Let’s Talk FoodSummary and Analysis of the Chatham-Kent Community Food System AssessmentBrian Cook, PhDCatherine Mah, MD, PhD

March 2015

FO DLet’s Talk

Core Working Group MembersLyndsay Davidson, Registered Dietitian, Chatham-Kent Public Health UnitNicole Dupuis, Manager, Chronic Disease and Injury Prevention, Chatham-Kent Public Health UnitMichaela Smith, Epidemiologist, Chatham-Kent Public Health UnitKaren Loney, Health Educator, Chatham-Kent Public Health UnitKim Cooper, Agriculture Specialist, Economic Development, Municipality of Chatham-KentRebecca Green-Lapiere, Registered Dietitian, Chatham-Kent Community Health CentreMarthe Dumont, French Language Services Coordinator, Erie St. Clair LHINSHelen Heath, Director of Community Impact, United Way of Chatham-KentKathy Tomecek, Registered Nurse, Chatham-Kent Public Health UnitMary Alice Searles, Employment and Social Services, Municipality of Chatham-KentMike Buis, Buis BeefJamie McGrail, McGrail Farm EquipmentDipti Patel, Local Immigration Partnership Project, Municipality of Chatham-Kent

Acknowledgements:

This development and collection of data for this Community Food System Assessment was done as a collaborative project from a Core Working Groups. We would like to thank the members of this group for their time and input provided to bring this project forward.

Executive SummaryA growing public interest in the quality, healthfulness, and provenance of food, and interests in food culture, has placed food at the forefront of many stakeholder discussions. In the last decade, many local governments and public health authorities have begun to pay special attention to food themselves. In October 2011, Regional Council approved an Official Plan amendment where a ‘Sustainable Food Security Master Plan’ was recommended. In 2012, Chatham-Kent Public Health undertook Let’s Talk Food, a broad and inclusive stakeholder consultation, framed as a community food system assessment, to understand needs, hear ideas for a better regional food system, identify healthy eating policy priorities, and to begin the process of taking action on these ideas. This report summarizes feedback from community, local government and private sector consultations, alongside objective data on food system indicators. The report concludes with recommended next steps toward a Chatham-Kent regional food strategy.

In 2012, Statistics Canada found that only 29.5% of Chatham-Kent residents reported eating five or more fruits and vegetables each day. This was the lowest level reported by any of Ontario’s 36 health unit regions1. This is surprising, given the region’s robust fruit and vegetable production. Chatham-Kent grows more vegetables than any other region in Ontario, accounting for 20% of provincial production2. But locally grown foods are often not found in food outlets. In the summer of 2012, Public Health staff visited different types of food stores in Chatham-Kent and found that less than 2% of 600 surveyed items were grown in the region. Most residents of downtown Chatham and those in Thamesville are not within walking distance of a grocery store. In most rural areas, grocery stores are only accessible by vehicle, especially in Port Crewe, Port Alma, and Bradley. On average, the highest distress neighbourhoods in Chatham-Kent have three variety stores and three fast food outlets closer than the nearest grocery store3.

The community-based participatory research project, entitled Let's Talk Food, heard from stakeholders through a survey, focus groups and key informant interviews. Similar themes, as well as paradoxes, were reported throughout the consultations. For example, 47% of survey respondents reported buying locally grown foods as often as they can. The most common recommendation for change was to increase the number of farmers’ markets or roadside farm stands. However, some farmers questioned the depth of support for local foods among residents. The lack of success of farmers’ and roadside markets in Chatham-Kent in recent years is also a concern.

Consumers called for more information to be made available on a range of food skills such healthy eating, cooking, food shopping and gardening. Many expressed frustration at not being able to find local foods easily. Others suggested changes to public transit routes to align bus stops with grocery stores. Many respondents perceived healthier foods as being more expensive than unhealthy options. Those on limited income emphasized how difficult it was to afford a healthy diet. A striking one in five (20%) survey participants reported that they didn’t have enough money to buy the food they need. In the lowest income category (<$20,000/year), the proportion rose to 57%.

Those in the food sector highlighted challenges in connecting local production to local distribution. Larger supermarkets were accused of pushing out smaller neighbourhood-based retailers, and smaller food business owners found it difficult to access local products through traditional suppliers. Farmers were concerned about the future of Ontario agriculture given the rising average age of farmers and a trend toward increased foreign ownership. However, producers, processors, and other food sector experts also consistently emphasized the region’s food assets - arable soils, favorable climate, reliable rainfall and agricultural expertise. When asked for suggestions, food sector key informants called for a Chatham-Kent food terminal to improve local distribution, more infrastructure for local processing, better promotion and branding of local food and supports for young farmers.

A variety of progressive food system efforts are underway already in Chatham-Kent. Food banks, meal programs, and income support services are offered throughout the region by a number of community agencies, with support from local government departments. These efforts have led to coordinated networks such as Food Link Chatham-Kent that brings together Public Health, faith communities, farmers, community agencies, and individuals. Members collaborate on initiatives to promote universal access to “safe, nutritious, affordable and personally acceptable food”. The Public Health department spearheaded the launch of the Chatham-Kent Food Policy Council (May 2013). In the summer of 2013, Public Health distributed 1500 vouchers for $10 worth of fresh produce as part of the Aim for 8 Fruit and Vegetable Voucher Program to improve dietary habits. Farmers’ market cooking demonstrations and food skills sessions were conducted as well. In response to calls for stronger marketing of local businesses, a “Grown in CK” brand has been developed, in partnership with the Chatham-Kent Food Policy Council, the Chatham-Kent Public Health Unit, the Chatham-Kent Agri-Development Committee and Chatham-Kent Economic Development Services.

It is clear that Chatham-Kent could benefit greatly from a coordinated food system approach that links diverse stakeholders under a common vision. Research from the U.S.4,5, United Kingdom6, and Australia7 has found that local governments and local health departments, although varied in structure, size, and mandate, have unique and important levers to support healthy eating and sustainable food. For example, they can promote, facilitate and/or coordinate food distribution mechanisms (mobile markets, healthy corner stores, etc.); initiatives to make food information more easily accessible; regional urban-rural networks to bridge the divide between local producers and consumers; food-related local economic development; and update zoning, licensing, procurement and other regulations to remove barriers to positive food system initiatives.

Many cities and local authorities have launched food strategies or food system plans to coordinate these actions. Generally, a food strategy includes a vision statement and a set of short and long-term actions. However, a strategy is more than a report or set of recommendations. As Toronto’s 2010 Food Strategy report states: “It is the ongoing process of identifying, building and strengthening positive connections - between local government and residents, among City Divisions, within the community, and with the countryside”8. In other words, the process of developing and implementing a coordinated food system plan

or strategy is just as important as the formal objectives. Based on the experience of other jurisdictions, a number of fundamental components are required to move toward a food strategy:

Data Collection, Analysis and Knowledge TransferOngoing research will inform specific policies and proposals to stakeholders and external funders for initiatives. More detailed information about the private sector's role in production, processing, distribution, and retail is important for the public and community sectors' understanding of how the broader system works.

Identify Local Government’s Food System Roles and ResponsibilitiesWhile some roles and responsibilities will seem obvious (public health’s role in nutrition promotion and food safety), many others will require critical analysis and creative thinking to unearth indirect effects and unintended consequences on food and health.

Create Collaborative InfrastructureCollaborative infrastructure refers to processes and space that allow diverse stakeholders to come together on a regular basis to assess needs and identify priorities based on the best available evidence as well as residents’ lived experiences. One useful approach is a food policy council, something that Chatham-Kent implemented in 2013.

Assign Staff Coordination Resources While a Non-Governmental Organization (NGO) or community agency could act as the region’s food strategy lead, most do not have the capacity or resources to work effectively with complex bureaucratic structures. Integrated leadership within government makes it easier to bridge the bureaucratic silos, an essential component of any coordinated long-term food system strategy.

Link with Food Networks Locally and GloballyConnecting to existing networks locally and globally to share knowledge and insights will give Chatham-Kent a higher chance of success.

Take ActionUltimately, a food system strategy or plan is about making meaningful changes in people’s lives. While careful planning is critical, it is important to also take advantage of the unique momentum that food initiatives bring. Other cities’ experiences reveal that starting early with even small multi-sectoral pilot projects can help build buy-in to support future innovations.

ConclusionGiven the interconnectedness of food system issues, effective solutions can only be identified and implemented through a broad, multi-sectoral systems approach. A Chatham-Kent food system strategy could provide multiple benefits, over and above specific policy or program outcomes. Addressing complex food system issues also requires governments to evolve out of their traditional bureaucratic silos. In an era of diminishing public sector resources, the ability to work more effectively interdepartmentally or with outside stakeholders, and to

leverage existing resources to accomplish more with less, are all important shifts that a food system strategy can help incubate. Chatham-Kent is in a strong position to move forward. The Public Health department’s Let’s Talk Food consultations assessed community needs and identified gaps and the Chatham-Kent Food Policy Council provides a venue to build connections across the food system, identify key priorities, and catalyze new initiatives. In light of the information presented in this report, a series of actions are provided below as suggested next steps for the Municipality of Chatham-Kent.

Strategic Next Steps

O Assign staff resources to explore the development of a Chatham-Kent Food Strategy, including a proposed governance model and process for implementation.

O Conduct research on the region’s food flows to understand the movement of food in and out of the area, distribution channels, and opportunities to support better access to healthy, affordable food in underserved areas.

O Select key regional food system indicators and work with surveillance and other social and economic monitoring stakeholders to ensure that high-quality longitudinal information will be available for monitoring future progress.

O Develop a centralized data collection system related to key food system issues (e.g. food production, location of food retail outlets and emergency food providers, food consumption data, etc.) and make it easily accessible by Municipal staff and the public.

O Identify all of the direct and indirect food policy roles and responsibilities within the Municipality of Chatham-Kent departments and associated agencies and boards.

O Use annual work planning processes to identify opportunities to integrate food portfolios within government.

O Create an inventory of local government-owned land and facilities; identify opportunities for markets, gardens, etc.; and make information on accessing land and facilities easily accessible to the public.

O Research barriers that hinder Chatham-Kent grocery stores, small food retail outlets and restaurants from accessing locally grown foods.

O Review alternative food distribution models (e.g. mobile produce markets, “healthier convenience stores”, aggregated food procurement for community agencies, community kitchens, community freezers).

O Explore ways to build capacity among Municipal staff and the community sector to understand government roles and responsibilities related to food. For example:

• make information on Municipal regulations related to starting a food business, organizing a community garden, using public land for food growing, and more, easily accessible on the Municipality’s website, and

• develop food policy workshops for Municipal staff or link with other cities doing the same.

O Develop an inventory of settings in which a healthier and more sustainable food system could be operationalized. For example, retailers, schools, workplaces, recreation centres.

O Combine existing food skills training and nutrition education with exploring behavioural insight strategies (“nudges”) that could be effective in increasing the consumption of healthier foods, especially fresh fruits and vegetables. Assess opportunities to partner with settings to prototype and evaluate these strategies.

O Continue to expand the "Grown in CK" branding program.

O Advocate to the provincial and federal governments for improvements to income security programs to ensure all residents have the baseline economic resources to afford a healthy diet .

References 1 Statistics Canada, Canadian Community Health Survey (CCHS). CANSIM table 105-0502 is an update of CANSIM table 105-0400.2 Municipality of Chatham-Kent (2015). Agricultural Profile. Available from http://www. chatham-kent.ca/Newcomers/Entrepreneurship/Pages/agriculturalprofile.aspx.3 Gilliland, J. & Sadler, R. (2011). Mapping Environmental Barriers and Enablers for Healthy Living in Chatham-Kent. Prepared for Chatham-Kent Public Health. Human Environments Analysis Laboratory (HEAL), UWO. Presentation November 30th, 2011.4 U.S. Institutes of Medicine (2009). Local Government Actions to Prevent Childhood Obesity. The National Academies of Science.5 Pomeranz, J.L. (2011). The unique authority of state and local health departments to address obesity. American Journal of Public Health. 101(7):1192-7.6 Mitchell, C., Cowburn, G. & Foster C. (2011). Assessing the options for local government to use legal approaches to combat obesity in the UK: putting theory into practice. Obes Rev. 2011 Aug;12(8):660-7. 7 Allender, S., Gleeson, E., Crammond, B., Sacks, G., Lawrence, M., Peeters, A., Loff, B. & Swinburn, B. (2012). Policy change to create supportive environments for physical activity and healthy eating: which options are the most realistic for local government? Health Promot Int. 2012 Jun;27(2):261-74. 8 Ibid.

Table of ContentsIntroduction 10Issue History 11Diet and Health of Chatham-Kent Residents 12 Fruit and Vegetable Consumption 12 Chronic Disease 14 Overweight and Obesity 15 Household Food Insecurity 16 Food Skills 16 Agricultural Production 17 Food Retail Environments 17 Fresh Produce Pricing & Availability 18

Let’s Talk Food Consultations 19 Survey Results 20 Focus Groups & Key Informant Interviews 27

Current Policies, Programs and Initiatives 37 Analysis: Toward a Chatham-Kent Regional Food Strategy 38

Key Limitations 44Conclusion 47Strategic Next Steps 47References 50

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IntroductionIn the last decade, many local governments and local public health authorities have begun to pay special attention to food. This is not altogether new—many 20th century local public health structures were developed to mitigate food risks, including protection from foodborne diseases and contamination of food and water. With growing industrialization, urbanization, and globalization by the mid century, however, food had become principally a concern for the private sector and higher levels of government.

The current era of local action around food can be traced to the 1980s, when macro-economic trends produced growing inequities in access, even in wealthy countries where there was an abundance of homegrown or imported food. Since then, the motivations for local government involvement in the food system have been many: diet-related chronic diseases, food safety scares, rising levels of obesity alongside persistent hunger, the long-term regional economic viability of family farming, rising food prices, the impact of climate change on food production, and more. While these problems seem separate, they arise out of a broader system of inter-related food stakeholders (producers, consumers, retailers, government agencies, etc.) and functional activities (food production, processing, distribution, retailing, consumption and waste management).

When seen from the perspective of an overall “food system”, many community, private, and public sector voices are calling for a re-evaluation of how the system operates. A growing public interest in the quality, healthfulness, and provenance of food, and interests in food culture, has placed food at the forefront of many stakeholder discussions. Food has become central to many community and cultural events. A new generation of entrepreneurs, retailers, investors, and farmers are keen to maximize the positive health and social impacts of their businesses alongside realizing economic goals. Moreover, local authorities are gaining a new sense of what kinds of independent steps they can take to shift food systems to become more health-promoting and sustainable. Local governments are learning from each other through horizontal networks and public engagement.

Figure 1, used during community consultations in 2012, highlights how these themes are central to the vision for food system renewal in Chatham-Kent.

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Local governments in Canada have traditionally been peripheral to food governance. Their formal roles tend to be linked to “downstream” issues of waste, food safety inspections and nutrition promotion. But food-related problems are being experienced more acutely in cities and towns. With stretched budgets, local governments are looking for more innovative ways to address these issues. And more and more people are recognizing that food initiatives (farmers’ or community fresh food markets, festivals, linking local producers with schools and institutions, food enterprise incubation, community gardening, etc.) contribute to a community’s health, social and economic prosperity.

Local governments are also recognizing that some food systems concerns are common to jurisdictions, and other issues reflect the unique character of its residents and geographic region. For example, Chatham-Kent is facing many of the same issues of diet-related disease and unhealthy food environments as its Ontario and Canadian counterparts, but also has its own specific mix of food assets and challenges.

Issue HistoryChatham-Kent coordinated a series of research projects and consultations focused on the food system, the health and wellbeing of residents, and associated opportunities for intervention. Food skills surveys were conducted in 2009, 2010, and 2011. The Chatham-Kent Healthy Communities Partnership (CKHCP), with the support of the Ontario Ministry

FIGURE 1 Chatham-Kent Food System Vision: Let’s Talk Food Consultation

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of Health and Long-Term Care Healthy Communities Fund, led a series of analyses and consultations throughout 2010 and 2011 to identify opportunities and policy options for creating more supportive environments in Chatham-Kent, including policies related to improving access to local foods where residents live, learn, work and play.

In October 2011, Regional Council approved an Official Plan amendment where a ‘Sustainable Food Security Master Plan’ was recommended. Since then, the Chatham-Kent Public Health Unit has taken a lead role in bringing partners together in a collaborative effort to define assets and needs, and initiate action, supporting the work of CKHCP, Food Link CK and the Prosperity Round Table.

In 2012, Chatham-Kent Public Health undertook Let’s Talk Food, a broad and inclusive stakeholder consultation, framed as a community food system assessment, to understand needs, hear ideas for a better regional food system, identify healthy eating policy priorities, and to begin the process of taking action on these ideas. Community food system assessments aim to apply ‘systems thinking’ such that a wide range of stakeholder inputs are taken into account in shaping the future of the local food system through a participatory process.1

This report summarizes Let’s Talk Food feedback from community, local government and private sector consultations. It considers what makes Chatham-Kent unique in terms of regional advantages, but also what unique barriers it needs to address in developing the local food system for greater sustainability and improved population health. It assesses the feedback alongside objective data on Chatham-Kent food system indicators. Finally, it recommends next steps in moving toward a strategic plan that optimizes the health, social and economic benefits of the food system for all residents.

Diet and Health of Chatham-Kent ResidentsThis section summarizes key cross-sectional and longitudinal indicators for Chatham-Kent, including health, food security, and food behaviours of the region’s residents; and a snapshot of the local food supply chain, including agricultural production and retail. This section is intended to contextualize some of the results of the primary data collection carried out in the food system assessment.

Fruit and Vegetable ConsumptionIn 2012, Statistics Canada found that only 29.5% of Chatham-Kent residents reported eating five or more fruits and vegetables each day. This was the lowest level reported by any of Ontario’s 36 health unit regions.2 It was also significantly lower than the provincial median of 38.6%. In 2007/2008, slightly more residents reported five or more daily servings (32.2%). This is a surprising result, given the region’s robust fruit and vegetable production. Unhealthy eating, as well as physical inactivity and smoking have the greatest impact on reduced life expectancy; 2.0, 2.4, and 2.5 years of life lost, respectively.3

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FIGURE 2 Fruit & vegetable consumption, five or more per day (2011/12) By health unit regions (ages 12 and older)

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Chronic DiseaseChatham-Kent has higher than average mortality rates for eight major chronic diseases. Chronic diseases, including heart diseases, chronic lung diseases, diabetes and cancers are the region’s leading causes of death and hospitalization. Figure 3 shows the prevalence per 100,000 people from 2011 for Chatham-Kent and Ontario as a whole. The region has Ontario’s second highest cardiovascular disease mortality rate and is the third highest for ischemic heart disease.

FIGURE 3 Age standardized chronic disease mortality rates per 100,000 – Ontario and Chatham-Kent (2011)4

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Overweight and ObesityIn 2007/08, approximately 60% of Chatham-Kent adults were classified as overweight or obese (see Figure 4), with men having particularly high rates compared to men in the province overall and compared to females.5 Data are not available for overweight and obesity among children under 12 in the region. Figure 5 shows that over 40% of those aged 12-17 fell into this category in 2012 suggesting that a significant percentage of children under 12 may also be overweight or obese. Children who are overweight or obese and maintain an unhealthy weight into adulthood are more likely to suffer from type 2 diabetes, high blood pressure, heart disease and arthritis. The Province’s Healthy Kids Panel reported that overweight and obesity threaten the sustainability of the health care system and cost Ontario $4.5 billion dollars in 2009.6 Childhood obesity has been identified as a public health crisis by Canadian governments.7,8 International agencies9 have increasingly attributed obesity to caloric overconsumption rather than inadequate energy expenditure.10

The rise in obesity throughout the world has occurred at the same time as the global food system is producing greater quantities of processed, affordable and heavily marketed food than ever before.11

FIGURE 4 Self-Reported Adult Overweight/Obese Rate, Age-Standardized (Age 18+), Chatham-Kent And Ontario (2003 To 2011/12)12

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FIGURE 3 Self-Reported Youth Overweight/Obese Rate, (Age 12-17), Chatham-Kent And Ontario (2003 To 2011/12)13

Household Food Insecurity According to the 2006 census, approximately 8% of Chatham-Kent residents live in low-income households as of the 2006 census. In 2011, a survey of 601 adults across Chatham-Kent found 12% of respondents reporting some experience of food insecurity, meaning they answered yes to at least one question related to their ability to afford enough healthy food for their household. Those reporting food insecurity were less likely to own a car, more likely to have a higher body mass index (BMI), consume a less healthy diet and report worse health than food secure respondents. The survey found no clear relationships between geography and diet. The respondents’ dietary habits tended not to vary based on proximity to grocery stores, variety stores or fast food restaurants.14

Food SkillsThe Chatham-Kent Public Health Unit conducted the most recent Food Skills Survey in 2011. The objective was to understand residents’ food shopping and preparation skills and gain insight into the barriers to buying and consuming healthy foods. Similar to the Statistics Canada findings, the survey found that only 12% of residents reported consuming Health Canada’s recommended 7-10 servings of vegetables and fruit per day. Almost half of male respondents reported eating less than three servings of vegetables and fruit per day. Respondents who did not meet the recommended servings of vegetables and fruit per day did recognize that they should be eating more.

The problem of fresh foods spoiling too fast, and becoming bored with eating the same kinds of foods repeatedly were among the most commonly cited barriers to healthy eating. Women were more likely to report that their family acted as a barrier to consuming more

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and new types of vegetables and fruit, whereas men were more likely to report that they were not aware of the health benefits of vegetables and fruit.

Most people reported meal planning in advance as their worst food skill, followed by the ability to modify recipes, understand food labels, prepare balanced meals, and include variety in meals. In general, men reported significantly poorer food skills than women.

In their report to the Board of Health in 2012, Chatham-Kent Public Health concluded that having better food skills and reporting fewer barriers was directly correlated with increased vegetable and fruit consumption among Chatham-Kent residents. Therefore, focusing programs that address food skills and barriers should impact vegetable and fruit consumption within the Chatham-Kent community.15

Agricultural ProductionChatham-Kent is home to some of the best farming and farmland in Canada. The region’s agriculture is a $3 billion annual industry employing over 16,000 people.16 Chatham-Kent grows more vegetables than any other region in Ontario, accounting for 20% of provincial production.17 It is Canada’s number one producer of tomatoes, carrots, seed corn, pumpkins and cucumbers.18 While the price of farmland has leveled off in most parts of Ontario, one real estate firm reported that Chatham-Kent’s per acre prices increased by 40% between 2013-2014.19 In 2013, the Chatham-Kent Agri-Development Committee launched the We Grow for The World website (wegrowfortheworld.com) to promote the area’s agricultural sector, including profiles of local farm and processing businesses.

Food Retail EnvironmentsThe food environment, including the distribution of retail outlets, is increasingly recognized as a significant determinant of people’s diet and health over and above individual preferences, knowledge, and behaviours.20 Although inadequate income is the most significant barrier to healthy food purchasing, many individuals and families also live in neighbourhoods that have few quality food retail options within easy walking distance, poor access to transportation, and increased access to unhealthy foods.

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Dr. Jason Gilliland and Richard Sadler assessed food retail environments in Chatham-Kent in 2011 and found that some areas could be considered “food deserts”, referring to high socioeconomic distress, poor pedestrian access to healthier food sources, and high population density.21 Most residents of downtown Chatham and those in Thamesville are not within walking distance of a grocery store. In most rural areas, grocery stores are only accessible by vehicle, especially in Port Crewe, Port Alma, and Bradley. Proximity to less healthy food establishments such as convenience stores and fast food was found to be higher across the region. On average, the highest distress neighbourhoods in Chatham-Kent were found to have three variety stores and three fast food outlets closer than the nearest grocery store.22

Gilliland and Sadler found no systematic inequalities along income lines with proximity to healthy food sources. Residents in the most distressed areas were a closer distance to the nearest 1, 2 or 3 grocery stores than less distressed areas. But the same holds true for distance to unhealthy food sources such as fast food and convenience stores.23

Of the small number of studies that have evaluated the diet or health-related outcomes of opening grocery stores in low-income, underserved areas, only one has found improvements in diet.24 However, many more studies have found significant improvements in diet or health outcomes after interventions to expand the availability of healthier foods in convenience stores which typically represent sources of unhealthy foods.25 The equivocal effects of grocery store interventions may be the result of the large amounts of both healthy and unhealthy foods that they carry.

Fresh Produce Pricing & AvailabilityIn the summer of 2012, Public Health staff visited supermarkets, convenience stores, farmers’ markets and roadside fruit and vegetable stands in Chatham-Kent to collect information on fresh produce availability, prices and place of origin. To gauge price differences, surveyors converted all prices to a “per kilogram” figure. The survey included 32 fruits and vegetables that are locally grown in July and August. A diverse range of supermarkets was included in the survey, including large discount chains, independent grocers, and others. Staff visited a small number of convenience stores in areas with below average density of supermarkets.

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While the data are from 2012, several relevant trends emerged. Not surprisingly, fresh produce generally was not available in convenience stores, including those in “food deserts” with few large food retailers nearby. Supermarkets and farmers’ markets/stands had a wide range of fresh produce. In terms of price, some supermarkets had lower prices than farmers’ markets/stands but there was a lot of variation. Many factors can affect fruit and vegetable prices, over and above the large-scale procurement advantages that large retailers have. Given their perishable nature, pricing tends to be quite variable. Depending on the length of time from field to store shelf, distribution problems or changes in supply or quality can lead to significant price differences. The 2012 survey found that locally grown fruits and vegetables from markets and stands were priced competitively in most instances with the average of the 10 surveyed supermarkets. The notable exceptions were cauliflower and tomatoes. Locally grown cauliflower sold at a farm stand had the highest price, while the opposite was true for Chatham-Kent field tomatoes. Farmers’ market and farm stand tomatoes were the least expensive, not surprising given that the region is Canada’s largest producer.

The most striking finding was the lack of Chatham-Kent produce in supermarkets. Among the nearly 600 food items that were recorded across the 10 surveyed supermarkets, less than 2% were grown in Chatham-Kent. This is surprising, not only because of the region’s strong agricultural sector, but also because the survey took place in July, prime growing season for many crops. Their absence from store shelves was clearly not a direct result of limited local supply. Indeed most supermarket fruits and vegetables (61%) were sourced from other parts of Ontario or Canada. The remainder came from the U.S. (33%) and other countries (4%).

Let’s Talk Food ConsultationsIn the spring of 2012, Chatham-Kent Public Health coordinated a local community food system assessment for the region. This community-based participatory research project, entitled “Let’s Talk Food”, aimed to assess food needs, engage diverse stakeholders on important issues and gather ideas to inform a coordinated food system strategy for the region.

The consultations included three components:• survey• focus groups, and• key informant interviews.

Using different types of approaches meant that staff could gather insights from a larger number of people (survey) but also explore specific issues in greater detail (focus groups and interviews). As part of the process, health unit staff and community members came together to form a working group to guide the project, including survey tool development, recruiting survey participants and facilitating focus group sessions. The consultations were not intended to be comprehensive or representative, but did aim to be as broad and inclusive as possible. The various consultations invited individuals to participate from all across the region, from diverse socioeconomic backgrounds and those with specific expertise in

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food. Questions were asked about food eating habits, food availability, accessibility and affordability, and residents’ overall concerns about food. The remainder of this section includes a summary of the results, key themes and implications for next steps.

Survey ResultsChatham-Kent Public Health conducted the Let’s Talk Food survey in collaboration with the Chatham-Kent Healthy Communities Partnership, Food Link Chatham-Kent and the Centre for Community Based Research. More than 1,200 people completed the survey (online or hard copy) that asked questions about food costs, proximity to stores, barriers to healthy eating, perceptions of local food, and suggestions for improving the food system. The majority of survey participants were female (79%). Respondents encompassed all income groups, but those reporting under $40,000 in annual gross household income made up a larger proportion (41%) of the sample. All age groups were represented. The vast majority of respondents (89%) reported being residents of Chatham-Kent for more than five years. Below is a summary of the survey results according to specific topics.

Food ShoppingAlmost everyone (97%) who completed the survey said that they do most of their food shopping at a supermarket. They cited, in order, price, quality, variety, and proximity to their home as the most common reasons for shopping there. Most people (84%) drove to the supermarket, but those reporting <$20,000/year in household income were more likely to take public transportation (28%) or walk/bicycle (24%). Figure 7 below shows that price, nutrition and freshness were the most important considerations for respondents when purchasing food.

FIGURE 7 What are your top priorities when purchasing food?

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Forty percent of respondents said that they can always get the types of food they want in Chatham-Kent and almost everyone else (58%) said it was possible most of the time. Nevertheless, more than half (54%) of respondents said that they regularly or occasionally buy groceries outside the region. The most common reason, by far, was lower prices. Many reported going to London or Windsor and 160 people mentioned Costco as a specific destination. It should be noted that Costco is a membership-based store and therefore not accessible to all consumers. About a third of respondents (32%) said that they buy food from convenience stores often or occasionally. Men, those under 30 years of age, and those reporting <$20,000/year in household income were more likely to visit convenience stores.

Food Availability, Accessibility and AffordabilityA striking one in five (20%) survey participants reported that they didn’t have enough money to buy the food they need. In the lowest income category (<$20,000/year), this percentage jumped to 57%. Eating less food was the most common strategy to make ends meet, followed by borrowing from family, friends, selling household items, and loans from a payday lender. Those under 30 years of age were the only group to cite “borrowing money from family” as their first option. The under 30s were also the most likely to report having used a food assistance program at some point (62%).

Self-Reported Healthy EatingJust over half (51%) of people reported that they followed a healthy diet, including 10% who said their eating habits were “very healthy”. Those with an annual household income under $20,000 were the least likely to report a healthy diet (32%, “healthy” and “very healthy” combined). There was a clear gradient along age categories for the overall survey sample. Those over 60 were the most likely to agree that their diet was healthy (68%) and the percentage dropped with each younger age group. Only 40% of those aged 30-39 and under 30 reported a healthy diet.26 When asked how people get information about nutrition, most said the Internet (71%), followed by family (51%), friends (41%), and various media sources (41%).

Half (51%) of all survey participants said they eat at a fast food restaurant several times a month or more. People in the lowest (<$20,000) and the highest (>$100,000) household income groups ate fast food least frequently (42% of each group said “never”). Those in the second lowest income category ($20,000-60,000) were the most frequent fast food

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consumers; 45% reported eating fast food every day or several times per week. Figure 8 below shows that convenience is by far the most appealing factor for those deciding to eat out, but taste and time pressures were also common reasons.

FIGURE 8 Why do you eat at restaurants?

Local FoodOverall, people reported placing a high value on food grown in Chatham-Kent with 47% buying it as often as they can. Another 36% of respondents agreed that they buy local food whenever it’s in season. Responses to this question didn’t vary by income, except with regard to where purchases are made. Lower income residents were more likely to purchase local food from grocery stores and farmers’ markets. Higher income residents were more likely to buy directly from local farmers and pick your own farms. Age appeared to be the factor most closely associated with support for local food. People over 60 were the most likely to reporting buying local “as often as I can” (59%). The percentage dropped with

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each successive age group; only 35% of those under 30 gave the same response. Figure 9 shows the variety of reasons people cited for not buying local food. Availability, price and lack of information stood out as the most common barriers.

FIGURE 9 What are your reasons for not buying local food?

What is the most important concern you have about food?Figure 10 below shows the most common responses to this question. Four in ten respondents cited nutrition, while only 10% were concerned that food needed to be less expensive. However, when asked in an earlier survey question about their top priorities when shopping, price (77%) was the most common answer, ahead of health and nutrition (69%). One explanation for the difference in responses could be that the question about “food concerns” appeared among a series of questions about healthy food. Respondents might have been primed to think more about nutrition when answering this question. Focus

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FIGURE 10 What is the most important concern you have about food?

Community/Participant Suggestions for Improving the Food System At the end of the survey, participants were asked for suggestions on ways to improve the food system in Chatham Kent. There were over 400 specific comments but most fell into one or more categories of themes described below.

More Farmers’ Markets and Farm StandsMore than 100 participants mentioned the need for better access to farmers’ markets or roadside farm stands to buy healthy, local food. Many people said that the markets should be open later and throughout the year. Others suggested having a market in downtown Chatham coupled with better promotion of market locations and times.

It should be noted that the broad support for direct farm sales stands in contrast to the experience Chatham-Kent market organizers in recent years. Almost all of the region’s farmers’ markets have proven to be unsuccessful in the long term.

EducationPeople said that more information should be available on a range of food skills: healthy eating, cooking, food shopping, gardening, etc. There were suggestions of having chefs

A year-round covered farmer’s market would be an excellent addition to Chatham-Kent and would help promote our agri-businesses and cultural heritage as a food growing region.

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in grocery stores to teach recipes, free cooking classes, and making existing nutrition resources more widely available. Many emphasized that education on nutrition and food systems should start in schools with children at an early age.

Local Food PromotionDozens of people called for a Chatham-Kent local food brand to be developed. Many expressed frustration at not being able to find or identify local foods easily. It was also seen as important to promote local food maps, prominent Chatham-Kent farms and information about the seasonality of different fruits and vegetables. Many people also called for area grocery stores to stock more local foods. There was a theme of frustration among many survey participants at the lack of Chatham-Kent produce in stores, especially during the prime growing seasons.

It really irks me to see the local grocery stores selling produce from the US and Mexico when it is available locally.“ “

To really improve the food system in Chatham-Kent, we need to educate elementary school kids about food and where it comes from. If young children grow up understanding the importance of good food, locally grown food, they will turn into adults who will shop for good food and locally grown food.

“ “There should also be local fruit-vegetable garden tours so people can see how beautiful, creative and beneficial these gardens can be. Our children learn so many useless things in school; why not teach them the basics so they can do the same for their children and families when it comes time?

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Transportation LinksGiven that the population of Chatham-Kent is spread across a large geographic area, many people noted that accessing local food at stores or farmers’ markets was sometimes a problem. They suggested changes to public transit routes to align bus stops with grocery stores, occasional public transit to farmers’ markets and “pick your own” farms. Others offered the idea of a carpooling program that links people with vehicles to families or seniors that need to get to stores.

AffordabilityMany respondents perceived healthier foods as being more expensive than unhealthy options, and called for solutions such as farmers’ market vouchers for those with low income, and working with food banks to stock more fresh produce. Other ideas included a good food box program, improving access to existing income support programs, and advocating increases in social assistance payments. Some survey respondents had personal experience in not being able to afford enough food for their family.

Other CommentsPeople suggested many other ideas to improve the food system in Chatham-Kent. Some stressed the need to deal with the region’s “food deserts” and called on governments to find ways to keep more grocery stores from closing. Survey responses included specific locations such as Thamesville and the east side of Chatham. Many called for a municipal composting program to divert organic waste from landfills. Local government was asked to play other leadership roles: adopting a local food procurement policy, facilitating con-nections between farmers and retailers, and coordinating a “Shop Local” food festival to promote the area’s producers.

I am not interested in driving long distances to purchase locally grown food. I do not want to spend gas money to buy food. I would like to go to a central location to buy all my locally grown food but find that at the moment, I have to travel sometimes up to half an hour to buy locally grown apples, tomatoes, sweet potatoes and strawberries.

“ “

I am on social assistance and most of my money goes to shelter costs and my cellphone. Thus leaving me with barely enough money to get by on... For some reason it costs an arm and a leg to eat the healthier selections of products whether organic products with whole grain/flax seed/oats etc. It is frustrating to want the best for my family and I can only provide about 30% of their needs it seems. Even at worst when I break down to go to food banks and thank God for them I might add. You are still limited with little meat and vegetables and so forth.

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ACCESS

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Focus Groups & Key Informant InterviewsIn order to gain a more in depth understanding of people’s personal and professional experiences with the food system in Chatham-Kent, Public Health staff and community partners conducted 30 focus group sessions and 10 key informant interviews.

A total of 50 community members were recruited to facilitate the focus group sessions. Each person received training in focus group facilitation and organizers paired facilitators with groups with whom they had a similar background. Participants learned about the sessions through friends, family, and promotion through a variety of media, including radio, newspapers, social media and local libraries. Participants were reimbursed for any transportation and childcare costs and were provided a full meal. The focus group sessions explored eating habits, food shopping, affordability, perceptions of local food and ideas for improving the food system. Other questions were tailored to specific audiences. Sessions were held at locations across the region: Chatham, Ridgetown, Thamesville, Blenheim, Dresden, Wallaceburg and Tilbury. To get the most out of these discussions, staff decided to organize stakeholder-specific focus groups. This step in the consultation was not intended to be comprehensive, but a diverse mix of stakeholders was invited to participate, including the following:

Almost 250 people in total participated in focus group sessions. There was a higher percentage of women than men but a fairly equal distribution across age, education and employment categories.

• Aboriginal• Municipal Council• Agritourism• Municipal Staff• Daycare Providers• Parents with Young Children• Employment & Social Services Staff• Registered Dietitians• Farmers• Restaurant Owners/Staff

• Francophone Community• Schools• Health Care Practitioners• Seniors• Immigrant/ Refugee• St Clair College• Low-Income Families • Student Nutrition Program• Mennonite • Youth

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The objective of the key informant interviews was to gain insights into the strengths and weaknesses of the region’s food system. Interviewees were individuals who know their community well and could provide an informed key stakeholder perspective on the current state of Chatham-Kent’s food system and opportunities for positive next steps. Staff completed interviews with individuals working in food production, processing, foodservice, retail, waste, higher education, land development and poverty reduction.

The focus group discussions and interviews revealed many of the same themes that emerged from the survey results. But people were also asked what food means to them, over and above a necessity for nourishment. They talked about eating as an experience connected to pleasure, culture, traditions and social settings. Some expressed strong feelings about the role food plays in their lives and their families:

Many residents noted a variety of barriers to meeting their food needs and/or those of others in the community. Many talked about the high cost of healthy food, the need for more education related to nutrition, cooking and shopping on a budget, and the lack of food stores in many parts of the region. Many also spoke of the disconnects across the food system; farmers growing high quality food but feeling undervalued for their work and consumers frustrated that they can’t access locally grown foods more easily. Smaller food business owners talked about wanting to serve the community but finding it hard to compete with big business.

Rather than summarize each discussion in isolation, the section below organizes the in-depth feedback according to themes that will be core to a Chatham-Kent food system plan: access, supply, and governance.

Access to Healthy, Affordable, Diverse FoodFood access has economic, geographic, and information components. Interest in alternative food sources and growing one’s own food is increasing, but most people rely on retail

Food means showing you care; you love. - Recent Immigrant

“ “

I think that it [food] also means pleasure. That’s the moment you take something, like you bring someone joy. My son really loves beans – yesterday I told him we have rice and beans and farofa [Brazilian dish], …and when I hear – “I love you mom, you made farofa tonight”. Pleasing him...I like to tell him I did something special. - Recent Immigrant

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stores for access to food. Over 70 cents of every food dollar spent in Canada is spent on food in retail settings. For residents to be able to access adequate amounts of food for their families, they need money; they need to be able to get to retail stores, markets, or other settings to procure food; and they need transparent and accurate information about food choices, shopping strategies, and meal preparation.

Focus group participants identified similar barriers found in the survey results but the sessions also provided more detailed insights from people with specific experiences: those living on low income, recent immigrants, and professional groups from the public and private sectors.

Economic AccessThe consultations heard from numerous people who highlighted concerns about affordability of quality food for lower income Chatham-Kent residents. The consensus was that healthier food was perceived to be more expensive than less healthy options. Social assistance payments for some, especially single-person households, were seen as too low to allow someone to afford a healthy diet:

Those who work or volunteer at community food programs such as food banks noted an increase in demand in recent years:

We’re lucky to have the government we do with the stuff that you do get when you’re on welfare and that. But if you’re a single person with no kids, you’ve got an extra $30-50 a month to live off of. You can get your rent paid, at maximum $400 and then you get $50 or $60 for the whole month. Could you imagine living off $60 for the whole month? - Youth Focus Group

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We are seeing a huge numbers of new families—we’re in a neighborhood of 90 to 100 new families every month that are registering since Christmas time. I find that more disturbing than the number of families that have been ongoing. To see that kind of increase; because that’s just something that we haven’t seen in recent years. - Food Bank Volunteer

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Although there are many agencies, including local government, who are partnering to address poverty and hunger, some believed that these issues receive less attention because people don’t see obvious signs of deprivation in Chatham-Kent. In big cities, poverty and hunger are much more visible. Other problems connected to hunger are even less visible. For example, many seniors who live independently at home don’t have the means or ability to eat well. For example, even though food assistance programs exist for some individuals, they are unable to fully meet food needs:

Geographic AccessMany focus group participants and interviewees used the concept of “food deserts” to frame and describe the region’s geographic access issues. They emphasized the need to address geographic access to healthy, affordable food outlets in an integrated way.

The problem of geographic access was seen as the result of multiple, interconnected factors. One issue mentioned was ever-larger supermarkets pushing out smaller neighbourhood-based retailers, but others discussed a problem of inadequate transportation options for all residents. Many talked about the difficulty of relying on public transit to do grocery shopping.

In the absence of nearby grocery stores, residents in some areas have had to rely on convenience stores, few of which carry a wide range of fresh produce and/or other healthy staples.

When you talk about sociability, there are people that put their Meals on Wheels meal in the fridge and don’t even eat it because socially there’s nobody there to eat it with. - Community Food Program Volunteer

“ “…it’s carrying 6 bags of food home, if you’re getting on the bus, if you have a baby buggy, carrying the baby over the shoulder and the food goes in the baby buggy. They either have to walk across town, or they have to get all that food on a bus. So that does create a big issue for a lot of the folks. - Food Bank Volunteer

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“ “Food deserts are critical. That would be to me one of Chatham-Kent’s biggest issues. I think because it ties into the larger major concern we have right now with the unemployment and our low-income citizens. I think that is a huge issue. If you can’t get access to healthy food or food in general besides fast food, that has so many ripple effects in all of our departments. - Municipal Staff Focus Group

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Information/ EducationAlongside economic and geographic factors, such as household income and living or working close to food stores, people talked about the need for more supports for education related to nutrition, food shopping, preparation, and knowledge about the food system, in general. Interestingly, when people called for more education, the intended audience was almost always someone else, not themselves. Children were the most commonly cited target group for potential changes to education practices. Many identified schools as an important setting to integrate more nutrition and food skills education into the existing curriculum:

Some participants suggested lower income families needed more support to learn how to shop on a budget and prepare healthy meals. But the consultations also revealed the inappropriateness of viewing those in poverty as a homogenous group. Lack of money was the only common characteristic for low-income populations; low-income groups were identified as highly diverse. Some had strong cooking skills and good nutrition knowledge, while others reported having none of these skills.

We are becoming, or rather the generations below us, are becoming completely ignorant of food. If they can run out and grab it at a 7-11, fine. I’ll go get my nachos and instant cheese there…There has to be some sort of initiative, somewhere along the line, preferably in the school system, to wake everybody up. - Low Income Families Focus Group

“ “

I would eat healthier if I could afford it, but I can’t afford it so that’s how it is. - Low Income Families Focus Group

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Residents also want more information about local foods: who sells them, the time and location of farmers’ markets, and what qualifies as local. Older residents were more likely to express support for local producers, but many were unclear where and when local foods were available. Chatham-Kent local food marketing materials already exist and some suggested they be distributed more widely.

What are Your Suggestions for Addressing these Issues?Each focus group and interview included a request for solutions to the issues that were raised. Some ideas target a specific barrier, but many are multi-pronged solutions that cannot, and should not, be placed into a particular category. Below, not in any order of priority, is a list of the most commonly cited suggestions for action on theme of access:

• Advocate a living wage for all residents• Cooking classes for preparing healthy meals on a budget• Grocery store tours to show people how to buy healthy, affordable food• More farm tours, especially for school children, to build an awareness among consumers

about where their food comes from• More food education in schools starting at a young age• Better school nutrition programs• Help food banks be able to stock fresh, healthy food • Align existing bus routes with grocery store locations • Better promotion of existing “buy local” information

Food Production, Distribution and RetailFocus group sessions and interviews with people working in various Chatham-Kent food sectors highlighted some key challenges in connecting local production to local distribution,

I don’t know how to make a lot of stuff. I know how to make Kraft Dinner. And just simple stuff, like… I know how to put stuff in the oven. I know how to boil stuff… I’m a really bad cook, but I try so hard to cook. - Youth Focus Group

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and some worrying signs for the future. But producers, processors, and other food sector experts were also very clear in singing the praises of the region’s food system and unique assets:

The region possesses an enviable combination of arable soils, favorable climate, and reliable rainfall. Others noted the region’s strong knowledge base in terms of agricultural, processing, and other types of expertise. Rural communities, in particular, were seen as very supportive of local farms because, in the words of one producer, “people really do understand where the bread is buttered”. In spite of its advantages, many people commented on the challenges in getting more Chatham-Kent grown foods on local dinner tables. The region was seen to be lacking infrastructure and a coordinated strategy to make that happen. There are few processing facilities and no regional distribution hub. Without a hub to act as a consolidator for locally grown products, it’s much easier for producers to export their harvest to larger centers such as Toronto.

There were concerns about the future of agriculture in Chatham-Kent. The rising average age of farmers across Ontario is well documented and very few in the next generation want to pursue agriculture. Farmers also expressed a concern about increased foreign ownership:

Others were pessimistic about the support for local agriculture among the region’s current residents:

I think this is just the best place there is from an agricultural standpoint. Two, I think we’ve got the best options available to us of any municipality I’ve ever been in. Three, those options are never going to be accessed unless the municipality and the community as a whole starts with a base knowledge of what the hell they’ve got here. Quote me because it makes me mad; a number of people here don’t have a clue how good it is here and how much they have going for them. - Local Farmer

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“…companies from China wanted to buy our land to feed their people. They know what’s important. But that’s one of my fears. What if my kids can’t farm? I’m going to sell my farm to the highest bidder more than likely and it could be from China or Germany and they’re going to bring their food back there, and that’s not right, but there’s more and more of that. Nobody wants to take my place here, then what am I supposed to do? - Local Farmer

“ “

We have a lot of farmers in our family. And they’re not interested in marketing to the little guys. Most farmers are one or two or three people. That’s it…. Because for them, it’s time consuming and if there’s already one stop delivery, that’s better for them. - Restaurant Owner

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The consultations heard from many residents who expressed support for local food, but it’s unclear to what extent this support leads to actual purchases. Grocery store contacts suggested that price is still the overriding focus for consumers. The industry is looking at the full spectrum from field to fork to find ways to cut costs and keep prices low for consumers.

But many retailers who want to support local producers believe the system isn’t enabling that shift. Grocery store employees said they wanted more local food but acknowledged that big food retailers still prefer to centralize their distribution in larger cities such as Toronto. Convenience store owners and restaurateurs talked about the difficulty in ordering local foods from existing distributors. Many are unable to meet the minimum order amount and have no way of aggregating orders with other businesses.

A small number of people commented on food waste. The region has no organic waste composting program for households or business so it ends up in landfills. Processors and retailers saw opportunities to divert excess food to community food agencies, but legal liabilities often got in the way:

What are Your Suggestions for Addressing these Issues?To support Chatham-Kent food production, processing and retail, especially small businesses, the Let’s Talk Food consultation participants proposed several solutions, including:

• a Chatham-Kent food terminal;• more infrastructure for local processing;• alternative food distribution models to support local small business;

There is no future of farming in Chatham-Kent because people don’t want to pay for real good food, they don’t want to support it, …They don’t see the relevance of it here. They don’t see that we really have it good. - Local Farmer

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“ “Because we’re small, a lot of the services that deliver won’t deliver unless you order a large quantity, which overrides what I need…. That’s what I’m finding, that all the big companies are eating up the little companies. So all the independents are almost extinct. I have to drive all the way to Toronto to get products that I could have gotten delivered here. - Restaurant Owner

There’s a lot of things in the food industry where um, we might get and have too much produce that’s not top quality, but you don’t give that to a Food Bank because of the liabilities involved with giving them something that if they eat, it’s not any good. - Grocery Store Manager

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• more promotion and branding of local food; • supports for young farmers; and,• a municipal organic waste collection program.

A diverse range of people, not just producers or processors, suggested the creation of a food distribution hub. It was seen as critical to connecting local production to local demand. A central hub to aggregate Chatham-Kent grown foods would, ideally, connect to new distribution channels to serve local grocers, restaurant, and even convenience stores. Some cited examples from other regions, such as 100km Foods Inc. in Toronto that specializes in the sale and distribution of local, sustainable foods. Adding more food processing facilities in the region was also important. This wouldn’t just provide producers with more options; people talked about whole orchards that were lost when structural supports for value-added products, such as a local fruit processing plant, closed. Better marketing of Chatham-Kent products could build greater demand locally. Survey participants suggested the development of a clear and consistent brand because consumers may not always recognize the names of specific farms.

GovernanceConsultations also touched on the role of local government in supporting, or sometimes hindering, a healthier, more sustainable food system. Interestingly, those working in government tended to be the most vocal advocates of more enabling government policies and processes. Some specifically commented on the practical challenges for food system players to work effectively and efficiently with local government and regional policy.

Although few people called specifically for a coordinated food strategy, many expressed frustration about government’s disconnected approach to implementing initiatives:

The number of hoops that you make people jump through to make something happen. …we’re asking them to get paperwork from every food vendor that they want to participate [at an event]. … the paperwork and chasing them down and having them complete the forms… it’s just onerous and everyone gets testy. - Municipal Staff Focus Group

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Comments were directed at other levels of government too. Some judged the provincial government’s approach to improving school food environments (e.g. prohibiting the sale of many unhealthy foods and beverages) as too heavy handed, and lacking appropriate community engagement and funding. Some advocates of more food skills training in schools questioned how feasible it would be, believing that the Ministry of Education curriculum development process was too rigid.

But not all staff believed that promoting healthy food was practical, or even appropriate for their department’s mandate. For example, selling less healthy foods at events or City-owned was seen to be more profitable. In other cases, attempts to incorporate more nutritious items into children’s programs or events hadn’t been successful, so staff concluded that: “it’s not what the kids want”.

Feedback from municipal staff revealed a diversity of perspectives on Chatham-Kent’s role as a food system leader. More than anything, the discussions revealed that there is a lack of clarity among staff about the municipality’s food system vision and how different departments fit within it. What are Your Suggestions for Addressing these Issues?Participants from inside and outside government identified a number of action opportunities for improving food system governance, including more enabling roles for local government, such as:

• exploring the feasibility of planning rules to limit the density of fast food outlets; • aligning public transit bus routes with grocery store locations; and,• supporting entrepreneurs interested in local food processing and distribution serving

small business.

Sometimes I think what happens is we try to do too much as opposed to let’s do one thing really well and establish it and sustain it and then we move on. I don’t think we’re as successful in areas as we could be because we become so diluted. - Municipal Staff Focus Group

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It’s special, it’s a treat. Certainly for me personally when I go to an event, I want to eat the food that I don’t normally eat. Maybe I shouldn’t be eating. But that’s what’s there because it’s fun. ….we have a lot of, a myriad of free special events in Chatham-Kent—attendance is free. And the only thing you’re going to pay for is food. So it becomes a bit of an economic driver whether that’s from established restaurants who might have food trucks or the not for profits that setup the barbecues and so forth. - Municipal Staff Focus Group

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CHATHAM-KENT

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While no one specifically recommended a Chatham-Kent regional food strategy, one could argue that a strategy was an implicit suggestion based on the feedback as a whole. Many talked about overcoming government silos, leveraging collective resources and common goals more effectively, and experimenting with innovative ideas to address food system issues - all core components of any food strategy.

Current Policies, Programs and InitiativesA combination of local government staff, community agencies, and individuals are already spearheading initiatives to address some of the issues identified above. Much of the work to date has focused on emergency food assistance. Food banks, meal programs, and income support services are offered throughout the region by a number of community agencies, with support from local government departments. These efforts have led to coordinated networks such as Food Link Chatham-Kent that brings together Public Health, faith communities, farmers, community agencies, and individuals. Members collaborate on initiatives to promote universal access to “safe, nutritious, affordable and personally acceptable food”. The Food Link website provides an online monthly food resource calendar showing the times and locations for food assistance programs across the region.

More recently, the Public Health department spearheaded the launch of the Chatham-Kent Food Policy Council (May 2013). Food policy councils and other citizen roundtables have been in existence for over two decades in Canada, and jurisdictions have increasingly turned to the development of a council as a way to convene a group of citizens with more integrated food governance in mind. MacRae & Donahue,28 who conducted a broad survey of city-region food initiatives across Canada, noted that some of the most successful councils to date have been ones with dedicated local government or public health unit supports. The Chatham-Kent Food Policy Council has 29 members with diverse expertise and experiences related to food. The Council represents an important venue where broader food system issues and solutions can be identified and discussed. Members are collaborating on food access and availability initiatives such as:

• research into kitchen incubators to support food entrepreneurs;• a Farm to School Pilot Program to educate children about food and increase purchasing

and potentially consumption of local fruits and vegetables;

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• composting workshops;• advocacy to other levels of government on issues of poverty reduction, menu labeling

and more;• research into the region’s interest in a local food procurement policy to support Chatham-

Kent producers and processors; and• exploring the feasibility of a Community Food Centre for Chatham-Kent.

In the summer of 2013, Public Health distributed 1500 vouchers for $10 worth of fresh produce as part of the Aim for 8 Fruit and Vegetable Voucher Program to improve dietary habits. Farmers’ market cooking demonstrations and food skills sessions were conducted as well. A follow-up survey found that 81% of respondents agreed or strongly agreed that the voucher program helped them access fresh fruits and vegetables. More than one in five (22%) believed that they were eating more fresh produce as a direct result of the program.29

With the support of the Province’s Healthy Communities Fund, Public Health is researching opportunities for field gleaning to make use of local farmers’ surplus produce. Public Health Nurses and Registered Dietitians also support the Building Healthy Babies program that offers group classes on healthy pregnancy, nutrition and infant care. Public Health also tracks the price of a healthy diet annually through the Nutritious Food Basket survey and reports findings to the Board of Health.

In response to calls for stronger marketing of local businesses, a “Grown in CK” brand has been developed, in partnership with the Chatham-Kent Food Policy Council, the Chatham-Kent Public Health Unit, the Chatham-Kent Agri-Development Committee and Chatham-Kent Economic Development Services. Several businesses are using the logo now, and efforts are continuing to expand it. Other resources exist to link consumers to local producers through the Kent Federation of Agriculture’s website (buylocalbuyfreshchathamkent.com).

Many individuals and organizations in Chatham-Kent want to support and are invested in a vibrant, healthier, and more sustainable food system. Many have taken some action through donations to food assistance programs, supporting local farms, or nutrition education. But it’s clear that there is a long way to go to address any of the food system issues highlighted through the Let’s Talk Food consultations. Many more coordinated actions could be taken to scale up positive impacts for the whole region and population. Coordinated and collaborative action is also needed to ensure health equity. Too many initiatives continue to rely on very tight budgets and a small number of committed volunteers. All could benefit from an overarching regional food system strategy that maps out an effective path forward, optimizes local governance, and leverages Chatham-Kent’s existing assets.

Analysis: Toward a Chatham-Kent Regional Food StrategyThe community food system assessment has provided a significant amount of information to inform the “Sustainable Food Security Master Plan” approved by Council in 2011. Taking a socio-ecological perspective, the assessment revealed that the food system in Chatham-

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Kent is shaped by diverse, interconnected and sometimes, conflicting forces within the environment and among stakeholder groups.

The disconnects happen on many levels throughout the system. The food available to Chatham-Kent residents today, 12 months of the year, is among the safest, highest quality and least expensive anywhere in the world. But many residents can’t afford to eat well or face other barriers to accessing the food they need. Some communities are without nearby grocery stores. The region’s agricultural sector is among the best in the country, but farmers are aging and few in the next generation want to follow in their steps. Chatham-Kent residents aren’t able to take advantage of the bounty of locally grown fresh produce. The region ranks the lowest in fruit and vegetable consumption, and the prevalence of obesity and most chronic diseases is higher than the provincial average. Chatham-Kent farmers want to see more of their harvest reaching local dinner tables, but the system has little infrastructure or incentives to enable producers to get their products into local retail outlets and restaurants, and to enable eaters, restaurateurs, and retailers to access them.

People talked about food in many different ways, reflecting regional diversity and important individual, organizational, and sector priorities. Yet the most promising finding of the consultation was that there were also clear alignments. The Let’s Talk Food consultation feedback suggests a shared vision. People want a food system that allows everyone access to healthy, affordable food; a system that enables and supports people to apply their skills, knowledge, and capacity to purchase and prepare healthy meals; a system that breaks down barriers while leveraging key assets; and a system in which everyone who gets our food from farm to fork can do so profitably and sustainably.

The consultations also revealed a consensus that the necessary food connections to operationalize this common vision aren’t being made. Many people are taking action independently, making the best of the system, rather than the system supporting them to be able to do so in a coordinated way. Retailers want to divert their excess food to support those in need but face barriers, so the food goes to waste. Consumers say they want to support the region’s farmers but say it’s difficult to find local food in stores and often don’t understand why fruits and vegetables grown close to home often cost more. Some people expressed concern about the current lack of coordination or foresight within the region’s government to support, coordinate and grow positive food system innovations.

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These paradoxes are not unique to Chatham-Kent. As a nation, there is more than enough food (either home grown or imported) for every Canadian, yet too many families still report experiences of food insecurity and most households do not consume Health Canada’s recommended number of fruit and vegetable servings. In any sector these contrasts would be troubling. But when they apply to such a fundamental area as food—and health—it becomes clear why so many cities and regional governments have begun to take food systems issues more seriously.

Municipalities have limited formal authority over aspects of the food system, but they are faced with the consequences of the loss of nearby agricultural land, the local effects of pollution and climate change, farmers’ financial struggles, residents’ uneven access to food, food affordability, public health problems associated with inadequate or poor quality diets, and shrinking local food infrastructure.30

Cities and regions can lead and facilitate innovations to better align the food system’s health, social, and economic goals. Mah & Thang argue that local and regional authorities can have a substantial incremental and ‘bottom-up’ impact on population health, through direct community engagement, informal networks, nimble pilot projects, and advocacy to other levels of government.31 A 2013 inventory found that 64 local and regional municipalities across Canada are working to improve the food system through a mix of municipal policies, programs, platforms for coordination and collaboration, and civil-society interventions.32

Some cities and regions have developed coordinated plans described as a food strategy, food system plan, or other titles.33,34,35,36 These food strategies often see public health engaging in policy work to integrate health goals with agricultural production, economic development, and environmental sustainability, through food interventions. These initiatives generally include a vision statement and a set of short and long-term objectives. However, a food strategy is more than a report or set of recommendations. As Toronto’s 2010 Food Strategy report states: “It is the ongoing process of identifying, building and strengthening positive connections - between local government and residents, among City Divisions, within the community, and with the countryside”.37 In other words, the process of developing and implementing a coordinated food system plan or strategy is just as important as the formal objectives.

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It is clear that Chatham-Kent could benefit greatly from a coordinated food system approach that links diverse stakeholders under a common vision. The outcome could be labeled a food strategy, food system master plan, or something else. But the critical factor is that the result is a strategic, coordinated and effective approach for all food system stakeholders to work together to optimize health, economic, social, and environmental benefits for all of the region’s residents. Research from the U.S.,38,39 United Kingdom,40 and Australia41 have found that local governments and local health departments, although varied in structure, size, and mandate, have unique and important levers to support healthy eating and sustainable food systems. MacRae & Donahue42 note the leadership roles that public health has played in Canada and the U.S. by promoting, facilitating and/or coordinating:

• unique food distribution mechanisms (mobile markets, healthy corner stores, etc.)• initiatives to make food information more easily accessible in restaurants• safe food growing in urban environments (soil safety protocols)• regional urban-rural networks to bridge the divide between local producers and

consumers• food-related local economic development (food enterprise incubators, Toronto’s

Community Food Works program, etc.)• urban agriculture as a community building activity, and• updated zoning, licensing, procurement and other regulations to remove barriers to

positive food system initiatives.

The first step taken by many communities along that path is to develop a Food Charter, a detailed vision statement that can guide future policies and decision-making related to food. At least 30 municipalities or regions across Canada have created Food Charters through an inclusive process of engaging a wide range of voices. The collaborative process of developing a shared understanding can be just as useful by creating and deepening networks between city, community, private sector and institutional stakeholders and by spanning silos within government. The Let’s Talk Food consultations highlighted goals that could inform a Chatham-Kent Food Charter, such as support for local producers, ensuring adequate access to healthy, affordable food, expanding access to food skills and education, promoting creative linkages among food system players, and creating an enabling policy and regulatory environment.

Based on the experience of other jurisdictions in developing and implementing a food system strategy or plan, the following next steps are also proposed:

Data Collection, Analysis and Knowledge TransferData collection and analysis is a key part of any plan, and especially important when trying to influence a complex food system. Ongoing research will inform specific policies and proposals to stakeholders and external funders for specific initiatives. The community food system assessment already gathered a significant amount of research on areas such as household food insecurity, food production, economic indicators, and geographic density

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of food retail. More detailed information about the private sector’s role in production, processing, distribution, and retail is important for the public and community sectors’ understanding of how the broader system works. Often this type of information is proprietary and not easily accessible. Building relationships with private sector stakeholders, including industry associations, can help this knowledge sharing.

To ensure that all stakeholders are on a level playing field in terms of their ability to make informed decisions, Chatham-Kent should commit to an open data policy as part of its food strategy development. Notwithstanding privacy rules, all data and research should be publicly available and accessible in easy to understand formats. This not only contributes to an overall transparent process, it also enables greater innovation by those outside government, such as making it possible for developers to create smartphone apps to help consumers to find retailers selling local food.

Identify Local Government’s Food System Roles and ResponsibilitiesIn order for governments to play an enabling role, there must first be an assessment of the full range of ways in which policies, programs, and funding already connect to food. While some roles and responsibilities will seem obvious (public health’s role in nutrition promotion and food safety), many others will require critical analysis and creative thinking to unearth indirect effects and unintended consequences on food and health. These levers are just as significant as the more straightforward mandates and often produce effects in a punitive way for different stakeholders. This reflects the reality that policy is often developed within silos to achieve specific policy aims, whereas an area like food crosses departmental or disciplinary boundaries. In other cases, the full effect of historical decisions don’t become evident until much later. For example, many cities have outdated licensing regulations that were adopted for good reason, but today, prohibit innovative food retail models such as mobile produce markets. In the City of Toronto, the municipal Sign Bylaw still does not permit food stores (or any commercial enterprises) to have an outside sign if in a “Residential Apartment”-zoned apartment building. This type of information and analysis is critical to support coordinated efforts and to educate City staff who, charged with their own focused tasks, are often unaware of which part of the bureaucracy is responsible for particular food issues.

Create Collaborative InfrastructureCollaborative infrastructure refers to processes and space that allow diverse stakeholders to come together on a regular basis to assess needs and identify priorities based on the best available evidence as well as residents’ lived experiences. Without this, food issues naturally tend to drift back into their silos (health authorities focus on nutrition, agriculture focuses on production, etc.). Similar to many other cities and regions across North America, Chatham-Kent has already created such a space in 2013 with the region’s Food Policy Council. These councils can support governments with advice on food system matters, be a venue for community consultation, increase awareness of food policy issues and be a place to connect diverse actors and catalyze innovative initiatives.

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Assign Staff Coordination Resources MacRae & Donahue43 note that many city/regional food strategies have struggled in their implementation phase, usually because of a combination of inadequate staff time or capacity, lack of funding to develop and implement initiatives, as well as weak structural linkages to the places and leaders where decisions are made. While a Non-Governmental Organization (NGO) or community agency could act as lead, most do not have the capacity or resources to work effectively with complex bureaucratic structures. Integrated leadership within government makes it easier to bridge the bureaucratic silos, an essential component of any coordinated long-term food system strategy. Public Health staff in the Region of Waterloo coordinate a regional Food System Roundtable that links local farmers, emergency food providers, food processing, distribution and retail, business and health professionals, government staff and more. Toronto Public Health has hosted a similar Food Policy Council model since 1990, the oldest in Canada, and more recently set up a Food Strategy unit to catalyze further action across City departments and with civil society. Local government or public health staff leads generally require a range of skills and knowledge, including food policy expertise, the ability to think strategically, identify opportunities to leverage existing funding, implement initiatives with diverse stakeholders, and leverage the expertise of community partners. As noted above, public health authorities across Canada and the U.S. already have a track record of food policy leadership. That experience, along with the fact that only 25% of the funding for local public health units in Ontario comes from municipalities, makes public health a natural home for a region’s food strategy coordination.

Link with Food Networks Locally and GloballyJurisdictions across Ontario and around the world are experimenting with different solutions to common problems such as hunger, unhealthy eating, chronic disease, the viability of local farming operations, and climate change adaptation. Connecting to existing networks locally and globally to share knowledge and insights will give Chatham-Kent a higher chance of success. Many staff will already be linked to organizations such as Food Secure Canada and Sustain Ontario, but building greater links at the political and senior management level will be important as well.

Take ActionUltimately, a food system strategy or plan is about making meaningful changes in people’s lives. While careful planning is important, it is important to also take advantage of the unique

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momentum that food initiatives bring. It is an issue that all stakeholders can relate to, either personally or professionally. Other cities’ experiences reveal that starting early with even small multi-sectoral pilot projects can help build buy-in to support future innovations. The strengthening of working relationships among government, community, and private sector partners is as important an objective as the specific activities laid out in a food strategy. Cels, et al. emphasize that innovation is as much about designing and managing a process as it is about developing and implementing an idea.44 Chatham-Kent Public Health’s very process of coordinating a community food system assessment is one example. Research such as this will build greater awareness and understanding of food-related issues, develop partnerships, and increase community participation in shaping the food system.45

Key LimitationsThe following is a discussion of the key learning related to the limitations of this report.

TimelinesThe Let’s Talk Food project was funded through the Healthy Communities grant provided by the Ministry of Health and Long-Term Care. The funding request had a very quick deadline for which we had to submit our application. This meant that Chatham-Kent Public Health had one month to develop the research process, write the Request for Application (RFA) for consultants to conduct the research, and subsequently select the successful consultants to carry out the project. It was important through this research process that the needs of the Chatham-Kent community were clearly understood, so consultants who specialized in community- based research were chosen. It was crucial to get participation from the agricultural community prior to the beginning of their busy farming season in June. This meant a small window of opportunity to complete the research, resulting in less time to prepare the research design and test protocols. The intention for the project was to have the data analyzed over the summer and results to be ready for September. In the end, the data analysis took longer than expected due both to the volume of data collected and the need to re-analyze data, forcing the timelines to extend well beyond what was originally intended.

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Use of an Outside Research GroupOne of the main challenges for this project was working with consultants who did not fully understand the challenges, opportunities, culture, and structure of the local food system in Chatham-Kent. It is very important that consultants be familiar with the community or, if that is not possible, to defer decisions around participants and culture to the community members. While the consultants assisted with training of the facilitators for the focus groups, they did not participate in any of the data collection. This may have hindered their ability to interpret and understand what was happening or being said because they lacked the context or background of the information being shared.

In the end, the data had to be reanalyzed by local staff and an additional consultant with a stronger understanding of the work done around food systems research. Over the last two years, the number of consultants with this understanding has increased.

Recruitment of participantsDue to the short timelines, there were challenges recruiting participants for some of the focus groups, even with the support of community partners. Unfortunately, this resulted in three of the focus groups being cancelled. In some cases however, other groups were added in the place of the cancelled ones. For example – although the low income focus group in one community was cancelled, a focus group with the local Canadian Prenatal Nutrition Program (CPNP) was added, along with another focus group in one of the outlying communities.

Internal Capacity for ResearchChatham-Kent Public Health and the community had never engaged in a participatory research project before. None of the staff at the health unit, with the exception of the Chronic Disease and Injury Prevention (CDIP) manager at the time, had ever done this type of research or was comfortable working with and analyzing qualitative data. The CDIP manager acted with the epidemiologist to oversee the project, and staff provided support for the ongoing activities of the project.

The community had limited experience with conducting research, or more specifically, focus groups. In order to do the project, training was required for all those involved (both for health unit staff and community partners) in conducting, facilitating, and observing focus groups.

The Health Unit had limited tools available to analyze qualitative data. In order to analyze the data, qualitative software, NVivio, was purchased and staff was trained to use the program. Although this increased internal capacity to analyze qualitative data sets, it also required time, pushing back timelines further.

FisheriesFisheries were identified as one area that is key to understanding the food system in Chatham-Kent. Many attempts were made to connect with local fishery organizations and local fishermen to have discussions around the needs of the fishery system. Unfortunately, the groups were unable to participate in the research.

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Although this is recognized as a gap in the research, fisheries remain an important component of the local food system in Chatham-Kent and partnership will continue to be explored with this group.

Successes and Key LearningsEnhanced partnerships in communityWhile this community is known for its ability to partner and work towards a common goal, the enormity of the project and number of community organizations that worked together to accomplish this research helped to strengthen partnerships further. This was very positive as it has allowed Chatham-Kent Public Health to consider new programs and initiatives and create new opportunities to collaborate with partners.

Strong community buy-inFood is a topic that excites passion for many people and that was evident in the research process. People were very vocal about their views, values, beliefs, and wants for the community around food. The participation in the survey and the large number of focus groups strongly demonstrated that the community wanted to be included in the discussion and work together to shape the local food system.

Capturing the Voice of rural communities and high risk populationsThrough the research, the voice of small rural communities and high risk populations in our community was captured. It was very important to ensure that as many population groups, sectors, and partners were included in the assessment as possible. Often times the rural communities are required to travel to the larger centres to participate in everything from programs to community meetings, but the assessment was designed to ensure that each of the outlying communities had a focus group held in a library close to home. Transportation, child care, and a meal were offered at each focus group. Barriers to participation were considered for the survey as well. Barrier-free opportunities to be included in the process, including having surveys available both online and in paper copy at all municipal libraries,helped to ensure that those who wanted to participate in the discussion were able to.

Increase in community research capacityGenerally, the amount of research that the health unit had the capacity to participate in and assist with was limited. Health Unit staff and community partners underwent extensive focus group training, resulting in a significant increase in the ability of the community to assist with or conduct research. Through this training, not only has a larger resource pool for conducting this type of research been created, but community partners who were trained are able to bring back those skills to use in their own organizations.

As an added benefit, the health unit has had additional opportunities and requests to consult on various research initiatives by community partners as we are being seen as an expert in research for our community.

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ConclusionChatham-Kent Public Health’s community food assessment documented the need for food system improvements and highlighted contradicting trends common to many regions. Strong local agricultural production exists alongside household food insecurity and low levels of healthy eating. Diet and health-related information is more accessible than ever, but many residents reported insufficient food preparation skills or knowledge of healthy eating. Given the interconnectedness of food system issues, effective solutions can only be identified and implemented through a broad, multi-sectoral systems approach. A Chatham-Kent food system strategy (or plan) could provide multiple benefits, over and above specific policy or program outcomes. Addressing complex food system issues also requires governments to evolve out of their traditional bureaucratic silos. In an era of diminishing public sector resources, the ability to work more effectively interdepartmentally or with outside stakeholders, and to leverage existing resources to accomplish more with less, are all important shifts that a food system strategy can help incubate. This approach also fits with the Municipality of Chatham-Kent’s corporate mission to be “a proud, proactive, progressive team committed to innovation and leadership”.

Chatham-Kent is in a strong position to move forward. The Public Health department’s Let’s Talk Food consultations assessed community needs and identified gaps. A significant amount of research on key food system issues has been done already. The Chatham-Kent Food Policy Council provides a venue to build connections across the food system, identify key priorities, and catalyze new initiatives.

For local government to become a leader in enabling healthy, sustainable food systems, it will require a commitment to see food issues as core to its mandate and a willingness to create sufficient time and space for staff to explore creative multi-sectoral solutions.

In light of the information presented in this report, a series of actions are provided below as suggested next steps for the Municipality of Chatham-Kent.

Strategic Next Steps O Assign staff resources to explore the development of a Chatham-Kent Food Strategy, including a proposed governance model and process for implementation.

O Conduct research on the region’s food flows to understand the movement of food in and out of the area, distribution channels, and opportunities to support better access to healthy, affordable food in underserved areas.

O Select key regional food system indicators and work with surveillance and other social and economic monitoring stakeholders to ensure that high-quality longitudinal information will be available for monitoring future progress.

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O Develop a centralized data collection system related to key food system issues (e.g. food production, location of food retail outlets and emergency food providers, food consumption data, etc.) and make it easily accessible by Municipal staff and the public.

O Identify all of the direct and indirect food policy roles and responsibilities within the Municipality of Chatham-Kent departments and associated agencies and boards.

O Use annual work planning processes to identify opportunities to integrate food portfolios within government.

O Create an inventory of local government-owned land and facilities; identify opportunities for markets, gardens, etc.; and make information on accessing land and facilities easily accessible to the public.

O Research barriers that hinder Chatham-Kent grocery stores, small food retail outlets and restaurants from accessing locally grown foods.

O Review alternative food distribution models (e.g. mobile produce markets, “healthier convenience stores”, aggregated food procurement for community agencies, community kitchens, community freezers).

O Explore ways to build capacity among Municipal staff and the community sector to understand government roles and responsibilities related to food. For example:

• make information on Municipal regulations related to starting a food business, organizing a community garden, using public land for food growing, and more, easily accessible on the Municipality’s website, and

• develop food policy workshops for Municipal staff or link with other cities doing the same.

O Develop an inventory of settings in which a healthier and more sustainable food system could be operationalized. For example, retailers, schools, workplaces, recreation centres.

O Combine existing food skills training and nutrition education with exploring behavioural insight strategies (“nudges”) that could be effective in increasing the consumption of healthier foods, especially fresh fruits and vegetables. Assess opportunities to partner with settings to prototype and evaluate these strategies.

O Continue to expand the “Grown in CK” branding program .

O Advocate to the provincial and federal governments for improvements to income security programs to ensure all residents have the baseline economic resources to afford a healthy diet.

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References1 British Columbia Provincial Health Services Authority (2008). Community Food Assessment Guide.

Available from http://www.phsa.ca/Documents/communityfoodassessmentguide.pdf2 Statistics Canada, Canadian Community Health Survey (CCHS). CANSIM table 105-0502 is an update of

CANSIM table 105-0400.3 Institute for Clinical Evaluative Sciences & Public Health Ontario (2012). Seven More Years: The impact of

smoking, alcohol, diet, physical activity and stress on health and life expectancy in Ontario. Available from http://www.publichealthontario.ca/en/BrowseByTopic/HealthPromotion/Pages/Seven-more-years.aspx.

4 Vital Statistics, Data Years 2003-2011 (extracted September 25, 2014), Ontario Ministry of Health and Long-Term Care, IntelliHEALTH ONTARIO. Available from http://www.publichealthontario.ca/en/DataAndAnalytics/Snapshots.

5 Zettler, L. & Maaten, S. (2011). Chatham-Kent 2010 Health Status Report. Chatham-Kent Public Health Unit: Chatham, Ontario.

6 Healthy Kids Panel. (2013). No Time to Wait: The Healthy Kids Strategy. Available from: http://www.health.gov.on.ca/en/public/programs/obesity

7 Ibid.8 Public Health Agency of Canada (2010). Curbing Childhood Obesity: A Federal, Provincial and Territorial

Framework for Action to Promote Healthy Weights. 9 World Health Organization. (2012). Population-based approaches to childhood obesity prevention.

Geneva, Switzerland, http://apps.who.int/iris/bitstream/10665/80149/1/9789241504782_eng.pdf.10 Swinburn, B., Sacks, G. & Ravussin, E. (2009). Increased food energy supply is more than sufficient to

explain the US epidemic of obesity. Am J Clin Nutr. 2009;90(6):1453–6.11 Swinburn, B., Sacks, G., Hall, K.D., et al. (2011). The Global Obesity Pandemic: Shaped by global drivers

and local environments. Lancet. 2011;378(9793):804–14.12 Public Health Ontario. Snapshots: Chatham-Kent Public Health: Nutrition & Healthy Weights and Physical

Activity, Age-standardized rates, 2003- 2011/12. Toronto, ON: Ontario Agency for Health Protection and Promotion.

13 Ibid.14 Assessing the Impact of Food Environments on Healthy Eating, Obesity & Health in Chatham-Kent Dr.

Jason Gilliland & Richard Sadler of the Human Environments Analysis Laboratory (HEAL), UWO March 19th, 2012.

15 Municipality of Chatham-Kent (2012). Chatham-Kent Food Skills Survey Results. Report to the Board of Health. June 5, 2012.

16 Municipality of Chatham-Kent (2013). Chatham-Kent and Agriculture: Did you know? Available from http://www.lkaitc.org/resources?download=1:chatham-kent-agriculture-statistics-2013.

17 Municipality of Chatham-Kent (2015). Agricultural Profile. Available from http://www.chatham-kent.ca/Newcomers/Entrepreneurship/Pages/agriculturalprofile.aspx.

18 “Did you know?” Chatham-Kent Agriculture Development, We Grow For the World. Available from http://wegrowfortheworld.com/did-you-know/.

19 RE/MAX (2014). Farm Report 2014. Available from http://download.remax.ca/PR/FarmReport/FinalReport.pdf.

20 Story, M., Kaphingst, K.M., Robinson-O’Brien, R. & Glanz, K. (2008). Creating healthy food and eating environments: Policy and environmental approaches. Annual Review of Public Health 29(1): 253–272.

21 Gilliland, J. & Sadler, R. (2011). Mapping Environmental Barriers and Enablers for Healthy Living in Chatham-Kent. Prepared for Chatham-Kent Public Health. Human Environments Analysis Laboratory (HEAL), UWO. Presentation November 30th, 2011.

22 Gilliland, J. & Sadler, R. (2011). Mapping Environmental Barriers and Enablers for Healthy Living in Chatham-Kent. Prepared for Chatham-Kent Public Health. Human Environments Analysis Laboratory (HEAL), UWO. Presentation November 30th, 2011.

23 Ibid.24 Wrigley, N., Warm, D. & Margetts, B. (2003). “Deprivation, Diet, and Food-Retail Access: Findings From

the Leeds ‘Food Deserts’ Study,” Environment and Planning. A 35: 151-188.

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25 Gittelsohn, J., Rowa, M. & Gadhoke, P. (2012). Interventions in small food stores to change the food environment, improve diet, and reduce risk of chronic disease. Preventing Chronic Disease. 2012; 9:110015.

26 Let’s Talk Food: Overview and background (2013). Presentation by Nicole Dupuis and Lyndsay Davidson, Chatham-Kent Public Health Unit.

27 Statistics Canada. 2014. Average household food expenditure, by province (Canada). Available at: http://www.statcan.gc.ca/tables-tableaux/sum-som/l01/cst01/famil132a-eng.htm, last accessed Sep 23, 2014.

28 MacRae, R. & Donahue, K. (2013). Municipal Food Policy Entrepreneurs: A preliminary analysis of how Canadian cities and regional districts are involved in food system change. A report for the Toronto Food Policy Council, Vancouver Food Policy Council and the Canadian Agri-Food Policy Institute.

29 Chatham-Kent Public Health Unit (2014). Aim for 8 Fruit and Vegetable Voucher Program 2013: Program evaluation summary report.

30 MacRae, R. & Donahue, K. Op. cit.31 Mah, CL & Thang, H. (2013). Cultivating Food Connections: The Toronto Food Strategy and municipal

deliberation on food. International Planning Studies. Vol. 18, no. 1: 96-110.32 MacRae, R. & Donahue, K. Op. cit.33 City of London (2006). Healthy and Sustainable Food for London: The Mayor’s food strategy summary. 34 City of Vancouver (2013). What Feeds Us: Vancouver food strategy. 35 Healthy Food Chicago (2012). A Recipe for healthy places: Addressing the intersection of food and obesity

in Chicago.36 City of Toronto (2010). Cultivating Food Connections: Toward a healthy and sustainable food system for

Toronto. Report to the Toronto Board of Health.37 Ibid.38 U.S. Institutes of Medicine (2009). Local Government Actions to Prevent Childhood Obesity. The National

Academies of Science.39 Pomeranz, J.L. (2011). The unique authority of state and local health departments to address obesity.

American Journal of Public Health. 101(7):1192-7.40 Mitchell, C., Cowburn, G. & Foster C. (2011). Assessing the options for local government to use legal

approaches to combat obesity in the UK: putting theory into practice. Obes Rev. 2011 Aug;12(8):660-7.41 Allender, S., Gleeson, E., Crammond, B., Sacks, G., Lawrence, M., Peeters, A., Loff, B. & Swinburn, B.

(2012). Policy change to create supportive environments for physical activity and healthy eating: which options are the most realistic for local government? Health Promot Int. 2012 Jun;27(2):261-74.

42 MacRae, R. & Donahue, K. Op. cit.43 MacRae, R. & Donahue, K. Op. cit.44 Cels, S., de Jong, J. & Nauta, F. (2012). Agents of Change: Strategy and tactics for social innovation.

Washington, D.C.: Brookings Institution Press.45 Ross, S. & Simces, Z. (2008). Community Food Assessment Guide. Report for the British Columbia Provincial

Health Services Authority.

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HEALTHY COMMUNITIES PARTNERSHIPChatham-Kent