Health Bucks Program

1. Health Bucks Program Alyson Abrami, MS, RD Manager, Farmers Market Programs New York City Department of Health and Mental Hygiene Physical Activity and Nutrition Program Farmers Market Federation: March 4, 2011

2. Physical Activity and Nutrition Program,Bureau of Chronic Disease Prevention and Control, Division of Health Promotion Disease Prevention • Mission: Make it easier for at-risk populations to eat healthier and exercise more • Developed in 2005 to develop and implement programs and policies around physical activity and nutrition • Interventions target areas with highest rates of obesity and other chronic disease, and least access to healthier foods and opportunities for physical activity • Policies and social marketing staged citywide

3. Examples of PAN Programs & Policy Work • Food Retail Initiatives • Calorie Labeling Regulation • Are you Pouring on the Pounds Social Marketing Campaign • Water in school cafeterias • Day Care Regulations • Physical activity in schools and day cares

4. Prevalence of Adult Obesity, NYC (2009) • 57% of NYC adults are overweight (34%) or obese (23%) • In some neighborhoods, as many as 70% of adults are overweight or obese

6. District Public Health Offices

7. Increasing Access to Fruits and Vegetables in Food Retail Venues in Target Areas Corner Stores: • Healthy Bodegas Initiative Supermarkets: • FRESH Supermarket Initiative • Healthy Supermarkets Program Mobile Food Vending: • Green Carts Farmers Markets: • Health Bucks and EBT promotion at farmers markets • Stellar Farmers Markets Nutrition Ed/Cooking Demos

8. Health Bucks Program

9. Initial Concept • Certain areas of the City have less access to healthy foods like fresh produce • We need to support the existence of all types of healthy food retail in these areas, including farmers markets • Farmers may be unwilling to come to poor neighborhoods because of perceived lack of demand • Financial incentives for customers thereby support both supply and demand

10. Program History • 2005: Piloted in South Bronx with approximately 3000 Health Bucks • 2006: Expanded to all three DPHO areas • 2007: EBT incentive added • 2008: Funding secured to expand EBT incentive • 2010: Over 130,000 Health Bucks distributed to over 160 CBOs and 60 farmers markets

11. How Health Bucks Are Distributed 1: To community groups to incentivize first time visits • Only organizations and sites in DPHO areas can apply for Health Bucks (application avail. online) • 50-200 given per org based on previous redemption rates and needs • Must be distributed as part of a nutrition education program • In 2010, over 160 orgs distributed ~30,000 Health Bucks

12. How Health Bucks are Distributed 2. As an Incentive for using SNAP Benefits • For every $5 spent in EBT, customer gets a $2 Health Buck (unlimited), representing a 40% increase in purchasing power • Customer approaches market manager, decides how much EBT to spend, receives EBT $ in tokens and corresponding Health Buck coupons • EBT can be used for any non alcoholic food, Health Bucks only for non processed produce

13. How Health Bucks are Distributed In 2010, ~100,000 Health Bucks were distributed as an EBT incentive at 60 participating markets in all 5 boroughs

14. How Health Bucks are Used • Customers bring their Health Bucks to the market or receive them upon spending EBT at the market • Customers use Health Bucks at individual farm stands to purchase fresh produce (no change given) • Health Bucks can be used at any participating market over the course of the season • Unlike EBT tokens, they expire every year

16. How Farmers Are Reimbursed • Farmers collect Health Bucks and mail them to the Farmers Market Federation for reimbursement • They do this on their own schedule, must be mailed in by mid December • All reimbursement complete by early January

17. How Health Bucks are Promoted & Supported • Promotional materials including maps and posters provided to distributing organizations, markets, and nearby sites offered free of charge • Website updated annually with all materials, downloadable via PDF • Press releases • Mailing sent to all SNAP recipients in DPHO areas • Banners, buttons, and aprons provided to all participating markets promoting EBT incentive • Stimulus funds for mini-grants to markets to ensure they accept EBT (29 markets awarded grants in 2010) • Interns stationed near markets directing people to their location

19. Empower Food Stamp (SNAP) eligible New Yorkers to make healthier food choices Enhance nutrition knowledge and improve skills in purchasing and preparing simple recipes using locally grown, seasonal produce. Complimentary Program: Stellar Farmers Markets

20. What does Stellar Farmers Markets Provide Practical nutrition information Quick and easy recipe demonstrations, taste sample and recipe handout Tips and ideas for planning and preparing delicious, healthy meals Food safety information Nutrition handouts Free gift for each participant

21. Program Administration • Each year Health Bucks are printed in a different color to differentiate between years • Unique serial number identifies each Health Buck to limit fraud and enable tracking • Farmers remit coupons to Farmers Market Federation who trains all farmers and sends them reimbursement checks over the course of the season

22. Health Bucks Distribution and Redemption2006-2010 Note: includes both EBT and organization distribution data from all three boroughs

23. Health Bucks Distribution and Redemption2008-2010

24. Health Bucks Incentive Increases EBT Use at Participating Markets (2009)

25. ABT/CDC Evaluation • Health Bucks selected by RWJ/CDC as a promising national practice • CDC funding evaluation conducted by ABT Associates • Multi pronged evaluation effort conducted in 2010 to assess impact and feasibility for national implementation • Results and toolkit should be available soon

26. Thank you!