The Colorado Health Foundation’s HEAL Evolution

(Illustration by Chiara Zarmati) 

One of Colorado’s overriding stereotypes is that it’s one of the healthiest states in the nation. In reality, although Coloradans are known for their outdoor pursuits and active lifestyles, good health is beyond the reach of many of our residents, especially those facing inequities.

Healthy Eating, Active Living

This collection of articles, produced for Grantmakers In Health and supported by the Colorado Health Foundation, explores the latest thinking from health funders, researchers, and advocates on healthy eating and active living (HEAL) and healthy communities.

• Healthy Eating, Active Living: Reflections, Insights, and Considerations for the Road Ahead | 1

   

• Healthy Eating and Active Living Through an Equity Lens

   

• Connecting Health and Education So Children Can Learn and Thrive | 1

   

• The Future of Healthy Eating Research | 2

   

• How to Improve Physical Activity and Health for All Children and Families

   

• The Colorado Health Foundation’s HEAL Evolution

   

• How Market Forces Could Improve How We Eat

   

• The Power of Business to Change Food Culture for the Better | 1

   

• Political Power as a Tool to Improve the Health of All Americans | 1

   

• Evaluate, Invest in Advocacy, and Shrink the Change

   

Starting in 2008, the Colorado Health Foundation recognized healthy eating and active living (HEAL) as essential to the well-being of Coloradans. Colorado was a comparatively “healthy” state overall in 2008, according to commonly used metrics, but one of the most alarming statistics involved its children, with rates of obesity rising faster than in almost all other states in the nation. Working with these data, we began to focus on childhood obesity and nutrition education. Our funding and advocacy work centered on increasing physical activity and access to and consumption of healthy foods statewide, specifically for children.

Now, we understand that many factors influence healthy eating and active living, which directly contribute to creating social and physical environments that promote good health. We are focused on evolving this understanding by engaging with each community in our state, listening to understand, bringing an equity lens to all that we do, and focusing specifically on Coloradans living on low incomes or those with less power or privilege. We aim to serve Coloradans for whom good health is furthest from reach. But it was not a linear journey to get where we are today.

After initiating work to address childhood obesity and nutrition in 2008, we soon discovered that our past approaches and partnerships, in the traditional health and health-care sectors, could not simply be replicated in the HEAL space. Our immediate questions were: In this new space, who are our partners? How do we work at the local level in addition to the state and federal agency levels, where we have a higher level of comfort and deeper knowledge base?

So we started by working in and funding areas that seemed most intuitive: in schools and in food deserts. In schools, we focused on funding physical education, cooking from scratch, and providing nutritious breakfasts. Partnering with the Food Trust, we did a scan identifying communities across Colorado that lacked access to affordable, healthy food. This quickly led to the formation of the Denver Food Access Task Force, from which the Colorado Fresh Food Financing Fund (CO4F) was born. The foundation seed-funded CO4F, which was modeled after the Pennsylvania Fresh Food Financing Initiative. An evaluation of CO4F, completed in March 2017, showed promising results in that this investment was creating access to healthy food for underserved communities. Investment in 10 stores to carry healthy food has resulted in 143 new jobs, 125 jobs retained, and 134,000 square feet of retail space created or maintained.

Meanwhile, as part of our commitment to HEAL, our policy advocacy work focused on getting quality physical education (PE) into all public schools. Initially we concentrated on statewide policy change. In 2011, we were successful in passing legislation to require a minimum of 30 minutes of physical activity for all public school elementary students; however, passing a statewide PE requirement met multiple political hurdles. Recognizing the challenges of a statewide mandate, we formed the PE for All coalition, which was focused on local-level policy change to support PE.

In 2016, the foundation, along with the PE for All coalition, issued “Physical Education and Colorado: A Report on the State of PE across Colorado’s Public School System.” This report was designed to answer two sets of questions: What are the current PE programs in school districts across Colorado, and where do inequities exist? And, what are the barriers to improving quality PE and addressing these inequities? As a group, we recognized that although we could influence people at the local level to a certain extent, there were also limitations. Unless the ideas were being generated and championed locally, they weren’t as sustainable.

In 2013, we worked closely with advocacy partners to promote and ultimately pass a bill in the state Legislature to provide universal free breakfast to kids in schools across Colorado, which took us from being one of the worst states in the country for such provision to being 11th best in the nation. We also engaged in federal advocacy and convened partners to inform and shape the federal Farm Bill and Child Nutrition Act reauthorizations. And through the HEAL network, we advocated for preserving the Supplemental Nutrition Assistance Program (SNAP) as an entitlement program instead of a block-grant program—a change that would have significantly limited funding and flexibility to serve families in need. As an organization, we were starting to make the connection between the federal food assistance programs and health outcomes, and policy advocacy was our entry point into understanding the issue.

While we had some major successes in promoting HEAL initiatives, a top-down, statewide approach was not always appropriate in a state like Colorado, which favors local control. Over time and through several failed attempts, we came to realize that policies and programs were not going to be as successful or sustainable unless they were prioritized at the local level.

Fast-forward to 2015: Karen McNeil-Miller comes to the foundation as president and CEO. With experience in education, organizational change, and place-based philanthropy, she took the helm with clear intent. Two weeks into her new position, she was out on the road with the #HealthiestCO Statewide Listening Tour.

Over a period of six months in 2015, McNeil-Miller, along with many members of our staff, visited all 64 counties in Colorado. Our goal was to learn what was happening on the ground in communities across Colorado. The tour illuminated the core issues that communities face when it comes to barriers to health, and the social determinants of health came up loud and clear. We learned that basic needs like access to food and affordable housing were not being met in both urban and rural communities across Colorado, with significant health impacts.

Our vision is that across Colorado, each of us can say, “We have all we need to live healthy lives.” It is the vision of a place where communities support the health of every resident.

In support of continued local-level listening, we implemented a new community engagement model in 2016. We learned through the tour that being community-informed was critical to our work, and so we restructured our program staff to ensure that we were able to listen and learn from communities. With this model, our program staff are in communities much more often, and, more important, they are listening to community members. We know that if program officers are in a town only once every year, we’ll hear only about the community’s most urgent needs. However, if our engagement is more frequent and consistent, we’ll better understand the systemic challenges.

Communities continue to want opportunities for children to be active in a safe and fun way, so physical activity remains a priority area for us. However, funded projects and programs must reflect our cornerstones of serving low-income Coloradans, being community-informed, and creating health equity.

With the input from the tour and our continued community-engagement efforts, and building on our HEAL-focused initiatives of the past, we began thinking about what a more comprehensive strategy around hunger and food insecurity might look like. In 2016, the foundation invested in efforts to consolidate research on hunger in Colorado and the programs, organizations, and initiatives working to alleviate hunger throughout the state. This research helped identify areas of focus to create a hunger-free state and highlighted benefits of reaching this goal for individuals, communities, and the overall Colorado economy.

In June 2017, the foundation convened nearly 100 key stakeholders to more closely examine the challenges of hunger in Colorado. Representatives from various sectors and institutions—health care and hospital systems; state health and human services agencies; local county human services; advocacy, policy, and legal organizations; community-based organizations; Feeding America food banks; foundations; businesses; consumers; and the office of the governor—attended this meeting and agreed that Colorado needed a road map to achieve the goal of a hunger-free state. The idea for the Colorado Blueprint to End Hunger was born.

A steering committee of more than 35 stakeholders provided leadership to create and advance the blueprint, enhance public and political will to end hunger, and leverage their influence to find solutions. At the highest level, the blueprint envisions linking systems and solutions to create real and meaningful progress. Five goal areas are identified as opportunities to make a measurable difference for Coloradans:

• Increase public understanding and awareness that solving hunger is vital to the health and well-being of all individuals and families, the Colorado economy, and every local community.
• Increase the number of Coloradans who can access affordable, nutritious food in their communities.
• Increase the number of Coloradans who can access food assistance and nutritious food through community-based organizations. 
• Maximize SNAP and WIC (Women, Infants, and Children) enrollment to propel Colorado to become a leading state for enrollment in these health and nutrition benefits.
• Maximize participation in federal child nutrition programs, moving Colorado to become a national leader in delivery of these vital programs.

The blueprint was released in January 2018, and we are now focused on implementation. The foundation is taking deliberate steps to ensure that blueprint implementation is truly owned by and accountable to the community. We are keenly focused on including those affected by hunger with this project, and to that end we have engaged partners to develop a tool kit for creating a diverse, equitable, and inclusive community that contains key steps and core strategies to increase access, stimulate cross-cultural contributions, and help eliminate barriers that prevent individuals from fully participating and authentically engaging in the blueprint’s work.

Shortly after the blueprint’s launch in the spring of 2018, following a yearlong strategic refinement process, the foundation announced four new focus areas and 10 new priorities. Under our new “strengthen community health” focus area, we’ve added food access and security as a distinct priority. This new strategy keeps equity at the heart of our work. And this is because although we know that healthy eating and active living are goals we should have for every Coloradan, we must dive deeper to understand the why. So our strategic framework now includes food access and security work alongside more traditional HEAL-related funding for efforts like physical activity opportunities for children and youth.

We are focused on pulling the levers that will benefit the largest number of Coloradans, specifically those living on a low income or with less power or privilege. We are supporting community food programs and food program participation while we partner with organizations across the state on the implementation of the blueprint. It is the intentional evolution of our initial HEAL work, the result of a decade of focus on policy advocacy, research, funding, and strategic experimentation. Our vision is that across Colorado, each of us can say, “We have all we need to live healthy lives.” It is a vision of a place where connected communities support the health of every resident and where healthy eating and active living is part of a state of well-being that is accessible, vibrant, and whole.

Read more stories by Dara Hessee, Khanh Nguyen & Alexis Weightman.