Healthy Food Procurement in the County of Los Angeles Public Health Alliance of Southern California Leadership Council May 31, 2013 Michelle Wood, MPP Division of Chronic Disease and Injury Prevention
Presentation Overview Share LA County s experience with operationalizing nutrition standards and other procurement practices in government departments/programs. Present lessons learned and preliminary findings of healthy food procurement efforts.
Healthy Food Procurement Food Procurement encompasses the process of procuring, distributing, selling, and/or serving food. Nutrition Standards Food Purchasing Standards Environmental Approaches Source: Robles B, Wood M, Kimmons J, Kuo T. Comparison of nutrition standards and other recommended procurement practices for improving intuitional food offerings in Los Angeles County, 2010-2012. Adv Nutr 2013; 4(2): 191-202.
Creating Healthier Food Environments Access to healthy food and beverage options. Improve the quality of food and increase food security. Leverage the purchasing power of large institutions. Support local economies. Improve the health of employees, and community members who use government programs and facilities.
Needs Assessment 2009 5
Needs Assessment: County Food Service Environments There are hundreds of worksite food service venues within County departments (e.g., cafeterias, snack shops, vending machines). In many of these venues, including cafeterias and snack shops, patrons are often residents of nearby low-income neighborhoods.
Estimated Reach of Food Procurement Policies Setting/Program Worksite Cafeterias (e.g., Public Works, Hall of Administration, Health Services Headquarters) # of meals served per day 1,820 Mobile Trucks 2,500 Snack Shops 1,000 Jails 80,000 Probation camps 11,050 Hospitals 3,589 County of Los Angeles Government ~ 37 million meals per year *estimates based on needs assessment findings
Approach to Establishing Food Procurement Policies in the County of Los Angeles Targeting departmental food service contracts and contracting process. Based on local data and evidence on venue-based approach (e.g., 2009 needs assessment). Conduct review of current food standards, policies and practices. Develop evidence-based nutrition recommendations.
Food Service Contracting Process Institution (e.g. Hospitals, Schools, Workplace Cafeterias, etc.) Request for Proposal (RFP) or Invitation for Bid (IFB) Contractors Submit Proposals Final Food Service Contract DPH Recommended Nutrition Standards and Healthy Purchasing Practices Approach to Integrating Nutrition Standards in Food Service Contracts
Approach to Establishing Food Procurement Policies in the County of Los Angeles Technical Assistance and Support Site visits Menu review & nutrition technical advice Monitoring, Compliance and Evaluation Annual Food Policy Forum
County of Los Angeles Board Motion: Passed March 22, 2011 I THEREFORE MOVE THAT THE BOARD OF SUPERVISORS: Instruct the CEO and County Departments to consult with the Director of the Department of Public Health prior to the release of any Requests for Proposals for County food services contracts that involve the purchase, distribution, and/or sale of food and beverages in County facilities and programs to ensure that dietary requirements within the final contract promote healthy nutrition and comply with previously adopted Board policies. The Director of the Department of Public Health will work directly with affected agencies to incorporate nutrition recommendations to the extent feasible within each contract. 11
Food Procurement Advisory Committee American Diabetes Association American Heart Association California Dietetics Association California Center for Public Health Advocacy California Food Policy Advocates Los Angeles County Department of Public Health Los Angeles Food Policy Council Kaiser Permanente Urban Environmental Policy Institute
County Food Service Assessment Conducted interviews with County departments following adoption of Board motion. Interview Topics Type(s) of food service venues and locations Profile of customers served Food preparation Contracting processes Number of meals and snacks offered/sold Nutrition-related standards or guidelines
Food Service Environments ~37 departments ~101,000 staff ~12 departments purchase, sell, or distribute food Food Contracts Vending Machines
Venues Impacted Jails, juvenile detention centers, probation camps Worksite cafeterias, Concession stands, and Snack Shops Distributive food programs (i.e. senior meals programs) Mobile Vending Vending Machines
Departments Making Changes in the County of Los Angeles County of Los Angeles Department Department of Health Services Department of Public Works Probation Department Food Venue (s) Hospital Cafeterias Vending Machines Workplace Cafeteria Vending Machines Juvenile Halls & Probation Camps Parks and Recreation Department Chief Executive Office Summer Food Service and After-School Snack Program Vending Machines Vending Machines
Sample Nutrition Standards and Other Procurement Practices Worksite Cafeterias Healthy entrée, side options, snacks Reduced portion size for sugar sweetened beverages (SSB) Gradual sodium reduction plan Purchase locally grown food Signage for healthy items and menu labeling Price incentive policies
Implementation Plan On-going outreach to County departments. DPH-led environmental scan of selected food setting (s). One-on-one meetings and technical support. On-going monitoring and compliance. Bi-annual workgroup meetings with departments. Quarterly Advisory committee meetings.
Evaluation Purpose Document the potential effectiveness of expanding access to healthy food options for County staff, clients, and other members of the public. Evaluation Activities Examine compliance with nutrition standards. Gauge acceptability of changes to new menus. Review inventory of food sold or consumed at facilities.
Department of Public Works (DPW) Cafeteria and Vending Machines Pre-Implementation of Nutrition Standards Post-Implementation of Nutrition Standards
Department of Public Works (DPW) Cafeteria and Vending Machines County Vending Machine Nutrition Policy Environmental scan conducted using validated vending machine measurement tool (NEMS-V) Pre Post 41% (14/34) healthy snacks 30% (8/27) healthy beverages 80% (47/59) healthy snacks 79% (33/42) healthy beverages
Lessons Learned
Lessons Learned: Facilitators Review past and/or current procurement practices. Assess institutional readiness to operationalize new approaches. National support and momentum (e.g., NYC/NSRI, CDC, GSA/HHS). Strong partnerships with key stakeholders. Technical assistance to support ongoing implementation.
Lessons Learned: Barriers Each institution has its own internal administrative processes, contracts divisions, and unique needs and concerns. Variance among department s understanding of nutrition concepts. Concerns about cost, availability and acceptability of healthier food options. Evaluation data collection.
Implementation Resources
Adoption and Implementation of Healthy Nutrition Standards and Other Procurement Practices A Potentially High- Yield/High-Impact, Sustainable System Change in Los Angeles County
Acknowledgements Los Angeles County Department of Public Health Dr. Paul Simon Dr. Tony Kuo Michael Leighs Brenda Robles Patricia Cummings Ali Noller
Contact Information Choose Health LA www.choosehealthla.com/ Michelle Wood, MPP Program Manager, Food Procurement & Policy Choose Health LA Division of Chronic Disease and Injury Prevention Los Angeles County Department of Public Health micwood@ph.lacounty.gov 213.351.7847