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2014 Model Practices

Application Name: 2014 Model Practices : Cincinnati Health Department : Creating Healthy Communities
Applicant Name: Mrs. Denisha Porter
Name of Practice:
Creating Healthy Communities
Submitting LHD/Agency/Organization:
Cincinnati Health Department
Street Address:
3101 Burnet Ave.
Submitting LHD/Agency/Organization/Practice website:
Practice Contact:
Denisha Porter
Practice Contact Job Title:
Public Health Educator
Practice Contact Email:
Head of LHD/Agency/Organization:
Cincinnati Health Department
Provide a brief summary of the practice in this section. Your summary must address all the questions below. 
Size of LHD jurisdiction (select one):
In the boxes provided below, please answer the following:
1)Where is LHD located? 2)Describe public health issue 3)Goals and objectives of proposed practice 4)How was practice implemented / activities 5)Results/ Outcomes (list process milestones and intended/actual outcomes and impacts. 6)Were all of the objectives met?  7)What specific factors led to the success of this practice? 8) What is the Public Health impact of the practice?
For Cincinnati, food access is an issue of health equity. The incidence of diet-related diseases is disproportionately high amongst populations in lower-income neighborhoods. In correlation, residents have a higher incidence of food insecurity compared to the average American household. A 2011 study of Cincinnati found that 69% of residents live at least 1.5 miles or more (a 30 min. walk) from a mainstream grocery outlet. Of these residents, 82% are African American compared to 41% White, further emphasizing the disproportionate inequities amongst minority populations and increasing risk of other chronic health conditions . Widening gaps in health disparities correlate with median incomes. For Cincinnati residents, median household income in 2009 was $21,971 for African Americans compared to $42,868 for White residents . This data illustrates the increasing strain on our current health system and the impending long-term costs. The Cincinnati Health Department’s Urban Farming Program, led by the CHD's Creating Healthy Communities program, addresses Cincinnati's food and health-related inequities through:  systemic assessment of food access issues;  education and engagement;  collaborating with local government, policymakers, and community stakeholders;  and effecting environmental, policy, and systems changes. Goal: To increase access, consumption, and production of healthful fruits and vegetables amongst low-income populations. Our objectives are to (1.) establish and promote access to fresh produce and healthy living programs in targeted neighborhoods, (2.) support food production areas (community-gardens, urban farms, etc…) through education, engagement, and technical assistance, (3.) establish ‘shared-use’ of public space through developing community-based partnerships among community organizations, (4.) and work with local policy makers to establish supportive urban agriculture policies. Since it's inception in 2010, the Urban Farming Program has recognized urban agriculture as an innovative and comprehensive approach to improving the health of social, ecological, and economic systems. Through community engagement and small-scale intensive farming methods, our community-based farms are able to provide nutritious foods to neighborhood residents, community recreation centers, community food pantries, faith-based organizations and local senior centers. The Urban Farming program (servicing the neighborhoods of Winton Hills, Spring Grove Village, Bond Hill, North Avondale, and Madisonville) has strengthened community partnerships, leveraged local assets, and built sustainable local food sources that foster health, equity, and strong local economies. Based upon an innovative ‘open door’ model focusing on shared-use of public space, we have experienced annual increases in community participation and food production. In 2012, the UFP’s six community-based farms provided over 4,000lbs of fresh fruits and vegetables to residents and community organizations. Our work ‘on the ground’ within the communities helps educate and shape our policy initiatives. The UFP has worked with Cincinnati City Council to develop notable policies and programs that support the development of local food systems as key initiatives to the sustainable health of our region. Surveys administered annually indicate factors of: • increases in daily consumption of fruits and vegetables, attributed to the proximity of the food source (garden) to home; • increases in community participation, stewardship, and pride; • increases in physical activity amongst youth and elderly populations (ages ranging from 8-68); • increases in food literacy; • increased awareness of a community’s food security and related ecosystem functions (such as storm-water management, enhanced biodiversity, and soil remediation).
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Finally, given the inter-dependent relationships of a ‘local food system’ our partnerships and collaborations continue to identify new opportunities for integrating food access and production into the places in which we live, work, and play to support healthy eating and community resilience.
Supplemental materials:
You may provide no more than two supplement materials to support your application. These may include but are not limited to graphs, images, photos, newspaper articles etc. (Please use one of the following: pdf; txt; doc; docx; xls; xlsx; html; htm)
Model Practice(s) must be responsive to a particular local public health problem or concern. An innovative practice must be 1. new to the field of public health (and not just new to your health department) OR 2. a creative use of an existing tool or practice, including but not limited to use of an Advanced Practice Centers (APC) development tool, The Guide to Community Preventive Services, Healthy People 2020 (HP 2020), Mobilizing for Action through Planning and Partnerships (MAPP), Protocol for Assessing Community Excellence in Environmental Health (PACE EH). Examples of an inventive use of an existing tool or practice are: tailoring to meet the needs of a specific population, adapting from a different discipline, or improving the content.  
In the boxes provided below, please answer the following:
1)Brief description of LHD – location, jurisdiction size, type of population served 2)Statement of the problem/public health issue 3)What target population is affected by problem (please include relevant demographics) 3a)What is target population size? 3b)What percentage did you reach? 4)What has been done in the past to address the problem?5)Why is current/proposed practice better?  6)Is current practice innovative?  How so/explain? 6a)New to the field of public health OR 6b)Creative use of existing tool or practice 6b.1)What tool or practice did you use in an original way to create your practice? (e.g., APC development tool, The Guide to Community Preventive Services, HP 2020, MAPP, PACE EH, a tool from NACCHO’s Toolbox etc.) 7)Is current practice evidence-based?  If yes, provide references (Examples of evidence-based guidelines include the Guide to Community Preventive Services, MMWR Recommendations and Reports, National Guideline Clearinghouses, and the USPSTF Recommendations.)
This model practice addresses a multitude of public health issues. Foremost, the Cincinnati Health Department’s Urban Farming Program (UFP), serving the City of Cincinnati with a population of approximately 300,000, utilizes evidence-based change strategies to impact chronic disease and obesity rates amongst low-income populations within Cincinnati. Furthermore, the UFP comprehensively addresses issues of: • assessment of local food systems; • accessibility, consumption, and production of fruits and vegetables amongst low-income populations; • disconnect between local health programs, community-based organizations, and the residents in need of services; • sustainable community-building based on innovative engagement, education, and policy processes – premised on urban agriculture. According to a 2011 Food and Health study of Hamilton County (population 802,000), 69% of Cincinnati residents live in areas with low healthy food access, 1.5 miles or more from a mainstream grocery outlet . This data correlates with high incidence of chronic disease, limited access to healthful foods, and increased food insecurity. Poor health outcomes such as cancer, heart disease, diabetes, and obesity can, in part, be attributed to unhealthy diets, which are typically chronically low in fruits and vegetables. The UFP’s target neighborhoods include Winton Hills, Spring Grove Village, Bond Hill, North Avondale, and Madisonville, impacting an approximate population of 31,500. Of these residents, 82% are African American compared to 41% White, further emphasizing the disproportionate inequities amongst minority populations. Additionally, the widening gaps in health disparities correlate with median incomes. For our target neighborhoods the median household income in 2009 was $21,971 for African Americans compared to $42,868 for White residents. The consumers of this demographic group find they have greater distances to travel for healthy foods, with many lacking the appropriate means of transportation. As is common for most urban neighborhoods, the convenient stores that are within walking distance offer little in the ways of fruits and vegetables, while local food pantries have limited supplies and/or no cooling systems to keep produce fresh. The model practice of the UFP takes a systems perspective, seeking to utilize urban agriculture as an innovative and comprehensive approach to improving the health of social, ecological, and economic systems. Through innovative and strategic ‘shared-uses’ of public/private land, responsive community engagement, small-scale intensive farming methods, and comprehensive policy initiatives – our model practice has integrated food production and access into the fabric of neighborhoods. The systemic approach of the UFP is based on conceptual theories and scientific-evidences derived from the Guide to Community Preventive Services, Change Lab Solutions, and specific model practices from NAACHO’s Toolbox. The UFP’s model practice of urban food systems addresses the CDC’s Winnable Battles of Nutrition, Physcial Activity, and Obesity. Our innovative practice links the complex relationships of the food system. Our program goes beyond implementation of community-gardens. By identifying emergent properties and strengthening the integrative levels of the system, the UFP comprehensively addresses a multitude of issues related to the health of low-income populations.
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Does practice address any CDC Winnable Battles?  Select all that apply.
Nutrition, Physical Activity, and Obesity
The LHD should have a role in the practices development and/or implementation. Additionally, the practice should demonstrate broad-based involvement and participation of community partners (e.g., government, local residents, business, healthcare, and academia). If the practice is internal to the LHD, it should demonstrate cooperation and participation within the agency (i.e., other LHD staff) and other outside entities, if relevant. An effective implementation strategy includes outlined, actionable steps that are taken to complete the goals and objectives and put the practice into action within the community.  
In the boxes provided below, please answer the following:
1)Goal(s) and objectives of practice
2)What did you do to achieve the goals and objectives? 2a)Steps taken to implement the program 3)Any criteria for who was selected to receive the practice (if applicable)? 4)What was the timeframe for the practice 5)Were other stakeholders involved? What was their role in the planning and implementation process? 5a)What does the LHD do to foster collaboration with community stakeholders? Describe the relationship(s) and how it furthers the practice goal(s) 6)Any start up or in-kind costs and funding services associated with this practice?  Please provide actual data, if possible.  Else, provide an estimate of start-up costs/ budget breakdown.
The Cincinnati Health Department is the lead agency for the Creating Healthy Communities Urban Farming Program. The UFP demonstrates broad-based community participation and involvement from local government, residents, academic institutions, and community organizations. Since it's inception in 2010, the UFP has engaged residents and established thriving community partnerships with the fundamental goal of improving the health of Cincinnati residents. Ancillary goal(s) are to increase accessibility and consumption of healthy foods through increased production of local fruits and vegetables via ‘shared-use’ models of public space. Our objectives are to: (1.) establish and promote access points for fresh produce and healthy living programs in targeted neighborhoods; (2.) establish ‘shared-use’ of public space through developing community-based partnerships among community organizations; (3.) support food production areas (community-gardens, urban farms, etc…) through education, engagement, and technical assistance; (4.) and work with local policy makers to establish supportive urban agriculture policies. The innovative approach of the UFP embraces a systems perspective, seeking to utilize urban agriculture as a platform to improving the health of social, ecological, and economic systems. The comprehensive approach undertaken is sustained creating equitable, healthy partnerships. The UFP coordinator is responsible for the implementation and completion of program goals. Implementation processes include coordinating with local agencies, facilitating meaningful community engagement in planning and land-use decisions. Building community ownership is essential, meeting the needs of diverse neighborhoods and incorporating the collective vision is imperative in building broad support, effective public processes, and sustainability. Additional steps include conducting community assessments and identifying assets. Community stakeholders include neighborhood residents, community councils, governmental agencies, community redevelopment corporations, community recreation centers, local food pantries, faith-based organizations, local schools and senior centers. The role of community partnerships is specific to each neighborhood. Their roles in the planning and implementation processes vary based upon capacity and organizational mission. The UFP fosters collaboration with each community stakeholder, utilizing their assets to strengthen the collective network that comprises each neighborhood’s local food system. For instance, we support community-gardens at specific Community Recreation Centers, which serve as positive social hubs within our target neighborhoods. They provide the appropriate setting for shared-public space for food production, distribution, and educational classes. Collaborating partners include the Cincinnati Health Department, the City of Cincinnati’s Office of Environmental Quality, the Civic Garden Center, the Cincinnati Recreation Commission and the Bond Hill CRC, Winton Hills CRC, and North Avondale CRC, the Madisonville Community Redevelopment Corporation, Gaines United Methodist Church, New Mission Baptist Church, Cincinnati Bible Way Church, the Evergreen Holistic Learning Center, Funke’s Green House, SideStreams, the Light House Youth Center, the Cincinnati Nutrition Council, the Green Umbrella, and Cincinnati City Council.
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Through small-scale intensive farming methods and technical assistance, the UFP has been able to engage stakeholders and implement food production areas (community gardens, urban farms, etc…). Since 2010, we have implemented seven community-based gardens. Each site has its own group of ‘primary’ gardeners, engaged and vetted by the UFP coordinator. Additionally, each site is unique to itself personifying the vision of the neighborhood residents and community agencies. Initial start-up costs vary based on site remediation (soil quality and infrastructure). Approximate costs range from $500-$1,000. Beginning in January, monthly planning meetings are held to create a vision, share ideas, and plan for the upcoming year. Beginning in mid-March (weather pending) bi-weekly community workdays and technical trainings are held. Each ‘garden group’ shares information about sustainable gardening, volunteer management, food literacy, and healthy lifestyle practices. As the gardens grow, so does community participation. All sites adhere to an ‘open-door’ policy, in which the gardens are accessible to all. This is no fencing or any restrictive structures prohibiting access. Furthermore, food is available to all regardless of participation.
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The ‘grass roots’ initiatives taken by the UFP provide the framework for comprehensive policies that enhance local food systems and sustain healthful food access. Our collaboration with community partners, and work with community members on the ground and ‘in the gardens’, provides the experience and ability to understand the challenges to accessing healthful foods. We are provided first hand knowledge of the obstacles faced by residents and communities as a whole. This allows us to effectively work with policy makers and governmental agencies to implement effective and sustainable policy initiatives. Based upon the work of the UFP, the following notable programs and policies have been adopted by the City of Cincinnati:  2012 Mobile Food Vending Program; ◦ a pilot program to increase the vitality of city streets, establish new markets, expand small business opportunities, and improve affordable food choices. Pilot program runs July 1, 2012 – June 30, 2014.  2012 Mobile Produce Vending Program; ◦ a pilot program to increase access to fresh produce by issuing permits to community gardeners, urban farmers, and entrepreneurs to sell fresh fruits and vegetables near community gardens and in neighborhoods with 'food deserts'. Pilot program runs May 1, 2012 – April 30, 2013.  2012 approval for commercial composting facility;  2010 Urban Agriculture Program; ◦ a program for community members to utilize vacant, city-owned parcels of land for agricultural use.  2009 defined 'community garden' and permitted use in all zones, excluding Downtown and Riverfront zones.
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Evaluation assesses the value of the practice and the potential worth it has to other LHDs and the populations they serve. It is also an effective means to assess the credibility of the practice. Evaluation helps public health practice maintain standards and improves practice.

Two types of evaluation are process and outcome. Process evaluation assesses the effectiveness of the steps taken to achieve the desired practice outcomes. Outcome evaluation summarizes the results of the practice efforts. Results may be long-term, such as an improvement in health status, or short-term, such as an improvement in knowledge/awareness, a policy change, an increase in numbers reached, etc. Results may be quantitative (empirical data such as percentages or numerical counts) and/or qualitative (e.g., focus group results, in-depth interviews, or anecdotal evidence).
In the boxes provided below, please answer the following:
1)What did you find out?  To what extent were your objectives achieved?   Please re-state your objectives from the methodology section.
2)Did you evaluate your practice? 2a)List any primary data sources, who collected the data, and how (if applicable) 2b)List any secondary data sources used (if applicable) 2c)List performance measures used.  Include process and outcome measures as appropriate. 2d)Describe how results were analyzed 2e)Were any modifications made to the practice as a result of the data findings?
The purpose of the UFP is engage residents and established thriving community partnerships with the fundamental goal of improving the health of Cincinnati residents. Furthermore, we seek to increase accessibility and consumption of healthy foods through increased production of local fruits and vegetables through ‘shared-use’ models of public space. Through strategic community engagement and effective partnership building, we have determined that there is a strong community desire to incorporate localized food systems within our neighborhoods. Based upon annual surveys conducted by the UFP and in-depth gardener interviews, our processes have successfully engaged community participation and awareness. Our gardener evaluations have determined an increased desire for a more intimate relationship with food, the land that produces it, and affiliated healthy lifestyle choices. Outcomes have indicated that the ‘hands-on’ participation resonates with an inherent relationship with our natural environment. The food becomes then a product of this relationship. Based upon our successful model of unrestricted accessibility, it is difficult to quantify the amount of food produced. According to local extension offices approximation of plant production, the UFP’s seven community-gardens yielded approximately 4,000lbs of fresh fruits and vegetables in 2012. During the months of March-November, community participants indicated a decrease in dollars spent at the grocery, amounts ranging from $10-$25 weekly. The UFP’s policy outcomes are clearly identified. The UFP coordinator has worked with local policy makers to implement five separate policy initiatives and/or programs. Beginning in 2009, the City of Cincinnati defined ‘community gardens’ as a permitted use in all zones, established a City-wide Urban Agriculture Program making available vacant city-owned parcels for agricultural use; the approval of a commercial composting facility; and the implementation of a Mobile Produce and Food Vending Program, allowing access points to be strategically identified within neighborhoods classified as ‘food deserts’. Participant data is collected by the UFP. The data collected includes only participating community members. Much of the recipients from our food production are through extended partnerships, including local food pantries, senior centers, and community recreation centers.
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Sustainability is determined by the availability of adequate resources. In addition, the practice should be designed so that stakeholders are invested in its maintenance and to ensure it is sustained after initial development. (NACCHO acknowledges fiscal crisis may limit the feasibility of a practices continuation.)  
In the boxes provided below, please answer the following:
1)Lessons learned in relation to practice  2)Lessons learned in relation to partner collaboration (if applicable) 3)Is this practice better than what has been done before? 4)Did you do a cost/benefit analysis?  If so, describe 5)Sustainability – is there sufficient stakeholder commitment to sustain the practice? 5a)Describe sustainability plans
The UFP has established strong collaborations with committed stakeholders within each of its targeted communities. Our initial engagement processes successfully identified committed community partners. Site locations, partnering organizations, and dedicated community members were all part of the initial visioning and planning sessions. These practices create a sense of ownership, providing a strong foundation for commitment over the years. Our community-garden model is designed around sustainable practices. Our gardening techniques ensure sustainability. Adhering to organic gardening practices such as composting, water harvesting, seed collection, and strong community engagement, our food production sites (gardens) increase prosperity and production annually. These practices contribute to the overall health of the site’s eco-system, reducing the need for long-term financial support for supplemental resources. Additionally, each year our gardeners gain experience and knowledge, which contributes to site sustainability. Beyond the community garden component, bridging the complex relationships of the local food system comprehensively strengthens the overall network of partners and their roles. As a whole, the network is stronger. This unique attribute contributes to the sustainability of our program and fundamental goal of improving the health of Cincinnati residents through increased access to healthful foods. Sustainability is rooted in the overall strength of the system. Utilizing our experiences within the neighborhoods to affect appropriate policies and identify the necessary community agencies, strengthens the local food system. Our model practice of identifying emergent properties and strengthening integrative levels, allows us to enhance and sustain the complexities of our local food system.
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Please identify the topic area(s) the practice addresses. You may choose up to three public health areas:
Practice Category One:
Chronic Disease
Practice Category Two:
Community Involvement
Practice Category Three:
Community Assessment
Check all that apply:
E-Mail from NACCHO
Are you a previous applicant?: