HealthScaping NorthWest

Creating healthy, vibrant communities

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Parents and Childcare: Working Together to Help Kids Eat Healthy

Written by Kylie Menagh-Johnson, MPH for Parenting in Portland


“Can I give her some Fruit Loops?”

I shook my head in disbelief and told the childcare provider, “No… she’s only nine months old.”

It was my daughter’s first day in childcare. I couldn’t believe the teacher was offering sugary, processed cereal to my baby girl. I couldn’t believe they would offer that to any child, of any age.

Despite paying a premium price for downtown childcare, I realized I couldn’t count on the quality of the food they served. For the next six months, I stayed up late, chopping finger foods to send with my daughter the next day. It was exhausting. After transferring her to a marginally better center, I gave up on the late-night food preparation and settled for “good enough.”

We constantly hear that parents should take responsibility and instill good eating habits in their children. Many of us do our best. Yet sometimes, it feels like an uphill battle if the schools and programs in which we entrust our children don’t reinforce healthy habits.


Many childcare providers could be doing better to support our children’s health, according to a Multnomah County survey by the Oregon Public Health Institute and partners (2011). Areas of particular concern were:


  • Access to water
  • Enough time to play and be active
  • Too many sugar-sweetened beverages
  • Too much screen time (television, video games)
  • Letting children decide when they are full


Parents, childcare providers, and health advocates are working together to promote better nutrition in childcare centers and in-home providers across Oregon.


But First, What Are the Rules?


 Licensed childcare providers in Oregon are required to follow the U.S. Department of Agriculture (USDA) rules for the Child & Adult Care Food Program (CACFP).


Child and health advocates have asked the USDA to update the rules to:


  • include more whole grains, beans, and orange and green fruits and vegetables,
  • eliminate sugar sweetened beverages,
  • decrease trans fats, solid fats, added sugars, and sodium, and
  • offer fat-free and low-fat milk (instead of whole milk).


If these efforts are successful, we should see a wider variety of whole foods, fruits, and vegetables being offered to our children. Health and education experts across the state have come together to support childcare centers in making this shift.


Oregon Initiatives to Promote Nutrition in Childcare


 Many local organizations work with childcare providers to improve nutrition. The Oregon Department of Education (ODE) won funding from the USDA to promote a holistic approach to health among childcare providers. ODE provides small grants to 35 “Childcare Wellness Champions” and helps them improve across five key areas:


  1. Increase the amount and variety of fruit and vegetables
  2. Increase healthy beverages
  3. Increase accommodations for breastfeeding
  4. Eliminate screen time (television, videos, computer games)
  5. Increase physical activity


ODE provides an online Child Care Wellness Warehouse that is chock-full of curriculum ideas for eating local fruits and vegetables, gardening, cooking classes, and more.


The Harvest for Healthy Kids Program is another inspiring effort to help preschool kids eat healthy. The program introduces new fruits and vegetables to young children through picture books, gardening, local produce, games, and family-style meals that provide role modeling. It’s a collaboration between Mount Hood Community College Head Start and Portland State University. Ecotrust has launched the Oregon Farm-to-Preschool Coalition to spread similar programs.


The Right from the Start Coalition, formed last October to promote nutrition in childcare. Amanda Peden, Master of Public Health, of theOregon Public Health Institute believes it “has the potential to make a really strong impact in childcare.”


With a focus on improving accommodations for breastfeeding at childcare, the Right from the Start Coalition also works on nutrition, physical activity, and screen time.


“We know it’s important to support health in the early years, so that children have the best start in life and are set on a path for a healthy, successful life,” says Peden. “Nutrition also includes healthy first foods for baby—think about how your childcare provider supports you when you are going back to work and continuing to breastfeed.”


“Healthy and Local” is a Growing Trend


“Many programs are offering more local and organic options – especially dairy and produce. We offer organic milk, and our produce vendor offers an ‘Organic Pick of the Week’ which varies in price. Although this option is more expensive, more centers are seeing the value in offering this option because of the demand from families,” observes Jillian Hoy ofCreative Minds Learning Center (CMLC).


CMLC’s program includes gardening, cooking classes, and a vegetarian menu. Gardening and cooking classes help the kids get more excited about trying new foods because they are more involved in the process from start to finish.


“Most parents are excited that it’s fresh and we’re not messing around with processed meats and frozen fish sticks,” says Hoy. “CMLC prides itself on offering freshly made meals and snacks, with no processed foods that tend to be full of sodium, refined sugars, and empty calories. The vegetarian menu saves on the cost of using fresh and grain-fed meats, which are just too expensive, and reduces the chances of cross-contamination and food-borne illness.”


They incorporate beans and cheese into the menu for protein, and train the teachers on how to patiently introduce new foods to young children.


What Parents Can Do


If your childcare center is already doing a great job, let them know you appreciate the extra effort and care they are taking. Gratitude goes a long way toward encouraging them to keep up the good work!


If you are unsure, some questions to ask your existing or potential childcare provider include:


  1. Is the food fresh, homemade, or frozen/prepackaged?
  2. Do you offer both fruits and vegetables at every meal?
  3. Do you offer vegetarian entrees?
  4. Do you serve whole grains at least half the time you serve grains?
  5. How do you accommodate allergies and special diets?
  6. What do your teachers do when a child says they are full or still hungry?
  7. Are meals served family-style?
  8. Is there a quiet, designated space for breastfeeding?
  9. Do you have written guidelines for storage and handling of breastmilk?
  10. How do you incorporate nutrition education into your curriculum (stories, gardening, cooking classes, etc.)?


The National Resource Center for Health and Safety in Child Care and Early Education also offers a full checklist for parents.


As parents and care providers work more closely together to offer healthy foods to our children, Peden offers some final wisdom: “Young children often must be offered a new food ten times before they’ll eat it. Just keep trying! They’ll eventually eat them. These are the habits that they’re learning for a lifetime.”




HealthScaping: Creating Vibrant, Healthy Communities

Is your neighborhood more likely to have fast food joints or farm stands? Can your children walk or bike to school along a system of safe, connected sidewalks? Does your workplace keep you safe from secondhand smoke and other environmental pollutants? None of these things are accidental. They are all a result of public and private policies and laws, funding decisions, and community action. In their book, Prescription for a Healthy Nation: A New Approach to Improving Our Lives by Fixing Our Everyday World,Deborah Cohen and Tom Farley describe several factors that shape our “healthscape.”

Our community shapes our choices, but we can help shape our community.

For example, if we live in a walkable neighborhood with sidewalks, well-lit streets, and destinations (e.g., shops, libraries, parks), we are more likely to take walks and get exercise. We are more likely to meet neighbors and feel a sense of belonging.

STOP Smoking

But “walkability” doesn’t happen by accident. It is shaped by public policy, urban planning, neighborhood redevelopment funding and zoning decisions… and the concerted action of citizens to influence these things.

In fact, public health and urban planning share common roots; both disciplines began as cities became crowded, ghettoes formed, infectious diseases spread, and it became necessary to intervene by improving sanitation and housing conditions. One of the seminal events in public health was when Dr. John Snow mapped the London cholera epidemic to the Broad Street water pump in 1854. The reduction of infectious diseases, largely through advances in sanitation, clean water and food, as well as vaccination, has been hailed as one of the ten great public health achievements of the 20th century.

Shifting the Curve

Cohen and Farley propose “shifting the curve” so that we are all healthier. Shifting the curve means using strategies that improve health for everybody–not just targeting a few. Similarly, Thomas Frieden’s “A Framework for Public Health Action: The Health Impact Pyramid” points out that targeted interventions, such as individual or small-group health counseling, are often too resource-intensive to be successful at improving the whole society’s health. It takes a population approach to make the biggest difference. 

Frieden’s Health Impact Pyramid

Community-level strategies that change the overall HealthScape are most effective, reach the greatest number of people, and produce the best results.

Frieden calls this “changing the context.” Cohen and Farley call this “curve shifting.” I call this HealthScaping.

HealthScaping–creating healthy community conditions–will have a stronger impact than just targeting interventions to the highest risk individuals

“HealthScaping” is a new term for an old practice: Health Promotion.

Health promotion focuses on preventive strategies that create the conditions in which people can be healthy. Our health is inextricably linked to the community in which we live. As expressed in the Ottawa Charter for Health Promotion (1986), “Health is created and lived by people within the settings of their everyday life; where they learn, work, play and love.”

Good health is not merely the result of good medical care but the result of what we do as a society to create conditions in which people can be healthy. Public policy can be one of the most effective approaches to protecting and improving the health of the population. “Healthy” public policy is particularly important in a time of scarce resources, because it can diminish or preclude the need for other, more costly and potentially less effective interventions. For the Public’s Health: Revitalizing Law and Policy to Meet New Challenges, Institute of  Medicine

HealthScaping to Reduce Chronic Diseases

HealthScaping is all about changing the context, making healthy options the “default choice,” as Frieden says.

Just as iodized salt has virtually eliminated goiter and cretinism, and water fluoridation has reduced tooth decay by 40-70 percent, we can HealthScape our neighborhoods, schools, and workplaces to reduce obesity, diabetes, heart disease, and cancer. We can improve quality of life, extend length of life, and reduce healthcare costs.

Tobacco use, poor nutrition, and lack of physical activity are the single greatest factors underlying the biggest killers: heart disease, cancer, and lung disease. 

Cohen and Farley list several aspects of our environment, our context, our HealthScape, that can be changed:

1. Design neighborhoods to increase safety and promote physical activity

2. Make healthy foods, especially fruits and vegetables, easier to get

3. Make unhealthy items, like junk food and tobacco products, harder to get

4. Make healthy behavior more socially acceptable (smoke-free workplaces, physical activity breaks at work)

5. Harness the power of popular media, advertising, and movies

For example, we can reduce obesity, diabetes and heart disease by making healthier food available in workplace and school cafeterias and vending machines. We can reduce youth tobacco use by licensing tobacco retailers, getting rid of menthol and other flavored “starter” tobacco products, and by making more public places tobacco-free. We can promote breastfeeding, which reduces obesity, infectious diseases, and improves school success by providing paid family leave.

Future posts will cover all these HealthScaping ideas, and more!

In the meantime, what ideas do you have to create a healthier community where you live, work, study, or play?