Mass in Motion is a state-wide initiative that currently funds over 60 communities across the commonwealth. Mass in Motion (MIM) Worcester is housed within the Worcester Division of Public Health (WDPH), largely working through the Worcester Food and Active Living Policy Council (FALPC). The goal of MIM is to support residents’ ability to make healthy eating and active living choices through policy, systems and environmental changes. Through a community-action plan, yearly objectives are established that reflect the priorities not only of WDPH, but of longstanding FALPC community partners.
Many of the initiatives prioritized in MIM’s yearly action plan mirror the priorities of the 2012 Greater Worcester Community Health Improvement Plan’s (CHIP) first domain: healthy eating and active living. WDPH and its partners have established significant progress in increasing nutrition and physical activity in the residents of Worcester. While rates of overweight/obesity in school-aged children have slightly decreased over the past several years statewide, MIM communities have seen double that decrease.
Healthy People 2020 has prioritized increasing access to fruits/vegetables locally, as well as increasing the incorporation of fruits and vegetables into individuals’ diets by increasing the proportion of calories that come from these foods. A national best practice for doing so is by working with corner store owners. Corner store initiatives have been shown to increase both supply and demand for fresh fruits and vegetables in low income neighborhoods and areas with high proportion of racial and ethnic minorities. WDPH partners with the Regional Environmental Council (REC) to source local produce to participating stores and to continue the availability of produce during winter months, with Maines Produce Express.
Through MIM, WDPH staff recruited two stores to the Healthy Corner Store Initiative: Tineo’s Market in the summer of 2013, followed by Great Brook Valley Market. Over 240 stores in the region have been assessed for proximity to other food resources, proximity to schools, and participation in SNAP and WIC. From that pool, 40 stores were selected for more intensive assessment of feasibility, interest in participating, and current store conditions. Full participation requires stores to stock four new types of produce, with REC assisting in sourcing the produce from local farmers. WDPH has set a goal of full participation of 12 stores in the region by September 2014.
The Centers for Disease Control (CDC) recommends expanding farmers’ market coverage as a strategy for increasing access to healthy foods and reducing the local burden of chronic disease. Increasing the number of food retailers, including temporary food establishments such as mobile grocers, has been shown to increase food security in traditional food insecure locations. In the summer months, when these options are most abundant, food deserts can shrink and in some cases disappear temporarily. As such, another healthy eating objective of MIM is to increase access to farmers’ markets.
In 2013, the Regional Environmental Council’s (REC) mobile farmers’ market was able to successfully expand its services. During the summer, the market was able to make 16 stops per week to Worcester’s low-income neighborhoods. The market accepts WIC, EBT and Senior Coupons at all locations and offers a 50% match through most of the summer.
In 2014, REC will summarize and report the statistics of the Mobile Farmers’ Markets to FALPC, which provides support to Domain 1 of the CHIP. The group will utilize this information to improve and expand the markets during summer 2014, prioritizing neighborhoods with limited access to healthy foods. In order to promote the markets, REC will work with MIM to advertise the schedule and locations through employers in Worcester and through a summer CHIP media campaign. REC will meet with all host sites prior to the season to develop plans for improved collaboration.
Encouraging and supporting community gardens is another strategy to increase healthy food availability. Literature reviews have revealed an association between the presence of community gardens and increased fruit and vegetable intake. One review article recommends that local communities expand access to community gardens by bringing together city administrators (planners, health departments, etc.) and community groups to identify appropriate locations and pool resources.
The number of community gardens in the city of Worcester grew to a total of42, 18 of which are part of the School Garden network. REC offered 17 gardening workshops to the public and community garden sponsors to promote healthy eating. In 2014, REC will work to expand participation in their community garden educational programming, as well as expand funding for community garden programming. As new school and community gardens enter the network, REC will work with those organizations to provide support in establishing and maintaining those gardens. WDPH will work with REC to encourage and support funding applications for new gardens.
Joint Use Agreements
Within the objectives relating to increasing physical activity, Healthy People 2020 includes a goal of increasing the percentage of schools that provide access to facilities for physical activity during non-school hours by 10%. The National Prevention Strategy similarly recommends encouraging community design and development to facilitate access to safe, accessible, and affordable places for physical activity. A primary active living strategy for MIM, in 2014 is to establish Joint Use Agreements (JUA) with the Worcester Public Schools (WPS) which will open school playgrounds to the public outside of school hours.
Studies have found that playgrounds are a critical resource for physical activity, especially in urban environments. Increased access to facilities and recreational opportunities increases physical activity in children. This strategy was chosen based on the strong evidence base and its potential benefits to the community.
WDPH, in partnership with WPS, submitted an application for and received a $52,500 grant from KaBOOM!, a non-profit organization that supports expanded playground resources for children. Extensive assessment of current playground access was completed over the summer in advance of the grant application by both WDPH and WPS. This grant will fund signage, limited infrastructure repairs, policy development for WPS playgrounds, as well as open up the playgrounds to expanded funding opportunities as a publicly accessible play resource. A JUA Task Force will oversee a timeline for implementation, with an anticipated adoption date of Fall 2014..
Increasing physical activity is a priority of national health agencies. Healthy People 2020 includes 15 objectives relating to increasing physical activity across age groups, as well as increasing access to opportunities for physical activity. The Guide to Community Preventive Services recommends street-scale urban design and land use policies for increasing physical activity in the community. Given this, another policy prioritized in the CHIP and MIM is Complete Streets, a policy approach to ensure that streets are designed to accommodate all users; making streets safer for drivers, transit users, pedestrians and bicyclists.
Observational research found traffic speed and volume to be among the neighborhood environment features with the greatest association with youth physical activity. People living in areas with lower traffic speeds reported using parks more frequently. A literature review demonstrated the positive impacts that infrastructure changes, like the improving sidewalks or adding bike lanes can have on physical activity. Not only do such changes increase physical activity in the community, but also improve attitudes toward active transportation. For example, people reported that they feel safer while walking after infrastructure improvements are made.
In 2013, WDPH held a Complete Streets training for the Office of Human Rights & Disabilities that was open to the public. In 2014, WDPH plans to build stakeholder support through education and outreach as well as conduct targeted assessments of the health impact of Complete Streets in three neighborhoods of the region. WDPH will create materials for use by city officials and partner organizations to educate others about Complete Streets, provide opportunities for education regarding healthy community design to city boards, commissions, and departments, work with DPW to craft an approach to bicyclist and pedestrian accommodations and build WDPH capacity for input on healthy community design.
Safe Routes to School
Increasing the proportion of trips less than one mile that are made by walking for both children and adults is an objective of Healthy People 2020. Rates of walking and biking to school have fallen nationwide from over 50% in the mid-1960s to less than 15% today, with more students driven to school in personal vehicles. One consequence is less physical activity at a time when childhood obesity is alarmingly high. Safe Routes to School (SRTS) is a nationally promoted program that aims to improve health by increasing physical activity, reducing air pollution and improving safety for pedestrians. Safe Routes to School policies that consider bussing distances, traffic patterns surrounding schools and speed limits can increase the proportion of students that walk to school. Therefore, SRTS is also prioritized by MIM as a means to increase physical activity in our community which aims to reverse the decline in active travel to school. A comprehensive SRTS approach comprises five Es: Engineering, Enforcement, Education, Encouragement and Evaluation. .
In January 2013, WDPH launched a SRTS Task Force under its MIM initiative and as part of the CHIP. This group has representation from WPS (School Committee, safety, transportation, health and physical education and wrap-around services), city departments (Planning and Police), and transportation agencies (Central Mass Regional Planning Commission and MassRIDES).
The Task Force systematically identified three WPS elementary schools where walking to school could be increased among students living within a mile of the school (Canterbury Street School, Grafton Street School and Vernon Hill School). The group is currently providing technical assistance to each of these schools to build a SRTS program, including a map of recommended routes to school, pedestrian safety education and encouragement activities.
Early Childhood Nutrition
WDPH, through the MIM initiative, also provides support to organizations working to increase nutrition practices, policies and programs through school, after-school and early childhood programs.
The Harvard Pilgrim Health Care Foundation awarded WDPH with $10,000, from the Massachusetts Healthy School Food Champions grant program. This funding is specifically earmarked to expand the Massachusetts Farm to School Project / Worcester Kindergarten Initiative (KI) program to an additional 350 students in 16 classrooms at 6 public elementary schools in Worcester for the 2013-2014 school year. The Worcester KI is a multi-sensory food education program that combines a nutrition-focused curriculum with weekly in-class lessons embedded into normal school life and taught by the kindergarten teachers. In addition to these lessons, the KI provides local fruit and vegetable taste-tests, take-home packages of produce, recipes and nutrition information. In addition, youth take trips to local farms, have in-class visits from farmers and cooking demonstrations in which families participate.