BC First Nations

Healthy Food & Beverage

Community Initiatives

Catalyzing Community Food Action

Phase II Evaluation Report

Healthy Food and Beverage Sales in Recreation & Local Government Buildings

December 2009

Revised March 2010

Suzanne Vander Wekken, B.A., Patti-Jean Naylor, PhD School of Exercise Science, Physical and Health Education Institute of Applied Physical Activity and Health Research University of Victoria

ii

Executive Summary The BC Healthy Eating Strategy was developed and formally adopted by the BC Healthy Living Alliance (BCHLA) in May 2007 as one of four targeted approaches to health promotion in the province. One of the goals of the strategy was increase the availability of healthy choices, consumption of healthy choices, and skills related to making healthy choices in environments where families live, learn, work and play.

The Healthy Food and Beverage Sales (HFBS) initiative was lead by the British Columbia Recreation and Parks Association (BCRPA) and aimed to build community capacity for action and provide support to encourage the provision or promotion of healthy options. In addition to 17 Municipalities that received funding to address recreation facilities, five First Nations communities were awarded grants of $7, 500 CDN to implement the initiative in Phase II.

An evaluation of the First Nations initiative was conducted between February and December 2009 by the University of Victoria in cooperation with the Social Research and Demonstration Corporation (SRDC). The purpose of the evaluation was to determine the activities, impact key implementation issues of the HFBS initiative in the five communities and to act as a catalyst to encourage communities in the process of making sustainable changes. The evaluation process included 3 main components: 1) a before and after Community Overview assessment 2) a Monthly Phone Check-In and 3) a Final Interview with Project Staff. The Community Overview was a self-rating assessment tool designed to look at capacities in the areas of planning, environments and communications. Data collection was supplemented with monthly phone conversations so that project coordinators could share their community process and stories of change, challenge and success. Input from the phone conversations was recorded in note form by the evaluator and explored for common themes and unique achievements and issues. The findings from this process are presented in this report. Project coordinators completed the Community Overview assessment and rated their communities‟ current level of healthy eating capacity at the beginning and end of their initiative. Results showed that communities reported an increase in capacity and support for healthy eating between the start and end of their initiative across all categories, including strategic planning, supportive environments and communication & education. The HFBS First Nations Community Initiative made an impact on nutrition awareness and capacity for change. Although each community began their initiative from very different starting points, a majority of their goals and hopes for their projects were achieved. A diverse range of activities were carried out across the communities including providing healthy cooking classes, training catering staff, implementing a healthy school lunch program, building a community garden and increasing awareness and education around healthy eating. Communities indicated that the HFBS initiative had contributed and reinforced positive change in the following areas:

Increased awareness and education

Increased healthier choices served

Improved access to fresh produce

Increased children‟s focus in school

Improved health of individuals

Increased sense of community pride

A positive ripple effect into other areas of the community were foods are served

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The challenges encountered in the process of their project as reported by communities included:

Obtaining the buy-in or support from community leaders, caterers and community members

Engaging community members

Gaining and keeping community members interested and involved

Turn-over and level of training of project staff

Cost and accessibility of healthy options

A culture of junk food (e.g. prevalence of pop and “junk foods”)

Delays around policy approval

Implementing the initiative during a time of change and transition in the community The things that helped to facilitate implementation of changes to support healthy eating as reported by communities included:

Community engagement and support from leaders, caterers and community members

Involvement of Community Health Workers and Dietitians

Project resources and supports including grant funding, Healthy Food Guidelines and the Brand Name Food List (BNFL)

Having a project focus and defined goal for the initiative

The evaluation process and the supports provided Communities reported being satisfied with the HFBS grant and the support that accompanied it. These supports included individual technical support, inter-community knowledge sharing and consultation provided by the HFBS project coordinator and evaluation team. However, the need for resource materials specifically designed for First Nations communities was highlighted. Although these findings should be interpreted in light of the limitations of the evaluation (use of self-report, lack of comparison communities and high variability across communities) they show that the HFBS First Nations Initiative served as a catalyst for community action for healthy food and beverage choices. Sustaining the momentum will require ongoing dedicated resources within the community and support for community champions.

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Table of Contents

Executive Summary .................................................................................... ii

Table of Contents ...................................................................................... iv

Introduction ................................................................................................. 1

Participating Phase II First Nations Communities ....................................... 2

Evaluation Purpose ..................................................................................... 4

Initiative Activities and Involvement............................................................. 6

Project Description & Activities ................................................................... 7

The Implementation Process .................................................................... 10

Challenges ................................................................................................ 10

Facilitators that Facilitated Change ........................................................... 13

Evaluation Outcomes ................................................................................ 16

Community Overview Results ................................................................... 17

How the HFBS Initiative Made a Difference .............................................. 19

Success Stories ........................................................................................ 21

Community Feedback on the Program ...................................................... 25

Where to go from here... ........................................................................... 26

Conclusions .............................................................................................. 27

1

Introduction This report documents the evaluation of Phase II of the Healthy Food and Beverage Sales

Initiative in First Nations communities. The evaluation examined both the implementation and

the perceived impact of the initiative and is primarily based on self-report by the communities.

Whenever possible, direct quotes from coordinators who led the project in the communities

are presented to highlight their perceptions of the initiative in the community setting.

Background

The BC Healthy Eating Strategy was developed and formally adopted by the BC Healthy

Living Alliance (BCHLA) in May 2007 as one of four targeted approaches to health promotion

in the province. Within the Strategy were four initiatives targeted at increasing the availability

of healthy choices, consumption of healthy choices, and skills related to making healthy

choices in environments where families live, learn, work and play.

Prior to the implementation of the BCHLA strategy, a provincial needs assessment explored

the current situation in British Columbia recreation facilities; illustrating that municipal

recreation facilities across the province had eating environments that were not „health

promoting‟ and in fact appeared „obesogenic‟1‟. The needs assessment showed that

recreation stakeholders were interested in taking action to improve this situation and a model

to facilitate change was developed.

The BCHLA BC Food and Beverage Sales in Recreation Facilities and Local Government

Buildings Initiative (HFBS) adopted and adapted the broader food environment model to

facilitate change in municipal recreation facilities. The initiative was lead by the British

Columbia Recreation and Parks Association (BCRPA) and aimed to: a) build organizational

and community capacity for action, b) provide support to local government buildings and

recreational facilities to encourage the voluntarily adoption of the sale of healthy food and

beverages guidelines and c) encourage the provision or promotion of healthy options in all

areas of recreation operations (e.g. children‟s programs and events). The expanded HFBS

initiative was piloted and evaluated to determine the feasibility and impact of the initiative on

municipal recreation food environments and in First Nations communities. The evaluation was

conducted under direction of Dr. PJ Naylor at the University of Victoria in cooperation Social

Research and Demonstration Corporation (SRDC).

Phase 1 included one First Nations community. The feedback from this community suggested

a modified evaluation and implementation approach. The context for action and the approach

used within the First Nations community was also more community-wide and less facility

orientated. The evaluation process was adapted based on this finding and key

recommendations from Phase I and rolled out in Phase II as reported in this document.

1 „Obesogenic‟ environments are places where “the influences, surroundings, opportunities, or conditions of life promote obesity

in individuals or populations.” Swinburn B, Egger G. Preventive strategies against weight gain and obesity. Obesity Reviews

2002;3(4):289–301

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Participating Phase II First Nations Communities Five First Nations communities were awarded grants of $7,500 CDN to implement the

initiative in Phase II and participated in the tailored evaluation between February and

December 2009.

In comparison to the other 17 communities that were accepted for grants in Phase II of the HFBS initiative, the First Nations communities had much smaller populations and were more remotely located (See Figure 1). This demographic and geographic context influenced the rollout of the initiative. For example, most of these communities did not have a recreation facility with food services and vending machines where they could focus their efforts. Instead these communities addressed healthy eating through areas like community catering and public awareness and in settings like schools and band halls.

*2006 British Columbia Indian Reserve Census Figures, http://www.bcstats.gov.bc.ca/data/cen06/ir2006.csv

** Indian and Northern Affairs Canada (2008). First Nation Registered Population.

Community Population

Seabird Island Band 495

Sechelt Indian Government District 827*

Chehalis Indian Band 973**

Heiltsuk First Nation 2, 192**

Lower Post (Daylu Dena Council) 176

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Figure 1: Geographic location of First Nations Communities Participation in Phase II of the Healthy Food and Beverage Initiative in British Columbia

Map Source: BC Ministry of Transportation, http://www.th.gov.bc.ca/popular-

topics/distances/bcmap.html.

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Evaluation Purpose The purpose of evaluating the Healthy Food and Beverage Sales project in First Nations Communities was to explore the feasibility, implementation and impact of the HFBS initiative. The aim of the evaluation was essential the same as it was for the 17 Non-First Nations communities participating in Phase II of the initiative, but with greater emphasis on qualitative capturing the narrative shared by initiative coordinators and less emphasis on. More specifically the purpose was to:

1) To describe what activities were undertaken.

2) To determine the impact of HFBS project on: The overall community food environment. Strategic planning, education and awareness efforts. Community choices and perceptions of healthier options

3) To identify key issues related to implementation:

The process of changing food and beverages available and served in the community.

What was challenging and helpful in implementation of changes. The use of project resources and supports. Plans for future action and sustainability.

4) To act as a catalyst to encourage and support communities in the planning and

process of making sustainable changes.

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Description of the Evaluation Activities Completed

Table 1: Evaluation activities completed by Phase II First Nations Communities

Description of Evaluation Activity Completed

Community Overview Fourteen statements that project coordinators within each community rated on a scale of 0-3 (0=not in place, 1=under development, 2=partially in place/need improvements, 3=Fully in place). The overview measures the communities‟ level of development in the areas of a) strategic planning, b) supportive food environments, and c) communication & education. Some communities completed these by hand and submitted them; however most were completed over the phone with an evaluator who read the statement and asked them to provide an accurate rating based on their understanding of their community. The project coordinator in one community left before the end of the initiative and the follow-up overview for that community was never completed.

Baseline (Mar-Jun ‟09) n= 5 communities Follow-up (Aug-Oct ‟09) n= 4 communities

Monthly Phone Check-In During the course of the project, one of the evaluation team members called to collect information about the progress, challenges or successes the local initiative was experiencing.

Mar-Oct „09 2-6 phone calls per community.

Final Interview This was a semi-structured interview with each project coordinator at the end of the project that asked them to discuss how things had gone in developing and implementing the project and what challenges and successes they had experienced.

Aug-Oct „09 4 community leads

Community Focus Group Community members were invited to participate in a semi-formal focus group discussion. Questions were asked about what they thought it makes it easy or difficult to make healthy eating choices in their community; if they were aware of the initiative and how they thought it had an impact; and what their community would need to support making healthy choices. Only one community chose to sponsor a focus group.

1 community, 6 attended

Note: None of the five communities opted to complete the optional Vending Audit, Food Services Assessment or Policy Assessment. Although one vending audit was completed at baseline, no follow-up was done.

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Initiative Activities and Involvement What went on in the communities? What did they do? Who was involved?

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Project Description & Activities The general goals and direction of each of the five communities were unique and depended on the context for change and level of readiness of community members. A description of the five projects was extracted from the project applications. Their primary goals and intended activities at the outset are presented following:

A more specific listing of the activities reported by the Phase II First Nations communities is summarized in the table below:

Table 2: Activities and community involvement as reported by Phase II First Nations Communities

Activity

# of Communities that reported this activity (out of 5)

Who was involved?

Established healthy foods in the local school

o Established healthy lunch program

o Changed to healthy food choices in the school canteen

1

150 students ages 4-18

20 teachers & administrators

parents

Built a community garden

1

32 volunteers including elders and children

All 176 community members benefited from the harvest.

Developed/implemented a food and beverage policy

o establish a standard of nutrition for Band programs, activities and events

2

Project coordinators within each community (others involved not specified)

(Continued on next page …)

1. Establish guidelines for distribution of food products; assessment committee organized; protocol for serving food and beverages at community gatherings; process for ordering healthy foods and beverages for school canteen

2. Increase awareness and knowledge of healthy food and beverages; taste testing; development of healthy nutrition bar in fitness centre

3. Increase knowledge and awareness of impact of diet on health; access to traditional foods; workshops with children and elders

4. Develop policy; educate staff on importance of healthy choices; increase nutritional value of healthy food and beverage choices and increase access to these products.

5. Organize healthy choices committee; identify all food offerings in admin buildings; develop guidelines; education and workshops

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(… Continued from last page)

Activity

# of Communities that reported this activity (out of 5)

Who was involved?

Supported local caterers to be more healthy in their practices

o What they serve (decrease salt, sugar, fat and hydrogenated oils etc).

o Supported taking/updating Food Safe

3

approximately 30 caterers

Increased awareness and provided educational opportunities to learn more about healthy eating

o Diabetes workshops hosted by First Nations Dietitians and Community Health Workers

4

o Providing opportunities for Food Safe Training 2

Approx. 25 individuals

o Healthy Food sampling (e.g. serving healthy meals at Council meeting)

2

o Distribution and awareness of the First Nations Canada Food Guide

2

o Educational talk by Dietitian at school 1

o Handing out „Health and Wellness Diaries‟ for community members (made available by First Nations Health Council)

1

Staff at fitness centre

20+ community members

o Provided open learning kitchens, and two canning workshops

1 17 participants

o Handing out „Health and Wellness Diaries‟ for community members (made available by First Nations Health Council)

1

Staff at fitness centre

20+ community members

o Presentation to increase awareness and gain support from leaders 1

Approximately 40 elders or community staff participated

Ran a “Drop the Pop” community challenge; limiting sugar-sweetened beverage intake 1

20 participants signed-up, 12 completed

Visited neighboring FN communities to support them in their healthy eating 1

1 project coordinator

Planning for future healthy eating initiatives 5

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The Implementation Process What did the implementation process look like? What were the challenges? Who and what helped support the initiative?

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The Implementation Process Each of the five First Nations communities had a unique process to implementing their Healthy Food and Beverage Sales initiative. The target for change was diverse from one community to the next and included a local school, a fitness centre, band offices, community feasts and celebrations. Depending on the context, those responsible for rolling out the initiative ranged from school directors, fitness centre staff, local government staff and dietitians. Each community identified a coordinator to work with the HFBS team and manage the implementation. These individuals the consulted with Band members to further identify needs and clarify the approach beyond what was first described in the application. This individual then worked with Band members to implement the identified activities.

Challenges We collected information through phone check-ins and final interviews. Key themes related to challenges are displayed in Figure 1 and described using the words of community members. To summarize, change was challenging and complex and there was not enough time. Buy-in was critical and their wasn‟t enough time to for the process. Importantly there were not enough people involved and that staff turn-over and training was an issue. Finally, challenging individual is an uphill battle.

Figure 2: Challenges in implementing change reported by Phase II First Nations communities

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Community Quotes Regarding Implementation Challenges: Challenge: Buy-in or support Lack of buy-in or support from leaders

“This is endorsed but not yet approved as a mandate by chief and council.” “I invited some of the Council to the workshop and they didn’t show up.”

“My department head doesn’t seem to be more enthusiastic about it when I first applied ... he does not seem to be as keen on it. I have not quite sorted that out.”

Lack of buy-in by community caterers “There is some resistance from the caterers here. They figured that if the cook healthy it’s going to cost more and they won’t get hired.” Note from the focus group: The main concern from caterers was that they will lose the contract if they don‟t give people the foods they want. For example some caterers are well known for their fried bread and they are worried that if they don‟t give the public what they want they will not be asked to cater an event or meeting again. Hence making sure that all caterers have to comply with the guidelines is really important. Lack of buy-in from community members

“That is what everyone is worried about, if you cook healthy you aren’t going to have anything that tastes good. So it would be nice to have more time to develop some of those and put them on record and put them out into the community. Have people realize that it doesn’t cost all that much eat healthy; it does sometimes costs a little bit more, and how to do it.”

Note: Initiatives that are perceived from the “outside” are not trusted or valued; people feel they are being told what to do.

Challenge: Engaging community members

“There is effort to educate and make the community aware of eating healthy, but not everyone is picking up on it yet. There have been some meetings to talk about changes that the caterers have been invited to but not everyone has come.”

Gaining and keeping community members interested and involved (e.g. as volunteers on a committee or maintaining garden or healthy lunches program)

“The committee is cut down to 3 because a few are moving. One is my coworker ... [and another] from the school resigned… I am trying to get local health nurse to come out to a meeting ... [and] invited the local corner store owners to the meeting...but they didn’t show up.”

Challenge: Staff turn-over and training Staff turn-over: Several of the original staff to apply for the grant leave (e.g. maternity leave) once the project is underway. Individuals passed the project have expressed feeling overwhelmed about what to do and where to start.

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“[The woman] who originally applied for grant went away for maternity leave. I was given the project without much instruction.”

Lack of training

“My main one was just jumping into it my way of thinking is that I was that I need more training.” “I was pretty nervous about this project before [the Dietitian] came…I’ve never done anything like this…never had to organize a workshop or anything like that”

Challenge: Cost and accessibility of healthy options

“In our community, by the time fresh fruits and vegetables and bread get here its close to their expiry date.” “The next really big issue is the quality (and price) of vegetables and fruits available in the store... the produce selected for shipment to the community being inferior in the first place. Even if the produce is of prime quality, the distribution process does not appear to support maintenance of food quality... It is thought that the store manager wants to sell off the produce that is still on the shelf before the new produce is put out.”

Challenge: A habit and culture of junk food Prevalence of accessible sugar-sweetened beverages and “junk foods”

“There is a lot of other fried foods that we had in the band .. some people prefer white bread, and the list goes on and on and on. And then pop is probably the biggest issue or juice at catering.” “We have [fast food stores]...and a small grocery food store on band land as well. So there is unhealthy food all around us. That is one of the biggest challenges is trying to encourage people instead of getting the fast easy convenient choice is to do healthier choices. “There is just shelves and shelves of different sweeten beverages ... Everybody is addicted to Pepsi here...You see a lot of the boys walking around with 2L of pop.”

Note from the focus group: There seems to be an awareness and acceptance within the community that health is a concern for all. Knowing what to do and doing it is the real issue in the community. Challenge: Issues in policy approval

“All I am waiting for is council to have time to review our policy for adoption....which I have been told by the managers in April when it was handed in could take some time.” “We did put a policy together. We have submitted it to chief and council and just this week, we have received a reply from department heads ... They wanted to change the name of the policy, because they don’t want it to affect the food that they have for their meetings. So that’s very interesting response.”

Challenge: Time of change and transition in the community

“The community is going through a very large transition that seems to be quite painful with several deaths lately”

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Facilitators that Facilitated Change We collected information about factors that helped to facilitate the project in the communities through phone check-ins and final interviews. Key themes related to facilitators are displayed in Figure 3 and described using the words of community members. To summarize, those factors that were most helpful in supporting achievement of project goals were having a project champion (someone passionate about healthy eating and making a change), having community members (including health professionals, caterers and leaders), having appropriate and easy-to access resources and supports as well as having a specific project focus (one tangible outcome goal, opposed to several general goals). As anticipated, when staff and resources were present and the community had bought-in things went well.

Community Quotes for Regarding Factors that Helped with Implementation: Facilitator: Community buy-in and support Leader (Chief, Elders, Council, Administrators) show they support healthy eating

“Chief and Council are beginning to really support healthy eating more because of the diabetes problem.”

“This is a commitment I have made as a director. This is just what we are going to do. This has always been my attitude and the attitude I have instilled in my staff: we are going to do what is best for the kids ....”

Figure 3: Factors that helped with implementation reported by Phase II First Nations communities

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“We had the Chief plow the ground and lend us a tractor and then other ones plowed it again. It was a lot of work.”

Having community members believe that healthy eating is important (Positive role modeling of teachers, parents and leaders, helping to build and take care of the community garden, attending educational workshops and cooking classes)

“Buy-in by staff, buy-in by kids. Once you have that, our attitude is always the same: we are always is going to what is best for the kids. If you like it, hop on. If you don’t that’s ok too but we are going to keep doing this whether you like it or not. That approach has been very effective.”

“Our staff are tremendous and they wanted good choices for kids too...the initial feel and hesitation was quickly translated into a lot of support.” “[The children] were real big supports ... you can get them to do different things and it is learning experience for them. They got to plant and they had never done that before.”

“Diabetes is a real concern in the community. Every department has done a good job of improving the choices that are making nutritionally.” “There are some fears there, and that is why the open learning kitchens have been helpful. We can demonstrate that there are foods that people like and can cook with healthy ingredients and it’s not that difficult.

Caterers

“[they] want to know how to cook healthier. They really liked the sandwiches, he healthy sandwiches that we put on for that meal ... they want to know how to cook them.”

Facilitator: Involvement of Community Health Workers and Dietitians

“Even getting this project going we had to get the support of our Community Health Representatives. What she has offered to do is to cover all the healthy food and beverage training and teaching in the community. It is an ongoing thing. She has done that in order for us to spend all our money and get our garden started.”

Facilitator: Project resources and supports Grant funding

“We truly appreciated the funding because it did help, it was 11% of our budget.” “Funding [helped us] otherwise we could not have hired [a project staff], paid for these education events ... open learning kitchens and the equipment we purchased.”

Health Food Guidelines

“I think the healthy food guidelines was the impetus that actually helped me because it is so much work putting those guidelines together. It was great to share that with the caterers and get started, rather than drafting up something from scratch.”

Brand Name Food List

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“Looking on the Brand Name Food List I was amazed with how much sugar are in a lot of things. It really opened my eyes up to what I was looking at…I didn’t understand the labels I was reading before, but now do.”

Facilitator: Evaluation

“I think the evaluation, although it seemed a bit cumbersome, has been great. It helped us focus ... [and] start discussing the sport concessions sites, and then look at our catering.”

Facilitator: Having a project focus It was observed by the evaluation team that communities who were more certain of what they specifically wanted to do with the grant money seemed more satisfied with their accomplishments and the impact of the initiative.

“We know what where were going to do, we knew what we could do. We knew out limitations, our manpower, costs, equipment....so we just did it.”

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Evaluation Outcomes What were the outcomes of the activities? Did the Healthy Food and Beverage Sales Initiative make a difference?

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Figure 4: Community Overview Results for Phase II First Nation Communities

Community Overview Results for Phase II First Nation Communities

18%

26%

35%

26%

54%

47%

85%

62%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

100%

Strategic

Planning

Supportive

Environments

Communication &

Education

TOTAL

Community Overview Category

Pe

rce

nta

ge

(%

)

Baseline Average

Follow-up Average

Community Overview Results Project coordinators rated their community on 14 statements organized into 3 categories. They

indicated their state of development in the areas of strategic planning, supportive environments and communication & education.

4 communities completed the Community Overview Assessment Questionnaire at baseline (May-June 2009) and several months later at the end of the grant timeline (August-October 2009). One community‟s project coordinator left on maternity leave before the end of the initiative and the follow-up overview for this community was never completed.

Communities indicated an increase in capacity and support for healthy eating across all categories including strategic planning, supportive environments and communication & education for healthy choices (See Figure 3 and Table 3).

Scores most greatly increased in their communication and education category as this was a key focus for their efforts.

Table 3 on the following page provides a detailed break-down of the results of the Community Overview by category statement.

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Table 3 provides a detailed break-down of the average results of the Community Overview by category statement, according to the data provided by the 4 communities that complete the baseline and follow-up assessment.

Table 3: Average Community Overview Results for Phase II First Nations Communities

Assessment Statement

Baseline Average

Follow-up Average

Total Possible

Str

ate

gic

Pla

nn

ing

A Healthy Choices Committee been formed 0.6 1.75 3

A Healthy Choices Plan and/or policy been written and approved by decision makers

0.6 1.5 3

The community has dedicated resources and/or assigned responsibility for the plan.

0.8 2 3

The community's healthy choices goals are monitored and evaluated.

0.2 1.25 3

Strategic Planning Total 2.2 6.5 12 % 18% 54% 100%

Su

pp

ort

ive

En

vir

on

me

nts

Vending machines serve healthy choices in accordance with the Guidelines

0.2 0.25 3

Concession/Snack Bar serve healthy choices in accordance with Guidelines

0.8 1.25 3

Events serve healthy choices in accordance with the Guidelines 0.8 1.75 3

All fundraising done with healthy choices or non-food choices 1.4 2 3

At formal meetings in our community (e.g. Band Meetings) healthy foods are served

0.8 1.5 3

Our community members support making healthy changes to the community

0.6 1.75 3

Supportive Environments Total 4.6 8.5 18

% 26% 47% 100%

Co

mm

un

ica

tio

n &

Ed

uca

tio

n

Community members are made aware of this healthy food and beverage imitative.

0.8 2.75 3

There is a communications campaign to educate community members about health and healthy eating choices.

0.6 2.25 3

Food Safe training is available for community leaders and volunteers

1.4 3 3

Work shops, classes, or other training opportunities in relation to healthy eating are offered regularly

1.4 2.25 3

Communication & Education Total 4.2 10.3 12

Communication & Education % 35% 85% 100%

TOTAL OVERVIEW 11.0 25.3 42

TOTAL % 26% 62% 100%

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How the HFBS Initiative Made a Difference Project coordinators were asked how the HFBS initiative had made a difference, if any, in their community. Although the initiative had been a relatively short period of time (10 months) they reported that several important positive outcomes had occurred as a result of their efforts. Specifically, one project coordinator reported that the community garden they had built had fostered a sense of community pride. Another reported that the school‟s healthy lunch program that had begun because if the HFBS initiative grant was directly responsible for improved behaviours amoung students. Yet another project coordinator shared that several individuals who had participated in the “Drop the Pop Challenge” had reported losing significant weight, feeling more energized and experiencing other direct health benefits. In general, project coordinators believed that their initiatives had increased awareness and knowledge about the importance of healthy eating in their communities. Several also perceived that the direct impacts of their initiative would have a ripple effect on the entire community--potentially influencing change in other areas. The positive outcomes of the HFBS in Phase II First Nations are presented in Figure 4 following.

Figure 5: The perceived positive outcomes of the HFBS initiative as reported by project coordinators in Phase II First Nations Communities

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Community Quotes Regarding Project Outcomes: Healthier options served “I think it has helped the cooks and the caterers diversify some of their thoughts around the catering. The different types of sandwiches they can make and they are actually starting to use the salt substitutes and alternatives, and reducing salt. They are more conscious of the fact. I think it has improved, its been educational. We are slowly seeing changes.” Children focus better in school “We have seen a lot fewer unwanted behaviors…that in the past we would have attributed to poor diet and sleep habits…diets were really high in sodium, sugar and fat…” Sense of community pride “The whole project is a success story for our community. Even just the people who just walked by the garden, there was a sense of pride.” Increased access to healthy foods “The closest grocery store is 15 miles and the produce is never very fresh there ... otherwise we have to drive 300 miles to [the next major town]...[now[ we had potatoes, tomatoes, carrots, Brussels sprouts, lettuce, turnips and beats from our own garden.” Improved health of individuals “Everyone won with the drop the pop challenge. There is a 15 year old that used to drink a case of pop a day. And his mother was saying he doesn’t drink any more. She says he is doing really well, and feels better.” Increase awareness and education “The awareness and education are having a huge impact as community member are now reading nutrition labels, and they never were before. Even kids are reading the labels [and] the elders are wanting to know what are in there foods now.” Ripple effect in the community “I think within the community, choosing healthy choices, may be related to what we do or it may be a spin off. But at community events, If they are healthier in the school the…the food choices are getting really healthy. Even at the administrative meetings I attend too they are getting far more healthy choices. You see far more healthy food choices. I would like to say that that’s a spin-off of what we are doing here.”

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Success Stories

What is the story behind the data?

Story telling is a tradition of First Nations communities. To honour this and their culture we used their narrative from their phone check-ins and final interviews to capture the stories from three of these community projects. These stories are a part of celebrating their success with them.

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Success in a Community School‟s Healthy Lunch Program One of the First Nations Communities used the grant funding from the Healthy Food and

Beverage project to kick-start their healthy-choice lunch program in their community school. Every morning students got to order what they wanted on their healthy sandwich. The School Director commented:

The kids just absolutely love it because they now have some ownership over what they choose to eat … they get a full deli sandwich showing up for them wrapped up with their name on it.

The lunch program has been in place for several years but in the past has consisted of more processed and fried foods. Students are now having their pick of an array of healthy sandwich toppings from lean meats, to a variety of fresh veggies always on a whole wheat bun for their lunches. In addition, student receive veggies and their choice or milk and pure juice to have with their sandwich. The school is committed to sending a consistent message with every area of food offered in the school. Not only is the old pop machine gone but the school canteen is selling out before anything else and students are found strolling down the hallways with bottles of water in tow. “The kids want snacks…and they are going to eat them regardless, so we might as well offer something that is healthy” says the School Director, “I can‟t believe the change …kids are gulping down water…in the past these kids were gulping down pop.” In addition to the healthy lunches and snacks, students are learning more about how to make healthy eating choices in workshops delivered by the community dietitian. Like any big change, there was some speculation that the healthy lunch program and canteen choices wouldn‟t be well received. But students have adapted quickly to the changes and both teachers and parents are noticing a difference. One student says “I love drinking water from the school store. I got used to the new sandwiches and they are good.” Parents and teachers are noticing behavior improvements too. One teacher noted, “My students are ready for learning and are not coming down from the sugar high or being lethargic due to unhealthy lunches.” The Community School has committed to continue to supporting the healthy lunch program and educating students on positive eating habits. The trend of healthy lunches is now catching on around the province and change is being enacted in other schools as the word spreads. The school Director says “As long as the kids benefit, we don‟t mind doing the work and sharing it with others.”

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Community Garden Success One of the First Nations communities that received a grant in Phase II of the Healthy Food and Beverage initiative used their funding to establish a community garden that was a big success. “We had an awesome garden,” says the community member who coordinated the garden project. The 50‟x50‟ garden was set up right in the middle of the community where everyone could see it. Thirty-two of the 172 community members volunteered their time to build the garden plots, a fence, a watering system and then plant. It took two days to build the garden plot and then four to five days to plant. Everyone from elders, to youth to young children helped out with the set-up, planting, tending and harvest. The harvest included potatoes, tomatoes, carrots, Brussels sprouts, lettuce, turnips and beats.

There was one lady who planted and her potatoes got so big. I

said “You must have prayed!” She said “Well actually I did!”

Producing food in the community is especially significant for this small community considering their location and accessibility challenges. The nearest grocery store, about 20 km away, has limited options and is often pricey. After that, community members must drive 300km to purchase food. Next to hunting and fishing, a local produce garden is another way the community can make healthy eating more accessible and sustainable. The project coordinator shared:

The community is very proud seeing the garden get started and come to completion. It was a very positive experience for the community. A lot of people got to share in the harvest. We even had the children digging up the plants and bringing them home to their parents.

In addition to building a community garden, this community also worked on increasing education and awareness around healthy eating. The local Council is supporting all caterers in the community to take Food Safe; the First Nation‟s Canada Food guide is being made readily available; and regular workshops are providing educational opportunities for community members to learn about nutrition, diabetes and food choices. There is an emphasis on more traditional First Nations food and discouraging fast foods, especially among the youth. The awareness and education is influencing the outlooks of community members, including children are now reading and understanding the nutrition labels of the packaged foods they eat. Work towards offering more nutritious lunch for elders, students and the preschool program is also underway. Next year, the community is hoping to build a greenhouse with funding from the Aboriginal Health Network in their continual effort to increase sustainable and healthy eating in their community.

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Community Members Take On the Personal Health Challenge The goals of one of the First Nations communities that received a grant in Phase II of the Healthy Food and Beverage initiative was to “increase awareness and knowledge of healthy food and beverages in the community,”—and their project has done just that. A First Nations Dietitian was invited to come and host a healthy eating for diabetes sessions for community members and the school. Twelve people, including a chief attended the community session.

In response to the session, one community member working said: Looking on the Brand Name Food List I was amazed with how much sugar is in a lot of things. It really opened my eyes up to what I was looking at…I didn’t understand the labels I was reading before, but now do.

Another great success was the Health and Wellness Diaries which were handed out at the annual community health fair. The diaries have information on how to set goals, keep track of your weight, exercise, how much water you intake and ways of keeping track of your meal. The diaries were such a hit that they ran out of copies and needed to order more. Several community members have mentioned that the dairy is really helping them look at what they eat and how active they are and encouraging them to make healthy living goals. The community‟s project coordinator noted:

A lot of my friends who have diabetes depend on their medicine when they could control this with healthy diet ... this has to stop and we have to start getting healthy again.

Perhaps the greatest success though was the “Drop the Pop Challenge” and commit to not drinking pop and calling in on a telephone accountability system every week. 20 community members signed up to participate and 6 finished this challenge. One 15 year-old boy, who was drinking a case of pop a day, decided to stop drinking pop the very moment he saw a promotion for the challenge on the local add channel. His mom was very excited to report that within the month he has gone from a 32 waist to a 30 and his acne cleared.

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Community Feedback on the Program In final interviews, project coordinators from all five of the participating Phase II First Nations Communities expressed that the resources and support from the HFBS initiative had helped them to have a focus for positive change and increase awareness around the healthy choice. Several also mentioned that the evaluation process and support had been instrumental in helping them in their implementation. One are of suggestion was that initiative information and materials be made more suitable for First Nations Communities. The following points and supporting quotes highlight these findings. The project provided an opportunity to focus on making change.

“Its great to have a project like this so you can just focus on it and hopefully it will change the way other people think and eat.” The work of these projects is important to communities and there is concern

regarding the timeline of the initiative and sustainability of changes. “I think it was a project that was very dear to me, very important so it was priority for me. I think sustainability is a big question. It is introduced as policy how do we make sure that people follow it and keep it positive instead of negative.” “Overall, the time of project seems too short and the project coordinator is worried about being able to continue with changes after the project and find ways to monitor, evaluate and ensure changes are sustainable.” The evaluation added to the work but helped to focus change activities.

“Well, I think the evaluation, although it seemed a bit cumbersome, has been great. It helped us focus on the vending machines, at the start discussing the sport concessions sites, and then look at our catering, although we had the catering pretty much sorted out.” “You guys run a top-notch organization. I’ve never worked so hard for so little money. And that is a complement because it means you are doing your job. I have proposals that are 2-300 thousand dollars. But you guys are good. They should let you look after the big bucks. You are on it.” The initiative resources are not geared towards First Nations.

“As far as the website is concerned, many of the resources aren’t aboriginal and I didn’t use many of the materials. I think that is something that needs to be developed. We didn’t use many of the marketing tools.”

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Where to go from here...

Opportunities: Community project coordinators identified that the initiative had increase community capacity, motivation and momentum for future change towards supporting health eating. They were excited about the opportunity to maintain their projects and share the ideas, knowledge and stories of their success with others. Plans for the future: When asked what their plans for the future were, communities reported the following:

o Continued monitoring of the current lunch program o Seeking grant funding opportunities o Maintaining and expanding community garden o Building a greenhouse to increase and expand on accessibility to healthy foods o Increasing community engagement o Discontinuing pop machine

What communities need for sustainability: When asked what they needed the said:

o Consistent, committed project staff o Constant reinforcement of a healthy eating message o Community engagement- e.g. faithful volunteers o Training for caterers so they know how to adapt recipes and find alternatives o Continued grant funding opportunities o A commitment from elders and Band Council o Aboriginal resources and support (including marketing materials, communication etc...)

“We use to go all ice-finishing in the winter, and now things have changed. We need to have the whole community come together, and working as one,

pushing for change.”

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Conclusions The HFBS First Nations Community Initiative was implemented in five communities. Although each of the First Nations communities began their project from very different starting points, each community was able to take steps forward and increase their capacity to change. A range of initiative activities were carried out across the communities ranging from community diabetes talks to training catering staff to implementing a healthy school lunch program to building a community garden. Overall, the HFBS initiative brought people together with a new or renewed focus on the importance of healthy eating. Communities expressed that the HFBS grant and the dedicated support was helpful in moving them forward and encouraging them to take a closer look at the issues around food provision and healthy eating choices. The person-to-person technical support, inter-community sharing and consultation provided was helpful; however, the need for resource materials specifically designed for aboriginal communities was highlighted. Although these findings should be interpreted in light of the limitations of the evaluation (use of self-report, lack of comparison communities and high variability across communities) they show that the HFBS First Nations Initiative served as a catalyst for community action for healthy food and beverage choices. Sustaining the momentum will require ongoing dedicated resources within the community and support for community champions.