Sectors of Influence – Evaluation Framework

Introduction

The epidemics of obesity, diet-related disease, and other chronic diseases are complex problems that require a multi-pronged solution. Low-income neighborhoods, villages, and communities of color disproportionately suffer from unequal access to healthy and affordable options for nutritious foods and free or low-cost physical activity. The Dietary Guidelines for Americans recognize that all sectors of society—including individuals and families, educators and health professionals, communities, nonprofits, businesses, and policy makers—shape the context and characteristics of the environmental settings and jurisdictions where people eat, learn, live, play, shop, and work. To prevent and reduce obesity in SNAP-Ed eligible communities, approaches must move away from one-time interventions in single settings toward large-scale local, state, territorial, and tribal approaches that have the potential to transform conditions for a large segment of the population and be sustained over time.

Low-income neighborhoods and communities of color disproportionately suffer from unequal access to healthy and affordable options for nutritious foods and free or low-cost physical activity.

This chapter of the framework focuses on reforming food systems, increasing access to healthy foods in low-income areas, and promoting safe and livable communities through public health approaches. The over-arching evaluation question is: To what extent is SNAP-Ed programming working with other sectors to collectively impact lifelong healthy eating and active living in low‐income communities? The sectors of influence focus on local, state, territorial, and tribal-level PSE and marketing changes that can be achieved through public, private, and non-governmental partnerships. Community and public health SNAP-Ed interventions should focus on low-income areas, such as a set of census tracts in which 50 percent or more of the households have income less than 185 percent of the federal poverty level or it could be a city or federally designated zone of economic need. The intervention does not have to only affect the low-income area, but the low-income area must be prioritized.

SNAP State Agencies and SNAP-Ed Implementing Agencies have an essential role in halting the obesity epidemic among vulnerable populations by partnering with other sectors of influence, such as agriculture, media, food industry, education, and community design. See the complete list of sectors of influence below. Consistent with SNAP-Ed Approach 3, as defined in the Food and Nutrition Act and the 2016 SNAP-Ed guidance, the evaluation indicators in this sphere of influence focus on tracking policies, improvements, and associated outcomes resulting from multi-sectoral changes across geographic levels. These levels include: local (e.g., neighborhoods, communities, parishes, cities, towns, counties, and boroughs), state, territory/commonwealth, and recognized Indian Nations (often referred to as tribes, nations, bands, pueblos, Rancherias [in California], native villages, and Alaska Native Corporations).

Sectors of Influence

There are many essential components for state and community coalitions working across sectors—from leadership to communication to alignment of funding toward a common vision. When SNAP-Ed and non-SNAP-Ed funded partners collaborate, they can work toward achieving a common community change goal that no agency can achieve on its own. One of the driving forces in SNAP-Ed community and public health approaches is community engagement. Low-income communities that are disenfranchised, where conditions contribute to health inequities and social injustices, benefit from participating in community-level changes. Community members are often at the center of SNAP-Ed strategies and interventions.

Collective Impact

At this level of the Social-Ecological Model, it is difficult to tease out the relative contributions of SNAP‐Ed from other state- or community-based programs, including other USDA/FNS programs (e.g., child nutrition, food distribution, and WIC), as well as programs funded by the CDC and private foundations, such as the Robert Wood Johnson Foundation. For the Sectors of Influence indicators, we consider the combined impact of partnerships among multiple agencies that receive complementary funding streams. The Stanford Social Innovation Review published a commentary on a model known as collective impact, defined as “the commitment of a group of important actors from different sectors to a common agenda for solving a specific social problem” (Kania and Kramer, 2001). In order for collective impact to work, five elements must be in place:

1. Common Agenda: A mutually agreed upon solution to solving widespread problems (e.g., food insecurity, childhood obesity)
2. Shared Measurement Systems: A uniform data tracking system to constantly monitor and review data outcomes to inform continuous quality improvement.
3. Mutually Reinforcing Activities: SNAP-Ed, other FNS programs, and non-FNS funded programs play a complementary role, and in developing state plans of operations and grant activities, all partners should identify their strengths, resources, unique activities, and the collective results.
4. Continuous Communication: Public health nutrition and obesity prevention programs use their own jargon and adhere to their own regulations, which differ from those of other sectors. There is a need for a shared vocabulary and regular productive meetings over time.
5. Backbone Support Organizations: One of the most frequently cited reasons that collaborations fail is the lack of a supporting organization that builds the infrastructure and “manages” the collaboration. Given power dynamics and time and resource constraints, it can be difficult to identify one agency that best fits this role. In some instances, SNAP-Ed may take the role of backbone organization when there is funding available for dedicated staff to manage the collaboration. Other times, multiple funding streams are pooled to create a new entity with staff for the coalition. One example of a backbone support organization is the Washington State Food System Roundtable, for which SNAP-Ed funding pays for a portion of a dedicated project manager to oversee the multi-sector, statewide collaboration.

Evaluating Obesity Prevention Efforts

In August 2013, the Institute of Medicine (IOM) released Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress. This report provides specific recommendations for CDC, NIH, USDA, and NCCOR. The overall emphasis is to improve the collective impact of obesity prevention efforts across the following five areas. A pictorial representation of these strategies appears below.

1. Improve the physical activity environment.
2. Improve the food and beverage environment.
3. Improve the messaging environment.
4. Improve health care and worksites.
5. Improve school and child care environments.

Figure Content In Text-only Format:

5 Solutions for Changing our Communities

1. Integrate physical activity every day in every way.
2. Strengthen schools as the heart of health.
3. Market what matters for a healthy life. Eat well!
4. Activate employers and health care professionals.
5. Make healthy foods available everywhere, like fresh produce.

On their own, any one of these five solutions might help speed up the progress in preventing obesity, but together, their effect would be reinforced, amplified, and maximized.

Anyone and everyone can be a leader and play a part in implementing these five solutions. What can you do to help solve our obesity problem?

Source: Institute of Medicine. Evaluating Obesity Prevention Efforts: A Plan for Measuring Progress. August 2, 2013.  https://iom.nationalacademies.org/Reports/2013/Evaluating-Obesity-Prevention-Efforts-A-Plan-for-Measuring-Progress.aspx

Each goal area contains a number of specific and measurable indicators of progress at the community and population level, some of which are appropriate for SNAP-Ed and informed the content in the Sectors of Influence indicator write-ups. Most of the indicators in this chapter can be measured using existing or secondary data sources, including policy tracking and other public health tools. Otherwise, the measures are identified as developmental; SNAP-Ed agencies can help to develop practical approaches over time. SNAP-Ed agencies are also encouraged to use Community Commons, which provides public access to thousands of meaningful data layers that allow mapping and reporting capabilities. Visit https://www.communitycommons.org/.

Chapter Overview

The Sectors of Influence chapter begins with an assessment of capacity and readiness for community-driven, multi-sectoral changes through partnerships and planning in the short-term. Medium-term indicators identify PSE changes championed by different sector representatives that take effect at the local, state, territorial, or tribal level. Each indicator includes outcome measures of specific PSE changes and associated reach, which is described as the estimated number of people in the target population who have increased access to or are protected by a strategy or intervention (Soler, et al., 2016). Following the parameters established in the CDC’s Communities Putting Prevention to Work program, reach is calculated by using census data or aggregating setting-specific data (e.g., school enrollment). When multiple communities benefit from an intervention, combine all reach data. The maximum reach a community could have for any one intervention is the census population. Where feasible, calculate a proportion of the population reached that is SNAP-Ed eligible—that is, within 185 percent of the federal poverty level. This helps ensure SNAP-Ed interventions are reaching disparate populations, Last, the long-term indicators focus on the impacts to communities, states, territories, and Indian Tribal Organizations resulting from the PSE changes. These long-term measures demonstrate the societal value of SNAP-Ed through improvements in educational attainment, reductions in health care costs, increased agricultural sales, and establishment or strengthening of regional and local food systems.