Emma Tsui

Evidence, Power, and Policy Change in Community-Based Participatory Research

Meaningful improvements in health require modifying the social determinants of health. As policies are often underlying causes of the living conditions that shape health, policy change becomes a health goal. This focus on policy has led to increasing interest in expanding the focus of community-based participatory research (CBPR) to change not only communities but also policies. To best realize this potential, the relationship between evidence and power in policy change must be more fully explored. Effective action to promote policies that improve population health requires a deeper understanding of the roles of scientific evidence and political power in bringing about policy change; the appropriate scales for policy change, from community to global; and the participatory processes that best acknowledge the interplay between power and evidence.

Can a Food Justice Movement Improve Nutrition and Health? A Case Study of the Emerging Food Movement in New York City

In response to increasing obesity, diabetes, and food-related contributions to climate change, many individuals and organizations are mobilizing to advocate for healthier and more just local and national food policies and systems. In this report, we describe and analyze the food movement in New York City, examine tensions within it, and consider its potential role in improving health and nutrition. We conclude by suggesting that public health professionals can amplify the health effects of such movements by creating opportunities for dialog with movement participants, providing resources such as policy-relevant scientific evidence, documenting problems and evaluating policies, and offering technical, political, and organizational development expertise.

Missed Opportunities for Improving Nutrition Through Institutional Food: The Case for Food Worker Training

The institutional food sector-including food served in schools, child care settings, hospitals, and senior centers-is a largely untapped resource for public health that may help to arrest increasing rates of obesity and diet-related health problems. To make this case, we estimated the reach of a diverse institutional food sector in 1 large municipality, New York City, in 2012, and explored the potential for improving institutional food by building the skills and nutritional knowledge of foodservice workers through training. Drawing on the research literature and preliminary data collected in New York City, we discuss the dynamics of nutritional decision-making in these settings. Finally, we identify opportunities and challenges associated with training the institutional food workforce to enhance nutrition and health.

Engaging youth in food activism in New York City: lessons learned from a youth organization, health department, and university partnership.

Research indicates that insufficient emphasis on community collaboration and partnership can thwart innovative community-driven work on the social determinants of health by local health departments. Appreciating the importance of enhancing community participation, the New York City Department of Health and Mental Hygiene (DOHMH) helped lead the development of the Health Equity Project (HEP), an intervention aimed at increasing the capacity of urban youth to identify and take action to reduce food-related health disparities. DOHMH partnered with the City University of New York School of Public Health and several local youth organizations to design and implement the intervention. HEP was conducted with 373 young people in 17 cohorts at 14 unique sites: six in Brooklyn, six in the Bronx, and two in Harlem. Partnered youth organizations hosted three stages of work: interactive workshops on neighborhood health disparities, food environments, and health outcomes; food-focused research projects conducted by youth; and small-scale action projects designed to change local food environments. Through these activities, HEP appears to have been successful in introducing youth to the social, economic, and political factors that shape food environments and to the influence of food on health outcomes. The intervention was also somewhat successful in providing youth with community-based participatory research skills and engaging them in documenting and then acting to change their neighborhood food environments. In the short term, we are unable to assess how successful HEP has been in building young leaders who will continue to engage in this kind of activism, but we suspect that more extended interactions would be needed to achieve this more ambitious goal. Experiences at these sites suggest that youth organizations with a demonstrated capacity to engage youth in community service or activism and a commitment to improving food or other health-promoting community resources make the most suitable and successful partners for this kind of effort.

Intimate partner violence risk among undergraduate women from an urban commuter college: the role of navigating off- and on-campus social environments

The current attention that is being paid to college sexual assault in policy circles and popular media overlooks a critical issue: the possible role played by the urban social environment in intimate partner violence (IPV) risk for the large number of urban commuter college students throughout the USA and beyond. This article helps to illuminate this dynamic using qualitative research collected at an urban commuter campus in New York City. Specifically, we conducted focus groups and in-depth interviews with 18 female undergraduate students, exploring the nature and consequences of IPV in students’ lives, perceived prevalence of IPV, and resources for addressing IPV. Our results indicate that college attendance may both elevate and protect against IPV risk for students moving between urban off- and on-campus social environments. Based on this, we present a preliminary model of IPV risk for undergraduate women attending urban commuter colleges. In particular, we find that enrolling in college can sometimes elevate risk of IPV when a partner seeks to limit and control their student partner’s experience of college and/or is threatened by what may be achieved by the partner through attending college. These findings suggest a role for urban commuter colleges in helping to mitigate IPV risk through policy formulation and comprehensive ongoing screening and prevention activities.

Training New Community Health, Food Service, And Environmental Protection Workers Could Boost Health, Jobs, And Growth

General job training programs, and separate disease prevention or health promotion programs, are usually viewed as two different strategies for reducing poverty and promoting community development. We propose that with better alignment of the strategies, new jobs with the potential to simultaneously improve population health, lower the cost of health care, and reduce unemployment could be created and filled. Initiatives for three types of entry-level positions-in the fields of community health, environmental remediation and protection, and food preparation-show particular promise as vehicles for health and economic improvement at the individual and community levels. Building on current federal programs, new pilot projects financed by federal funding should be created to test and refine such initiatives and their impact and assemble an evidence base for future policy action.

Institutional food as a lever for improving health in cities: the case of New York City

OBJECTIVES To describe and examine the factors that most facilitate and impede the provision of healthy foods in a complex institutional food system. STUDY DESIGN Comparative case study of three institutional food settings in New York City. METHODS Document review and interviews with relevant city government staff. RESULTS Factors that facilitate and impede the provision of healthy food vary across institutional food settings, and particularly between centralized and decentralized settings. Generally pro-health factors include centralized purchasing and the ability to work with vendors to formulate items to improve nutritional quality, though decentralized purchasing may offer more flexibility to work with vendors offering healthier food items and to respond to consumer preferences. Factors most often working against health in more centralized systems include financing constraints that are unique to particular settings. In less centralized systems, factors working against health may include both financing constraints and factors that are site-specific, relating to preparation and equipment. CONCLUSIONS Making changes to institutional food systems that will meaningfully influence public health requires a detailed understanding of the diverse systems supporting and shaping public food provision. Ultimately, the cases in this study demonstrate that agency staff typically would like to provide healthier foods, but often feel limited by the competing objectives of affordability and consumer preference. Their ability to address these competing objectives is shaped by a combination of both forces external to the institution, like nutritional regulations, and internal forces, like an agencys structure, and motivation on the part of staff.

Pan de Yuca and Brown Rice

Abstract Efforts to provide “good” food to vulnerable populations in the United States are proliferating, and one major set of venues for these initiatives is publicly funded foodservice. While some aspects of these initiatives are well studied, the work that cooks do under new healthy food initiatives is often overlooked. Cooks shape what ends up on the plate and what is eaten, and thus their work influences the success of these efforts. At the same time, their work in these new regimes contributes to their own labor experiences and lives in important ways. Examining this latter issue, I study the experiences of cooks implementing a healthy meal program in childcare centers, afterschool programs, senior centers, and shelters in New York City. I find that healthy meal programs teach cooks new skills and offer new avenues for caring for clients and family members. However, these programs also place additional demands on and create new anxieties for cooks, particularly in terms of in how they communicate their work to the leaders of “good” food initiatives. Cooks’ communication challenges and silences provide insight into the functioning of racial and class inequities within the “good” food movement.