Healthy Food for Denver’s Kids BASELINE ASSESSMENT September 2020 HFDK Baseline Assessment | 2 Suggested Citation: Oppenheimer, S., Lacy, K., & Kathlene, L. (2020). Healthy Food for Denver’s Kids Baseline Assessment. Change Matrix Healthy Food for Denver’s Kids Evaluation. Change Matrix. Retrieved from (https://changematrix.org/wp-content/uploads/HFDK_Baseline_2020.pdf) Contributing Authors: Sophie Oppenheimer, MS, MPH Kristin Lacy, MDP, Change Matrix Lyn Kathlene, PhD, LK Consulting LLC Technical Support/Graphic Design: Annie VanDan, MBA, Change Matrix Alina Taniuchi, BA, Change Matrix Acknowledgements: The HFDK Evaluation Team would like to acknowledge assistance and contributions that came from HFDK staff, HFDK commission members, and data from numerous state and local departments that contributed to the development of this document. This work was supported by the City and County of Denver. HFDK Baseline Assessment | 3 Click below to jump to the section. 04 44 Introduction Objective 4: Existing Efforts, Key Findings Healthy Food for Denver’s Kids Baseline Objectives 50 Objective 5: Gaps in the Local System, 06 Key Findings Summary of Key Takeaways 10 55 Objective 1: Health Equity, Key Findings Lessons from COVID-19 15 57 Objective 2: Current State of Child Food References Insecurity, Key Findings 32 65 Appendices Objective 3: Best Practices, Key Findings HFDK Baseline Assessment | 4 The Denver Department of Public Health and Environment (DDPHE) contracted with Change Matrix and partners to serve as evaluator for the Healthy Food for Denver’s Kids (HFDK) initiative. This baseline assessment is the critical first step in HFDK evaluation and strategy for 2020-2021, by providing a landscape analysis of the current state of child food security in Denver. The key objectives of the assessment are to: Understand how food insecurity affects different populations with respect to health equity, including 1 healthy food access and nutrition-related health outcomes. Understand and document the current state of food insecurity, diet quality and nutrition, and 2 food skills and food systems education for children and youth in the City and County of Denver. 3 Identify evidence-based practices and policies that may inform HFDK strategy. Understand existing efforts and initiatives in place to support child food security and identify 4 opportunities to leverage that work. 5 Identify gaps and shortcomings in current programs at the local level. The baseline assessment draws on the following sources of information: secondary data at the neighborhood, county, and state levels; The Healthy Food for Denver’s Kids qualitative data from community (HFDK) Initiative (Ordinance 302) was approved by members and organizations; voters in November 2018 and went into effect in reports, strategic plans, and other January 2019. The 0.08% increase in sales and use documents related to existing food tax within the City and County of Denver is expected security efforts; to generate approximately $11 million dollars annually interviews with agency leaders and for ten years, with the money disbursed through HFDK commission members; competitive grants to agencies of local government organizational data and literature and non-profit organizations. The funding will be related to evidence-based practices aimed primarily at low-income and at-risk youth, and funding decisions will be made by a Commission and policies; and made up of non-profit, government, and community primary data collected from the member volunteer appointees. Colorado Blueprint to End Hunger/HFDK COVID-19 Emergency Response Grants and the DDPHE Emergency Food Needs Assessment survey. HFDK Baseline Assessment | 5 Limitations of the Baseline Assessment In general, secondary data is helpful in capturing a broad view of systems at a moment in time and reviewing a variety of indicators that can be used to measure progress in the future. However, secondary data can also sometimes be outdated or lack specificity in terms of location (for example, some sources lack neighborhood-level data) or target population (for example, some data is not disaggregated by all races and ethnicities). Additionally, work on the baseline began in February 2020, and has been greatly impacted by the COVID-19 pandemic. Most of the data in the Baseline Assessment is drawn from pre-COVID-19 information, as post-COVID-19 data is just emerging, and the extent of impacts will not be fully understood for years. Still, incoming COVID-19-related data and learnings are integrated into the baseline as appropriate and feasible and are beginning to reveal strengths and weaknesses of the food system under exceptionally challenging health and economic crises. Supporting materials As part of the overall evaluation, the Baseline Assessment is coupled with three important components to inform the HFDK strategy: (1) HFDK Systems Map that visually represents connections (or lack thereof) of actors in the local system; (2) Theory of Change Strategic Roadmap which outlines the intended strategy of HFDK (available Summer 2020); and (3) HFDK Macro Evaluation Plan with specific indicators to track over time and measure impact. How this report is structured Findings from the Baseline Assessment are organized by the five baseline objectives (see above). Each objective includes a summary data box at the beginning (in yellow boxes), followed by a narrative description of the findings for that objective. Importantly, the data points in the yellow summary boxes are not the macro-level indicators for the overall evaluation; rather, they are data points used to gain an understanding of the current landscape of child food insecurity for the Baseline Assessment. Some of these points may be used in the Macro Evaluation Plan, coming Summer 2020, but not necessarily all will be used. A full list of references is included at the end of the report, and additional maps and materials are included in the appendices. HFDK Baseline Assessment | 6 This HFDK Baseline Assessment draws upon a myriad of data to lay a foundation of understanding of health inequities, give a broad view of the current state of child food insecurity in Denver1 and review some existing strategies and best practices. Overall, the HFDK commissioners may consider the following key takeaways from the data as they begin their strategic grantmaking: Neighborhoods with higher populations of people of color, immigrants and refugees are most heavily impacted by food insecurity. The city has a culturally-diverse population of children, including ~37% of children living in immigrant family households often located in at-risk neighborhoods.2 Also, children of color are more likely to live in Denver neighborhoods lacking healthy food options and with higher rates of diet-related health conditions (i.e. obesity, diabetes, heart disease). Namely the regions of West, Southwest, North and Far Northeast Denver are neighborhoods with higher populations of children of color as well as higher rates of food insecurity (see more in Objective 1). Recognizing the stark, consistent disparities along race and ethnicity lines in the data, it will be important to center and explicitly highlight racial inequities in funding decisions. Funding criteria and evaluations should develop metrics that track progress toward undoing racial disparities and their underlying causes. Programs must be responsive to the cultural food choices of racially- and ethnically-diverse families in order to effectively influence dietary choices and behaviors. Funding opportunities should be accessible through various communication channels and be posted in languages other than English. Collaborations with community-based models that represent the cultural diversity of populations most affected should be strongly encouraged. Child food insecurity is tied to a complex web of socioeconomic indicators, most notably poverty and race. Food insecurity is often a result of other systemic inequities affecting a family’s ability to purchase food, including low wages, lack of stable employment, and high medical and housing costs. Funding approaches should support programs that respond to the complexity of factors contributing to household food insecurity, like income, employment and housing. Also, funding should consider the inherent family and household nature of the drivers of food insecurity by supporting holistic programming including “whole child”, “2-generation”, and parent/care-giver approaches. Federal food assistance programs are often not reaching children who need it most. The Supplemental Nutrition Assistance Program (SNAP) is one of the most effective programs for reducing food insecurity, one of the quickest responding programs in economic recessions, and two-thirds of SNAP benefits go to families with children. Similarly, the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) has shown improvements in birth outcomes, infant feeding practices, and child nutrition and food security (see more on page 18). Yet, 1 For the purposes of this report, the term “child food insecurity” is synonymous with “children living in households experiencing food insecurity,” which is consistent with Feeding America’s definition. However, it should be noted that this is not always accurate, as children are often shielded from disrupted eating patterns and reduced food intake (USDA Economic Research Service, 2018). 2 The HFDK Commission’s working definition of at-risk is defined as: “Individuals who demonstrate status including but