LHC_ConnectionBrief_Econ-Obesity_v4 by Global Policy Solutions

M a k i n g t h e C o n n e c t i o n B r i e f | F e b r u a ry 2 0 1 1

Making the Connection: Linking Economic Growth to Policies to Prevent Childhood Obesity

Our nation is facing the worst economic crisis since the Great Depression.1 Nearly 15 million Americans are now unemployed, including 6.2 million who have been jobless for more than six months.2 Almost 3 million homes were foreclosed on in 2009 alone.3 Experts warn that it may take years before the U.S. economy fully recovers.4,5,6 To address economic hardships, policy-makers must find win-win solutions that spur economic growth while supporting struggling families, businesses and communities. Cities that increase access to healthy food markets and build activity-friendly environments can help reduce obesity rates while creating jobs and stimulating local economies.

Leadership for Healthy Communities is a national program of the Robert Wood Johnson Foundation.

Making the Connection

Leadership for Healthy Communities Making the Connection Brief

As our nation strives to overcome an economic crisis, it also faces a health crisis.7,8 Currently, more than two-thirds of American adults are overweight or obese.9,10 Among young people, obesity rates have nearly tripled over the past four decades with nearly one-third of American children and adolescents either overweight or obese.11â&#x20AC;&#x201C;14 These youths are at greater risk of being overweight as adults and developing a host of serious health conditions, including heart disease, arthritis, stroke, high blood pressure, asthma, cancer and type 2 diabetes.15,16,17 Unless we reverse the epidemic of childhood obesity, health experts warn this generation of children could be the first to live shorter, less-healthy lives than their parentsâ&#x20AC;&#x2122; generation did.18 If this trend continues, it is expected that three out of four Americans will be overweight or obese by 2020.19 While these health outcomes are alarming, they also are troubling from an economic perspective. All told, obesity costs place a tremendous strain on our health care system, workforce and ability to compete in the global market.20 It has been estimated that as much as one-quarter of health care expenditures in the United States are related to obesity.21 Adult obesity is estimated to cost as much as $147 billion annually, and childhood obesity costs an estimated $14 billion per year in medical care alone.22,23 Experts predict that obesity-related costs could rise to about $344 billion by 2018 if obesity trends remain unchanged.24 Additionally, obesity has a sizeable impact on our labor market and workforce.25 Recent estimates show that employers lose roughly $73 billion per year to obesityrelated costs in health care services, absenteeism and loss of worker productivity.26 As todayâ&#x20AC;&#x2122;s generation of children become adults and enter the workforce, these costs are likely to accelerate, placing an unsustainable burden on taxpayers and our economy.27 The good news is that, as policy-makers work to stabilize our economy, they also can take steps to reverse this pressing health epidemic.28 In fact, many of the policy interventions that could help prevent obesity could also promote local economic growth and development. These include policy interventions that:

Provide Economic Benefits to Local Governments, Homeowners and Real Estate Markets

Greenbelts are areas of largely undeveloped, wild, or agricultural land surrounding or neighboring urban areas. They provide public access to green spaces and opportunities for residents of all ages and abilities to be physically active. Walkable communities facilitate pedestrian transportation by locating homes, businesses, schools, shops and other services, which are connected by sidewalks, bicycle lanes and trails, within an easy and safe walk from each other. Open space is land that has been set aside for public use. It is typically void of any man-made materials or buildings.

Daily physical activity reduces the risk of obesity and other chronic health conditions.29 Designing more compact, mixed-use developments and planning for open spaces can increase opportunities for young people and families to be active, because these types of spaces make it more convenient and appealing for residents to be outdoors and active on a regular basis.30,31,32 At the same time, these efforts bolster real estate markets by enhancing property values, increasing home-sale prices and attracting new homebuyers.33,34 For example, the development of greenbelts in Salem, Ore., enhanced the value of nearby urban properties by roughly $1,200 per acre.35 Studies also indicate that people are willing to pay more to live in compact, walkable neighborhoods with open spaces, such as parks and recreation areas.36 The redevelopment of Orenco Station, in Portland, Ore., into a compact, mixed-use and walkable neighborhood has led to a 20 percent to 30 percent increase in home-sale prices.37 These economic benefits for property owners and real estate markets translate into higher revenues in property taxes for local governments.38 A study in southeastern Pennsylvania found that local governments and school districts brought in an additional $240 million per year in property and transfer tax revenues from those homes located within one mile of protected, open space in the region.39 Also, investing in compact development strategies that protect open spaces can reduce infrastructure costs for municipalities. The state of Rhode Island determined that it could save almost $72 million a year by preserving open spaces and building new housing units within existing compact urban areas.40

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Promote Shopping and Local Businesses Communities can use urban-design improvements to increase opportunities for physical activity and healthy eating while revitalizing neighborhoods and local economies.41,42,43 Improvements could include making bike and pedestrian paths safer by adding lights, crosswalks and appropriate signage. Making wider sidewalks that are directly connected to stores, schools and residences also makes cities more pedestrian-friendly. A recent study found that young people walk more when sidewalks and homes are in close proximity to schools, parks and businesses.44 These types of settings can improve community access to grocery stores, which increases access to healthy food options for young people and families. According to one study, children with greater perceived access to food shops, including various food markets with fresh produce, consume more fruits and vegetables and less dietary fat than children with less perceived access.45,46 These children also are less likely to be overweight or obese.47 Promoting these design elements within communities also can revitalize neighborhoods and local economies by creating livable, walkable and attractive settings for residents.48 For example, a streetscape and pedestrian-design improvement project in downtown Lodi, Calif., attracted 60 new businesses, increased tax revenues from sales by 30 percent and reduced its vacancy rate by 12 percent.49 Along with economic-development incentives, the city attributes these economic benefits to wider sidewalks, improved lighting, more trees and benches, and other pedestrian and bicyclist amenities.50 An extensive state project in North Carolina that created safer bike paths and lanes along the Northern Outer Banks is another successful example of how preventing obesity and encouraging economic growth can complement each other. 51 This project resulted in economic benefits for businesses, workers and local governments through boosts in business, tourism and retail sales. In fact, the annual economic impact has been estimated at $60 million—nine times the state’s initial investment.52 Activity-friendly environments also promote shopping within communities by allowing consumers to spend less on fuel and vehicles and more on personal consumer goods.53 Research suggests that pedestrians and bicyclists shop and spend more per customer than those who drive.54

Create New Markets for Jobs, Businesses and Farmers The availability of healthy foods, including fruits and vegetables, can lead to overall improvements in diet quality and can help people reduce their risk of becoming obese and developing chronic diseases.55 However, many children and families live in food deserts, where they lack adequate access to healthy foods.56 In fact, more than 23 million Americans live one mile or more from the nearest supermarket and do not have access to a vehicle.57 By addressing these disparities, policy-makers can help improve families’ access to healthy affordable foods while creating new markets for jobs, businesses and farmers.58,59 Policy changes include bringing new food outlets into underserved areas, such as grocery stores, farmers’ markets, farm stands, cooperatives and mobile food carts or vendors.60,61 Financing initiatives can be used to create economic opportunities while working to eliminate local food deserts.62 The Fresh Food Financing Initiative, for example, provides loans and grants to applicants who commit to addressing healthy food shortages in underserved areas.63 Since 2004, the program has encouraged the development of 83 grocery stores and food retail businesses in 27 underserved areas, and created and preserved 5,000 jobs.64 In addition, farm-to-school programs can be effective tools for addressing both obesity and economic issues by improving the quality of school meals for children in underserved areas while providing local farmers with a steady and lucrative market.65 On average, farmers participating

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Leadership for Healthy Communities Making the Connection Brief

in a farm-to-school program have seen a 5 percent to 10 percent increase in their revenues.66 In Massachusetts, the farm-to-school program has generated more than $700,000 each year in additional revenue for farmers.67 In addition, farmers in Arkansas, Alabama, Mississippi, Georgia and Florida have doubled their incomes by selling fresh produce to more than a million students in 72 school systems through the New North Florida Cooperative Association.68 In this case, farmers recognized that sourcing to schools would create an additional market that would help economically support small farming operations throughout the region.

Leadership for Healthy Communities Making the Connection Brief

Policy Recommendations As policy-makers work to rebuild our economy, they have a unique opportunity to help reverse or prevent childhood obesity. Moreover, they can help reduce the economic burden of obesity on our health care system and workforce, thereby strengthening our national economy and global competitiveness. Some of the strategies that improve the economy while supporting better health include:

Promoting land-use plans that support compact, mixed-use development

Transit-oriented development is a development pattern created around a transit facility or station that is characterized by higher density, mixed uses; a safe and attractive pedestrian environment; reduced parking; and direct and convenient access to the transit facility. Form-based zoning codes concentrate first on the visual aspect of development: building height and bulk, façade treatments, the location of parking and the relationship of the buildings to the street and to one another. Complete streets are streets designed to function in ways that enable safe access for all users. Pedestrians, bicyclists, motorcyclists and bus riders of all ages and abilities are able to safely move along and across a complete street. Overlay zoning is additional or stricter standards to existing zoning that can be used to protect particular natural or cultural features. Transfer-of-development rights programs use the market to implement and pay for development density and location decisions by allowing landowners to sever development rights from properties in government-designated low-density areas. This makes it possible for development to be sold to purchasers who want to increase the density of development in areas that local governments have selected as higher density areas.

Policy-makers can help stimulate local economic development with the following policies: Provide access to trails and sidewalks and ensure that these connect to public transit routes;69,70,71 Develop community planning documents that improve pedestrian and bicycle access to local businesses, shops and healthy food markets;72 Implement mixed-use strategies, placing residences, businesses, grocery stores, recreation areas and other facilities near public transportation, major roads and trails;73 Adopt ordinances for transit-oriented development, placing compact, pedestrian-friendly housing, offices and shops in close proximity to transit stations;74 Create public-private partnerships with developers to identify land near residential areas to use as space for quality, affordable grocery stores;75 and Adopt form-based zoning codes to ensure building locations and their relationship to streets and public spaces create a livable, attractive and walkable community.76

Investing in community design that encourages healthy eating and active living Policy-makers can stimulate local economies by supporting measures that: Ensure entrances to businesses, retail shops, grocery stores and civic buildings are directly accessible to pedestrians and bicyclists, and that amenities, such as bicycle racks, are available for use; Identify funding streams, such as federal transportation funds, for implementing safety measures for bicyclists and pedestrians; Promote “eyes-on-the-street” safety features, such as adequate lighting and storefronts with windows overlooking sidewalks; Adopt complete streets policies to ensure safe street access for all users;77 and Require wider, connected and accessible sidewalks with more trees and benches.78

Increasing and preserving open green spaces within communities Policy-makers can enhance local real estate markets and property values by advancing measures that: Promote the preservation of open spaces, fields and farmlands through land acquisition, overlay zoning, transfer-of-development rights and partnerships with conservation groups;79,80 Support the development of greenways, trails, nature preserves or parks within 500 to 600 feet of residential areas;81

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Restore blighted areas by converting them into community gardens, farmers’ markets, parks and other green spaces through the federal Community Development Block Grant;82 Provide incentives to organizations for creating and managing open spaces that are converted into community gardens, such as reducing or waiving plot fees;83 Promote and protect community gardens through resolutions, land-use plans or zoning ordinances;84 and Support efforts to help fund the development of outdoor recreation areas through the federal Land and Water Conservation Fund State Assistance Program.85

Addressing local food deserts by attracting affordable, healthy food retail and markets Policy-makers can create new job and business markets by supporting measures that: Conduct a food mapping assessment through the U.S. Department of Agriculture Food Environmental Atlas to identify food deserts;86 Require developments and redevelopments to include healthy food retail;87 Provide incentives to promote healthy food market development in underserved areas, such as grants or loans, tax-increment-financing strategies or small business or economic development programs;88 Lift zoning requirements that make it difficult for healthy grocery stores to locate into urban or rural neighborhoods;89 Create a public-private partnership to leverage funds to invest in the development of healthy food retail;90 Encourage the state department of agriculture or local and tribal governments to apply for funding or technical assistance through the federal Healthy Food Financing Initiative to address local food deserts;91 Provide incentives for mobile food markets to offer convenient, affordable healthy foods in underserved communities;92 Require stores to accept electronic benefit transfer (EBT) cards for the Supplemental Nutrition Assistance Program (SNAP);93 and Create a food policy council or task force to advance affordable, healthy food access.94

Leadership for Healthy Communities Making the Connection Brief

Improving access to local healthy foods By supporting the following measures, policy-makers can provide more marketing opportunities for farmers and spur local economic growth: Encourage farm-to-school programs, through which schools purchase fresh foods from local farmers;95 Establish grants and subsidies to bring in farmers’ markets, especially in underserved neighborhoods; 96 Provide financial support to operators of farmers’ markets to reduce the vendor fees that farmers must pay, which, in turn, should decrease costs to local consumers;97 Provide subsidies to farmers’ markets that accept EBT cards for SNAP;98 Establish local farm-to-community distribution systems;99 Give incentives for retailers in underserved areas to buy locally produced foods;100 Favor local, healthy foods in government-supported facilities;101 and Support farm stands, small farms, community-supported agriculture, regional food initiatives and direct farm-to-institution relationships.102,103

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Food deserts are areas where residents lack access to affordable fruits, vegetables, whole grains, lowfat milk, and other foods that make up the full range of a healthy diet. Tax Increment Financing (TIF) can function differently in each state, but the approach generally involves local governments subsidizing costs by raising funds for development projects through the issuance of bonds guaranteed by future increases in property tax revenue. The increased revenue is generated as a result of the new development and/or as a result of pay-as-you-go notes financed by accumulated TIF fund tax revenues.

Endnotes 1

Leadership for Healthy Communities

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Making the Connection Brief

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Leadership for Healthy Communities Making the Connection Brief

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Leadership for Healthy Communities Making the Connection Brief

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ibid.

“Complete streets are streets designed to function in ways that enable safe access for all users. Pedestrians, bicyclists, motorists and bus riders of all ages and abilities are able to safely move along and across a complete street.” See Action Strategies Toolkit.

ibid.

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Copyright 2011 Robert Wood Johnson Foundation. This brief was produced by Global Policy Solutions with direction from the Robert Wood Johnson Foundation (RWJF) for RWJF’s Leadership for Healthy Communities program. To request permission to reprint: If you wish to reprint any portion of this document, please visit http://www.rwjf.org/policies/copyrights.jsp. You’ll need to download and complete the form that’s linked from that page, e-mail it to creativerequests@rwjf.org and wait to receive a response.