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Healthy Food Procurement in the County of Los Angeles

Evidence Summary

Underlying Theory:  The County of Los Angeles’ healthy food procurement initiative is based on the policy and organizational levels of the socio-ecological model.  It also uses health marketing strategies of product, place, price and promotion. 

Strategies Used:

  1. Changing access and availability to favor healthy foods and beverages
    This evidence-based strategy supports making it easier to obtain healthier foods and beverages, while also making it harder to obtain less healthy foods and beverages. This strategy has been recommended in a variety of settings, including the workplace. Specifically, the County’s healthy food procurement initiative was designed to change the food and beverage environment within government facilities to favor healthier choices. The food procurement process was changed so that all foods and beverages had to meet specific nutrition standards that are consistent with the USDA, FDA and other federal/state/local agency recommendations. 
  2. Point-of-purchase and point-of-decision labeling to favor healthy food and beverages
    A promising environmental strategy to promote healthier choices in workplace cafeterias and vending machines is point-of-purchase and point-of-decision labeling to favor healthier foods and beverages. In the County of Los Angeles initiative, several approaches were used. DPH is working with departments to label healthier menu options, place healthier snacks (like fresh fruit) closer to the cash register and move the less healthy snacks (like candy) farther away from the cash register. DPH is also working to promote water by placing water at eye-level in beverage cases and vending machines and requiring calorie labeling to help consumers make informed choices. In addition, general table tents and signs on walls were created to promote healthier choices. 
  3. Pricing strategies to favor healthy foods and beverages
    Pricing strategies that make healthy food less expensive and unhealthy food more expensive can be effective in changing purchasing behaviors. The healthy food procurement initiative in Los Angeles County included multiple pricing incentives for retail food venues, including: (a) the prices of healthy entrées, side items, snacks/desserts and beverages must not exceed the price of the other menu options, and (b) bottled water must be available as a beverage option and the price per ounce cannot be higher than any other beverage option.

Research Findings or Evaluation Outcomes: 

The County of Los Angeles has 37 departments (12 are involved in food procurement) and over 100,000 employees. The healthy food procurement initiative is a very large undertaking and the creators have outlined short (1-3 year), intermediate (3-5 year) and long-term (6+ year) outcomes. At this time, only the short-term outcomes have been assessed. 

The initial assessment involved an extensive survey of the settings (e.g., cafeterias, vending machines, and concessions), practices (current nutrition standards, dietary accommodations), and challenges anticipated by each County department. At the time of the Center TRT review, the first three departments to participate were the Department of Health Services, the Department of Public Works, and the Probation Department. The Department of Public Works had adopted and began implementation of new food service requirements, while the other two departments were in the adoption phase.

During the past year, Public Health has also worked with the Chief Executive Office, the Department of Parks and Recreation, and the Department of Health Services on a second food service contract. DPH provided technical assistance to all five departments, conducted site visits and menu reviews, recommended nutrition standards to be integrated into their solicitation processes, and established a monitoring and compliance system.

An adapted version of the validated Nutrition Environment Measures Survey (NEMS) tool was used to collect baseline data on the food and beverage options offered in vending machines and cafeterias at selected facility locations. The evaluation was repeated approximately six months after food requirements implementation. The data presented to date are preliminary and suggest that there have been some meaningful changes. Specifically, the DPH evaluation team documented that three entrées were labeled as healthy compared to none at baseline. Also compliance with the 12 oz. cup limit for sugary drinks was noted, however, it was unclear that the larger size cups (16 to 24 oz) were only for diet drinks. In addition, improvements in percent of healthy snacks (41 to 80%) and beverages (30 to 79%) were observed in vending machines. Early observations also suggest the department is implementing some of the pricing, placement, and promotion activities recommended in the food service contract.

Although the initiative is still in its very early stages, there are plans to conduct further impact evaluation. DPH plans to continue their technical assistance through the dissemination of healthy food procurement toolkits, promotion of model procurement guidelines for a variety of venues and institutions, and recognition for departments that have made changes. DPH evaluation team has published several articles and is currently working on a number of papers to document the challenges and successes of creating healthier food environments in the County of Los Angeles. Contribution to this evidence base should provide valuable information for informing similar efforts in other sectors (e.g., cities, private companies, community-based organizations with food services).