000.00
Total costs in 2015: $6,500.00
One of the primary objectives of the UCHD-CHC program and its partners in the establishment and sustainment of the Richwood Farmers Market is the regular evaluation of the market and the community's health. Prior to the market's implementation, data from multiple sources was analyzed. Census data, Union County Community Health Assessment data, and mapping data to assess food availability and distance to healthy foods in the Village of Richwood we are all reviewed, and as a result, it was found that fruit and vegetable consumption was low and risk factors like blood pressure and cholesterol levels among Union County residents, which are influenced in part by diet, were high. The mapping data also revealed that Richwood was a food desert. The combination of these data points prompted the UCHD-CHC and its partners to prioritize this area for intervention, and do further assessment to measure the viability of a farmers market in the Village. The UCHD-CHC and its partners then developed a survey for Richwood residents that would measure level of interest, behaviors, and attitudes around having a farmers market in the community. The results of this survey, along with the data reviewed, served to further develop the parameters of the market, and provided a baseline to measure future outcomes.
As process objectives for the development of the 2015 market were established, so were process evaluation measures. These measures would be used to evaluate the success of each objective, and provide insight into the completion of the market. Some key process evaluation measures reviewed were number of key community partners, number of committee meetings held, number of vendors recruited for the market, number of preliminary interest survey results gathered, number of marketing materials disseminated, number of communication mediums used to distribute market information to residents, number of customers at the market per market day, and number of market days held for residents.
By the end of the 2015 market season, it was clear that the process objectives had been met using the process evaluation measures and a viable market had been established as an immediate outcome measure. In order to effectively measure the success of the market as a nutrition and food access intervention, outcome evaluation measures were developed. Using methods such as dot surveys, market surveys, customer counts, vendor counts, sales data, and other measures, the UCHD-CHC and its partners were able to capture quantitative and qualitative data on the market that could be compared between the 2015 season and 2016 season. These outcome evaluation measures included changes in average number of customers, changes in vendor counts, amount of fruits and vegetables consumed by customers consumed on weeks where they shop at a market, number of market days available per 10,000 residents, designation as a satellite market under the Union County Farmers Market, and acceptance and buy-in of a farmers market in Richwood from community members.
A primary goal of the UCHD-CHC program and its partners is to develop every project with sustainability in mind. Within the Richwood Farmers Market, several mechanisms have been put in place to assist with sustainability as the market grows. At the end of every market season, the Market Managers from both the Union County Farmers Market and the Richwood Farmers Market meet with the UCHD-CHC Coordinator to perform a Strengths, Weaknesses, Opportunities, and Threats (SWOT) analysis, as well as other review tools in order to capture crucial information that can be used to help build and support the market into the future. The Market Managers, UCHD-CHC Coordinator, and other committee partners also meet with the Union County Farmers Market Board to recap both markets and discuss market performance, budgets, survey results, vendor feedback, and other pertinent data. This information is then used to develop a plan for the next season, as well as matched against long-term plans for both markets. With this kind of sustainability review, the UCHD-CHC program and partners are able to plan for the continuation of a viable market once supporting funds from the grant expire. Both the Richwood Market and Union County Farmers Market have also utilized partnerships with the local Chamber of Commerce and other local businesses to secure sponsorship commitments for operational funds once grant funds are depleted.
Sustainability needs will also be met through continued partnership from community organizations, like the Richwood-North Union Library, Union County Health Department, Richwood Civic Center, and others with technical support to ensure the market's future success in providing healthy food for Richwood residents. Through increased programming, vendor sales, community partner and Market Board support, and consistent annual market evaluation, the Richwood Farmers Market will continue to thrive and grow as part of the fabric of the Richwood community. In approaching the 2017 market season, the Richwood Farmers Market looks to continue to provide low-cost access to healthy foods, and with the help of partners like the UCHD-CHC program, reduce the burden of chronic disease in the Village of Richwood and Union County.
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