Healthy Farmer

Goals and objectives:

The Healthy Farmer's Markets (Markets”) stand out from other markets because our goal is to be an integrated community health hub within underserved communities, serving as a gathering place for residents to access affordable and healthy food, food and health education, and preventative health services all in one location. The market also provides TCHD supported health related resources for all ages in an easy to access format.

Objectives of the Markets are:

1) To increase food access via healthy, culturally relevant foods and health education

2) To increase access to health related services by collaborating with local health and wellness vendors

3) To create economic opportunities for new, local entrepreneurs to create and/or further develop their businesses as vendors and sell their products

In 2019, TCHD established a second location to increase food access and enhance the model of the Healthy Farmer's Market to diminish the barriers corresponding to healthy food access. The Healthy Farmer's Markets promote a cross-sector program for community members to easily access the assistance necessary to improve their health outcomes and wellbeing. Increased success of the Markets are attributed to newly implemented efforts resulting from the expansion of program capacity. Our partners create opportunities for food insecure and lower-income community members to learn more about their health, be connected to and build trust with health care professionals in their community and ultimately live healthier lives.

Steps taken to implement the program:

A particularly unique accomplishment of this partnership is the ability to combine efforts to address food insecurity in combination with health literacy, resources, and access to services that support health. Deliberate steps were taken to include a diverse network of health related resources by screening vendors that would provide links to better health. The library locations promote education and health literacy that allow the Markets to stand out from a traditional farmer's market. As the Markets grow and expand, this partnership is able to showcase community offerings, incentives and programs that apply to all of the social determinants of health. Funding the last two years permitted the addition of interactive classes and educational vendors such as Cooking Matters, the Learning Source, Hunger Free Colorado and Growing Home. Cooking Matters provides nutrition education through cooking demonstrations utilizing produce from the market and offers budget-friendly recipes to enhance family knowledge on how to feel more confident as they shop for groceries and prepare meals. The Learning Source supports future achievements for adults and families looking to advance their English skills, GED competencies, and learn English as a second language. Hunger Free Colorado provides SNAP application assistance and referrals to other community food resources such as food pantries. Growing Home provides further education and referrals to families on the health and wellness resources available to them and promotes equitable opportunities to improve social determinants of health through local partnerships.

What was the timeframe for the practice? Were other stakeholders involved?

            The practice timeframe is 13-weeks as it is a seasonal project running from early July through early October. The partners responsible for implementing this practice are Tri-County Health Department (TCHD), the American Heart Association (AHA), City of Thornton, Lulu's Farm and the Anythink Libraries. For members of this Steering Committee, this project is ongoing and requires monthly meetings to analyze and foster new ideas in order to sustain Market success. The members of this Committee are passionate and committed to community-based opportunities and are working towards finalizing working agreements that maintain accountability for the roles and responsibilities of all members.

What was their role in the planning and implementation process? What does the LHD do to foster collaboration with community stakeholders?

The reach of TCHD and the 1.5 million people we serve, creates more opportunity for engagement due to a widespread agency mission of diminishing health inequities. What makes TCHD unique is our ability to collaborate internally across our multiple program disciplines and with external partners. Our organization has been able to work with one another, with community partners and local government agencies to continually innovate new structures that promote equitable opportunity. TCHD has been fostering collaboration with community stakeholders for three years working to build a coalition in order to diminish food insecurity throughout the City of Thornton. The Healthy Farmer's Markets have been a foundation to build on food security with the help of community members, local businesses, partners and all those committed to addressing hunger throughout Colorado. The Healthy Farmer's Markets bring together local community vendors for market participants to support small business and craft artisans. Local vendor offerings include cottage industries that provide baked goods, jams, jellies, local honey and sprouts as well as hand knitted and crocheted clothing, homemade aprons, hot pads, jewelry, note cards and photography.

The first partnership was with the Anythink libraries, who pride themselves on being a community hub of local resources within their municipality. They believe that the Healthy Farmer's Markets fit their mission and vision to be the catalyst for innovation in Adams County by being the hosting locations of the Healthy Farmer's Markets. By using an established community organization, the location of the Markets are able to provide support and education for children, families and our aging population. SPARK, the quarterly Anythink newsletter, highlights on the Market collaboration and quotes an Anythink staff person stating you can't have a curious mind with an empty stomach.”[1] Many participants of the Market engaged in other library offerings, which included, Preschool Story Time, Baby Bounce and signing up for library cards. Preschool Story Time is for ages 3-5, while Baby Bounce is appropriate for ages birth-23 months and their caregivers. Anythink is hoping to add some adults programming in 2020 that can be related to and incorporated into the Markets. The first Market in 2018 ran at the Anythink Huron Street library from July through October. TCHD led the Steering Committee of partners to meet each month between the market seasons to discuss lessons learned and explore ways to improve for the 2019 season. In 2019, the Steering Committee felt confident in expanding to a second location, the Anythink Wright Farms Library. Providing two locations within the City of Thornton, each with a different time offering, established more opportunities for families and residents to partake in Market offerings that fit in with their everyday schedules. The Markets were able to draw attention to Anythink's interest in meeting both literacy and health needs of the community.  

Second, the City of Thornton became the connector; the link between the idea and the action. Due to the City of Thornton's desire for a consistent farmers market, the city did not charge a fee for the temporary use permit and was able to provide the capacity to recruit community members and local vendors. Their staff has been able to inform action strategies in market infrastructure pertinent to how the Markets can be most effective. They provide insight on what their community needs are and how to best achieve those needs. Also, the City of Thornton has been able to provide and incorporate bilingual support throughout the Markets through their presence and with marketing materials. Marketing in and promoting the availability of persons speaking Spanish has been able to provide a level of comfort for non-English speakers who may have felt more intimidated to an event such as this and reduces a communication barrier.

Next, Lulu's Farm, the primary farmer of the Markets, exemplifies a bright spot of community engagement and outreach in this partnership. Indicated by their slogan Not Your Ordinary Produce Market, Lulu's Farm goes above and beyond and has received all qualifying certifications necessary to accept SNAP, including Double Up Food Bucks, and WIC benefits. Their partnership creates an opportunity for healthy foods to be available at a low cost and builds strength throughout the community to end hunger. Providing access for eligible WIC and SNAP beneficiaries is a part of the Markets' original objectives. Adams County WIC clients have experienced frequent access problems including not having enough money to buy fruits and vegetables, getting to a farmer's market when it was open, and finding farmer's markets in nearby locations. Through the partnership with TCHD and Lulu's Farm, qualifying individuals presented their WIC eligibility card and received a $5 coupon for each member of the family receiving WIC benefits to spend at the Healthy Farmer's Markets each week. WIC coupons were implemented in the Markets in order to incentivize Market offerings and target food insecurities. These coupons are provided in addition to an individual's WIC benefits already received. By advocating for these programs, our Healthy Farmer's Markets keep money within the local economy and sustain local, healthy food resources.

Finally, the American Heart Association (AHA) was a recommended key partnership due to their ability to provide a funder necessary to subsidize the farmer and provide marketing strategy and materials. Their reach throughout the nation has been able to connect TCHD to resources on a larger scale in order to continue the efforts of the Markets in order to sustain funding opportunities and seek out sponsorships that can aim to replicate this market format in communities throughout Colorado and beyond.

In addition to TCHD's partners and collaborators, the presence of health service providers as vendors is another hallmark of the Markets. Yahweh Health Care (YHC) Clinic is a local, non-profit organization whose mission is to is to promote the physical, emotional, and spiritual health of all those who need our care. This organization provided free health screenings and check-ups with local medical provider volunteers at the Markets. YHC also provided information and guidance on how to connect residents to additional community resources for a variety of health related needs. Having local providers serve as volunteers also created an opportunity for community members to get to know a local doctor, build trust with them, and be seen for any future needs in that clinic if they did not already have a primary medical home facility. Other health service vendors offered dental screenings, diabetes education classes, and breastfeeding education with lactation consultants. Residents also had the opportunity to learn more about a the Diabetes Prevention Program and Journey to Wellness, which are both health related classes, and our aging population received information on a Matter of Balance program which focuses on reducing falls risks. The Healthy Beverage Partnership offered education on beverage choices and health impacts of sugar sweetened drinks with the use of a spinning wheel and small prizes which appealed to all ages. The Steering Committee's resource table also provided education on a variety of assistance and education programs from the community, our partners, and TCHD including water conservation, vaping, sexual health, US Census jobs, and food pantry locations and times. In addition, Anythink Libraries, the community organizer and our farmer were recognized by TCHD as Public Health Heroes in 2019, for their outstanding efforts in 2018. Their contributions aided in the success of bringing the Farmer's Markets to create a more food secure area.

The continuation of networking based on these previous partnerships will further the internal and external collaboration to promote community-based and TCHD's agency-wide program offerings. The planning, coordination and implementation of the Markets with these community stakeholders builds a foundation upon which to continue and expand the Markets footprint not only within Thornton and Adams County, but hopefully throughout all of the counties served by TCHD.

Any start up or in-kind costs and funding services associated with this practice?

The American Heart Association (AHA) has been the primary fiduciary sponsor of the Markets. An initial grant of $10,000 in 2018, provided by an anonymous donor, has subsidized farmers, provided marketing materials and aided in market expansion and replication. This funding is what made the Markets possible, as TCHD did not have enough grant funding to be an independent funding source for project implementation.  In-kind costs include TCHD, Anythink Libraries, City of Thornton and Community members' time, printing costs of flyers and community resources, and volunteer hours. In addition, the 13 Steering Committee members have dedicated 1375 hours during the Market season and 425 hours outside of the Market season; an equivalent of .86 FTE. Exploration of sustainable funding opportunities for the 2020 season include a 3 year partial grant from AHA, development of sponsorship opportunities, and charging low-cost vendor fees to subsidize the costs of the Markets.

[1] Source: https://www.anythinklibraries.org/spark/fall-2019

What did you find out?

As a collaborative effort of partners and resources, the Healthy Farmer's Markets combat health inequities to make a difference in population health. The Markets' Steering Committee has standardized its qualitative and quantitative data collection methods from Market attendees and vendors. Objectives of the Markets are to increase access to food, health education and health related services as well as to create economic opportunities for local entrepreneurs. From our participation tracking, we found that our objectives were met and exceeded due to Market engagement and expanded capacity. The availability of SNAP/Double Up Food Bucks and WIC vouchers was able to enhance the efforts of increasing food access. Customers of the Markets relied on these vouchers and were a consistent incentive that brought members of this eligible population back to the Markets even when there was bad weather or a slower Market day. This was able to highlight a community need for affordable, healthy food that we were able meet.  The ability to replicate the Markets with Anythink's reach within the City of Thornton enhanced food access, access to health services and economic opportunities for local entrepreneurs. We learned that some vendors wanted to attend both markets but did not have the resources or capacity to do so. While the Market model is replicable, we found that each of the Markets looked different from one another with not all of the same resources and vendors being consistently available. For further implementation, the Steering Committee is exploring how to incentivize vendors to be a consistent Market participant at an established location in order to enhance dependability during the season. We believe that Market success will only increase as we define accountability for everyone involved.

Did you evaluate your practice?

Evaluation is an ongoing component of the Healthy Farmer's Markets to gain real-time feedback and analyze the overall strengths and weaknesses of the program as it develops and expands. WIC and SNAP transactions, farmer and vendor engagement and volunteer hours were collected and tracked by the TCHD organizers to maintain accountability. The purpose of tracking these primary data sources ensures that the Markets are reaching the target population and that attendees are aware and taking advantage of the benefits available to them that will reduce the economic burden associated with food access.

Performance measures of the Healthy Farmer's Markets include the number of sales conducted, SNAP and WIC transactions, WIC coupons redeemed at the market, attendance by community members, volunteer hours, number of health vendors represented, and number of craft vendors. The data from 2019 confirmed the following:

• 1200 total season farmer sale transactions,
• 38 SNAP transactions,
• 291 WIC coupons redeemed,
• 4,700 community members coming through,
• 320 total hours volunteered and
• 192 vendor participants (this includes multiple attendance by a single vendor).[1]

Evaluation of the practice has allowed an understanding of the impact of the Markets on health outcomes. The collected data provides further insight on the crucial strategies for further implementation of the Farmer's Markets within Adams County. Review of this statistical data shows significant increases to market participation and food resource transactions. In 2018, average attendance at the Anythink Huron Street Market was 125 per week, or 1,800 total participants over the 13 weeks of the Market. At the second location added in 2019, average attendance between the Huron Street and Wright Farms Markets was 336 each week with a total of 4,700 over the span of the Market season; equating to a weekly participation increase of 161%.

Secondary data sources include the stories and feedback from community members, but also local awards and recognition. Throughout the Market season, qualitative stories were collected from partners, vendors, volunteers and attendees to assess Market offerings and structure. As part of the marketing strategy, these stories provided tangible examples of how the Markets influence the community in a way that promotes a nurturing and welcoming environment. These stories are relatable and can encourage other members of the community to seek out the opportunities that the Markets can offer. The local community member who manages the vendors at the Markets in 2018 and 2019 was recognized by a local TV station and received an Every Day Hero Award” for their hard work and dedication to the Healthy Farmer's Markets. This award exemplifies everyday people, whose impact is measured by someone in the community empowered by their service. This individual, and many of those within Adams County, simply want to see their friends and neighbors thrive. As a result of these Markets, Thornton residents have been able to enjoy a marketplace where fresh food, resources and literacy can connect as a gathering space for individuals across the lifespan.

[1] Source: TCHD Farmer's Markets Data Dashboard

Lessons learned in relation to practice:

The Market Steering Committee members are exploring strategies necessary for maintaining vendor continuity at each location. Currently, Market vendors are only required to have a verbal commitment to Market participation. The philosophy behind this method was to provide support and encourage new and existing local entrepreneurs to participate while having access to a free space to promote their products. For many of these vendors, this was their first opportunity to showcase their crafts since booth fees were too high at other farmer's markets throughout the Denver metro area. The current discussion is focused on incentivizing consistent vendor participation without taking away the support of buying local products or having too burdensome of cost to new entrepreneurs.

An additional hurdle of the Market is the presence of farmers and their cost-benefit ratio on Market participation. Being a WIC and SNAP certified vendor has many requirements. The process can be long and many farmers do not want to take the risk without the immediate reward. Unfortunately, even a farm with a WIC certified storefront, may not be able to directly bring that service to a farmer's market setting due to various technology restrictions. The WIC coupons were established by the Market Steering Committee to invoice these transactions to the American Heart Association for reimbursement at the end of the Market season. Additionally, the funding from the American Heart Association pays a stipend to the farmer each month to cover any losses due to lower income areas and provide secure income in the case of lower attendance in new locations.  Providing the stipend has ensured the farmer's regular participation. Additionally, the Steering Committee is developing vendor and farmer working agreements to make qualifications to be a vendor/farmer, roles, and expectations are clear to all parties.

Furthermore, a Farmer's Market even of a smaller scale, requires a significant amount of capacity and resources. In 2019 an estimated 1375 hours were spent by the Steering Committee members and 320 hours of volunteers to staff the market, coordinate vendors, and address needs of partners during the Market season. An additional 425 hours were spent by the Steering Committee in the off-season for strategic planning, developing marketing materials, evaluation and more. Volunteers were added in the second year to provide additional day-of support to the Steering Committee. Additionally, TCHD utilizes two additional staff members to dedicate additional time to support the Markets infrastructure by providing facilitation of the Steering Committee to plan meetings, lead them through strategic planning and manage volunteer recruitment and expansion. TCHD was recently matched with a CDC Public Health Associate who will be dedicated to this work and support the team in preparation for the 2020 season. Some of the tasks will also include volunteer coordination, increased partnerships and improved processes to become more efficient with staff time.

Lessons learned in relation to partner collaboration:

Establishing a community collaborative calls for a strong emphasis on communication. The Healthy Farmer's Markets have a significant amount of moving pieces that require strict orchestration and accountability. In the Markets' second year, the Steering Committee realized that roles of each member needed to be more clearly defined. Throughout the Market season, some partners seemed to be taking on significantly more work than other partners at various times. Currently, the Steering Committee is establishing a working agreement to serve as a platform that lays a concise foundation for the roles and responsibilities of all participating parties. It maintains accountability for all current partners and can be amended in order to engage future partners and potential sponsors.

Did you do a cost/benefit analysis?

            A formal cost/benefit analysis has not yet been conducted for this practice.

Is there sufficient stakeholder commitment to sustain the practice? 

The collaborative efforts of the Healthy Farmer's Markets were already able to replicate and expand the Markets to reach further into the communities of the City of Thornton in just one year; two market seasons. One way TCHD will support and sustain the Healthy Farmer's Markets is through the five-year TCHD Public Health Improvement Plan (PHIP) which has identified food security as a priority area. One of the objectives includes providing access to fresh produce through healthy retail, including farmer's markets. The PHIP establishes the agency's and key community stakeholder's commitment through core strategies in improving the health outcomes of community members. The Health and Food workgroup is committed to a strategic planning model to achieve sustainable action and movement towards food security and promotion of food security through messaging, education, advocacy and policy development. TCHD's PHIP aligns closely with the statewide Colorado Blueprint to End Hunger. The goals of this blueprint are to increase public understanding and awareness of hunger; increase access to affordable and nutritious foods in their communities; increase access to food assistance and nutritious foods through community-based organizations, increase WIC and SNAP eligible beneficiaries to bring Colorado to the forefront of federal nutrition program enrollment; and maximize participation in federal child nutrition programs.[1] The outreach and education that the Blueprint provides encourages a call to action approach for local health organizations, policy makers, stakeholders and all individuals throughout the state of Colorado.

The Farmer's Markets partners have expressed a high commitment to this work and their dedication has fueled the sustainability of the Market model. This dedication is further solidified in the working agreements being developed for the 2020 and 2021 seasons amongst partners. To sustain the Markets, the Steering Committee is sourcing funding from variety of organizations through grants and seeking potential sponsorships. Currently, the American Heart Association has another anonymous donor interested in providing three years of funded support, but this source has not yet been confirmed. Future funding to continue this development falls into three focus areas which includes marketing, farmer subsidy and technology.

• Marketing will always to be a crucial component to the success of the Markets to increase awareness surrounding the unique resources that are provided. The Steering Committee has planned to highlight services that are provided in real-time in 2020 so attendees of the Markets are making the most of their trips.
• Technology is necessary to provide on-site, direct WIC services. Incorporating the necessary machinery (still in development by that State and expected to be ready in 2020) that remotely accepts WIC dollars at the Markets, would eliminate the need of using grant dollars to provide WIC coupons because participants would have direct access to their WIC benefits.
• Funding in each of these areas will increase awareness of the Markets to then increase participation and profit for the vendors. This would also reduce or eliminate the need to subsidize the farmer in future years as the Steering Committee could guarantee higher participation.

These developments will support the long-term goal of the Markets to be self-sustaining by reducing reliance on grant dollars for funding.  

The high stakeholder commitment and plans for sustainability for the Markets is part of this partnership's greater vision to support families, children and seniors who are greatly impacted by hunger. TCHD views food security as a basic human right. It is our goal to improve access to food resources for our communities through a system of collaborative efforts that establish the foundations of what it means for an individual to achieve optimal health in a productive population. TCHD can create a system that changes the environment that the members of our communities are exposed to, to decrease the prevalence of chronic disease through the Healthy Farmer's Market model. Until no longer needed, the Markets will continue to expand resources, grow capacity for food security and promote health education. The stakeholder commitment and collaborative partners' efforts, ensure a variety of resources available to those partaking in the Markets and that the success of the Markets contributes to establishing a marketplace that simplifies access to health resources for individuals of all ages throughout the community.

[1] Source: https://www.endhungerco.org/