HCHW T H eme Learning Ques T ions

We saw that kids were not eating the healthy choices we made available and wondered what we could do. We started timing how many minutes kids had to eat -- by the time they got their food and sat down, it was only 7 minutes! And, besides, they were anxious to get outside to play. They just didn’t eat the carrot sticks and celery. It took time and patience, but we convinced the teachers to give up 10 minutes of teaching time and we convinced the administration to put recess before lunch. They eat their carrot sticks now, and are prepared for an afternoon of learning. (School nurse in Tulsa)

Changing the food we serve our kids at school has been an incredibly hard thing to do, the bureaucracy and logistics has been overwhelming. (School Teacher, Kanawha County, WV)

4. Sometimes vendors make arbitrary omission of more healthy foods. Perhaps also big chains are less responsive to local requests and support.

We were surprised when the KFC in Turly, OK, took the healthiest option, grilled chicken, off the menu. When we asked why, they just said “corporate policy.” (Community member, north Tulsa)

I’m running a daycare and had real trouble finding fresh food for my babies. I talked to WalMart and for weeks tried to convince them to have more fresh veggies and fruits available. Nothing happened. One call to the local manager of our local store helped and a few days later they were stocked up with fresh groceries I wanted. (Day Care Founder & Health Council Leader, Las Vegas, NM)

5. Helping people begin to remember what healthy food is by helping them grow their own is what works best and community gardens at schools mean that kids establish a new relationship with food and ask their parents for veggies and fruits. Throughout Cherokee Nation, for example, community gardens at schools are a strategy to fill food desert gaps. Schools are also using the gardens for their science classes.

The kids planted a tomato seed and tended it as it started to grow. They watched as the fruit formed and when it got ripe, popped it into their mouth. Then they asked their parents for more. (Teacher in Anthony, New Mexico)

We did not hear anyone talking about an “industry response.” It may well be going on, but it is not very visible, especially in the more economically challenged areas where we did our listening. Paying attention to local nuances, noticing the local situation, and supporting local action to make more of a difference may be the important keys.

Healthy Schools

What language/narrative compels education decisionmakers, teachers, and parents to support and eventually generate action to advance healthy school environments?

Perhaps more than anything, a language of listening and paying attention is required. In general, our sense is that people do not need to be compelled. There are enough people ready and willing to do good work, and already doing it. They need to be supported, and these changes should be as easy as possible, not as hard as possible. Many people do, in fact, want to do the right thing.

Things have changed over the last 10-15 years. Importance of nutrition and exercise, ACES, and social determinants of health are no longer secrets. Enough people already know that language. And the ones who know are the ones who can invite others to come along.

What do they need? They need to be able to find those they can turn to so they can take action together -- like the people who made small changes in the school lunch regime in one school in Tulsa. They need access to stories about best practices and promising practices which have worked elsewhere. Sometimes they need a little money to start something new.

Those who will take action are already compelled -- but they are compelled by their love of children and their belief that child health is of primary importance.

What policies help foster healthy school environments, in alignment with WSCC (Whole School, Whole Community, Whole Child)?

It was beyond the scope of our work to look at which national policies may be helping to create healthy school environments. We did hear stories, however, of resentment about things created outside of communities and then imposed on communities.

n The Boone County school cook we mentioned above was just plain angry about outsiders telling her how to feed her kids. Her resentment was high enough that she wasn’t interested in hearing how the Indian Health Center in Tulsa made carrot sticks work. Bright and strong-willed, she wasn’t about to have someone from the outside tell her what to do.

n In New Mexico we heard stories about how the new State Secretary of Education’s efforts to get New Mexico to rise on the national ranking was just creating too much stress for both teachers and students and not showing the desired effects.

Something different happens when members of community come together and begin to formulate local policies to improve health.

n Members of the New Mexico Health Equity Partnership are stars in this area. They are supporting communities in doing Health Impact Assessments to provide data to policy makers and influence decisions that have severe impact on community health.

n The newly formed statewide ACEs Coalition in West Virginia is bringing professionals from across the state together, supporting them to become a community of practice creating policies and actions that help to overcome the powerful effects of ACEs.

n In Oakland, school-based health centers are being implemented and widely used across Alameda County, and restorative justice practices are being implemented across the whole Oakland Unified School district, which focus on building community and help kids develop social emotional skills. Every child in Oakland receives free breakfast at school.

n And seen from the ground level, policies must lead quickly and effectively to new practices and actions. The line between policy and practice becomes blurred as each informs the other.

n The Indian Health Center in Tulsa knew that district mandates for more student exercise were not enough, so they started offering a one day training for educators on how to incorporate more movement in their classes. A teacher is keeping data on the correlation between physical activity and academic performance which will be used to support further change in policy and practice.

n In Cherokee Nation the Vian Peace Center is collecting data on how hunger is seriously affecting children. Many, but not everyone involved in raising children knows this is true, and the Peace Center believes that more hard data will help others see how pervasive hunger is in the Nation.

Early Childhood and Education

High quality informal and formal child care are critical to healthy development. What are the most effective ways of promoting quality in both systems? What does quality mean within both systems; what does it mean to parents, to ECCE providers, and to “the field”? Does it differ across different populations? What does each group need to provide high quality care?

We encountered three very different kinds of stories:

1. Kids who are cared for by grandparents and aunts and uncles and unemployed single parents, being given as much love and attention as possible, often with caregivers stressed, tired and with minimal resources. We encountered so many good people providing this kind of care. They know their own limitations. From our perspective what’s needed most is ways of convening them at very local levels with each other and the professionals committed to supporting them. Together they will discover what they can do and what they will do with the resources they have at hand. That’s one of the things that happens at the Indian Health Center in Tulsa -- people come together and figure out what’s the next step in supporting kids. It’s what happens at La Semilla in southern New Mexico