nyc green carts something!!! to add to the obesity visit… michael p. goldman, md lauren...

NYC Green CartsNYC Green CartsSOMETHING!!! SOMETHING!!! To Add to the Obesity Visit…To Add to the Obesity Visit…

Michael P. Goldman, MDMichael P. Goldman, MDLauren Sanlorenzo, MDLauren Sanlorenzo, MD

RulesRules

PLEASE, if your ASCOM rings, just step out to PLEASE, if your ASCOM rings, just step out to answer it…. Thank you!answer it…. Thank you!

Outline / ObjectivesOutline / Objectives

• Introduce the Concept of Green CartsIntroduce the Concept of Green Carts

• Discuss Background Issue of Access to Produce Discuss Background Issue of Access to Produce and Define the Term “Food Deserts”and Define the Term “Food Deserts”

• Review Pattern of Adverse Health Outcomes Review Pattern of Adverse Health Outcomes Nationwide and LocallyNationwide and Locally

• Revisit Green Cart’s Mission and LegislationRevisit Green Cart’s Mission and Legislation

• Connect Green Cart’s Mission to Evidence Connect Green Cart’s Mission to Evidence Supported by the AAPSupported by the AAP

• Find Out What YOU Can Do About it!!! Find Out What YOU Can Do About it!!!

The AMAZING CHONY The AMAZING CHONY RESIDENT’S Typical Obesity VisitRESIDENT’S Typical Obesity Visit

• Discuss patient’s BMI.Discuss patient’s BMI.

• 5….2….1…0 – Let’s go Campaign!5….2….1…0 – Let’s go Campaign!

• Refer to nutritionistRefer to nutritionist

• Hand out Green BucksHand out Green Bucks

• Tell families about local fitness center discountsTell families about local fitness center discounts

• Portion control through drawing the mock dinner Portion control through drawing the mock dinner plateplate

• Scare tactics – DM, MI, Stroke, Metabolic syndromeScare tactics – DM, MI, Stroke, Metabolic syndrome

• See you in 3 months for another uplifting See you in 3 months for another uplifting discussion!!!!discussion!!!!

The Newest… Food The Newest… Food PlatePlate

3 Months Later…3 Months Later…

Its only been 3 months and you have put on Its only been 3 months and you have put on 7lbs…7lbs…

Oh, you missed the nutrionist appointment???Oh, you missed the nutrionist appointment???

So now you’re drinking Iced Tea as opposed to So now you’re drinking Iced Tea as opposed to coca-cola???coca-cola???

WIC gave you WHAT coupon???WIC gave you WHAT coupon???

You got another new video game!!!!!!!You got another new video game!!!!!!!

See you in 3 months… try drinking water!See you in 3 months… try drinking water!

WHAT IS GOING ON HERE AND WHAT ELSE WHAT IS GOING ON HERE AND WHAT ELSE CAN I DO HERE????????CAN I DO HERE????????

Why Green Carts…Why Green Carts…

Think for a second about grocery shopping Think for a second about grocery shopping options between 72options between 72ndnd St and 96 St and 96thth St. on the UWS St. on the UWS and compare that to grocery shopping between and compare that to grocery shopping between 145145thth and 181 and 181stst in Washington Heights. in Washington Heights.

This unequal sharing of healthy food resources is This unequal sharing of healthy food resources is not unique to NYC, but is seen across the not unique to NYC, but is seen across the country in both rural and urban low-income country in both rural and urban low-income communities. communities.

The NYC Green Cart Initiative is an innovative The NYC Green Cart Initiative is an innovative approach to address the issue of access to fruits approach to address the issue of access to fruits and vegetables in low-income neighborhoods in and vegetables in low-income neighborhoods in NYCNYC

The Reasoning Behind the The Reasoning Behind the CauseCause

Eating fruits and vegetables 3 or more times a Eating fruits and vegetables 3 or more times a day vs. less than 1 time a day is associated day vs. less than 1 time a day is associated with:with: • 27% lower risk of having a stroke 27% lower risk of having a stroke • 42% lower risk of dying from stroke 42% lower risk of dying from stroke • 24% lower risk of dying from heart disease 24% lower risk of dying from heart disease • 15% lower risk of dying from all causes 15% lower risk of dying from all causes

The Reasoning Behind the The Reasoning Behind the CauseCause

Eating 5 or more servings of fruits and Eating 5 or more servings of fruits and vegetables per day significantly lowers the vegetables per day significantly lowers the risk of developing type 2 diabetes. risk of developing type 2 diabetes.

How to define a food How to define a food desert?desert?

According to the CDC: Food deserts are areas that lack access According to the CDC: Food deserts are areas that lack access to affordable fruits, vegetables, whole grains, low-fat milk, and to affordable fruits, vegetables, whole grains, low-fat milk, and other foods that make up the full range of a healthy diet.other foods that make up the full range of a healthy diet.

The Department of Agriculture defines a food desert as: A The Department of Agriculture defines a food desert as: A Census tract where 33% or 500 people, whichever is less, live Census tract where 33% or 500 people, whichever is less, live more than a mile from a grocery store in an urban area or more than a mile from a grocery store in an urban area or more than 10 miles away in a rural area.more than 10 miles away in a rural area. AND… At least 20% of the residents must live below the federal AND… At least 20% of the residents must live below the federal

poverty line, currently $22,350 for a family of four.poverty line, currently $22,350 for a family of four.

Although the term “food desert” can mean a literal absence of Although the term “food desert” can mean a literal absence of retail food in a defined area, studies of food deserts more retail food in a defined area, studies of food deserts more commonly assess differential accessibility to healthy and commonly assess differential accessibility to healthy and affordable food between socioeconomically advantaged and affordable food between socioeconomically advantaged and disadvantaged areas.disadvantaged areas.

Prevalence of food Prevalence of food desertsdeserts

Right now, 23.5 million Americans, including 3 Right now, 23.5 million Americans, including 3 million in New York City, and almost 4 million million in New York City, and almost 4 million

people across the state, live in areas known as people across the state, live in areas known as “food deserts” . “food deserts” .

Is CHONY in a food Is CHONY in a food desert?desert?

The USDA created a website which mapped out food deserts , called The USDA created a website which mapped out food deserts , called Your Food Environment Atlas Your Food Environment Atlas http://www.ers.usda.gov/Data/FoodDesert/http://www.ers.usda.gov/Data/FoodDesert/

You can go to this website and search for your city to identify food You can go to this website and search for your city to identify food deserts. Again on this atlas the government used the definition of an deserts. Again on this atlas the government used the definition of an urban food desert as : “a census tract that is more than a mile from a urban food desert as : “a census tract that is more than a mile from a grocery store”. grocery store”.

This caused great controversy given that the USDA counted NYC This caused great controversy given that the USDA counted NYC bodegas, small corner stores that offer limited supplies, as grocery bodegas, small corner stores that offer limited supplies, as grocery stores.stores.

With that consideration, the USDA finds there are no food deserts in the With that consideration, the USDA finds there are no food deserts in the Bronx, Brooklyn or upper Manhattan, though local activists would beg Bronx, Brooklyn or upper Manhattan, though local activists would beg to differ.to differ.

Local officials estimate that if you excluded bodegas from the definition Local officials estimate that if you excluded bodegas from the definition of “grocery stores” that approximately 3 million New Yorkers live in a of “grocery stores” that approximately 3 million New Yorkers live in a food desert. food desert.

The Issue of Access…The Issue of Access…

In 2009, the Economic Research Service of the USDA In 2009, the Economic Research Service of the USDA reported:reported:

7% of densely populated urban zip codes lack a grocery 7% of densely populated urban zip codes lack a grocery store or supermarket of any kind and 53% lack a chain store or supermarket of any kind and 53% lack a chain supermarket.supermarket.

African-Americans are half as likely to have access to a African-Americans are half as likely to have access to a chain supermarket than Caucasians, while Hispanic chain supermarket than Caucasians, while Hispanic populations were one-third as likely. populations were one-third as likely.

Independent, convenience type stores with higher prices Independent, convenience type stores with higher prices were found to be far more common in minority communities.were found to be far more common in minority communities.

Small stores are also less likely to carry fresh fruits and Small stores are also less likely to carry fresh fruits and vegetables.vegetables.

ReviewingReviewing“The Scope of the “The Scope of the

Problem”Problem” Nationwide Obesity Trends – Nationwide Obesity Trends –

2009 NYC DOH Community Health Survey by 2009 NYC DOH Community Health Survey by NeighborhoodNeighborhood Obesity RatesObesity Rates Access to Medical CareAccess to Medical Care Sugar BeveragesSugar Beverages Produce ConsumptionProduce Consumption T2DMT2DM

The theme, as you all well know, is that the The theme, as you all well know, is that the neighborhoods that score badly in one category neighborhoods that score badly in one category tend to score badly across the board!!!tend to score badly across the board!!!

2000

Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2000, 2010

(*BMI 30, or about 30 lbs. overweight for 5’4” person)

2010

1990

No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

Obesity Trends by Obesity Trends by NeighborhoodNeighborhood

Access to Medical CareAccess to Medical Care

Physical ActivityPhysical Activity

Sugar Sweetened Sugar Sweetened BeverageBeverage

Produce ConsumptionProduce Consumption

Just one Consequence - Just one Consequence - DMDM

The Food Cart Scene Prior The Food Cart Scene Prior to Green Cartsto Green Carts

• • 4,100 mobile food cart permits in NYC 4,100 mobile food cart permits in NYC

• • As many as 2,500 people are on waiting lists As many as 2,500 people are on waiting lists for permits for permits

• • Few carts sold fruits and vegetables - < 10%Few carts sold fruits and vegetables - < 10%

Green Cart Initiative Green Cart Initiative

In the Spring of 2008, the Laurie M. Tisch Illumination Fund In the Spring of 2008, the Laurie M. Tisch Illumination Fund seeded the NYC Green Cart Initiative with a leadership grant seeded the NYC Green Cart Initiative with a leadership grant to increase the availability of fresh produce in low income to increase the availability of fresh produce in low income neighborhoods throughout New York City. neighborhoods throughout New York City.

The Initiative addresses an urban issue with an innovative The Initiative addresses an urban issue with an innovative blend of public policy, private philanthropy and grassroots blend of public policy, private philanthropy and grassroots entrepreneurship.entrepreneurship.

Designed to address issues of Designed to address issues of accessaccess and and proximityproximity (two (two factors strongly influencing consumption) by bringing fresh, factors strongly influencing consumption) by bringing fresh, affordable, high quality fruits and vegetables to high need affordable, high quality fruits and vegetables to high need communities.communities.

The goal of the initiative is to promote access to healthy food, The goal of the initiative is to promote access to healthy food, by expanding the number of food carts that only sell fresh by expanding the number of food carts that only sell fresh fruits and vegetables – ‘Green Carts’- in the New York City fruits and vegetables – ‘Green Carts’- in the New York City Neighborhoods that need them most. Neighborhoods that need them most.

ProposalProposal

• • The proposal was to create permits for The proposal was to create permits for 1,000 1,000 Green Carts in Green Carts in designated neighborhoods. designated neighborhoods.

• • The Green Carts would be able to sell unprocessed, unfrozen, raw The Green Carts would be able to sell unprocessed, unfrozen, raw fruits and vegetables .fruits and vegetables .

• • Green Cart areas were chosen to include only neighborhoods with Green Cart areas were chosen to include only neighborhoods with more than 15% of residents surveyed consumed no servings or fruits more than 15% of residents surveyed consumed no servings or fruits and vegetables on the previous day, as reported in the 2004 and vegetables on the previous day, as reported in the 2004 Community Health Survey. In some neighborhoods with lowest fruit Community Health Survey. In some neighborhoods with lowest fruit and vegetable consumption, that figure was nearly 26%.and vegetable consumption, that figure was nearly 26%.

DOHMH identified and targeted five regions across New York City DOHMH identified and targeted five regions across New York City -- the majority of the Bronx, Northern Manhattan and East/Central -- the majority of the Bronx, Northern Manhattan and East/Central Harlem, North/Central Brooklyn, Western Queens and Northern Harlem, North/Central Brooklyn, Western Queens and Northern Staten Island -- based on their low household consumption rates of Staten Island -- based on their low household consumption rates of fruit and vegetablesfruit and vegetables

Solving a Key Piece of Solving a Key Piece of the Problemthe Problem

PermitsPermits

• • A certain number of permits will be allocated for A certain number of permits will be allocated for carts in the Green Cart areas in each borough, based carts in the Green Cart areas in each borough, based on population in the designated areas:on population in the designated areas:

Bronx 350 permitsBronx 350 permits

Brooklyn 350 permitsBrooklyn 350 permits

Manhattan 150 permitsManhattan 150 permits

Queens 100 permitsQueens 100 permits

Staten Island 50 permitsStaten Island 50 permits

Goals of programGoals of program

The City’s Department of Health and Mental Hygiene (DOHMH) The City’s Department of Health and Mental Hygiene (DOHMH) estimated that Green Carts would:estimated that Green Carts would:

increase access to fresh produce in neighborhoods where increase access to fresh produce in neighborhoods where produce consumption was lowproduce consumption was low

increase consumption of fresh produce by at least 75,000 increase consumption of fresh produce by at least 75,000 New YorkersNew Yorkers

save approximately 100 lives annually over the long termsave approximately 100 lives annually over the long term

The positive health impacts of increasing fruit and vegetable The positive health impacts of increasing fruit and vegetable consumption occur when consumption remains high for many consumption occur when consumption remains high for many years, so the positive health impacts of Green Carts will be years, so the positive health impacts of Green Carts will be seen over the long term.seen over the long term.

Timeline of Green Cart Timeline of Green Cart Initiative Initiative

• • On February 27, 2008, the City Council voted On February 27, 2008, the City Council voted to approve the legislation. to approve the legislation.

On March 13, 2008, Local Law 9 was signed On March 13, 2008, Local Law 9 was signed by Mayor Bloomberg which established 1,000 by Mayor Bloomberg which established 1,000 permits for Green Carts.permits for Green Carts.

Now Working on Now Working on another Key Piece of another Key Piece of

the Problemthe Problem Carts improved access, but affordability is Carts improved access, but affordability is

another challenge…another challenge…

Approximately ONLY 30 carts accept EBT!!!Approximately ONLY 30 carts accept EBT!!! Wireless connectionWireless connection Battery PowerBattery Power Each EBT unit costs $900 – an upfront cost to Each EBT unit costs $900 – an upfront cost to

the vendor!the vendor!

Why this Matters To Why this Matters To Pediatricians?Pediatricians?

We are a profession of preventionWe are a profession of prevention

Early habits (like healthy eating) die hard, Early habits (like healthy eating) die hard, bad habits (like unhealthy eating) die harder!bad habits (like unhealthy eating) die harder!

We have few tangible resources to help our We have few tangible resources to help our obese patients combat obesityobese patients combat obesity

We Like Evidence We Like Evidence Based!Based!

But there isn’t evidence to say any one of the But there isn’t evidence to say any one of the above strategies will solve the obesity above strategies will solve the obesity epidemic.epidemic.

And the TRUTH IS that this problem is way And the TRUTH IS that this problem is way beyond a purely medical issue!beyond a purely medical issue!

But allow us to share what the experts But allow us to share what the experts recommend we do with respect to produce’s recommend we do with respect to produce’s role in preventing, assessing and treating role in preventing, assessing and treating obesity.obesity.

AHA’s Pediatric Dietary Strategies for AHA’s Pediatric Dietary Strategies for Individuals Aged >2 Years: Individuals Aged >2 Years:

Recommendations to All Patients and Recommendations to All Patients and Families Families

- Balance dietary calories with physical activity to maintain Balance dietary calories with physical activity to maintain normal growth normal growth

- 60 min of moderate to vigorous play or physical activity 60 min of moderate to vigorous play or physical activity daily daily

- Eat vegetables and fruits daily, limit juice intake Eat vegetables and fruits daily, limit juice intake - Use vegetable oils and soft margarines low in saturated Use vegetable oils and soft margarines low in saturated

fat and trans fatty acids instead of butter or most other fat and trans fatty acids instead of butter or most other animal fats in the diet animal fats in the diet

- Eat whole-grain breads and cereals rather than refined-Eat whole-grain breads and cereals rather than refined-grain products grain products

- Reduce the intake of sugar-sweetened beverages and Reduce the intake of sugar-sweetened beverages and foods foods

- Use nonfat (skim) or low-fat milk and dairy products daily Use nonfat (skim) or low-fat milk and dairy products daily - Eat more fish, especially oily fish, broiled or baked Eat more fish, especially oily fish, broiled or baked - Reduce salt intake, including salt from processed foods Reduce salt intake, including salt from processed foods

AAP Dietary RecsAAP Dietary Recs

• Good nutrition, a physically active Good nutrition, a physically active lifestyle, and absence of tobacco use lifestyle, and absence of tobacco use contribute to lower risk prevalence and contribute to lower risk prevalence and either delay or prevent the onset of either delay or prevent the onset of cardiovascular disease. cardiovascular disease.

• These observations have established the These observations have established the concept of prevention of the development concept of prevention of the development of cardiovascular risk factors in the first of cardiovascular risk factors in the first place, now called place, now called primordial primordial preventionprevention. .

Primordial PreventionPrimordial PreventionIs Essentially 5…2…1…Is Essentially 5…2…1…

00

Primordial PreventionPrimordial Prevention

5…2…1…0 AND5…2…1…0 AND No skipping meals No skipping meals Appreciate/work within cultural differences,Appreciate/work within cultural differences, Address eating behaviorsAddress eating behaviors

minimize food intake outside of the home, minimize food intake outside of the home, Involve the whole family in this lifestyle Involve the whole family in this lifestyle

changes. changes.

AAP Dietary Rec’sAAP Dietary Rec’s

Around 9 months – Around 9 months – During the transition from a milk-based diet to During the transition from a milk-based diet to

adult foods, the types of vegetables consumed adult foods, the types of vegetables consumed change adversely. change adversely.

E.g. Deep-yellow vegetables are consumed by E.g. Deep-yellow vegetables are consumed by 39% of children at 7 to 8 months and by 13% at 39% of children at 7 to 8 months and by 13% at 19 to 24 months, 19 to 24 months,

French fries French fries become the most commonly become the most commonly consumed vegetable by this age.consumed vegetable by this age.

***Parents can make age appropriate baby / ***Parents can make age appropriate baby / table foods if they had access to Produce! – table foods if they had access to Produce! – Green Carts!!!Green Carts!!!


2-6 Years2-6 Years Provide a wide variety of nutrient-dense foods such Provide a wide variety of nutrient-dense foods such

as as fruits and vegetables fruits and vegetables instead of high-energy-instead of high-energy-density/nutrient-poor foods such as salty snacks, density/nutrient-poor foods such as salty snacks, ice cream, fried foods, cookies, and sweetened ice cream, fried foods, cookies, and sweetened beverages beverages

Key issue identified = Key issue identified = Parents are the role Parents are the role models models and should model healthy eating and and should model healthy eating and healthy FOOD SHOPPINGhealthy FOOD SHOPPING

***Green Carts Attempt to intervene on this level.***Green Carts Attempt to intervene on this level.


• 6y – adolescents6y – adolescents

– Parallel to the psychosocial transition from dependence Parallel to the psychosocial transition from dependence on parental authority to independent thought on parental authority to independent thought processes, food choices and purchases are increasingly processes, food choices and purchases are increasingly made by the adolescent. made by the adolescent.

– Peer pressure for conformity, in part driven by media Peer pressure for conformity, in part driven by media promotion of fast food directly to teens, makes promotion of fast food directly to teens, makes overeating natural. overeating natural.

– Currently, adolescents have an increased intake of Currently, adolescents have an increased intake of sweetened beverages, French fries, pizza, and fast sweetened beverages, French fries, pizza, and fast food entrées, including hamburgers, and a consequentfood entrées, including hamburgers, and a consequent lack of recommended fruits, vegetableslack of recommended fruits, vegetables, dairy , dairy foods, whole grains, lean meats, and fish. foods, whole grains, lean meats, and fish.

– ***Green Carts In front of Hospitals, Schools, CBOs can ***Green Carts In front of Hospitals, Schools, CBOs can intervene here.intervene here.

AAP on Produce AAP on Produce Preventing ObesityPreventing Obesity

• An ADA evidence analysis concluded that the evidence An ADA evidence analysis concluded that the evidence supports a modest effect of fruit and vegetable intake in supports a modest effect of fruit and vegetable intake in protecting against increased adiposity in children. protecting against increased adiposity in children.

• Fruits and vegetables have been promoted for the Fruits and vegetables have been promoted for the prevention of childhood obesity because of their low prevention of childhood obesity because of their low energy density, high fiber content, and satiety value. energy density, high fiber content, and satiety value.

• Fruits and vegetables are most likely, compared with Fruits and vegetables are most likely, compared with other food groups, to be consumed in inadequate other food groups, to be consumed in inadequate amounts by childrenamounts by children

• 34 Several studies found no association between fruit and 34 Several studies found no association between fruit and vegetable intake and childhood adiposity; nevertheless, vegetable intake and childhood adiposity; nevertheless, in none of the 17 studies reviewed in the ADA in none of the 17 studies reviewed in the ADA evidence analysis was increased fruit and evidence analysis was increased fruit and vegetable intake related to increased adiposity. vegetable intake related to increased adiposity.

School Lunches… an School Lunches… an Ex. of the Peds’ Role in Ex. of the Peds’ Role in

AdvocacyAdvocacy Great Bills won’t pass without you!Great Bills won’t pass without you!

Healthy Hunger-Free Act of 2010Healthy Hunger-Free Act of 2010

Look who you are up against!Look who you are up against!

2010 - Congress blocked Dept of Agriculture from 2010 - Congress blocked Dept of Agriculture from limiting servings of potato (French Fries) to 2 servings limiting servings of potato (French Fries) to 2 servings a weeka week Potato Growers and frozen food companies (pizzas) Potato Growers and frozen food companies (pizzas)

lobbied against this bill and were able to make the Bill lobbied against this bill and were able to make the Bill less restrictive than the Obama Admin had hoped for.less restrictive than the Obama Admin had hoped for.

Conservatives said “the Gov’t should not tell children Conservatives said “the Gov’t should not tell children what to eat.”what to eat.”

But with support from the AAP and others, A Law was But with support from the AAP and others, A Law was passed 1/27/12 changing school lunches!!!!!!!!!passed 1/27/12 changing school lunches!!!!!!!!!

What CAN we do for What CAN we do for Green Carts / Markets?Green Carts / Markets?

Conclusion: Conclusion: Existing research provides clear evidence that food deserts Existing research provides clear evidence that food deserts exist in numerous low-income communities and communities of color across exist in numerous low-income communities and communities of color across the country, and that they have significant negative impacts on health, social the country, and that they have significant negative impacts on health, social equity, and local economic development. equity, and local economic development.

Further, there is a legitimate, though not fully evidenced based data to Further, there is a legitimate, though not fully evidenced based data to support the role of fresh produce in the prevention, assessment and support the role of fresh produce in the prevention, assessment and treatment of obesity. treatment of obesity.

Action:Action:

1.1. Federal GovernmentFederal Government

2.2. Local GovernmentLocal Government

3.3. Continue to increase your own knowledge of Continue to increase your own knowledge of community resourcescommunity resources

Federal Level AdvocacyFederal Level Advocacy

In December 2009, 39 members of Congress both political parties issued In December 2009, 39 members of Congress both political parties issued a resolution in the House of Representatives recognizing the need for a resolution in the House of Representatives recognizing the need for national policy to address limited access to healthy food in underserved national policy to address limited access to healthy food in underserved communities. communities.

In February 2010, the federal government under the Obama In February 2010, the federal government under the Obama Administration announced the details of an over $400 million Healthy Administration announced the details of an over $400 million Healthy Food Financing Initiative (HFFI), which will bring grocery stores and other Food Financing Initiative (HFFI), which will bring grocery stores and other healthy food retailers to underserved urban and rural communities healthy food retailers to underserved urban and rural communities across America.across America.

The HFFI is a partnership between the Departments of Treasury, The HFFI is a partnership between the Departments of Treasury, Agriculture, and Health and Human Services.Agriculture, and Health and Human Services.

The HFFI is a key component of the First Lady’s Let’s Move campaign to The HFFI is a key component of the First Lady’s Let’s Move campaign to reduce childhood obesity. reduce childhood obesity.

Current Legislation: H.R. Current Legislation: H.R. 3525: Healthy Food 3525: Healthy Food Financing InitiativeFinancing Initiative

Sponsor: Rep. Allyson Schwartz, D-PASponsor: Rep. Allyson Schwartz, D-PA

Co-Sponsors: Eleanor Norton [D-DC], Earl Blumenauer [D-OR], Robert Co-Sponsors: Eleanor Norton [D-DC], Earl Blumenauer [D-OR], Robert Brady [D-PA], Michael Burgess [R-TX], Marcia Fudge [D-OH], Jesse Brady [D-PA], Michael Burgess [R-TX], Marcia Fudge [D-OH], Jesse Jackson [D-IL].Jackson [D-IL].

Status:Status: This bill is in the first step in the legislative process. This bill is in the first step in the legislative process.

Explanation:Explanation: Introduced bills first go to committees that deliberate, Introduced bills first go to committees that deliberate, investigate, and revise them before they go to general debate. The investigate, and revise them before they go to general debate. The majority of bills and resolutions never make it out of committee.majority of bills and resolutions never make it out of committee.

Introduced on November 30, 2011.Introduced on November 30, 2011.

Referred to Committee-Referred to Committee- Referred to House of Agriculture Referred to House of Agriculture

Reported by committee - TBDReported by committee - TBD

House Vote - TBDHouse Vote - TBD

Senate Vote - TBDSenate Vote - TBD

Signed by President- TBDSigned by President- TBD

Letter WritingLetter Writing

To show our support of H.R. 3525 we could:To show our support of H.R. 3525 we could:

Write Charles Rangel, the representative for New York’s Write Charles Rangel, the representative for New York’s 15th congressional district (this is the district where 15th congressional district (this is the district where CHONY is located) stating our support for this bill.CHONY is located) stating our support for this bill.

Write to our state senators: Kristen Gillibrand or Charles Write to our state senators: Kristen Gillibrand or Charles Schummer to state our support of H.R. 3525. Schummer to state our support of H.R. 3525.

Of note, Kristen Gillibrand is New York’s first member of Of note, Kristen Gillibrand is New York’s first member of the Senate Agriculture Committee in nearly 40 years! She the Senate Agriculture Committee in nearly 40 years! She is already a supporter of the Green Carts Program!is already a supporter of the Green Carts Program!

Local Advocacy Specific to the Green Local Advocacy Specific to the Green Cart InitiativeCart Initiative

An organization called Citizens’ Committee for Children of An organization called Citizens’ Committee for Children of New York Inc. (CCC) collected data during the first year of New York Inc. (CCC) collected data during the first year of Green Cart implementation to determine if the presence of Green Cart implementation to determine if the presence of Green Carts had a positive impact on the consumption of Green Carts had a positive impact on the consumption of fruits and vegetables in targeted communities. fruits and vegetables in targeted communities.

Summary of key findings, which lead to key advocacy Summary of key findings, which lead to key advocacy issuesissues

Finding #1: Knowing about Green Carts increased the Finding #1: Knowing about Green Carts increased the likelihood of usage.likelihood of usage.

Constituents who saw or heard advertising were more likely to Constituents who saw or heard advertising were more likely to purchase from a Green Cart than those who had not seen purchase from a Green Cart than those who had not seen or heard such an advertisement.or heard such an advertisement.

ADVOCACY: • Expand public marketing of Green CartsADVOCACY: • Expand public marketing of Green Carts

Local Cont…Local Cont…Finding #2: For those who used Green Carts, the location Finding #2: For those who used Green Carts, the location played a critical role in consumer usage. played a critical role in consumer usage. Among Green Cart Among Green Cart users: 67% of constituents responded that the primary reason for users: 67% of constituents responded that the primary reason for shopping at a Green Cart was the convenient location of the cart.shopping at a Green Cart was the convenient location of the cart.

ADVOCACY: Encourage the targeted placement of Green Carts ADVOCACY: Encourage the targeted placement of Green Carts on public property, such as NYCHA facilities, Public Hospitals, on public property, such as NYCHA facilities, Public Hospitals, Child Health Centers. **THINK CHONY**Child Health Centers. **THINK CHONY**

Finding #3: Green Carts were reaching targeted populations.Finding #3: Green Carts were reaching targeted populations.

When vendors were asked on the street, “Who purchases from you When vendors were asked on the street, “Who purchases from you the most?” nearly 60% of those who responded said “children and the most?” nearly 60% of those who responded said “children and families.”families.”

ADVOCACY: Ask the city to facilitate the placement ADVOCACY: Ask the city to facilitate the placement of Green Carts in close proximity to CBO’s and allow of Green Carts in close proximity to CBO’s and allow for CBO cart adoption or sponsorship. **THINK for CBO cart adoption or sponsorship. **THINK Aliancia Dominicana**Aliancia Dominicana**

Continued..Continued..

Finding #4: Vendors were interested in efforts to Finding #4: Vendors were interested in efforts to increase usage of Green Carts by poor and working poor increase usage of Green Carts by poor and working poor consumers. consumers.

Vendors who participated in focus groups indicated that they Vendors who participated in focus groups indicated that they need the ability to accept Electronic Benefit Transfer cards need the ability to accept Electronic Benefit Transfer cards (EBT) if they are to be profitable in high poverty districts. (EBT) if they are to be profitable in high poverty districts.

ADVOCACY: Ensure that all Green Carts have access to ADVOCACY: Ensure that all Green Carts have access to EBT terminals so they can accept food stamp (SNAP) EBT terminals so they can accept food stamp (SNAP) benefits as well as WIC allotments. ***A Work In benefits as well as WIC allotments. ***A Work In Progress***Progress***

What You Can do in What You Can do in ClinicClinic

Talk to your patients about Green Carts.Talk to your patients about Green Carts.

Print out a few recipes from Print out a few recipes from NYC Green Cart NYC Green Cart CookbookCookbook to have for your patients! to have for your patients!

http://www.lmtilluminationfund.org/pdf/http://www.lmtilluminationfund.org/pdf/GreenCartCookbook_FINAL_2.28.pdfGreenCartCookbook_FINAL_2.28.pdf

Increase your own Increase your own knowledge on Green knowledge on Green

CartsCartsAttend local screening of Attend local screening of The Apple Pushers. The Apple Pushers.

The Apple PushersThe Apple Pushers, written and directed by Mary Mazzio, , written and directed by Mary Mazzio, narrated by Edward Norton, and underwritten by the Laurie M. narrated by Edward Norton, and underwritten by the Laurie M. Tisch Illumination Fund, follows immigrant street vendors who Tisch Illumination Fund, follows immigrant street vendors who are rolling fresh fruits and vegetables into the inner cities of are rolling fresh fruits and vegetables into the inner cities of New York (where finding a fresh red ripe apple can be a serious New York (where finding a fresh red ripe apple can be a serious challenge). challenge). http://www.applepushers.com/

Next Screening: NEW YORK February 6, 2012Next Screening: NEW YORK February 6, 2012Hosted by Citizens Committee for ChildrenHosted by Citizens Committee for Children

http://www.applepushers.com/

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nyc green carts something!!! to add to the obesity visit… michael p. goldman, md lauren...

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