South Central Public Health District (SCPHD) serves eight counties in south central Idaho. The population of our district is 187,000, with over 50% of the population living in rural parts of the counties where access to supermarkets that sell fresh produce and fruits is limited. 9.6% of families live below the Federal Poverty Level in the district. Over the years, several local farmers’ markets have opened to sell inexpensive, fresh produce and fruits. Recently fueled by the local food movement, the number of farmers’ markets has doubled since 2002; moreover, the markets have grown internally, becoming more diversified and larger.
Currently, there are 12 farmers’ markets in SCPHD offering products and samples of fresh produce and fruits, canned goods, preserves, baked goods, ready-to-eat food, shell eggs, dairy, and meats. The diversity of the products and the home-based nature of the industry present many public health challenges for SCPHD and the public. There was misinformation about what the minimum regulatory requirements were for different types of food products being sold. Customers are not confident that some of the products offered are safe to consume. Many produce growers are small family famers working on less than one acre of land and grossing less than $2,000/season in revenue.
Most food processors and vendors at the market are part-time, non-professional food handlers. They do not have adequate food safety knowledge and lack the basic understanding of regulatory requirements. Moreover, they have limited resource and time to obtain proper training. As a result, these farmers and vendors are not fully aware of the potential food borne illness risks associated with the products they sell. Consequently, food safety at farmers’ markets is in jeopardy and consumer confidence of some products is low.
Facing with this public health issue, SCPHD decided to implement a practice to address the food safety issues at the farmers’ markets in early 2012. The goal of the practice is to reduce the risks of food borne illness at farmers’ markets by providing food safety education to growers, vendors and consumers using three different venues. Four objectives were achieved to obtain the goal:1) develop a comprehensive training curriculum for growers and vendors by April, 2) conduct a pre-season, in-person workshop to train growers and vendors in May, 3) host an educational outreach event in mid-August at the Twin Falls Farmers’ Market to educate consumers and increase consumer confidence,4) post the training presentations and a certification exam on the Farmers’ Market page of SCPHD’s website for those who missed the pre-season training. This page also offers several informative brochures for consumers. (www.phd5.idaho.gov/Environment/Farmers_Market.html)
As of August 31, 2012, SCPHD successfully implemented the practice, achieving its goal and objectives. SCPHD generated a buzz about food safety at the farmers’ market; the local newspaper mentioned the training workshop and a local TV station covered the educational outreach event. The public is more aware of food safety at farmers’ markets. The food safety training reached not only local but also statewide target audience via internet. Since the training curriculum addresses the most common issues such as produce safety, safe canning, and safe food handling at the marketplace, the training presentations and the certification test can be easily modified and adopted by other LHDs to address their particular food safety issues.
SCPHD distributed limited DVD copies of the training materials to select LHDs and FDA staff at the Office of Food Safety at the Center for Food Safety and Applied Nutrition and received positive feedback. In November, our practice will be featured in We Are Public Health story series written by the Northwest Center for Public Health Practice which serves six Northwest states. SCPHD attributes the success of this practice to the following factors:1. Leadership from SCPHD - SCPHD initiated the project and applied for funding from the NACCHO’s FDA Voluntary National Retail Food Regulatory Program Standards Mentorship Program. Approximately $5,800 was spent on the implementation of the practice plus in-kind contributions from state and local partners (50 man hours) and SCPHD ($300 in marketing costs).2. Collaboration with state and local partners - Working with the State Food Program Manager and three University of Idaho Extension Office Educators, SCPHD put together a training curriculum and a certificate exam at no cost to the project. 3. SCPHD worked with Twin Falls Farmers’ Market organizers to host an educational outreach event. 4. In-house talents from SCPHD - SCPHD utilized internal expertise for marketing, graphic design, and web design.
The public health issue that this practice addressesThe main public health issue at the farmers’ markets is food safety. For example, a few vendors were found selling home canned goods without completing the required food processing review and licensing process. Improper canning is very dangerous because clostridium botulinum, a neurotoxin, can survive the canning process, if done improperly, and cause paralysis which could result in respiratory failure and death. Other vendors were found selling home-made food items such as tamales and sausages without obtaining the required plan review and approval as well as the necessary license from SCPHD. In addition, their food handling practices was unsafe. Common observations were lack of hand washing facilities and improper holding and/or cooking temperatures. When food is prepared unsafely in unapproved facilities, the potential for food borne illness outbreaks increases and the public health is threatened.
Process used to determine the relevancy of the public health issue to the communityTo ensure that our practice addresses the food safety issues at farmers’ markets, SCPHD collaborated with Idaho State Department of Agriculture (ISDA) and surveyed 58 farmers’ markets in Idaho in January 2012. Additionally, SCPHD met with the local food safety coalition in November of 2011 to discuss food safety issues at the local markets. Both the state and local surveys identified the following food safety issues at the farmers’ markets as well as suggested effective venues for providing training: 1. Ensuring food is handled safely during transportation and while at the farmers’ market 2. Ensuring processed foods are produced according to food safety guidelines (proper canning procedures are used and proper state or federal licenses are acquired) 3. Ensuring Good Agricultural Practices (GAPs) are used in the fields (proper application of manure and fertilizers, etc) 4. Educating consumers about food safety and increase their confidence about products at the market 5. Providing one-day workshop for grower and vendors and also making the training curriculum and the certification test available online.
How the practice addresses the issueSCPHD collaborated with the State Food Program Manager and three experienced University of Idaho Extension Educators to develop a food safety training curriculum that addresses the specific issues identified by the surveys. The training topics covered 1) safe food handling and sampling at farmers markets, 2) the ins and outs of canning, and 3) GAPs and how to reduce risks of microbial contamination during production. The State Food Program Manager and the university extension educators not only developed the training Power Point presentations but also taught at the workshop. During the in-person workshop, the State Food Program Manager reviewed the regulatory requirements of Idaho Food Code pertaining to farmers’ market. He clearly explained what products are exempt from regulations and what the procedures are for products requiring licensing. He answered the audience’s questions to clarify understanding. The university extension educators reviewed the dos and don’ts for proper canning, showcased essential equipment for proper canning, and answered questions from the audience. Produce safety was also covered in the workshop. Emphasis was placed on how to minimize microbial contamination during production, storage, and transportation. After the workshop, all the presentations and the certification test were made available online. www.phd5.idaho.gov/Environment/Farmers_Market.html To educate consumers at the farmers’ market, SCPHD hosted an educational outreach event with interactive games and informative brochures to raise consumer awareness of food safety and build their confidence of the market.
This is a creative use of an existing tool or practice
Tool or practice used in a creative waySCPHD used FDA’s Voluntary National Retail Food Regulatory Program Standards No.7 - Industry and Community Relations as a gold standard for designing our practice. There are two key components to Program Standard No. 7: 1) Industry and Consumer Interaction and 2) Educational Outreach. Prior to implementing the practice, we held a meeting with the local food safety coalition consist of local farmers, consumers, market organizers, university extension educators, and an ISDA representative to discuss food safety concerns and training needs for farmers’ markets. The initial meeting led to our collaboration with ISDA to conduct a statewide farmers’ market survey of training needs. Based on the survey results, we worked with our local and state partners to design a training curriculum. We offered the farmers’ market food safety training in person and online. We also educated consumers at the farmers’ market through an educational outreach event.
How the practice differs from other approaches used to address this issueThe distinctive feature of our practice is that it has multiple venues for delivering food safety training. Not only we have the in-person training course which can be easily repeated, but also we have the training and certification test online to reach a bigger target audience. Since our state and local partners have added links to our Farmers’ Market page on their websites, it has significantly improved the access to training for growers and vendors statewide. Once we are featured in We are Public Health story series by the NWCPHP at the end of this month, we expect our online training to reach an even bigger target audience in Alaska, Washington, Oregon, Montana, and Wyoming. We hope our practice will make an even bigger impact on farmers’ market food safety at the regional level. We are public health story e-postcard is one of the examples of how our practice of educational outreach is different from traditional approach of in-person training only. This e-postcard was sent out to over 8,000 email addresses according to the Northwest Center for Public Health Practice. We have been getting a steady response of people taking the online training and certification exam. http://www.nwcphp.org/publications/we-are-public-health/2012-11
Primary stakeholdersThe primary stakeholders in the practice are SCPHD, farmers’ market organizers, growers, vendors and consumers, the State Food Program Manager, local university extension educators, and an ISDA representative.
LDH RoleSCPHD took the leadership role and initiated the practice. SCPHD applied for funding from NACCHO’s FDA Program Standards Mentorship Program to support the development and implementation of this practice.
Stakeholder RoleSCPHD used FDA’s Voluntary National Retail Food Regulatory Program Standards No.7 - Industry and Community Relations as a gold standard for the design of the practice. SCPHD collaborated with the local food safety coalition and ISDA to conduct a survey of needs. SCPHD collaborated with our state and local stakeholders to develop and implement a food safety training curriculum specifically tailored to the identified needs. SCPHD organized the in-person workshop and invited the State Food Program Manager and the university extension educators to be the trainers of their areas of expertise. The trainers developed informative Power Point presentations for the workshop, and they also submitted test questions to be included in the certification exam.
After the training workshop, SCPHD posted all the training presentations and the certificate exam on the district’s website. In addition, our graphic designer created a Farmers Market Pocket Guide and posted it along with other informative brochures for consumers online. For educational outreach to consumers, SCPHD worked with market organizers and hosted a food safety promotional event at the Twin Falls Farmers’ Market.
SCPHD has fostered collaboration with key community stakeholders such as local food businesses, the university extension educators, and state food programs representatives over the years. Five years ago, SCPHD spearheaded the formation of a local food safety coalition with key community stakeholders. During the past five years, the coalition has worked on numerous projects such as production of food safety infomercials, consumer educational outreach events, food safety recognition awards for businesses, and community health hero awards to recognize important contributions from community stakeholders.
Through our collaboration, SCPHD has developed excellent working relationships with local business leaders and other stakeholders in state and local agencies. Our community stakeholders recognize the leadership role SCPHD plays in food safety in our community. They are always willing and ready to contribute their time and talents to community food safety initiatives. As a result, SCPHD was able to develop and implement this practice successfully.
Lessons learnedOur experience taught us that it is important to develop relationships with community stakeholder before the need for collaboration arises. When collaborating on a project, it is important to involve stakeholders from the very beginning, get their input, and develop a shared vision for the project. It is also important to share and celebrate successes. Once the project is completed, it is important to continue to nurture relationships and look for new opportunities to collaborate. The major barriers to collaboration are time and money.
Specific tasks taken • SCPHD provided guidelines and asked the State Food Program Manager and three university extension educators to create Power Point presentations for the food safety workshop • Collaborators created 3 Power Point presentations covering the topics for the training • SCPHD organized the in-person workshop by sending out invitations via emails and internet and followed by phone calls • SCPHD also advertised the workshop in the local newspaper. • Our event was picked up by the local newspaper and mentioned in the Wednesday Food section • SCPHD hosted the training workshop in our Twin Falls Office • SCPHD collected and analyzed post training survey and shared the results with collaborators • SCPHD designed interactive game and informative brochures for consumers • SCPHD advertised the consumer outreach event in the local newspaper • A local TV station picked up our story and interviewed us • SCPHD hosted an educational outreach event at the Twin Falls Farmers’ Market • SCPHD posted all training materials and informative brochures on the website
Time Frame The background work for the practice was done between Jan and March 2012. The design and implementation of the practice was done between April and August. The practice was completed by the end of August 2012.
Practice Implementation TimelineJan 2012 – SCPHD collaborated with ISDA and local food safety coalition to conduct surveys of farmers’ market food safety issues and training needs. SCPHD covered the cost of staff time spent on the survey. Jan 2012 – SCPHD applied and received funding from NACCHO to implement the practice. Staff time spent on grant application was supported by SCPHD. March - April 2012 – SCPHD collaborated with state and local stakeholders to develop a training curriculum. NACCHO grant supported the staff time for SCPHD, but other state and local stakeholders volunteered their time for putting together the presentations. May 2012 – SCPHD organized an in-person training workshop and invited state and local partners to provide food safety training in three main areas of concern. NACCHO grant supported the staff time for SCPHD, but other state and local stakeholders volunteered their time for presenting at the workshop. August 2012 – SCPHD hosted an education outreach event at the Twin Falls Farmers’ Market to educate consumers. Staff time was supported by NACCHO grant. June-August 2012 – SCPHD created education brochures and posted training presentations and certification exam online. Staff time was supported by NACCHO grant.
Lesson Learned Advance planning is the key to smooth implementation of the practice. It is also important to delegate responsibilities to partners, so all the tasks can be completed on time without being too much of a burden for any single person.
Overall Cost of Implementation Staff time: Approximately $5343 was spent by SCPHD to cover staff time spent on design and implementing the practice. This includes time spent by six staff members between March and August 2012. This cost was covered by the NACCHO grant. Supplies: Approximately $470 was spent on supplies such as a prize wheel for interactive games and prizes for the educational outreach event. This cost was covered by the NACCHO grant. In-kind costs: State and local stakeholders collectively contributed approximately 50 hours of their time for the design and implementation of the practice. In-kind contributions: SCPHD contributed approximately $200 in advertisement of training and educational outreach events and another $100 in producing informative brochures.
Goal: To reduce the risks of food borne illness at farmers’ markets by providing food safety training and education to growers, vendors and consumers using three different venues
Objective 1: To develop a comprehensive training curriculum for growers and vendors at farmers’ markets • Performance measures: 3 Power Point training presentations were developed by 4 collaborators, and they also submitted test questions for the certification exam. • Data collection: The training curriculum and the certification exam were developed based on survey results from 58 farmers’ markets and the local food safety coalition. The training topics were chosen based on the top three food safety concerns identified by the surveys. The venues for training were also determined by the surveys. • Outcome: The training curriculum addresses the most pressing food safety issues at the farmers’ markets
Objective 2: To conduct a pre-season, in-person workshop to train growers and vendors and to make the same training available online • Performance measures: 22 vendors from 7 of the 12 farmers’ markets in the area were trained at the workshop. The web search data showed 111 visits to the Farmers’ Market page on SCPHD’s website. Through the website, 7 more vendors completed and passed the Farmers’ Market Food Safety Certification Test. • Data collection: survey from the workshop showed that 80% of the trainees rated the training presentations to be valuable, 71% of them found the handout materials to be valuable, and 76% of them rated the overall value of the training to be valuable. • Outcome: Better understanding of the regulatory requirements for selling food at the farmers’ markets, improved knowledge of proper canning, and better understanding of produce safety • Evaluation results: the feedback from the workshop survey showed that the training workshop was a success in achieving the educational objective. The survey also showed that vendors want to be kept abreast of new developments in food safety whether it is changes in regulations or food safety practices. • Feedback: SCPHD reviewed the survey results and shared them with the presenters. The survey results reaffirmed the importance of keeping food safety information updated on our website on a regular basis.
Objective 3: To host an educational outreach event at the Twin Falls Farmers’ Market to educate consumers about food safety and increase consumer confidence • Performance measure: during the educational outreach event on August 18th at the Twin Falls Farmers Market, SCPHD engaged over 300 consumers in fun and interactive games about food safety. Prizes were awarded for their participation. SCPHD produced and distributed over 300 informative Farmers’ Market Food Safety Pocket Guides (see attached file in the supplemental materials section) and other brochures about safe food handling, canning, and produce safety. • Data Collection: SCPHD collected the outreach data based on prizes awarded and brochures distributed. • Evaluation results: Consumers of all ages were interested in the educational games. The interactive nature of the game helped engage the consumers. The prizes provided incentive for them to participate. Consumers feel more confident about products at the market knowing that SCPHD conducts regular inspections. • Feedback: The interaction at the promotional event was fun for both the consumers and SCPHD employees. Consumers see SCPHD as a resource for food safety.
Stakeholder CommitmentThis practice is very sustainable because SCPHD has developed excellent relationships with local businesses and fostered collaboration with community stakeholders over the years. The training curriculum can be easily updated to reflect the advances in food safety practice and changes in regulations. Our state and local partners appreciate SCPHD’s leadership in striving for continuous improvement in food safety. They are always willing to lend their expertise to collaborate with us, and they also count on mutual support from SCPHD for their food safety endeavors.
SustainabilitySince SCPHD posted all the training presentations and the certification test online, it is very easy to update the content as needed. We can reach a bigger target audience through our website. Growers, vendors and consumers can access the information at their convenience. In essence, we are providing the food safety training on an on-going basis and sustaining our efforts to improve farmers’ markets food safety.
Our state and local partners are adding links to the Farmers’ Market page of our website and helping us reach an even bigger audience. Once we are featured by the NWCPHP at the end of this month, our practice will be promoted throughout 6 states in the Northwest region. Hopefully other LHDs can use our training materials and model after our practice to improve farmers’ market food safety in their jurisdictions.