Union County Health Department
Reducing Food Insecurity through the Giving Garden: A Model for Community Healthy Food Access
The Union County Health Department, located in Marysville, Ohio, serves a rural community of over 55,000 residents. Union County's poverty rate is 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 outcomes. 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. 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 to identify priority communities and develop projects to address the underlying policy, systems, and environmental changes needed to improve residents' health in the areas of healthy eating, tobacco prevention, and physical activity. Some areas of concern noted upon review of CHA, census data, and discussions with community partners were the percentage of residents indicating low consumption of fruits and vegetables and food insecurity. Further review of the data highlighted that more than 11% of Union County residents receive regular food assistance. It was also mentioned that even with food assistance, the nutritional quality of available food, and limited supply of produce due to shelf life were common issues. This lack of consumption of fruits and vegetables, food security, and low availability of healthy produce resulted in the creation of partnerships that lead to the development of the Giving Garden program.
Through partnerships between the Dutch Mill Greenhouse (DMG), the UCHD-CHC program, the Union County Master Gardener Volunteers (UC-MGV), and West Central Community Correctional Facility (WCCCF), the groundwork for a garden program to combat food insecurity was established. Beginning spring of 2016, the aforementioned partners formed a committee, to include local meal and food distribution sites, and a plan and name for the program was formed the Giving Garden. The DMG provided garden beds behind their business and donated soil and seeds to help kickstart the program. The WCCCF offered to have inmates who were interested help tend the gardens, and the UC-MGV provided gardening education and onsite training to the inmates. The UCHD-CHC program provided some funding, technical assistance, and data collection and analysis to ensure program success. As of the end of 2017, the program has seen tremendous growth in its total weight of produce donated, and has gained the interest of other organizations, such as the local Board of Developmental Disabilities, and girl scout troops who want to learn about gardening and community service.
The creation and implementation of the Giving Garden required three main components: An adequate supply of produce, which is regularly donated to meal and food distribution sites to provide greater food access and assist in reducing the prevalence of chronic diseases, the development of educational opportunities for at-risk volunteers that address health inequities through newly learned gardening skills, and collaboration between local partners. Now, after completing its second year, averaging hundreds of pounds of donated produce, increased knowledge of gardening among at-risk volunteers, and sustained partnerships with unique organizations, the Giving Garden has met all of its previously mentioned objectives, and continues to develop new strategies to create sustainability, increase the variety and yield of produce, and expand gardening education. The success of the Giving Garden can be attributed to the guidance and collaboration with the UC-MGV, the support from the UCHD-CHC program, and the unique integration and partnership with the DMG, and WCCCF, all of which have helped make for a sustainable source of healthy food for residents in need. As the Giving Garden continues to grow, the long-term impact will be measured by greater food access, higher consumption of fruits and vegetables by those served in the program, a decreased prevalence of chronic diseases and chronic disease risk factors, increased knowledge of gardening principles for volunteers, and sustained partnerships with unique community partners.
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 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, 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. Two primary areas of concern noted upon review of Community Health Assessment data, as well as census data, was the low consumption of fruits and vegetables, and the number of Union County residents on food assistance (11%), which doesn't account for those who are food insecure, but do not meet qualifications for food assistance. Further investigation led to the discovery of a need for greater access to, and variety of, fresh fruits and vegetables by those served by local foodbanks and meal sites. Though Union County has several well-established locations for food distribution and meal sites for residents in need, there is a constant need for a variety of fresh, healthy produce at each site, and a supply that varies greatly throughout the year. The desire for greater consistency and variety at food distribution sites, along with the concern over fruit and vegetable consumption and food insecurity, prompted community organizations, such as the Union County Master Gardeners, a local greenhouse business, and the UCHD-CHC program to devise a strategy to best address the issues.
Upon meeting with the identified partnering organizations, it was decided that an intervention designed to provide a reliable source of fresh, healthy produce for those in need was a priority. One partnering organization, the Dutch Mill Greenhouse, proposed establishing a garden to meet that need. Other organizations, such as the Union County Master Gardener Volunteers and the UCHD-CHC program, responded to this idea, and posited that the garden could be designed around the communicated needs of some of the local food distribution sites. By this point, the various organizations had come together to form a committee, and a program name was born from the intention of the project, the Giving Garden. The next step for the team was to consult current evidence-based programs and best practices to determine the ideal route for implementation. 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 (Strategies 8: Support and promote community and home gardens, and 10: Include fruits and vegetables in emergency food programs), as well as the County Health Rankings and Road Maps â€“ What Works for Health, to facilitate the development and implementation of the garden. The team adhered to the guidelines and recommendations to ensure the use of best practices to help build a successful and sustainable garden that can support those in need within the community. The team also utilized the creative concept of partnering with a local correctional rehabilitation facility, West Central Community Correctional Facility, to provide an educational and community service opportunity to inmates who are working towards transitioning back into the community. This partnership has helped establish a consistent source and robust variety of healthy produce for people in need, as well as an opportunity to teach volunteers new lifelong skills in gardening. Other local organizations are also interested in the giving and educational opportunities this garden provides, and are now joining the team to provide a larger pool of volunteers who want to make a change in Union County. The team continues to build and expand the garden and its volunteer base, now moving into its third year, with sustainability and innovation in mind in order ultimately improve the health of the community.
The overall reach of the Giving Garden over the past two years has grown significantly. During the garden's first two years, there has been an increase in yield from just over 100 pounds of produce grown and donated in 2016 to over 750 pounds of produce grown and donated in 2017. There has also been a significant increase in the number of volunteers trained by the Master Gardeners. In 2016 a handful of volunteers were given training on how to garden and provided support to plant, maintain, and harvest in the garden, but in 2017 over 70 volunteers were trained, which assisted in increasing the number of available volunteers to work in the garden every week, as well as the overall number of plants that could be planted and harvested. When reviewing feedback from the trained volunteers, of the 36 who had never gardened before, all felt they had the readiness to grow their own garden after training with the Master Gardeners. In reviewing the need and availability of produce to Union County residents, local food and meal distribution sites were asked about estimations of clients served, as well as type of produce needed. Each site provided feedback on the what produce was needed, and client estimation, which came to about 1300 individuals in 2016. An estimation on reach is being reviewed for the 2017 season, and there are plans to increase harvest yield as well as number of sites served in 2018. The UCHD-CHC program and partnering organizations continue to annually review the Giving Garden 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 Giving Garden, the UCHD-CHC and its partners established objectives to reach the goal of building out the garden as part of the overall Creating Healthy Communities annual work plan for 2016. The first objective was to establish a formal committee to assist in the development and implementation of the garden. This committee would be made up of the Dutch Mill Greenhouse, Master Gardener Volunteers, West Central Community Correctional Facility, and the UCHD-CHC program. More partners have come to the table since, but the core organizations remain as pillars for the program. Once our committee was established, it was tasked with following through on the objectives and activities listed below to complete the goal of developing the garden:
Establish local partnerships to review the need and efficacy of a giving garden program.
Gather information from local meal and food distribution sites and survey them for produce needs and clients served.
Work with local partners to secure volunteer base and identify drop off sites.
Procure needed equipment, seeds and plants, and train volunteers to maintain garden.
Implement the Giving Garden at the Dutch Mill Greenhouse.
Build awareness and interest through the creation and implementation of a communications plan.
Complete an evaluation of the garden to measure yield, reach, and overall success.
Develop a sustainability plan with garden committee.
Provide continuous technical assistance to ensure garden success, expand garden reach, increase partnership and volunteer opportunities, and improve overall 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 them by the end of the 2016 season. The committee used feedback from the various distribution and meal sites to establish a time and day of the week for produce drop off, and organized volunteers to deliver the produce from the garden. Once the garden concept, distribution process, and volunteer base were established, a training series for West Central Community Correctional inmates was offered. After the Master Gardeners completed their training series, the committee decided on dates and times for volunteers to work in the garden, and funds from the UCHD-CHC program and Dutch Mill Greenhouse supplied the needed equipment, seeds and plants to begin the season. At the same time, the committee worked to establish a layout of the garden, and ideal crops to be planted based on feedback from the meal and distribution sites. Once plans were finalized and training was completed, planting began, and West Central Community Correctional Facility and Master Gardener Volunteers maintained the gardens on a scheduled weekly basis. Periodic communications would be sent through social media and local newspapers to help build awareness within the community, give participating partners recognition for their support, and also assist in garnering interest from other volunteer organizations and potential community partners. The committee also worked together to implement tracking tools to measure garden yield and distribution, as well as surveys for volunteers who complete the garden training by the Master Gardeners.
At the end of the 2016 season, members of the committee met to review the collected data and create a sustainability plan. This plan included the expansion of garden plots using a succession planting methodology to increase yield within the next season, the continuation of the gardening training program for volunteers, and a partnership review and outreach plan to address greater volunteer needs for 2017. The UCHD-CHC program also agreed to contract with the Dutch Mill Greenhouse and Master Gardener Volunteers to expand the program through the purchase of more equipment and supplies for the 2017 season.
The Giving Garden continued in to its second season starting in 2017, and due to proper planning and evaluation, saw even greater success than in 2016. The garden continues to improve every year due to involvement from a variety of community partners who are committed to the success of the program. The Giving Garden looks to continue to grow, and aims to improve reach and impact each year. General costs associated with the development and implementation of the Giving Garden totaled between the 2016 and 2017 seasons, are listed below. The costs associated with maintaining the program after the first year are relatively low, requiring only Periodic equipment replacement, soil augmentation/fertilizer, and seed/plants.
2016-2017 Giving Garden Costs:
Dutch Mill Greenhouse Contract: $1,700.00 (includes equipment and supplies)
Master Gardener Volunteer Contract: $500.00 (includes equipment and supplies)
Advertising and Printing: $200.00
In-Kind contributions from Dutch Mill Greenhouse:
Garden beds (14 â€“ 8'x8' railroad ties): $728.00
Soil: (310 cubic yards topsoil @$32.50): $10,075.00
Some plants/seeds, water: $100.00
Total costs and in-kind contributions (2016-2017): $13,303.00
One of the primary objectives of the UCHD-CHC program and its partners in the establishment and sustainment of the Giving Garden is not only the regular evaluation of the garden, but also the community's health. Prior to the garden's implementation, both census data and Union County Community Health Assessment data were analyzed. As a result, it was found that fruit and vegetable consumption was low, a moderate number of residents were living in poverty with some level of food insecurity, and risk factors like blood pressure and cholesterol levels among Union County residents, which are influenced in part by diet, was high. The combination of these data points, along with the willing partnership of a local greenhouse and community organizations, helped identify the need for, and establish the Giving Garden. From this, the UCHD-CHC program and its partners were able to identify and reach out to local organizations that make meals and distribute food to measure their level of interest and need. The result of the outreach, along with the data reviewed, served to further develop the parameters of the garden, and provided a baseline to measure future programmatic and community health outcomes.
As process objectives for the development of the 2016 garden 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 garden. Some key process evaluation measures reviewed were the number of key community partners, completion of a project outline, number of regular volunteers at the garden, number of volunteers trained by Master Gardener Volunteers, number of communication materials disseminated, pounds of fruits and vegetables harvested, number of organizations identified to distribute harvested produce, and number of clients served by the garden program.
By the end of the 2016 season, it was clear that the process objectives had been met using the process evaluation measures and a viable garden program had been established as an immediate outcome measure. In order to effectively measure the success of the garden, outcome evaluation measures were developed. Using produce yield data, survey data from training sessions, and feedback from meal and food distribution sites, among other measures, the UCHD-CHC program and its partners were able to capture quantitative and qualitative data on the garden that could be compared between the 2016 season and 2017 season. These outcome evaluation measures included changes in total pounds of produce yielded, number of volunteers trained, knowledge of gardening by volunteers trained, and change in variety of produce planted.
A primary goal of the UCHD-CHC program and its partners is to develop every project with sustainability in mind. Within the Giving Garden, several mechanisms have been put in place to assist with sustainability as the program grows. At the end of every season, the garden committee meets to review the outcomes of the season, draft next season's garden plan, review funds needed for the season, identify potential partners and volunteers for the next year, and the review of 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 the garden. With this kind of sustainability review, the UCHD-CHC program and partners are able to plan for the continuation of a viable garden program once supporting funds from the grant expire.
Sustainability needs will also be met through continued partnership from organizations like the Union County Master Gardener Volunteers, Union County Health Department, West Central Community Correctional, and the Dutch Mill Greenhouse. Through continued garden expansion and succession planting, volunteer groups, community partners, and consistent evaluation, the Giving Garden will continue to grow to better serve the community. In approaching the 2018 season, the Giving Garden program looks to continue to provide free, healthy produce to residents in need, and with the help of partners like the UCHD-CHC program, reduce the burden of chronic disease and food insecurity in Union County.
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